The Moderated Moderation Effect of Anxiety and Self-Esteem on the Influence of Daily Stress on Non-Suicidal Self-Injury among Middle School Students

Background: This study examined the moderation effect of anxiety and the moderated moderation effect of anxiety on self-esteem in the relationship between daily stress and non-suicidal self-injury (NSSI) among middle school students.Methods: Data from 1,948 middle school students from the Teen Mental Health Survey were analyzed using regression analysis and the SPSS PROCESS Macro method. Results: The findings revealed that daily stress had a significant positive association with NSSI. Furthermore, the moderation effect of anxiety was confirmed, indicating that the positive association between daily stress and NSSI was significantly amplified as anxiety increased. In addition, a moderated moderation effect was found, demonstrating that the moderation effect of daily stress and anxiety on NSSI varied depending on the level of self-esteem. Specifically, the negative moderation effect of daily stress and anxiety on NSSI decreased as self-esteem increased.Conclusions: Based on the results, this study proposes intervention strategies to prevent NSSI among middle school students, focusing on improving self-esteem and reducing anxiety and daily stress.