Child Abuse & Neglect 136 (2023) 105993

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Child Abuse & Neglect

journal homepage: www.elsevier.com/locate/chiabuneg

The effects of childhood abuse, depression, and self-compassion on

adolescent nonsuicidal self-injury: A moderated mediation model
Jie Wu a, b, Sihan Liu c, Jiawen Luo a, Xiaoan Li b, Jianing You b, *
a
Mental Health Education and Counseling Center, Guangdong University of Technology, Guangzhou 510006, PR China
b
Center for Studies of Psychological Application, Guangdong Key Laboratory of Mental Health and Cognitive Science, Key Laboratory of Brain,
Cognition and Education Sciences (South China Normal University), Ministry of Education, & School of Psychology, South China Normal University,
Guangzhou, 510631, P. R. China
c
Faculty of Psychology, Beijing Normal University, Beijing 100875, PR China

A R T I C L E I N F O A B S T R A C T

Keywords: Background: Nonsuicidal self-injury (NSSI) is a widespread public health issue in adolescents.
Nonsuicidal self-injury Exploring the risk and protective variables of NSSI is critical for prevention and intervention.
Childhood abuse Based on the experiential avoidance model (Chapman et al., 2006) and Nock’s (2009) integrated
Depression
model of NSSI, the current study tested a moderated mediation model to examine the impact of
Self-compassion
two risk factors, childhood abuse and depression, and one protective factor, self-compassion, on
Adolescents
NSSI.
Methods: Self-report measures were conducted among 758 Chinese adolescents (329 females and
429 males, mean age = 14.16 years, SD = 1.92) in Hong Kong, China regarding childhood abuse,
depression, self-compassion, and NSSI.
Results: Childhood abuse was found to be positively linked to NSSI, and this connection was
mediated by depression. Self-compassion weakened the strength between childhood abuse and
NSSI, along with that between childhood abuse and depression.
Conclusions: These results assist in understanding how NSSI develops and facilitate future studies
to investigate how the risk and protective variables for NSSI interact. The clinical application of
these findings was also discussed.

1. Introduction

Nonsuicidal self-injury (NSSI) is generally defined as the deliberate and direct injury of one’s body tissue without suicidal intent
(Nock, 2009). Cutting, scratching, hitting, and burning oneself are the most common NSSI methods. NSSI has become a major public
health problem among adolescents (Muehlenkamp et al., 2018; Swannell et al., 2014) with an estimated onset age of 13–16 years old
(Muehlenkamp et al., 2018). A meta-analysis demonstrates that the lifetime mean prevalence of NSSI around the world is 28.2 %
(Surace et al., 2021), while the prevalence of adolescent NSSI within one year is between 18.1 % and 24.9 % (Wan et al., 2015; You
et al., 2016). More crucially, NSSI is related to a wide range of emotional and social disorders, as well as being a significant risk factor
for suicidal ideation and attempts (Briere & Gil, 2010; Liu et al., 2020; You & Lin, 2015). Considering the increased prevalence of NSSI
and its negative effects, identifying risk and protective factors is critical for establishing effective prevention efforts. The present study

* Corresponding author at: School of Psychology, South China Normal University, Guangzhou 510631, PR China.
E-mail address: [email protected] (J. You).

https://doi.org/10.1016/j.chiabu.2022.105993
Received 14 July 2022; Received in revised form 3 December 2022; Accepted 7 December 2022
Available online 28 December 2022
0145-2134/© 2022 Elsevier Ltd. All rights reserved.
J. Wu et al. Child Abuse & Neglect 136 (2023) 105993

thus aimed to examine two risk factors for NSSI, childhood abuse and depression, and one protective factor, self-compassion, with a
sample of Chinese adolescents.

