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Article(id=1324077856627761768, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077716676424398, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202510131, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1760112000000, receivedDateStr=2025-10-11, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793614361197, onlineDateStr=2026-11-02, pubDate=1773072000000, pubDateStr=2026-03-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793614361197, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793614361197, creator=13701087609, updateTime=1793614361197, updator=13701087609, issue=Issue{id=1324077716676424398, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='5', pageStart='769', pageEnd='960', issueExtLink='null', onlineDate='null', pubDate='1773072000000', pubDateStr='2026-03-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793614327830, creator='13701087609', updateTime=1793614418028, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324078095132655884, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077716676424398, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324078095132655885, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324077716676424398, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=855, endPage=860, ext={EN=ArticleExt(id=1324077856833282665, articleId=1324077856627761768, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=The chain mediation role of social withdrawal and self-esteem between childhood trauma and depression among junior high school students, columnId=1228016568949474136, journalTitle=Modern Preventive Medicine, columnName=Child and Adolescent Health, Maternal and Child Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the chain mediation role of social withdrawal and self-esteem in the relationship between childhood trauma and depression among junior high school students, to inform youth mental health interventions.

Methods

From June to August 2025, a stratified sampling survey was conducted among 2 630 students from five junior high schools in Tai’an, Shandong. Core variables were assessed using the social withdrawal dimension of the Youth Self-Report, the Self-Esteem Scale, the Childhood Trauma Questionnaire, and the Depression Screening Questionnaire. Pearson correlation tested associations among variables. Multiple linear regression tested effects on depression. Mediation models with bootstrapping tested the chain mediation of social withdrawal and self-esteem.

Results

All trauma dimensions were positively related to social withdrawal and depression, and negatively to self-esteem. Social withdrawal was negatively related to self-esteem and positively to depression. Self-esteem was negatively related to depression. Further analysis showed that all trauma dimensions directly predicted higher depression (β=0.335, 0.113, 0.237, 0.152, 0.175; all P<0.001), and indirectly predicted higher depression via social withdrawal (β=0.196, 0.110, 0.172, 0.138, 0.176; Boot 95% CI excluded 0) and via the chain “trauma →social withdrawal → low self-esteem → depression” (β=0.020, 0.010, 0.025, 0.014, 0.026; Boot 95% CI excluded 0). Self-esteem also significantly mediated the associations between emotional abuse, emotional neglect, physical neglect, and depression (β=0.021, 0.037, 0.025; Boot 95% CI excluded 0).

Conclusion

Social withdrawal and low self-esteem play a chain mediation role in the relationship between childhood trauma and depression among junior high school students. Timely interrupting risk factors and developing protective factors are crucial for improving the mental health of adolescents.

, authors=Yu-fei WANG, Kui-li SUN, Xin MOU, authorsList=Yu-fei WANG, Kui-li SUN, Xin MOU, authorCompany=null, correspAuthors=Kui-li SUN, Xin MOU, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1324077857772806768, articleId=1324077856627761768, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=社会退缩和自尊在童年创伤与初中生抑郁中的链式中介作用, columnId=1228016570031604578, journalTitle=现代预防医学, columnName=儿少卫生与妇幼保健, runingTitle=null, highlight=null, articleAbstract=
目的

探讨社会退缩和自尊在童年创伤与初中生抑郁中的链式中介作用，为青少年心理健康干预提供参考依据。

方法

2025年6—8月，采用分层抽样法对山东省泰安市5所初中的2 630名学生进行问卷调查，采用青少年自评量表中的社交退缩维度部分、自尊量表、儿童期创伤问卷以及抑郁症筛查量表等工具对核心变量进行测量，采用Pearson相关分析检验各变量之间的相关性，采用多元线性回归分析检验各变量对抑郁的影响，采用中介模型和bootstrap法检验社会退缩和自尊的链式中介作用。

结果

童年创伤各维度均与社会退缩呈显著正相关，与自尊水平呈显著负相关，与抑郁呈显著正相关，社会退缩与自尊呈显著负相关，与抑郁呈显著正相关，自尊与抑郁呈显著负相关；进一步分析表明，童年创伤各维度能够直接正向预测初中生的抑郁程度（β=0.335、0.113、0.237、0.152、0.175，P均小于0.001），也能通过社会退缩这一中介变量（β=0.196、0.110、0.172、0.138、0.176，Boot95% CI均不经过0）或“童年创伤→社会退缩→低自尊→抑郁”的链式中介路径（β=0.020、0.010、0.025、0.014、0.026，Boot95% CI均不经过0）对初中生抑郁程度进行间接预测，自尊在情感虐待、情感忽视以及躯体忽视与初中生抑郁之间发挥显著的中介作用（β=0.021、0.037、0.025，Boot95% CI均不经过0）。

