Asnake Angwach Abrham, Taddese Asefa Adimasu, Merid Mehari Woldemariam
Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Sodo, Ethiopia.
University of Gondar, Gondar, Amhara, Ethiopia.
Front Psychiatry. 2025 Jun 17;16:1559939. doi: 10.3389/fpsyt.2025.1559939. eCollection 2025.
Childhood maltreatment increases the risk of substance use and substance use disorder (SUD) in adolescence and adulthood, with social support potentially mitigating this relationship. However, research in Ethiopia on mediating factors remains limited. This study uses structural equation modeling (SEM) to evaluate the influence of childhood maltreatment on substance use and the mediating role of social support among students in Gondar Town, Northwest Ethiopia.
A cross-sectional study was conducted from April 18 to May 9, 2023, among 1,235 preparatory and public high school students in Gondar Town who were selected via simple random sampling. Childhood maltreatment was assessed using the Childhood Trauma Questionnaire (CTQ), which yields a total score ranging from 28 to 140. For descriptive analysis, scores were categorized as "none" for values between 25 and 36 or as "some form of childhood maltreatment" for scores above 37. Substance use was measured using the Tobacco, Alcohol, Prescription Medication, and Other Substance Use (TAPS-1) tool. Problematic substance use was defined as any response greater than "never" within the past 12 months. Social support was evaluated using the Multidimensional Scale of Perceived Social Support (MSPSS). Structural equation modeling analyzed the relationships, calculating the mediation proportion.
The median age was 17 years, with 63.24% female participants. Of the students, 85.42% reported a history of childhood maltreatment, 23.48% had problematic alcohol use, and 10.04% had problematic drug use in the past 12 months. Childhood maltreatment significantly increased substance use (β = 1.181, 95% CI (lower, upper): 0.223-1.821). Specific maltreatment types-physical abuse (β = 1.422, 95% CI (lower, upper): 0.590-2.423), sexual abuse (β = 0.653, 95% CI (lower, upper): 0.652-1.320), emotional abuse (β = 2.252, 95% CI (lower, upper): 1.402-4.307), physical neglect (β = 4.101, 95% CI (lower, upper): 1.042-0.904), and emotional neglect (β = 1.513, 95% CI (lower, upper): 0.831-3.059)-were positively associated with substance use. Social support negatively mediated 28.30% of this relationship, reducing the effect of maltreatment on substance use.
Physical abuse, sexual abuse, emotional abuse, physical neglect, and emotional neglect all increase the likelihood of substance use. However, social support mitigates the relationship between childhood maltreatment and substance use. These findings highlight the need for interventions strengthening social support to mitigate the impact of maltreatment on substance use in Ethiopia.
童年期受虐待会增加青少年和成年期物质使用及物质使用障碍（SUD）的风险，社会支持可能会缓和这种关系。然而，埃塞俄比亚关于中介因素的研究仍然有限。本研究采用结构方程模型（SEM）来评估埃塞俄比亚西北部贡德尔镇学生童年期受虐待对物质使用的影响以及社会支持的中介作用。
2023年4月18日至5月9日进行了一项横断面研究，对贡德尔镇1235名通过简单随机抽样选取的预科和公立高中生进行了调查。使用儿童创伤问卷（CTQ）评估童年期受虐待情况，该问卷总得分范围为28至140分。在描述性分析中，25至36分的得分归类为“无”，高于37分的得分归类为“某种形式的童年期受虐待”。使用烟草、酒精、处方药和其他物质使用（TAPS - 1）工具测量物质使用情况。有问题的物质使用被定义为在过去12个月内任何大于“从不”的回答。使用感知社会支持多维量表（MSPSS）评估社会支持。结构方程模型分析了这些关系，计算中介比例。
中位年龄为17岁，女性参与者占63.24%。在学生中，85.42%报告有童年期受虐待史，23.48%在过去12个月内有问题性饮酒，10.04%在过去12个月内有问题性药物使用。童年期受虐待显著增加物质使用（β = 1.181，95%置信区间（下限，上限）：0.223 - 1.821）。特定的虐待类型——身体虐待（β = 1.422，95%置信区间（下限，上限）：0.590 - 2.423）、性虐待（β = 0.653，95%置信区间（下限，上限）：0.652 - 1.320）、情感虐待（β = 2.252，95%置信区间（下限，上限）：1.402 - 4.307）、身体忽视（β = 4.101，95%置信区间（下限，上限）：1.042 - 0.904）和情感忽视（β = 1.513，95%置信区间（下限，上限）：0.831 - 3.059）——均与物质使用呈正相关。社会支持对这种关系的负向中介作用为28.30%，降低了虐待对物质使用的影响。
身体虐待、性虐待、情感虐待、身体忽视和情感忽视均增加物质使用的可能性。然而，社会支持缓和了童年期受虐待与物质使用之间的关系。这些发现凸显了在埃塞俄比亚加强社会支持干预以减轻虐待对物质使用影响的必要性。
