Childhood Maltreatment and Adolescent Depressive Symptom: A Sequential Mediation Model of Alexithymia and Social Anxiety

BACKGROUND: Childhood maltreatment is a significant risk factor for adolescent depressive symptoms, yet the underlying psychological mechanisms remain insufficiently understood. Identifying mediating pathways through emotional processing deficits and social functioning impairments may inform targeted interventions. AIMS: This study examined whether alexithymia and social anxiety sequentially mediate the association between childhood maltreatment and depressive symptoms in Chinese adolescents. METHOD: A cross-sectional survey was conducted between February and April 2024 among 7,582 middle school students from 5 Chinese provinces. Participants completed validated questionnaires measuring childhood maltreatment (Childhood Trauma Questionnaire-Short Form), alexithymia (Perth Alexithymia Questionnaire), social anxiety (Social Anxiety subscale of the Self-Consciousness Scale), and depressive symptoms (Patient Health Questionnaire-9). Structural equation modeling with 5,000 bootstrap resamples was employed to test direct and indirect effects. RESULTS: Childhood maltreatment showed a significant direct effect on depressive symptoms (β = .318, 95% CI [0.290, 0.346]). Both alexithymia (β = .049, 95% CI [0.041, 0.058]) and social anxiety (β = .039, 95% CI [0.031, 0.047]) independently mediated this relationship. Sequential mediation through alexithymia to social anxiety was also significant (β = .036, 95% CI [0.032, 0.041]). CONCLUSIONS: Impaired emotional processing and heightened social anxiety represent important psychological mechanisms linking childhood maltreatment to adolescent depressive symptoms. These findings suggest that interventions targeting emotion regulation skills and social anxiety may help disrupt this developmental pathway. Longitudinal studies are needed to establish causal relationships.