1.1. The roles of childhood abuse and depression in predicting NSSI: A mediation model

Childhood abuse (e.g., physical, sexual, and emotional abuse, and neglect) has been identified as a significant risk factor for NSSI
(Johnson & McKernan, 2021; Liu et al., 2018). According to the US Child Abuse Prevention and Treatment Act, childhood abuse can be
defined as “all conduct by a parent or guardian that results in the death of a child, serious physical or emotional harm, sexual abuse or
exploitation, and underlying conduct that may result in a range of dangers” (Timmer & Urquiza, 2014). Nock’s (2009) integrated
model of NSSI suggests that the experience of childhood abuse, as a distal risk factor for self-injury, is one of the predisposing factors for
the occurrence of self-injury and may lead to abnormalities in emotional regulation and interpersonal communication later in life.
Individuals who are subjected to adverse situations (e.g., peer bullying, stern parenting style) and certain triggers (e.g., imitating a peer
who commits self-injurious behavior, or releasing guilt through the painful feeling of self-injury) may resort to self-injurious behavior
as a means of coping with the stress. Yates’s (2004) developmental psychopathology framework indicates that individuals develop five
competencies -motivational, attitudinal, instrumental, emotional, and interpersonal - during positive adaptation. However, early
traumatic experiences, such as abuse experiences, can hinder the development of these competencies, which in turn may make them
develop a new compensatory strategy - NSSI. According to recent meta-analysis studies, overall childhood maltreatment was asso­
ciated with non-suicidal self-injury (Johnson & McKernan, 2021; Liu et al., 2018). Researchers have indicated that exposure to any
adverse childhood experience, regardless of the type of event, increased the risk of self-harm between 2.7 and 6.1 times (Duke et al.,
2010). In addition, in a sample of Chinese mainland adolescents, Wan et al. (2015) found that either form of childhood abuse was
significantly associated with NSSI for individuals who were consistently exposed to abusive situations until adulthood. Further
research has investigated hypothesized mediators of the childhood abuse-NSSI relationship, including self-blame, alexithymia,
dissociation (Swannell et al., 2012), and emotion dysregulation (Peh et al., 2017; Titelius et al., 2018), the underlying mechanism
behind the association is still unclear.
Several studies have discovered that depressive symptoms may play a critical role in the development and persistence of NSSI
(Jiang et al., 2021; Liu et al., 2021; Tang et al., 2022; Wei et al., 2021). The experiential avoidance model (Chapman et al., 2006)
considers self-injury as a negative reinforcement for individuals to reduce or terminate negative emotions. If an individual is exposed to
external stimuli and experiences severe negative feelings (e.g., depression), the individual may resort to self-injury since it is a rapid
and effective method of regulating depressive feelings (Nock, 2009). The association between childhood maltreatment and self-injury
was found to be mediated by depression by Shenk et al. (2010) in their research of 211 teenage girls, however, it is unclear if the
findings hold true for both males and females. Moreover, depressive symptoms were found to have a significant impact on NSSI in
several meta-analyses (Cipriano et al., 2017; Valencia-Agudo et al., 2018). Self-injurers also tend to suffer from depression (Odelius &
Ramklint, 2014). NSSI is frequently used to combat the gloom and numbness that depression brings (Tang et al., 2022).
A review by Messman-Moore and Bhuptani (2017) indicated that childhood abuse has a detrimental influence on emotion regu­
lation development because parental reactions like acknowledging, naming, mirroring, and calming tension and distress help children
learn emotion management in close proximity to a secure attachment figure. However, abusive parental behavior undermines the
quality of the parent-child attachment relationship and limits the child’s access to his or her caregiver to learn to regulate emotions.
Researchers have reported that a significant contributor to adolescents’ increased risk for depressive symptomatology is deficiencies in
their ability to regulate emotions (Wolff et al., 2019). A meta-analysis by Nelson et al. (2017) found that nearly half of the individuals
with depression in the 184 studies had a history of childhood abuse. People who had abusive experiences as children were nearly three
times more likely to experience depression than adults. Empirical studies have indicated that men with childhood sexual abuse
experience are at higher risk of depression (Rice et al., 2021), and emotional abuse and neglect were found to be more significantly
associated with depression than with other types of maltreatment (Alloy et al., 2006; Pham et al., 2021).
Based on the theory and literature reviewed above, it is reasonable to expect that depression may serve as a mediator between
childhood abuse and NSSI.

