The Relationship Between Childhood Maltreatment and Depression in College Students: The Chain Mediating Effects of Perceived Social Support and Difficulties in Emotion Regulation

Abstract

Childhood maltreatment is a well-recognized distal risk factor for depression. College students have been recognized as one of the populations with a high incidence of depression, and a considerable proportion of them report experiences of childhood maltreatment. The potential pathways accounting for the association between childhood maltreatment and depression have been understudied, especially among college students. Childhood maltreatment enhances the risk of depression, possibly via perceived social support or difficulties in emotion regulation. However, studies investigating these associations simultaneously are still needed to be explored in deeply. This study attempts to construct an integrative chain mediating model in which the association between childhood maltreatment and depression was sequentially mediated by perceived social support and difficulties in emotion regulation among college students. A total of 1,728 Chinese college students (mean age 18.34) completed the Childhood Trauma Questionnaire-Short Form (CTQ-SF), Beck Depression Inventory (BDI), Perceived Social Support Scale (PSSS), and Difficulties in Emotion Regulation Scale (DERS). Chain mediation analyses were conducted. The results of the correlation analyses showed that CTQ-SF, BDI, PSSS, and DERS were significantly pairwise correlated (p < .01). The path analyses suggested that childhood maltreatment may be associated with depression through three pathways among college students: (a) the independent mediating role of PSSS (B = 0.028, 95% CI [0.005, 0.052]), (b) the independent mediating role of DERS (B = 0.111 [0.088, 0.136]), and (c) the chain mediating roles of PSSS and DERS (B = 0.059 [0.047, 0.074]). These findings contribute to a better understanding of the complex associations among CTQ-SF, PSSS, DERS, and BDI among college students, providing preliminary support for the framework of interpersonal emotion regulation. Some interventions targeting enhancing the level of perceived social support and developing adaptive emotional regulation strategies in college students with childhood maltreatment may be effective in reducing depression.

Keywords

childhood maltreatment depression perceived social support difficulties in emotion regulation chain mediating effects

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References

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders: DSM-5 (Vol. 5). American Psychiatric Association.

Beck

A. T.

Ward

C. H.

Mendelson

Mock

Erbaugh

(1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571. https://doi.org/10.1001/archpsyc.1961.01710120031004

Berking

Wupperman

(2012). Emotion regulation and mental health: recent findings, current challenges, and future directions. Current Opinion in Psychiatry, 25(2), 128–134. https://doi.org/10.1097/YCO.0b013e3283503669

Bernstein

D. P.

Stein

J. A.

Newcomb

M. D.

Walker

Pogge

Ahluvalia

Stokes

Handelsman

Medrano

Desmond

(2003). Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse & Neglect, 27(2), 169–190. https://doi.org/10.1016/S0145-2134(02)00541-0

Blumenthal

J. A.

Burg

M. M.

Barefoot

Williams

R. B.

Haney

Zimet

(1987). Social support, type A behavior, and coronary artery disease. Psychosomatic Medicine, 49(4), 331–340. https://doi.org/10.1097/00006842-198707000-00002

Chen

Zhang

Zhou

(2020). Effects of gender, medical school class year, and majors on sleep quality in Chinese medical students: a systematic review and meta-analysis. Sleep & Breathing, 24(1), 259–266. https://doi.org/10.1007/s11325-019-01905-4

Chu

Wang

Yao

Fan

Nie

Wang

Tang

(2022). Childhood trauma and current depression among Chinese university students: a moderated mediation model of cognitive emotion regulation strategies and neuroticism. BMC Psychiatry, 22(1), 90. https://doi.org/10.1186/s12888-021-03673-6

Cohen

Wills

T. A.

(1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98(2), 310–357.

Dai

(2023). Analysis of mental health status before and after psychological intervention in response to public health emergencies by medical students: A prospective single-arm clinical trial. Translational Pediatrics, 12(3), 462–469. https://doi.org/10.21037/tp-23-120

10.