结论

社会退缩和低自尊在童年创伤与初中生抑郁中发挥着链式中介作用，及时阻断风险因素、发展保护因素对于青少年心理健康状况的改善具有重要作用。

, authors=王雨菲, 孙奎立, 牟芯, authorsList=王雨菲, 孙奎立, 牟芯, authorCompany=null, correspAuthors=孙奎立, 牟芯, authorNote=

王雨菲（2001—），女，硕士在读，研究方向：卫生事业管理学

, correspAuthorsNote=
孙奎立，E-mail:
牟芯，E-mail:
孙奎立与牟芯为共同通信作者
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Schizophrenia Bulletin, 2013, 39(5): 1045-1055., articleTitle=Pathways between childhood victimization and psychosis-like symptoms in the ALSPAC birth cohort, refAbstract=null)], funds=[Fund(id=1324077862629810839, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077856627761768, awardId=22CSHJ04, language=CN, fundingSource=山东省社会科学规划研究项目(22CSHJ04), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1324077857978327665, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077856627761768, xref=null, ext=[AuthorCompanyExt(id=1324077857990910578, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077856627761768, companyId=1324077857978327665, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Social Work, School of Pharmaceutical Management, Shandong First Medical University, Tai’an, Shandong 271016, China), AuthorCompanyExt(id=1324077857995104883, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077856627761768, companyId=1324077857978327665, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=山东第一医科大学医药管理学院社会工作系，山东 泰安 271016)])], figs=[ArticleFig(id=1324077861589623437, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077856627761768, language=EN, label=Table 1, caption=

Descriptive statistics and correlation analysis (r)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量得分（）情感虐待情感忽视躯体虐待躯体忽视性虐待社会退缩自尊抑郁
情感虐待1.464±0.7551
情感忽视1.726±0.8540.341***1
躯体虐待1.274±0.6770.776***0.178***1
躯体忽视1.806±0.7370.513***0.464***0.427***1
性虐待1.176±0.6170.702***0.121***0.815***0.402***1
社会退缩1.463±0.4520.481***0.251***0.318***0.266***0.285***1
自尊3.023±0.439-0.316***-0.378***-0.138***-0.253***-0.081***-0.402***1
抑郁1.511±0.6550.618***0.335***0.437***0.375***0.351***0.705***-0.455***1
), ArticleFig(id=1324077861698675342, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077856627761768, language=CN, label=表1, caption=

描述性统计和相关分析(r)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量得分（）情感虐待情感忽视躯体虐待躯体忽视性虐待社会退缩自尊抑郁
情感虐待1.464±0.7551
情感忽视1.726±0.8540.341***1
躯体虐待1.274±0.6770.776***0.178***1
躯体忽视1.806±0.7370.513***0.464***0.427***1
性虐待1.176±0.6170.702***0.121***0.815***0.402***1
社会退缩1.463±0.4520.481***0.251***0.318***0.266***0.285***1
自尊3.023±0.439-0.316***-0.378***-0.138***-0.253***-0.081***-0.402***1
抑郁1.511±0.6550.618***0.335***0.437***0.375***0.351***0.705***-0.455***1
), ArticleFig(id=1324077861799338639, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077856627761768, language=EN, label=Table 2, caption=

Regression analyses between each variable and social withdrawal

, figureFileSmall=null, figureFileBig=null, tableContent=
变量方程一方程二方程三方程四方程五
βtβtβtβtβt
性别0.1247.278***0.1156.083***0.1548.347***0.1387.346***0.1528.150***
年龄（岁）0.0784.580***0.0955.021***0.1065.832***0.0965.146***0.1136.138***
居住地0.0201.1650.0010.0300.0010.016-0.008-0.440-0.012-0.662
是否独生-0.023-1.335-0.015-0.813-0.021-1.143-0.014-0.749-0.024-1.268
家庭经济-0.025-1.498-0.011-0.561-0.015-0.820-0.006-0.309-0.006-0.328
情感虐待0.47628.077***
情感忽视0.23712.578***
躯体虐待0.32817.999***
躯体忽视0.26414.184***
性虐待0.29816.145***
R20.2530.0840.1350.0980.116
F149.522***41.155***69.664***48.545***58.775***
), ArticleFig(id=1324077861887419024, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077856627761768, language=CN, label=表2, caption=

各变量与社会退缩之间的回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量方程一方程二方程三方程四方程五
βtβtβtβtβt
性别0.1247.278***0.1156.083***0.1548.347***0.1387.346***0.1528.150***
年龄（岁）0.0784.580***0.0955.021***0.1065.832***0.0965.146***0.1136.138***
居住地0.0201.1650.0010.0300.0010.016-0.008-0.440-0.012-0.662
是否独生-0.023-1.335-0.015-0.813-0.021-1.143-0.014-0.749-0.024-1.268
家庭经济-0.025-1.498-0.011-0.561-0.015-0.820-0.006-0.309-0.006-0.328
情感虐待0.47628.077***
情感忽视0.23712.578***
躯体虐待0.32817.999***
躯体忽视0.26414.184***
性虐待0.29816.145***
R20.2530.0840.1350.0980.116
F149.522***41.155***69.664***48.545***58.775***
), ArticleFig(id=1324077861996470929, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077856627761768, language=EN, label=Table 3, caption=