1.2. The protective role of self-compassion in NSSI: A moderated mediation model

From the above, we know that childhood abuse may act as a predictor variable of NSSI and may also influence NSSI through
depression, but are there other variables that could influence their direction and strength?
Inspired and guided by Eastern Buddhist wisdom, Neff (2003a) proposed a new and healthy view of the self as “self-compassion”.
Self-compassion refers to a form of friendly, open, forgiving, and non-avoidant coping of the self when individuals experience negative
emotions. According to Neff’s (2003a, 2003b) theory, instead of harshly blaming and criticizing, individuals with high self-compassion
face their problems and deficiencies with awareness and concern. This means that self-compassion can better help individuals cope
with negative life events and mitigate negative effects. And this theoretical assumption has been confirmed by other researchers. Neely
et al. (2009) found that when experiencing negative life events, high levels of self-compassionate individuals were more likely to
choose adaptive coping styles. Positive relationships exist between self-compassion and adaptive psychological functioning. Higher
levels of self-compassion, for instance, are linked to subjective well-being, emotional intelligence, and mastery aspirations, as well as
less depression, brooding, guilt, and fear of failing (Barnard & Curry, 2011; Neff, 2012).
Empirical evidence indicated that high self-compassion may weaken the relationship between childhood abuse and NSSI and the
link between childhood abuse and depression. As mentioned above, abusive parental behaviors limit the child’s access to learning to

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J. Wu et al. Child Abuse & Neglect 136 (2023) 105993

regulate emotions (Messman-Moore & Bhuptani, 2017). Owing to lack of effective emotional regulation strategy, individuals are more
likely to experience negative emotions, i.e., depression, and choose self-injury as a quick and effective way to relieve the depressive
feelings (Nock, 2009). Empirical studies suggest that self-compassion can mitigate the effects of childhood trauma on the severity of
cyberbullying victimization (Geng et al., 2022) or the severity of borderline personality disorder symptoms (Pohl et al., 2021). Patients
with borderline personality disorder (BPD) displayed high prevalence rates of self-injurious behavior (Niedtfeld et al., 2010). Acting
with knowledge, a facet of self-compassion, which means paying attention to activities carried out at present, could mitigate the impact
of cyberbullying victimization (Faura-Garcia et al., 2021) and other stressors (Calvete et al., 2017) on NSSI. Furthermore, Lathren et al.
(2019) suggested that adolescent self-compassion could moderate the relationship between perceived stress and internalizing
symptoms, i.e., anxiety disorders and depressive symptoms. A mindfulness-based intervention was found to be helpful for improving
self-compassion and psychological health among young adults with a childhood maltreatment history (Joss et al., 2019).
Self-compassion might moderate the positive correlation between depressive symptoms and NSSI as well. From the perspective of
the experiential avoidance model (Chapman et al., 2006), we knew that NSSI was characterized as a maladaptive coping strategy with
a strong negative affect (Wolff et al., 2019). In a longitudinal study of the non-clinical sample (Raes, 2011), self-compassion signifi­
cantly predicted changes in depression symptoms, such that higher levels of self-compassion at baseline were significantly associated
with greater reductions and/or smaller increases in such symptoms over the 5-month interval. The same finding was also confirmed in
the studies of Yamaguchi et al. (2014) and Krieger et al. (2013).
From the above, we find that self-compassion may act as an adaptive emotion regulation approach, protecting against the
involvement of psychopathology-related schema following state adverse affective events (Trompetter et al., 2017). That is, despite
having experienced childhood trauma, individuals who acquired higher levels of self-compassion would face their problems and
deficiencies with awareness and concern instead of hopelessness or depression. Even when exposed to depressive feelings, those who
gained higher emotional intelligence through the acquisition of self-compassion were less likely to resort to self-injury to alleviate
psychological distress.