Davidson

R. J.

Pizzagalli

Nitschke

J. B.

Putnam

(2002). Depression: perspectives from affective neuroscience. Annual Review of Psychology, 53, 545–574. https://doi.org/10.1146/annurev.psych.53.100901.135148

11.

Q. B.

McKone

K. M. P.

Hofman

S. J.

Morrow

K. E.

Brehm

M. V.

Ladouceur

C. D.

Silk

J. S.

(2025). Feeling socially connected to others is linked to better emotion regulation in adolescent girls’ daily lives: An ecological momentary assessment study. Journal of the Society for Research on Adolescence, 35(1), e70009. https://doi.org/10.1111/jora.70009

12.

Feldman

Greenbaum

C. W.

(1997). Affect regulation and synchrony in mother—infant play as precursors to the development of symbolic competence. Infant Mental Health Journal, 18(1), 4–23. https://doi.org/10.1002/(SICI)1097-0355(199721)18:1<4::AID-IMHJ2>3.0.CO;2-R

13.

Fridlund

A. J.

(1991). Sociality of solitary smiling: potentiation by an implicit audience. Journal of Personality and Social Psychology, 60(2), 229. https://doi.org/10.1037/0022-3514.60.2.229

14.

Feng

Qin

Wang

Cai

Lan

Yang

(2018). Reported prevalence of childhood maltreatment among Chinese college students: A systematic review and meta-analysis. PLoS One, 13(10), e0205808. https://doi.org/10.1371/journal.pone.0205808

15.

X. L.

Zhang

Chen

X. F.

Chen

Z. Y.

(2023). Report on national mental health development in China (2021–2022). Social Sciences Academic Press.

16.

Goemans

Viding

McCrory

(2023). Child maltreatment, peer victimization, and mental health: Neurocognitive perspectives on the cycle of victimization. Trauma Violence Abuse, 24(2), 530–548. https://doi.org/10.1177/15248380211036393

17.

Gomes

Matos

P. M.

Silva

E. R.

Silva

Sales

C. M. D.

(2022). Distress facing increased genetic risk of cancer: The role of social support and emotional suppression. Patient Education and Counseling, 105(7), 2436–2442. https://doi.org/10.1016/j.pec.2022.03.018

18.

Green

E. P.

Cho

Gallis

J. A.

Puffer

E. S.

(2018). The impact of school support on depression among adolescent orphans: A cluster-randomized trial in Kenya. Journal of Child Psychology and Psychiatry, 60(1), 54–62. https://doi.org/10.1111/jcpp.12955

19.

Gross

J. J.

(2002). Emotion regulation: Affective, cognitive, and social consequences. Psychophysiology, 39(3), 281–291. https://doi.org/10.1017/s0048577201393198

20.

Haber

M. G.

Cohen

J. L.

Lucas

Baltes

B. B.

(2007). The relationship between self-reported received and perceived social support: A meta-analytic review. American Journal of Community Psychology, 39(1–2), 133–144. https://doi.org/10.1007/s10464-007-9100-9

21.

Halouani

Daoued

Elleuch

Turki

Ellouze

Aloulou

(2023). Impulsivity and emotion regulation in medical students. European Psychiatry, 66(Suppl 1), S739–S739. https://doi.org/10.1192/j.eurpsy.2023.1552

22.

Hayes

A. F.

(2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. Guilford Press.

23.

Bai

Wang

Fan

Wang

Liu

Zhang

Yao

Xie

(2021). Identification of microRNA-9 linking the effects of childhood maltreatment on depression using amygdala connectivity. Neuroimage, 224, 117428. https://doi.org/10.1016/j.neuroimage.2020.117428

24.

Fan

Liu

Wang

Zhang

Xie

(2022). Insula network connectivity mediates the association between childhood maltreatment and depressive symptoms in major depressive disorder patients. Translational Psychiatry, 12(1), 89. https://doi.org/10.1038/s41398-022-01829-w

25.