Regression analyses between each variable and self-esteem

, figureFileSmall=null, figureFileBig=null, tableContent=
变量方程一方程二方程三方程四方程五
βtβtβtβtβt
性别-0.054-3.032**-0.042-2.444*-0.047-2.553*-0.059-3.263**-0.041-2.216*
年龄（岁）-0.006-0.3100.0120.707-0.010-0.567-0.001-0.067-0.010-0.540
居住地-0.010-0.587-0.009-0.540-0.003-0.149-0.001-0.022-0.003-0.185
是否独生-0.010-0.564-0.012-0.681-0.014-0.757-0.014-0.761-0.015-0.842
家庭经济-0.060-3.411***-0.054-3.148**-0.069-3.844***-0.065-3.667***-0.071-3.943***
情感虐待-0.160-7.899***
情感忽视-0.294-16.708***
躯体虐待-0.014-0.729
躯体忽视-0.161-8.774***
性虐待0.0341.791
社会退缩-0.318-15.579***-0.324-18.324***-0.390-20.364***-0.352-19.012***-0.405-21.380***
R20.1860.2470.1670.1900.168
F86.779***124.030***76.147***89.286***76.607***
), ArticleFig(id=1324077862092939922, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077856627761768, language=CN, label=表3, caption=

各变量与自尊之间的回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量方程一方程二方程三方程四方程五
βtβtβtβtβt
性别-0.054-3.032**-0.042-2.444*-0.047-2.553*-0.059-3.263**-0.041-2.216*
年龄（岁）-0.006-0.3100.0120.707-0.010-0.567-0.001-0.067-0.010-0.540
居住地-0.010-0.587-0.009-0.540-0.003-0.149-0.001-0.022-0.003-0.185
是否独生-0.010-0.564-0.012-0.681-0.014-0.757-0.014-0.761-0.015-0.842
家庭经济-0.060-3.411***-0.054-3.148**-0.069-3.844***-0.065-3.667***-0.071-3.943***
情感虐待-0.160-7.899***
情感忽视-0.294-16.708***
躯体虐待-0.014-0.729
躯体忽视-0.161-8.774***
性虐待0.0341.791
社会退缩-0.318-15.579***-0.324-18.324***-0.390-20.364***-0.352-19.012***-0.405-21.380***
R20.1860.2470.1670.1900.168
F86.779***124.030***76.147***89.286***76.607***
), ArticleFig(id=1324077862210380435, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324077856627761768, language=EN, label=Table 4, caption=

Regression analyses between each variable and depression

, figureFileSmall=null, figureFileBig=null, tableContent=
变量方程一方程二方程三方程四方程五
βtβtβtβtβt
性别0.0181.467-0.004-0.2730.0272.092*0.0100.7430.0181.379
年龄（岁）0.0534.348***0.0544.058***0.0624.908***0.0544.107***0.0654.974***
居住地-0.025-2.103*-0.040-3.001**-0.039-3.073**-0.044-3.387***-0.047-3.610***
是否独生-0.007-0.5780.0010.016-0.005-0.4200.0010.040-0.006-0.438
家庭经济0.0272.252*0.0402.992**0.0312.448*0.0403.089**0.0382.914**
情感虐待0.33524.043***
情感忽视0.1137.911***
躯体虐待0.23717.723***
躯体忽视0.15211.090***
性虐待0.17512.909***
社会退缩0.47432.596***0.60541.522***0.53937.132***0.58740.265***0.56137.826***
自尊-0.152-11.428***-0.164-10.844***-0.198-14.375***-0.174-12.068***-0.207-14.699***
R20.6210.5480.5870.5580.565
F539.903***400.110***468.313***416.490***428.326***
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各变量与抑郁之间的回归分析

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变量方程一方程二方程三方程四方程五
βtβtβtβtβt
性别0.0181.467-0.004-0.2730.0272.092*0.0100.7430.0181.379
年龄（岁）0.0534.348***0.0544.058***0.0624.908***0.0544.107***0.0654.974***
居住地-0.025-2.103*-0.040-3.001**-0.039-3.073**-0.044-3.387***-0.047-3.610***
是否独生-0.007-0.5780.0010.016-0.005-0.4200.0010.040-0.006-0.438
家庭经济0.0272.252*0.0402.992**0.0312.448*0.0403.089**0.0382.914**
情感虐待0.33524.043***
情感忽视0.1137.911***
躯体虐待0.23717.723***
躯体忽视0.15211.090***
性虐待0.17512.909***
社会退缩0.47432.596***0.60541.522***0.53937.132***0.58740.265***0.56137.826***
自尊-0.152-11.428***-0.164-10.844***-0.198-14.375***-0.174-12.068***-0.207-14.699***
R20.6210.5480.5870.5580.565
F539.903***400.110***468.313***416.490***428.326***
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Analysis of the chain mediation effects of social withdrawal and self-esteem

