The impact of sexual abuse in childhood on adolescents' non-suicidal self-injury behavior: A moderated mediation model

Objective: Childhood sexual abuse (CSA) is a well-established risk factor for a range of psychological and behavioral issues, including non-suicidal self-injury (NSSI), making it a critical area of research for understanding adolescent mental health. Despite its prevalence, the mechanisms underlying their relationship remain insufficiently explored. This study aims to explore the relationship between CSA and NSSI behavior, as well as the mediating role of social avoidance and the moderating role of perceived family support. Method: 1737 Chinese adolescents with a mean age of 14.86 years (SD = 1.65) from hospitals' psychiatric departments in nine provinces of China were recruited to complete surveys on CSA experiences, NSSI behavior, and social support. Results: The results suggested that the effect of CSA on adolescent NSSI behavior was mediated by social avoidance, and the effect of CSA on social avoidance and NSSI behavior varied by the level of perceived family support. CSA led to social avoidance and increased risk for NSSI behavior. Higher levels of perceived family support had a protective effect, which reduced the motives of social avoidance and NSSI behavior. Conclusion: These findings revealed the risk of CSA and emphasized the role of social avoidance as an NSSI motive and the protective role of perceived family support for adolescents experiencing CSA. The clinical implications emphasize the need for interventions targeting family support and alternative coping strategies in the Chinese context. Additionally, future research should explore the complexity of intra- and extra-familial abuse and the roles of peer and professional support.