1.3. The current study

From the aforementioned, we knew that previous studies established preliminary associations between childhood abuse, depres­
sion, and NSSI. Despite extensive studies on risk factors, little is known about protective variables. Since protective factors can boost
effective adaptive behaviors and mitigate the effects of risk factors on individuals (Ren et al., 2019), it is crucial to investigate the
protective variables for the prevention and intervention of NSSI. Based on Nock’s (2009) integrative model and the experiential
avoidance model (Chapman et al., 2006), the present study constructed a moderated mediation model (see Fig. 1) by including
childhood abuse and depression as two risk factors, and self-compassion as one protective factor, to investigate the underlying
mechanisms of NSSI. More specifically, we proposed the following hypotheses: (1) childhood abuse would be positively associated
with adolescent NSSI; (2) depression would mediate the relationship between childhood abuse and NSSI; (3) self-compassion would
moderate the indirect and direct relationships between childhood abuse and NSSI through depression, such that a higher level of self-
compassion would mitigate the indirect and direct impacts of childhood abuse on NSSI through depression.

2. Methods

2.1. Participants

Participants were recruited from a middle school and high school in Hong Kong, China. Stratified random cluster sampling was
used to select a total of 26 classes from the ninth grade to the twelfth grade. Both students and their parents signed written informed
consent forms. In total, 687 students were enlisted in the study. The final sample size was 604 (83 participants were excluded for not
entirely and correctly completing all the four measures). The mean age was 14.16 years (SD = 1.92 years, range = 11–19). Among this
sample, 54.5 % were female, and 46.0 % were from middle school.

Depression

Self-compassion

Childhood abuse NSSI

Fig. 1. A moderated mediation model of childhood abuse, depression, self-compassion, and NSSI.

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2.2. Measures

Nonsuicidal self-injury (NSSI) was measured by 12 NSSI behaviors, such as self-cutting, burning, biting, punching, scratching skin
severely, carving, or patterning on the skin, pulling hair hard, etching skin with acidic liquids, etc. The questionnaire was selected from
the first part of the Inventory of Statements About Self-injury (ISAS, Klonsky & Glenn, 2009). Participants were asked, “In the past year,
have you engaged in the following behaviors to deliberately harm yourself but without suicidal intent?” All 12 NSSI behavior items
were rated on a six-point scale ranging from 0 = never, 1 = once, 2 = twice, 3 = three times, 4 = four times, and 5 = five times or more.
The score is calculated by the sum of all responses, with higher scores indicating higher levels of NSSI. This measure has shown good
reliability and validity among Chinese adolescents (You et al., 2016; You & Lin, 2015). In the present study, Cronbach’s α for this scale
was 0.73.
Childhood abuse was measured by the Short Form of Childhood Trauma Questionnaire (CTQ-SF, Bernstein & Fink, 1998). This
measure consisted of 28 items assessing five dimensions and one Validity factor (positive aspects are reverse coded) covering
emotional abuse (5 items; sample item: “I feel like my parents wish they had never had me.”), physical abuse(5 items; sample item: “I
feel like my parents wish they had never had me.”), sexual abuse (5 items; sample item: “Someone tried to make me do or watch
something sexual.”), emotional neglect (5 items; sample item: “My family is very close.”), and physical neglect (5 items; sample item: “I
don’t have enough to eat.”). Items were rated on a 5-point Likert scale ranging from 1 (never) to 5 (always), and the total score of all
items was calculated, with a higher score reflecting more childhood abuse. The CTQ-SF has shown good reliability and validity in the
Chinese sample (e.g., He et al., 2019). In the present study, Cronbach’s α for this scale was 0.74.
Depression was assessed using the Depression subscale from the version of the 21-item Depression Anxiety Stress Scale (DASS21,
Taouk et al., 2001). The Depression subscale consisted of 7 items (sample item: “I find it hard to take the initiative to start working”).
Participants were asked to indicate their agreement with each statement from 0 (disagree) to 3 (strongly agree). The total score of all
items was calculated so that higher scores reflected a higher level of depression. This scale has shown good reliability and validity in
previous research (e.g., Gong et al., 2010). In the present study, Cronbach’ α of this scale was 0.84.
Self-compassion was measured by means of the Self-compassion Scale Short Form (SCS-SF; Raes et al., 2011). This measure
consisted of 12 items assessing six dimensions covering self-kindness (2 items; sample item: “When I’m going through a very hard time,
I give myself the caring and tenderness I need”), self-judgment (2 items; sample item: “I’m disapproving and judgmental about my
flaws and inadequacies”), common humanity (2 items; sample item: “I try to see my failings as part of the human condition”), isolation
(2 items; sample item: “When I fail at something important to me, I tend to feel alone in my failure.”), mindfulness(2 items; sample
item: “When something upsets me I try to keep my emotions in balance.”), and over-identification (2 items; sample item: “When I’m
feeling down I tend to obsess and fixate on everything wrong.”). Items are rated on a five-point response scale ranging from 1 (rarely) to
5 (almost always), and scores were calculated by adding all responses so that higher scores indicate a higher level of self-compassion
(positive aspects are reverse coded). The Cronbach’s α of the scale was assessed by the designers as 0.86 (Raes et al., 2011). In the
present study, Cronbach’s α of this scale was 0.73.