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中介模型路径效应值（Boot95%CI）Boot相对中介效应（%）
模型一总效应0.528(0.502～0.554)0.013100.00
直接效应0.291(0.267～0.315)0.01255.11
总间接效应0.237(0.213～0.262)0.01344.89
EA→社会退缩→抑郁0.196(0.171～0.220)0.01337.12
EA→自尊→抑郁0.021(0.014～0.030)0.0053.98
EA→社会退缩→自尊→抑郁0.020(0.015～0.025)0.0033.79
模型二总效应0.243(0.216～0.271)0.014100.00
直接效应0.087(0.065～0.108)0.01135.8
总间接效应0.156(0.130～0.182)0.01364.2
EN→社会退缩→抑郁0.110(0.088～0.133)0.01145.07
EN→自尊→抑郁0.037(0.028～0.046)0.00515.01
EN→社会退缩→自尊→抑郁0.010(0.007～0.013)0.0024.12
模型三总效应0.428(0.395～0.461)0.017100.00
直接效应0.229(0.204～0.255)0.01353.5
总间接效应0.199(0.168～0.230)0.01646.5
PA→社会退缩→抑郁0.172(0.142～0.202)0.01540.09
PA→自尊→抑郁0.003(-0.006～0.012)0.0050.67
PA→社会退缩→自尊→抑郁0.025(0.019～0.031)0.0035.74
模型四总效应0.313(0.281～0.344)0.016100.00
直接效应0.135(0.111～0.159)0.01243.23
总间接效应0.177(0.151～0.203)0.01356.77
PN→社会退缩→抑郁0.138(0.113～0.163)0.01344.19
PN→自尊→抑郁0.025(0.018～0.033)0.0048.01
PN→社会退缩→自尊→抑郁0.014(0.011～0.019)0.0024.57
模型五总效应0.382(0.345～0.420)0.019100.00
直接效应0.186(0.158～0.214)0.01448.69
总间接效应0.197(0.161～0.231)0.01851.57
SA→社会退缩→抑郁0.176(0.143～0.212)0.01844.85
SA→自尊→抑郁0.006(-0.018～0.003)0.0051.13
SA→社会退缩→自尊→抑郁0.026(0.020～0.034)0.0045.59
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社会退缩和自尊的链式中介效应分析

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中介模型路径效应值（Boot95%CI）Boot相对中介效应（%）
模型一总效应0.528(0.502～0.554)0.013100.00
直接效应0.291(0.267～0.315)0.01255.11
总间接效应0.237(0.213～0.262)0.01344.89
EA→社会退缩→抑郁0.196(0.171～0.220)0.01337.12
EA→自尊→抑郁0.021(0.014～0.030)0.0053.98
EA→社会退缩→自尊→抑郁0.020(0.015～0.025)0.0033.79
模型二总效应0.243(0.216～0.271)0.014100.00
直接效应0.087(0.065～0.108)0.01135.8
总间接效应0.156(0.130～0.182)0.01364.2
EN→社会退缩→抑郁0.110(0.088～0.133)0.01145.07
EN→自尊→抑郁0.037(0.028～0.046)0.00515.01
EN→社会退缩→自尊→抑郁0.010(0.007～0.013)0.0024.12
模型三总效应0.428(0.395～0.461)0.017100.00
直接效应0.229(0.204～0.255)0.01353.5
总间接效应0.199(0.168～0.230)0.01646.5
PA→社会退缩→抑郁0.172(0.142～0.202)0.01540.09
PA→自尊→抑郁0.003(-0.006～0.012)0.0050.67
PA→社会退缩→自尊→抑郁0.025(0.019～0.031)0.0035.74
模型四总效应0.313(0.281～0.344)0.016100.00
直接效应0.135(0.111～0.159)0.01243.23
总间接效应0.177(0.151～0.203)0.01356.77
PN→社会退缩→抑郁0.138(0.113～0.163)0.01344.19
PN→自尊→抑郁0.025(0.018～0.033)0.0048.01
PN→社会退缩→自尊→抑郁0.014(0.011～0.019)0.0024.57
模型五总效应0.382(0.345～0.420)0.019100.00
直接效应0.186(0.158～0.214)0.01448.69
总间接效应0.197(0.161～0.231)0.01851.57
SA→社会退缩→抑郁0.176(0.143～0.212)0.01844.85
SA→自尊→抑郁0.006(-0.018～0.003)0.0051.13
SA→社会退缩→自尊→抑郁0.026(0.020～0.034)0.0045.59
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社会退缩和自尊在童年创伤与初中生抑郁中的链式中介作用
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王雨菲 , 孙奎立 , 牟芯
现代预防医学 | 儿少卫生与妇幼保健 2026,53(5): 855-860
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现代预防医学 |儿少卫生与妇幼保健 2026 , 53 (5) : 855 -860
社会退缩和自尊在童年创伤与初中生抑郁中的链式中介作用
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王雨菲（2001—），女，硕士在读，研究方向：卫生事业管理学

