Childhood maltreatment and subsequent depressive symptoms: a prospective study of the sequential mediating role of self-esteem and internalizing/externalizing problems

Wenyan Li; Wenjian Lai; Lan Guo; Wanxin Wang; Xiuwen Li; Liwan Zhu; Jingman Shi; Kayla M Teopiz; Roger S McIntyre; Ciyong Lu

doi:10.1186/s12888-023-04654-7

Childhood maltreatment and subsequent depressive symptoms: a prospective study of the sequential mediating role of self-esteem and internalizing/externalizing problems

BMC Psychiatry. 2023 Mar 20;23(1):179. doi: 10.1186/s12888-023-04654-7.

Authors

Wenyan Li¹, Wenjian Lai¹, Lan Guo¹, Wanxin Wang¹, Xiuwen Li¹, Liwan Zhu¹, Jingman Shi¹, Kayla M Teopiz², Roger S McIntyre^{2

3

4

5}, Ciyong Lu⁶

Affiliations

¹ Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, 74 Zhongshan Rd 2, Guangzhou, 510080, China.
² Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.
³ Department of Pharmacology, University of Toronto, Toronto, ON, Canada.
⁴ Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
⁵ Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
⁶ Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, 74 Zhongshan Rd 2, Guangzhou, 510080, China. luciyong@mail.sysu.edu.cn.

Abstract

Background: Depression among adolescents is a seriously disabling public health problem with an extremely high prevalence. Identifying risk factors of depression at an early stage is important to reduce the disease burden. Childhood maltreatment (CM) is one of the major risk factors for depression. The key mediating processes that how CM affects the development of depression, however, still need further clarification. The present study tested the mediating effect of self-esteem, internalizing problems, and externalizing problems between CM and depressive symptoms. Potential sex differences in the foregoing associations were also explored.

Methods: A three-wave longitudinal study was carried out among 1,957 middle and high school students from 69 classes in 10 public schools in the Guangdong province of China. Data collection started when students were in grades 7 and 10 (median age: 13.0, range: 11-18) between January and April 2019, and the students were followed up once a year thereafter. Self-reported CM, depressive symptoms, self-esteem, internalizing and externalizing problems, and other demographics were collected. The multiple serial mediation analysis was conducted.

Results: We found that CM was positively related to subsequent internalizing and externalizing problems, as well as depressive symptoms, while self-esteem was negatively related to depressive symptoms. Serial mediation analysis indicated that self-esteem (mediator 1) and internalizing problems (mediator 2) sequentially mediated the path from CM to depressive symptoms in the overall and male population. Moreover, with externalizing problems as mediator 2, self-esteem (mediator 1) acted as a partial mediator in the association between CM and depressive symptoms in males, whereas externalizing problems played a complete mediating role in females.

Conclusion: Findings revealed that self-esteem and internalizing problems sequentially mediated the influence of CM on depressive symptoms whereas externalizing problems played an independent mediating role. In addition, sex differences need to be taken into consideration when designing prevention and intervention strategies, given the different psychosocial processes between boys and girls.

Keywords: Childhood maltreatment; Depressive symptoms; Internalizing and externalizing problems; Self-esteem; Sex differences.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Child
Child Abuse*
Depression* / psychology
Female
Humans
Longitudinal Studies
Male
Prospective Studies
Self Concept