2.3. Procedures

In collaboration with the school authorities, we conducted a survey on NSSI among students. All students from grades 7 to 12 were
invited to participate in this investigation, which was conducted with the consent of their parents and students themselves. Although
the participation was voluntary, the participation rates were close to 97 % due to the cooperation and strong support of the school
authorities. Participants were provided with instructions on each questionnaire and informed that some questionnaires would require
information on sensitive topics. Self-reported measures were administered to students in their classrooms. The inquiry took approx­
imately 25 min to complete. We informed all participants that they could submit the questionnaire at any time if they want to and there
is no need to complete all the questions if they felt uncomfortable. Those who disagree to participate or withdraw could arrange their
time quietly without interfering with others. All study materials and the entire process were approved by the ethics committee of the
first author’s university and were carried out in accordance with the ethical criteria outlined in the 1964 Helsinki Declaration and its
subsequent revisions.

2.4. Data analysis

First, descriptive statistics and correlations were tested by SPSS 23.0. Second, we investigated the indirect effect of depression
linking childhood abuse and NSSI using Hayes’ (2015) PROCESS macro (Model 4). To estimate the standard error of the indirect
impact, bias-corrected bootstrapping based on 1000 samples was utilized. Third, we used PROCESS (Model 59) to conduct a moderated
mediation analysis to determine whether self-compassion moderated the direct and indirect path. All variables were centered. Finally,
conditional indirect effects were calculated in order to test whether the indirect effect of depression varied under the condition of
different values of self-compassion. Given that adolescents’ age and gender might have effects on depression or childhood abuse, we
controlled the two demographic variables in our statistical analyses.

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3. Results

3.1. Descriptive statistics

In the present study, 17.38 % (n = 105) of the participants reported NSSI at least once in the past year. Among the participants
engaging in NSSI, 36.19 % (n = 38) reported using only one method, whereas 63.81 % (n = 67) reported using multiple methods. Apart
from that, the most frequently used NSSI methods by the subjects were carving or patterning the skin (67.62 %, n = 71), pulling the
hair hard (37.14 %, n = 39), cutting (20.95 %, n = 22), severe scratching (20.00 %, n = 21), and biting (16.19 %, n = 17), and the least
used NSSI methods were etching the skin with acidic liquid (0.01 %, n = 1) and scrubbing the skin with bleach (0.01 %, n = 1). There
was no significant difference in NSSI by gender (t = 0.31, df = 602, p > 0.05).
Table 1 presents the means, standard deviations, and correlations for the measured variables. As expected, childhood abuse,
depression, and NSSI were significantly and positively correlated with each other. Self-compassion was significantly and negatively
correlated with the other three variables.

3.2. Testing for mediation effect

Next, we tested the mediation effect of depression between childhood abuse and NSSI. As is shown in Fig. 2, childhood abuse was
positively associated with depression (b = 0.22, SE = 0.20, p < 0.001) and NSSI (b = 0.08, SE = 0.02, p < 0.001), and depression was
positively associated with NSSI (b = 0.24, SE = 0.03, p < 0.001). Depression partially mediated the relationship between childhood
abuse and NSSI, according to biascorrected bootstrapping results (indirect effect = 0.05, SE = 0.02, 95 %CI = [0.03, 0.09]). The
mediation effect accounted for 38.46 % of the total effect (b = 0.13, SE = 0.02, 95%CI = [0.10, 0.16]). As a result, Hypothesis 1 and 2
were supported.