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王雨菲, 孙奎立 , 牟芯
作者信息
  • 山东第一医科大学医药管理学院社会工作系，山东 泰安 271016
通讯作者:
孙奎立，E-mail:
牟芯，E-mail:
孙奎立与牟芯为共同通信作者
作者简介:

王雨菲（2001—），女，硕士在读，研究方向：卫生事业管理学

The chain mediation role of social withdrawal and self-esteem between childhood trauma and depression among junior high school students
Yu-fei WANG, Kui-li SUN , Xin MOU
Affiliations
  • Department of Social Work, School of Pharmaceutical Management, Shandong First Medical University, Tai’an, Shandong 271016, China
出版时间: 2026-03-10 doi: 10.20043/j.cnki.MPM.202510131
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摘要
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目的

探讨社会退缩和自尊在童年创伤与初中生抑郁中的链式中介作用，为青少年心理健康干预提供参考依据。

方法

2025年6—8月，采用分层抽样法对山东省泰安市5所初中的2 630名学生进行问卷调查，采用青少年自评量表中的社交退缩维度部分、自尊量表、儿童期创伤问卷以及抑郁症筛查量表等工具对核心变量进行测量，采用Pearson相关分析检验各变量之间的相关性，采用多元线性回归分析检验各变量对抑郁的影响，采用中介模型和bootstrap法检验社会退缩和自尊的链式中介作用。

结果

童年创伤各维度均与社会退缩呈显著正相关，与自尊水平呈显著负相关，与抑郁呈显著正相关，社会退缩与自尊呈显著负相关，与抑郁呈显著正相关，自尊与抑郁呈显著负相关；进一步分析表明，童年创伤各维度能够直接正向预测初中生的抑郁程度（β=0.335、0.113、0.237、0.152、0.175，P均小于0.001），也能通过社会退缩这一中介变量（β=0.196、0.110、0.172、0.138、0.176，Boot95% CI均不经过0）或“童年创伤→社会退缩→低自尊→抑郁”的链式中介路径（β=0.020、0.010、0.025、0.014、0.026，Boot95% CI均不经过0）对初中生抑郁程度进行间接预测，自尊在情感虐待、情感忽视以及躯体忽视与初中生抑郁之间发挥显著的中介作用（β=0.021、0.037、0.025，Boot95% CI均不经过0）。

结论

社会退缩和低自尊在童年创伤与初中生抑郁中发挥着链式中介作用，及时阻断风险因素、发展保护因素对于青少年心理健康状况的改善具有重要作用。

社会退缩  /  自尊  /  抑郁  /  童年创伤  /  初中生
Objective

To explore the chain mediation role of social withdrawal and self-esteem in the relationship between childhood trauma and depression among junior high school students, to inform youth mental health interventions.

Methods

From June to August 2025, a stratified sampling survey was conducted among 2 630 students from five junior high schools in Tai’an, Shandong. Core variables were assessed using the social withdrawal dimension of the Youth Self-Report, the Self-Esteem Scale, the Childhood Trauma Questionnaire, and the Depression Screening Questionnaire. Pearson correlation tested associations among variables. Multiple linear regression tested effects on depression. Mediation models with bootstrapping tested the chain mediation of social withdrawal and self-esteem.

Results

All trauma dimensions were positively related to social withdrawal and depression, and negatively to self-esteem. Social withdrawal was negatively related to self-esteem and positively to depression. Self-esteem was negatively related to depression. Further analysis showed that all trauma dimensions directly predicted higher depression (β=0.335, 0.113, 0.237, 0.152, 0.175; all P<0.001), and indirectly predicted higher depression via social withdrawal (β=0.196, 0.110, 0.172, 0.138, 0.176; Boot 95% CI excluded 0) and via the chain “trauma →social withdrawal → low self-esteem → depression” (β=0.020, 0.010, 0.025, 0.014, 0.026; Boot 95% CI excluded 0). Self-esteem also significantly mediated the associations between emotional abuse, emotional neglect, physical neglect, and depression (β=0.021, 0.037, 0.025; Boot 95% CI excluded 0).

Conclusion

Social withdrawal and low self-esteem play a chain mediation role in the relationship between childhood trauma and depression among junior high school students. Timely interrupting risk factors and developing protective factors are crucial for improving the mental health of adolescents.

