A network analysis of depressive symptoms on childhood trauma and the relationship with non-suicidal self-injury among hearing and hard-of-hearing adolescents

BACKGROUND: Childhood trauma exerts lasting negative effects on mental health, with hard-of-hearing adolescents particularly vulnerable compared to their hearing peers. Yet we still know little about the relationship between childhood trauma, non-suicidal self-injury (NSSI) and depressive symptoms in this population, especially at symptoms level. METHODS: In this study, a total of 2,008 Chinese students (hearing = 1,386; hard-of-hearing = 622) completed self-report questionnaires assessing childhood trauma, depressive symptoms and NSSI. Mediation analysis tested the indirect effect of depressive symptoms. Network analysis identified central and bridge symptoms, and directed acyclic graphs (DAGs) were used to explore potential directional pathways between symptoms. RESULTS: Depressive symptoms mediated the trauma-NSSI association, with a stronger effect among hard-of-hearing adolescents; For hearing adolescents, emotional abuse- and neglect-related items were central symptoms in trauma-depressive-NSSI network, whereas only an emotional neglect-related item was central for hard-of-hearing adolescents; DAGs further supported a pathway from trauma to depression to NSSI, pinpointing key symptoms driving this progression. CONCLUSIONS: Overall, this study underscores that trauma-depression-NSSI pathways vary across population at both construct and symptom levels, highlighting the importance of early identification and interventions targeting depressive symptoms to help prevent and relieve NSSI risk in trauma-exposed adolescents.