Hopfinger

Berking

Bockting

C. L.

Ebert

D. D.

(2016). Emotion regulation mediates the effect of childhood trauma on depression. Journal of Affective Disorders, 198, 189–197. https://doi.org/10.1016/j.jad.2016.03.050

26.

Ibrahim

A. K.

Kelly

S. J.

Adams

C. E.

Glazebrook

(2013). A systematic review of studies of depression prevalence in university students. Journal of Psychiatric Research, 47(3), 391–400. https://doi.org/10.1016/j.jpsychires.2012.11.015

27.

Jennissen

Holl

Mai

Wolff

Barnow

(2016). Emotion dysregulation mediates the relationship between child maltreatment and psychopathology: A structural equation model. Child Abuse & Neglect, 62, 51–62. https://doi.org/10.1186/s12888-017-1583-910.1016/j.chiabu.2016.10.015

28.

Lagdon

Ross

Robinson

Contractor

A. A.

Charak

Armour

(2021). Assessing the mediating role of social support in childhood maltreatment and psychopathology among college students in Northern Ireland. Journal of Interpersonal Violence, 36(3–4), NP2112–NP2136. https://doi.org/10.1177/0886260518755489

29.

Guo

Zhang

Wang

W. X.

W. Y.

Chen

X. L.

Shi

McIntyre

R. S.

(2021). The relationship between childhood emotional abuse and depressive symptoms among Chinese college students: The multiple mediating effects of emotional and behavioral problems. Journal of Affective Disorders, 288, 129–135. https://doi.org/10.1016/j.jad.2021.03.074

30.

Lippard

E. T. C.

Nemeroff

C. B.

(2020). The devastating clinical consequences of child abuse and neglect: Increased disease vulnerability and poor treatment response in mood disorders. American Journal of Psychiatry, 177(1), 20–36. https://doi.org/10.1176/appi.ajp.2019.19010020

31.

Mall

Mortier

Taljaard

Roos

Stein

D. J.

Lochner

(2018). The relationship between childhood adversity, recent stressors, and depression in college students attending a South African university. BMC Psychiatry, 18(1), 63. https://doi.org/10.1186/s12888-017-1583-9

32.

Mao

Hou

Duan

(2023). Cognitive reappraisal and corresponding neural basis mediate the association between childhood maltreatment and depression. Biological Psychology, 184, 108716. https://doi.org/10.1016/j.biopsycho.2023.108716

33.

Marroquín

(2011). Interpersonal emotion regulation as a mechanism of social support in depression. Clinical Psychology Review, 31(8), 1276–1290. https://doi.org/10.1016/j.cpr.2011.09.005

34.

Miu

A. C.

Szentágotai-Tătar

Balázsi

Nechita

Bunea

Pollak

S. D.

(2022). Emotion regulation as mediator between childhood adversity and psychopathology: A meta-analysis. Clinical Psychology Review, 93, 102141. https://doi.org/10.1016/j.cpr.2022.102141

35.

Niven

López-Pérez

(2025). Interpersonal emotion regulation: Reflecting on progress and charting the path forward. Emotion, 25(2), 277–286. https://doi.org/10.1037/emo0001472

36.

Pejičić

Ristić

Anđelković

(2018). The mediating effect of cognitive emotion regulation strategies in the relationship between perceived social support and resilience in postwar youth. Journal of Community Psychology, 46(4), 457–472. https://doi.org/10.1002/jcop.21951

37.

Remes

Mendes

J. F.

Templeton

(2021). Biological, psychological, and social determinants of depression: A review of recent literature. Brain Sciences, 11(12), 1633. https://doi.org/10.3390/brainsci11121633

38.

Santini

Z. I.

Koyanagi

Tyrovolas

Mason

Haro

J. M.

(2015). The association between social relationships and depression: A systematic review. Journal of Affective Disorders, 175, 53–65. https://doi.org/10.1016/j.jad.2014.12.049

39.