3.3. Testing for moderated mediation effect

Our moderated mediation model was tested, and the results were displayed in Fig. 3. Childhood abuse (b = 0.49, SE = 0.09, p <
0.001), depression (b = 0.48, SE = 0.17, p < 0.01), and self-compassion (b = 0.46, SE = 0.09, p < 0.001) were significantly associated
with NSSI. Childhood abuse (b = 0.63, SE = 0.09, p < 0.001) and self-compassion (b = 0.29, SE = 0.10, p < 0.001) were significantly
associated with depression. More importantly, self-compassion significantly moderated the impacts of childhood abuse on depression
(b = − 0.01, SE = 0.002 p < 0.001) and NSSI (b = − 0.01, SE = 0.002, p < 0.001). However, the impact of depression on NSSI was not
significantly moderated by self-compassion (b = − 0.007, SE = 0.004, p = 0.10).
We conducted the tests of simple slopes to demonstrate the patterns of self-compassion’s moderation effects in a clear way. As
shown in Fig. 4, under the condition of low self-compassion, the relationship between childhood abuse and depression was significant
(bsimple = 0.17, t = 9.06, p < 0.001). In the condition of high self-compassion, the relation was not significant (bsimple = 0.03, t = 1.07, p
= 0.29). Fig. 5 revealed a similar fact that for low self-compassion adolescents, the relationship between childhood abuse and NSSI was
significant (bsimple = 0.11, t = 6.49, p < 0.001). While, for those with higher levels of self-compassion, the relation was not significant
(bsimple = 0.001, t = 0.05, p = 0.96). In other words, self-compassion undermined the impact of childhood abuse on depression and
NSSI.
Finally, we further estimated the direct and indirect effects of the model. The indirect impact of depression was more noticeable on
low self-compassion adolescents (indirect effect = 0.04, SE = 0.01, 95 % CI = [0.02, 0.06]), than for those with high levels of
compassion (indirect effect = 0.003, SE = 0.007, 95 % CI = [− 0.004, 0.02]). Similarly, the direct effect of childhood abuse on NSSI
varied with the level of self-compassion. The direct effect of childhood abuse was more noteworthy for low self-compassion adolescents
(direct effect = 0.11, SE = 0.02, 95 % CI = [0.08, 0.15]) compared with those with high levels (direct effect = 0.001, SE = 0.02, 95 %
CI = [− 0.05, 0.05]). Therefore, hypothesis 3 was partially supported.

4. Discussion

Researchers proposed a risk-protective framework for suicidal ideation (Salami et al., 2015), considering decreasing levels of risk
factors and increasing levels of protective factors are two main methods in suicide prevention. Since NSSI and suicidal ideation was
strongly associated with each other (Liu et al., 2020), building a risk-protective framework is applicable in the current study for

Table 1
Means, standard deviations, and correlations of the study variables.
Variables M SD 1 2 3 4

1. Childhood abuse 47.48 6.48 –

2. Depression 2.54 3.42 0.42*** –
3. Self-compassion 45.73 6.47 − 0.34*** − 0.57*** –
4. NSSI 0.74 2.62 0.33*** 0.39*** − 0.21*** –

Note. n = 604.
***
p < 0.001.

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J. Wu et al. Child Abuse & Neglect 136 (2023) 105993

Depression

*** ***
0.22 (0.20 ) 0.24 (0.03 )

Childhood abuse NSSI

***
0.08 (0.02 )

Fig. 2. The mediating effect of depression in the association between childhood abuse and NSSI. ***p < 0.001.

*** Depression
0.63 (0.09 )

**
0.48 (0.17)
Childhood abuse
***
0.49 (0.09)
***
0.29 (0.10)
0.46 (0.09) *** NSSI
Self-compassion

*** ***
–0.01(0.002) –0.01 (0.002) –0.007 (0.004)

Self-compassion ™ Childhood abuse Self-compassion ™ Depression

Fig. 3. The moderating effect of self-compassion on the direct and indirect associations between childhood abuse and NSSI. *p < 0.05, **p < 0.01,
***p < 0.001.

Fig. 4. The moderating effect of self-compassion on the association between childhood abuse and depression.