Social withdrawal  /  Self-esteem  /  Depression  /  Childhood trauma  /  Junior high school students
王雨菲, 孙奎立, 牟芯. 社会退缩和自尊在童年创伤与初中生抑郁中的链式中介作用. 现代预防医学, 2026 , 53 (5) : 855 -860 . DOI: 10.20043/j.cnki.MPM.202510131
Yu-fei WANG, Kui-li SUN, Xin MOU. The chain mediation role of social withdrawal and self-esteem between childhood trauma and depression among junior high school students[J]. Modern Preventive Medicine, 2026 , 53 (5) : 855 -860 . DOI: 10.20043/j.cnki.MPM.202510131
正文
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初中阶段的心理健康状况对个体一生的健康发展轨迹具有深远影响[1]。然而，全球数据显示，青少年心理健康问题已成为一个对公共卫生日益严峻的挑战[2]。近期一项有关中国青少年精神健康的研究显示[3]，中国儿童和青少年精神障碍患病率为8.9%，上海精神卫生中心数据显示，初三、高三学生抑郁检出率已经超过20%。抑郁作为最常见的内部化问题，在初中生群体中的患病率持续攀升，严重损害了他们的社会功能、学业成就和生活质量，甚至会增加其非自杀性自伤和自杀行为的风险[4-5]。
童年创伤是指发生在个体18周岁之前生命历程中的压力性或创伤性事件，包括情感忽视、情感虐待、躯体忽视、躯体虐待以及性虐待[6]。童年创伤经历已经被证实为青少年抑郁的重要风险因素之一[7-8]。王晓明等[9]的研究表明，童年期的情感及躯体忽视与虐待经历均能够正向预测青少年的抑郁状况。
然而，抑郁并非童年期创伤经历这一因素直接引发，而是创伤经历与行为、认知等因素相互作用，形成的级联效应所致。发展心理病理理论认为，个体早期经历虽然塑造了后续的健康发展轨迹，但该轨迹并非一成不变，会受到个体行为与认知因素的影响[10]。而社会退缩与自尊作为个体行为和认知因素的关键变量，应该在童年创伤到抑郁形成的过程中发挥着中介作用。遗憾的是，学界对这一作用的研究尚不充分。因此，本研究着力阐明社会退缩和自尊在童年创伤与初中生抑郁形成过程中的作用机制，构建并检验“童年创伤→社会退缩→低自尊→抑郁”的链式中介模型，可以帮助人们理解从童年创伤到抑郁心理发展的路径，为初中生心理健康干预提供理论依据和实践指导。
1　对象与方法
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1.1　对象
2025年6—8月，采用分层抽样方法对山东省泰安市5所初中的2 768名学生进行问卷调查，纳入标准：（1）年龄小于18周岁的在读初中生；（2）同意参与本次调查；（3）排除因任何原因导致休假或休学者；（4）排除精神异常或沟通障碍，无法配合调查者；（5）排除在调查时已经接受或正在接受心理干预或精神科治疗者。共发放问卷2 768份，剔除存在数据缺失的问卷（n=138），最终获得有效问卷2 630份，有效回收率为95.0%。其中男生1 320人（50.2%），女生1 310人（49.8%），年龄范围为10~17岁，平均年龄（13.32±1.38）岁。本研究已通过山东第一医科大学伦理委员会批准（批准号：R202506160428）。
1.2　方法
1.2.1　社会退缩量表
采用青少年自评量表（youth self-report,YSR）[11]中社交退缩维度的测查题目对研究对象的社会退缩程度进行测量。该量表共8题，均采用0~2分3点计分法，得分越高表示研究对象社会退缩程度越严重。本研究中该量表的Cronbach α系数为0.885。
1.2.2　自尊量表
采用孙钦铃[12]修订的中文版自尊量表（self-esteem scale,SES）进行测量。该量表共10题，其中第3、5、7、9题为反向计分题目，在数据梳理时进行了反向处理，所有题目均采用0～3分4点计分法，总分越高表示初中生的自尊感水平越高。本研究中该量表的Cronbach α系数为0.862。
1.2.3　儿童期创伤问卷
采用赵幸福等[13]翻译的中文版儿童期创伤问卷（childhood trauma questionnaire-short form,CTQ-SF）。该问卷将童年创伤分为情感虐待、情感忽视、躯体虐待、躯体忽视和性虐待五个维度。问卷共28题，其中第2、5、7、13、19、26、28题为反向计分题目，在数据梳理时进行了反向处理，第10、16、22题为信度检测题目，不计入总分，所有条目均采用0～4分5点计分法，得分越高表示童年创伤越严重。本研究中，五维度的Cronbach α系数分别为0.848、0.860、0.887、0.779、0.945，均具有较好内部信度。