Sedlak

A. J.

Mettenburg

Basena

Peta

McPherson

Greene

(2010). Fourth national incidence study of child abuse and neglect (NIS-4). National Data Archive on Child Abuse and Neglect.

40.

Meng

Yang

D’Arcy

(2022). The relationship between childhood maltreatment and mental health problems: Coping strategies and social support act as mediators. BMC Psychiatry, 22(1), 359. https://doi.org/10.1186/s12888-022-04001-2

41.

Teicher

M. H.

Samson

J. A.

Anderson

C. M.

Ohashi

(2016). The effects of childhood maltreatment on brain structure, function and connectivity. Nature Reviews Neuroscience, 17(10), 652–666. https://doi.org/10.1038/nrn.2016.111

42.

Turner

H. A.

Shattuck

Finkelhor

Hamby

(2017). Effects of poly-victimization on adolescent social support, self-concept, and psychological distress. Journal of Interpersonal Violence, 32(5), 755–780. https://doi.org/10.1177/0886260515586376

43.

Vranceanu

A. M.

Hobfoll

S. E.

Johnson

R. J.

(2007). Child multi-type maltreatment and associated depression and PTSD symptoms: the role of social support and stress. Child Abuse & Neglect, 31(1), 71–84. https://doi.org/10.1016/j.chiabu.2006.04.010

44.

Wang

Gao

Wei

Duan

Huang

(2018). The impacts of childhood trauma on psychosocial features in a Chinese Sample of Young Adults. Psychiatry Investigation, 15(11), 1046–1052. https://doi.org/10.30773/pi.2018.09.26

45.

Wang

Mann

Lloyd-Evans

Johnson

(2018). Associations between loneliness and perceived social support and outcomes of mental health problems: A systematic review. BMC Psychiatry, 18(1), 156. https://doi.org/10.1186/s12888-017-1583-910.1186/s12888-018-1736-5

46.

World Health Organization. (2008). The global burden of disease: 2004 update. World Health Organization.

47.

World Health Organization. (2020). Child maltreatment. https://www.who.int/news-room/fact-sheets/detail/child-maltreatment

48.

Tao

Zhang

Sun

Tao

(2021). Geographic distribution of mental health problems among Chinese college students during the COVID-19 pandemic: Nationwide, web-based survey study. Journal of Medical Internet Research, 23(1), e23126. https://doi.org/10.2196/23126

49.

Yuhei

Ikeda

(2020). Perceived social support moderates the association between emotion regulation and psychological distress: A cross-sectional study among Japanese adults. Psychology Health & Medicine, 26(10), 1195–1205. https://doi.org/10.1080/13548506.2020.1802051

50.

Zaki

Williams

W. C.

(2013). Interpersonal emotion regulation. Emotion, 13(5), 803–810. https://doi.org/10.1037/a0033839

51.

Zhang

Wang

(2021). Childhood trauma and psychological distress: A serial mediation model among Chinese adolescents. International Journal of Environmental Research and Public Health, 18, 6808. https://doi.org/10.3390/ijerph18136808

52.

Zhao

X. F.

Zhang

Y. L.

L. F.

Zhou

Y. F.

H. Z.

Yang

S. C.

(2005). Reliability and validity of the Chinese version of childhood trauma questionnaire. Chinese Journal of Clinical Psychology, 9(20), 105–107.

53.

Zhou

H. Y.

Zhou

Zheng

T. X.

L. P.

Fan

M. X.

Liu

Zhao

X.-D.

Yan

(2025). Unraveling the link between childhood maltreatment and depression: Insights from the role of ventral striatum and middle cingulate cortex in hedonic experience and emotion regulation. Development and Psychopathology, 37(1), 292–302. https://doi.org/10.1017/s0954579423001591

54.

Zhou

Zhen

(2022). How do physical and emotional abuse affect depression and problematic behaviors in adolescents? The roles of emotional regulation and anger. Child Abuse & Neglect, 129, 105641. https://doi.org/10.1186/s12888-017-1583-910.1016/j.chiabu.2022.105641

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