Self-worth as a mediator between childhood maltreatment and non-suicidal self-injury severity in adolescent psychiatric inpatients: exploratory moderation by perceived economic status

Childhood maltreatment is an established risk factor for non-suicidal self-injury (NSSI), yet the psychological process and socioecological boundary conditions underlying this relationship remain insufficiently understood, particularly in clinical populations. This study aimed to examine the mediating role of global self-worth in the association between dimensions of childhood maltreatment and NSSI severity, and to explore the moderating effect of perceived economic status. A sample of adolescent psychiatric inpatients completed the Childhood Trauma Questionnaire, the Global Self-Worth Scale, and the Adolescent Non-suicidal Self-injury Assessment Questionnaire. Multiple mediation analysis was conducted to test self-worth as a mediator between five maltreatment dimensions and NSSI. Exploratory moderated mediation analysis was further employed to investigate whether perceived economic status influenced these pathways. Among the five maltreatment dimensions examined, only emotional abuse and emotional neglect were significant predictors of NSSI severity, whereas physical abuse, physical neglect, and sexual abuse showed no significant associations. Self-worth fully mediated the relationship between emotional neglect and NSSI severity, while partially mediating the association between emotional abuse and NSSI severity. At an exploratory level, the negative association between emotional neglect and self-worth appeared to be stronger among adolescents reporting higher perceived economic status. The cross-sectional findings support self-worth as a potential psychological pathway linking emotional maltreatment to NSSI severity. Adolescents from higher socioeconomic backgrounds may be particularly vulnerable to the adverse effects of emotional neglect, although this exploratory socioeconomic pattern requires replication in longitudinal studies. Interventions for adolescents who engage in self-injury should therefore aim to strengthen self-worth while addressing the broader socioecological context to reduce NSSI severity.