1.2.4　抑郁症筛查量表
采用徐勇[14]等修订的抑郁症筛查量表（patient health questionnaire-9,PHQ-9）。该量表共9题，均采用0～3分4点计分法，得分越高表示个体的抑郁程度越重。本研究中该量表的Cronbach α系数为0.938。
1.3　质量控制
在问卷编制阶段，采用本土化修订的成熟量表，在预调查中对各量表进行信度分析，确保各量表具有较高的内部信度，可用于后续研究。在对研究对象进行正式施测时，采用标准化机房环境，所有主试均已经过专业培训，通过现场讲解标准化指导语帮助研究对象明确填写要求，强调匿名性与真实性原则。
1.4　统计学分析
采用 SPSS 27.0软件进行统计学分析。经检验，本研究的数据资料分布符合正态性，采用（）进行描述；采用Pearson相关分析检验童年创伤各维度、社会退缩、自尊、抑郁等各变量之间的相关性；采用多元线性回归分析检验各变量对抑郁的影响，多重共线性分析结果显示，在本研究的各个回归方程中，所有方差膨胀因子（variance inflation factor，VIF）值均接近于1，最大的VIF值为1.466，因此本研究不存在严重多重共线性问题；采用SPSS process 4.1插件中的model 6分析社会退缩和自尊在童年创伤各维度与初中生抑郁之间的链式中介作用，采用bootstrap法进行5 000次重复抽样，计算效应量的95%置信区间。检验水准α=0.05。
2　结果
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2.1　共同方法偏差分析
由于本研究的各主要变量均由被试报告，因此采用Harman单因素统计控制法避免共同方法偏差对结果的影响，以第一因子方差解释率占方差总解释率的百分比作为判断依据。结果显示，第一个因子的方差解释率为30.76%，小于40%的标准，表明本研究不存在明显的共同方法偏差问题，数据可用于进一步分析。
2.2　各变量的平均数、标准差及相关矩阵
如表1所示，童年创伤的五个维度两两之间呈显著正相关，且均与社会退缩呈显著正相关，与自尊水平呈显著负相关，与抑郁呈显著正相关；社会退缩与自尊呈显著负相关，与抑郁呈显著正相关；自尊与抑郁呈显著负相关。
2.3　各变量与社会退缩的多元线性回归分析
以社会退缩为因变量，以童年创伤的五个维度分别作为自变量进行多元线性回归分析，在控制性别、年龄、家庭居住地、是否为独生子女以及家庭经济状况等因素后，结果显示，童年创伤的五个维度均能显著正向预测初中生的社会退缩程度，这表明，童年期创伤经历越多的初中生越容易发生社会退缩。具体分析结果见表2。
2.4　各变量与自尊的多元线性回归分析
将社会退缩分别纳入五个回归方程，以自尊为因变量，分别以童年创伤的五个维度作为五个方程的自变量，进行多元线性回归分析，分析结果显示，在控制性别、年龄、家庭居住地、是否为独生子女和家庭经济状况等变量后，童年创伤的情感虐待、情感忽视和躯体忽视维度与初中生的自尊感水平呈显著负向关系，表明在这三个维度中有较重童年创伤经历的初中生易表现出更低的自尊感，躯体虐待和性虐待与初中生自尊感的关系不具有统计学意义。同时，在五个方程中，社会退缩与自尊均呈现负向关系的显著性，这表明社会退缩越严重的初中生越容易表现出低自尊感。见表3。
2.5　各变量与抑郁的多元线性回归分析
将社会退缩和自尊分别纳入五个回归方程，以抑郁为因变量，分别以童年创伤的五个维度作为五个方程的自变量，进行多元线性回归分析，分析结果显示，在控制性别、年龄、家庭居住地、是否为独生子女和家庭经济状况等变量后，童年创伤各维度与初中生抑郁程度均呈显著正向关系，表明各维度的童年创伤经历均能正向预测初中生的抑郁程度。同时，在五个方程中，社会退缩与抑郁均呈现显著正向关系，表明社会退缩程度越严重的初中生抑郁症状越严重；而自尊与抑郁均呈现显著负向关系，表明自尊感水平越高的初中生抑郁程度越轻。见表4。
2.6　社会退缩和自尊的链式中介效应检验
由表5所示，在五个模型中，直接效应的Boot95% CI均不包含0，直接效应显著且效应值均为正数，表明童年创伤的五个维度均能直接正向预测初中生的抑郁状况。在间接效应的测量中，社会退缩的中介作用在五个模型中均显著，表明童年创伤各维度均能够通过社会退缩间接预测初中生的抑郁状况；自尊在模型一、模型二和模型四中的中介作用显著，表明童年创伤的情感虐待、情感忽视与躯体忽视维度能够通过自尊感水平间接预测初中生的抑郁状况；在五个模型中，“童年创伤→社会退缩→低自尊→抑郁”这一链式中介路径的Boot95% CI均未经过0，这表明社会退缩和自尊在童年创伤各维度与初中生抑郁状况的关系之间均起到链式中介作用。
3　讨论
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3.1　童年创伤各维度正向预测初中生抑郁状况