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Fig. 5. The moderating effect of self-compassion on the association between childhood abuse and NSSI.

effective NSSI prevention or reduction. Many studies investigated the development mechanism of NSSI, however, little study on
protective variables has been conducted. To assess how and for whom childhood maltreatment affects later NSSI, the current study
based on Nock’s (2009) integrated model of NSSI and the experiential avoidance model (Chapman et al., 2006) suggested a moderated
mediation model. The results suggested that depression partially mediates the association between childhood abuse and NSSI. Self-
compassion moderates both the direct and indirect effects of childhood abuse on NSSI through depression, i.e., self-compassion
buffers both the influence of childhood abuse on NSSI and the effect of childhood abuse on depression.
First, the prevalence of NSSI in this study was 17.38 %, which was consistent with the range of approximately 13–45 % incidence of
self-injury in Chinese adolescents from previous studies (Wan et al., 2015; You et al., 2016). Specially, we found that there was no
significant difference in NSSI at the gender level, which was supported by other researchers (Wan et al., 2015).
Second, we found a significant positive association between childhood abuse and NSSI, suggesting that invalidating abusive family
circumstances may contribute to higher emotional reactivity and an inability to handle such a response, and NSSI is used to manage
individual’s negative affect (Muehlenkamp et al., 2010; Wan et al., 2015). This finding also supports the theories of both Nock’s (2009)
integrated model of NSSI suggesting that exposure to childhood abuse is one of the distal risk factors for individuals’ self-injury and
Yates’s (2004) developmental psychopathology framework revealing NSSI is a management approach used to compensate for
developmental disabilities.
Thirdly, the study’s results revealed that depression partially mediated the association between childhood abuse and NSSI. Ac­
cording to Linehan (2018), One’s capacity for emotional control may also be impacted by parental guidance and the family envi­
ronment. A variety of theoretical ideas contend that deficiencies in emotion processing and control are the main causes of depression
(ie. Dryman & Heimberg, 2018; Kashdan & Farmer, 2014). That is, childhood abuse may be a distal factor in depression. This finding is
consistent with the results of both Zhou and Zhen’s (2022) study suggesting that childhood emotional abuse had direct effects on
depression and Levitan et al.’s (2010) study revealing childhood abuse and neglect increased the risk of major depressive disorder in
adulthood, and multiple types of abuse even increased the risk of major depressive disorder throughout life. Jardim et al. (2018) found
that childhood maltreatment was strongly associated with older adults’ depression, which means early abusive experiences may lead
to depression throughout life. Furthermore, the model supports the viewpoint that self-injury is a maladaptive response to coping with
strong negative emotions (i.e., depression). Since the opportunities to learn emotion regulation strategies are deprived due to early
traumatic experiences, individuals are more likely to suffer from emotional problems such as depression later in life. From the
emotional cascade model (Selby & Joiner, 2009), rumination on the abusive experiences in the depressive state could intensify
emotional experiences, leading individuals to engage in dysregulated behaviors (ie. NSSI) as a temporary distraction from negative
emotion (Wolff et al., 2019). Empirical studies are also consistent with this finding. Madjar et al. (2021) investigated 306 high school
students and found that NSSI was engaged to regulate depression. According to Wang and Liu (2019), among girls with migratory
experiences, depressive symptoms mediated the association between peer victimization and NSSI.
Last, in the association between childhood abuse and NSSI, we found that self-compassion moderated the mediation impact of
depression. In particular, self-compassion decreased the consequences of childhood abuse on depression. This conclusion is in line with
Neff et al. (2007) study, which found that as self-compassion grew, anxiety, depression, and thought suppression dropped dramati­
cally. According to Stanton (2011), individuals can obtain more positive emotion regulation methods by paying attention to their
feelings and making efforts to investigate and understand them. This also meets the definition of self-compassion. Although self-

