Department of Neurology and Psychiatry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
BMC Psychiatry. 2023 Apr 11;23(1):241. doi: 10.1186/s12888-023-04719-7.
High levels of childhood trauma (CT) have been observed in adults with mental health problems. Herein, we investigated whether self-esteem (SE) and emotion regulation strategies (cognitive reappraisal (CR) and expressive suppression (ES)) affect the association between CT and mental health in adulthood, including depression and anxiety symptoms.
We performed a cross-sectional study of 6057 individuals (39.99% women, median age = 34 y), recruited across China via the internet, who completed the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Childhood Trauma Questionnaire (CTQ), Self-esteem Scale (SES), and Emotion Regulation Questionnaire (ERQ). Multivariate linear regression analysis and bias-corrected percentile bootstrap methodologies were used to assess the mediating effect of SE, and hierarchical regression analysis and subgroup approach were performed to examine the moderating effects of emotion regulation strategies.
After controlling for age and sex, we found that (1) SE mediated the associations between CT and depression symptoms in adulthood (indirect effect = 0.05, 95% confidence interval [CI]: 0.04-0.05, 36.2% mediated), and CT and anxiety symptoms in adulthood (indirect effect = 0.03, 95% CI: 0.03-0.04, 32.0% mediated); (2) CR moderated the association between CT and SE; and (3) ES moderated the association between of CT and mental health in adulthood via SE, and such that both the CT-SE and SE-mental health pathways were stronger when ES is high rather than low, resulting the indirect effect was stronger for high ES than for low ES.
These findings suggested that SE plays a partially mediating role in the association between CT and mental health in adulthood. Furthermore, ES aggravated the negative effect of CT on mental health in adulthood via SE. Interventions such as emotional expression training may help reduce the detrimental effects of CT on mental health.
The study was registered on http://www.chictr.org.cn/index.aspx and the registration number was ChiCTR2200059155.
大量研究发现，心理健康问题成年人的童年创伤（CT）水平较高。本研究旨在探讨自尊（SE）和情绪调节策略（认知重评（CR）和表达抑制（ES））是否会影响 CT 与成年后心理健康（包括抑郁和焦虑症状）之间的关联。
我们对通过互联网在中国招募的 6057 名个体（39.99%为女性，中位年龄 34 岁）进行了横断面研究，参与者完成了患者健康问卷-9（PHQ-9）、广泛性焦虑障碍-7（GAD-7）、童年创伤问卷（CTQ）、自尊量表（SES）和情绪调节问卷（ERQ）。采用多元线性回归分析和偏置校正分位数引导方法评估 SE 的中介效应，采用分层回归分析和亚组方法检验情绪调节策略的调节效应。
在控制年龄和性别后，我们发现：（1）SE 部分介导了 CT 与成年后抑郁症状（间接效应=0.05，95%置信区间 [CI]：0.04-0.05，36.2%的中介作用）和 CT 与成年后焦虑症状（间接效应=0.03，95%CI：0.03-0.04，32.0%的中介作用）之间的关联；（2）CR 调节 CT 与 SE 之间的关联；（3）ES 通过 SE 调节 CT 与成年后心理健康之间的关联，且当 ES 较高时，CT-SE 和 SE-心理健康的关联更强，ES 较高时的间接效应强于 ES 较低时。
这些发现表明，SE 在 CT 与成年后心理健康之间的关联中起着部分中介作用。此外，ES 通过 SE 加剧了 CT 对成年后心理健康的负面影响。情感表达训练等干预措施可能有助于降低 CT 对心理健康的不利影响。
该研究在中国临床试验注册中心（ChiCTR2200059155）注册。