本研究表明，童年创伤经历越多的初中生表现出更严重的抑郁程度，这与王晓明等[9]的研究结果一致。值得一提的是，情感虐待对初中生抑郁的影响最大，这与近期国外的一项研究结果相契合[4]，这一发现强调了情感创伤对青少年心理发展的深刻影响，特别是在自我概念和自我价值的形成过程中，情感虐待可能导致个体出现自我否定和负性认知，从而加剧抑郁症状的发生[15]。这提示我们在对初中生进行心理健康干预时，既不能忽视每种童年创伤对初中生造成的影响，又要对经历过情感虐待的个体制定更具针对性的干预对策。同时，这一发现还警示父母或其他监护人在家庭教育中应尽可能避免对儿童造成身体或情感等方面的创伤。
3.2　社会退缩在童年创伤与初中生抑郁之间的中介作用
本研究发现，童年创伤各维度都能正向预测初中生社会退缩行为，进而预测抑郁症状的发生或加剧。这一过程与依恋理论的观点一致[16]，个体童年期的创伤经历使其形成不安全的依恋模式，使个体在进入青春期后难以与他人建立健康稳定的关系，因此初中生可能会选择采取社会退缩行为作为一种防御机制，然而，社会退缩作为一种应对方式，虽然短期内能减少潜在的伤害，但长期来看却是一种适应不良的行为[17]，社会退缩减少了个体在与他人交往中获取社会支持的机会，社会支持少的个体相较于其他人在面临压力事件时可能表现的更加脆弱，进而增加了初中生抑郁发生的可能性。这提示我们及时评估并干预初中生的社会退缩行为，是对初中生抑郁症状进行早期预防和治疗的关键途径。
3.3　自尊在童年创伤与初中生抑郁之间的中介作用
本研究表明，自尊在童年创伤的情感虐待、情感忽视和躯体忽视维度与初中生抑郁之间的中介效应显著，在躯体虐待和性虐待与初中生抑郁之间的中介效应不显著。情感虐待和忽视本质上是一种对个体价值的否定，因此情感上的童年创伤经历更容易被初中生内化为对自我的负面评价，直接损害其自尊水平[18]，而低自尊感是抑郁症的核心认知脆弱性因素之一，因此自尊在童年时期的情感创伤与初中生抑郁之间起到了关键的中介作用。然而，童年时期的躯体虐待和性虐待虽然同样会对个体造成巨大伤害，但其影响机制可能更为复杂，因此自尊的中介作用可能不是由躯体虐待或性虐待到初中生抑郁的主要路径。这启示我们对初中生自尊感水平的干预需要针对经历过不同创伤类型的个体制定更精准的对策。
3.4　社会退缩和自尊在童年创伤与初中生抑郁之间的链式中介作用
本研究最重要的发现是验证了“童年创伤→社会退缩→低自尊→抑郁”这一链式中介模型，为理解童年创伤如何通过行为和认知途径影响青少年抑郁提供了新的视角。经历过童年创伤的初中生首先将社会退缩行为作为一种防御性的应对策略，但长期的社会退缩行为使其脱离了正常的社会交往环境，无法从中获得积极反馈，也丧失了在与他人的互动中验证和发展自我能力的机会，使得他们更容易产生对自我的负面认知，从而导致自尊水平的降低，最终，低自尊作为一种稳定的认知易感性，显著增加了初中生出现抑郁症状的风险。这与发展心理病理理论的观点相契合[10]，发展心理病理理论认为个人成长过程中的压力源和情感创伤通过行为模式和认知模式的相互作用影响心理健康，本研究发现社会退缩（行为因素）和自尊（认知因素）在抑郁形成中的中介作用，揭示了创伤经历如何通过个体行为与认知通道，最终影响到青少年的心理健康。这启示我们，在对初中生的心理健康问题进行干预时，不仅要关注风险因素（社会退缩）如何增加初中生患抑郁症的风险，同时也要关注保护因素（自尊）如何降低初中生患抑郁症的风险，在引导初中生减少社会退缩行为的同时，帮助其提高自尊感，相较于针对单一因素进行干预，能够更有效地降低有童年创伤经历的个体在初中阶段发生抑郁或抑郁症状加剧的概率。
综上，本研究分别检验了童年创伤不同维度对抑郁的作用，并重点探讨了社会退缩和自尊在童年创伤各维度与初中生抑郁之间的链式中介作用机制，为青少年抑郁症的早期干预提供了理论支持和实证依据。该研究也存在着一定的局限性：（1）研究所采用的是横断面设计，无法揭示童年创伤、社会退缩、自尊和初中生抑郁等各变量之间的动态因果关系，未来研究可以考虑采用多期数据纵向研究方式，为因果效应检验提供更加可靠的证据支持；（2）本研究的样本仅限于同一城市的初中生，可能会对结论的普适性造成影响，未来研究可以扩展至不同地区的样本，以提高结论的推广性。
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  • 山东省社会科学规划研究项目(22CSHJ04)
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2026年第53卷第5期
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doi: 10.20043/j.cnki.MPM.202510131
  • 接收时间：2025-10-11
  • 首发时间：2026-11-02
  • 出版时间：2026-03-10
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  • 收稿日期：2025-10-11
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    山东第一医科大学医药管理学院社会工作系，山东 泰安 271016

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