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compassion is relatively stable from a trait perspective, it can also change in interaction with the environment. For those who
experienced maltreatment in their childhood, high self-compassion individuals can see those tragic sufferings in a more tolerant and
acceptive way, which helps them not to slip into depression. Similarly, self-compassion weakens the direct effects of childhood abuse
on NSSI. We supposed that traumatic events in childhood have long-term consequences on people’s emotional processing in adulthood.
The experiential avoidance model (Chapman et al., 2006) states that NSSI serves the purpose of avoiding or fleeing from unwelcome
emotional excitation (Klonsky, 2007). This drive for avoidance is made worse by individuals’ low distress tolerance, inability to control
unpleasant feelings when provoked, and deficiencies in emotion management abilities (Wolff et al., 2019). Self-compassion is an
effective emotion regulation approach. Individuals with high levels of self-compassion can view themselves more objectively and
accurately instead of harshly blaming and judging themselves. When experiencing negative life events, high self-compassion in­
dividuals are more likely to choose adaptive ways of coping (Neely et al., 2009) rather than non-adaptive ways of dealing with
emotional stress such as NSSI. However, the impact of depression on NSSI was not significantly moderated by self-compassion. This
finding contradicts prior research, ie. Xavier et al. (2016) found that the interaction of depression and self-compassion had a sub­
stantial influence on NSSI. The discrepancy could be explained by the presence of other variables that may influence the mechanism of
depression and self-compassion on NSSI. In a study by Gilbert et al. (2006), high self-criticism participants had greater trouble forming
the self-compassion schema than low self-criticism subjects. That is, if depressed patients have a high level of self-criticism, acquiring
the self-compassion coping style may be difficult, and self-compassion will have little effect on NSSI.
This study has certain limitations that should be recognized. To begin, this study selected a sample of adolescents in Hong Kong.
There are many differences between Hong Kong and mainland China in education, economy, and other aspects, so the participants in
the study cannot fully represent the general features of Chinese teenagers. Apart from that, the current study gathered data by self-
report measures. The results of the questionnaires are subject to societal approval due to the stigmatization of NSSI (Ross & Heath,
2002). Future studies can apply some other research paradigms, such as the interview method, the experimental method, and other
reporting methods, to increase the accuracy and reliability of the findings. Finally, since this research paper is based on overall
childhood maltreatment, the different types of childhood abuse are not stated in detail. It is also important to compare the effects of
different subtypes of childhood abuse on variables such as depression (Kwok & Gu, 2019; Choi et al., 2017; Remigio-Baker et al., 2014),
and researchers can expand the future studies from this perspective.
Despite these constraints, our findings testify to how depression partially mediates the association between childhood abuse and
NSSI, and how self-compassion as a protective factor decreases the direct and indirect effects of these factors. These findings have at
most two implications for adolescent NSSI prevention and intervention. On one side, these data emphasize the negative consequences
of childhood abuse and depression on NSSI. It may be beneficial to support initiatives aimed at reducing childhood abuse and
providing assistance to adolescents in confronting depression. Self-compassion, on the other side, should be recognized as a response-
focused approach to guiding individualized therapy for adolescent NSSI, considering that it lessens the association between childhood
abuse and depression, as well as the connection between childhood abuse and NSSI.

CRediT authorship contribution statement

Jie Wu conceived of the study, participated in its design and coordination, and drafted the manuscript; Sihan Liu managed the
literature searches and analysis, as well as the manuscript revisions.; Jiawen Luo and Xiaoan Li assisted in data collection and con­
ducted statistical analyses; Jianing You participated in the design of the study, performed the measurement, and helped revise the
manuscript. All authors contributed to and have approved the final manuscript.

Role of the funding source

This research was funded in part by the 2020 Guangdong Provincial University Ideological and Political Education Project
(2020GXSZ030), the National Natural Science Foundation of China (Grant No. 1771228), and the National Social Science Foundation
of China (Grant No. 19ZDA360).
The funders had no role in the study design, data collection, and analysis, decision to publish, or preparation of the manuscript.

Declaration of competing interest

All authors declare that they have no conflict of interest.

Data availability

The authors do not have permission to share data.

Acknowledgments

This study was also supported by the Regional Center of Mental Health Education and Counseling for College Students in
Guangdong Province, Guangdong University of Technology, Research Center for Crisis Intervention and Psychological Service of
Guangdong Province, South China Normal University, and the base of psychological services and counseling for “Happiness” in
Guangzhou.

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J. Wu et al. Child Abuse & Neglect 136 (2023) 105993

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