Childhood emotional abuse (CEA) refers to long-term negative attitudes towards children by their caregivers, which is a type of psychological, rather than physical, form (1). It involves verbal aggression on one’s sense of value or well-being, and a series of behaviors of criticism, threats, blame, shaming, humbling or demeaning (2). Experiencing emotional abuse during childhood may lead to adverse psychological outcomes that can continue until adulthood (3). Studies focusing on negative influence of childhood adversities have proved that people being emotionally abused as children were more prone to become depressive or anxious (2). Furthermore, CEA has been proved to be linked to suicide thoughts or attempts in adolescence and adulthood (4, 5). Although growing empirical evidence has identified adverse childhood experience related to suicide-related thoughts or behaviors (6, 7), most researches have focused on the negative outcomes of physical or sexual abuse in childhood (8), and few studies have explored the unique influence of CEA on psychological health status. Besides, the underlying psychological mechanism linking the associations between CEA and suicidal thoughts or behaviors remains unclear. Therefore, it is necessary to more exactly clarify the underlying influence process of CEA on suicide-related thoughts or behaviors to effectively prevent the occurrence of adverse events.

Non-suicidal self-injury (NSSI) is the deliberate hurt to body with no death desires, such as hitting or cutting skin (9). Suicidal ideation (SI) refers to excessive brooding about meaninglessness of life, and even thinking of ending life (10). SI and NSSI are associated with each other (11), and people with NSSI behaviors are much likely to experience SI later in their life (12), indicating that they might share similar underlying risk factors (7).

Dysfunctional emotion regulation or maladaptive emotion regulation strategies may be the underlying psychological processes leading to NSSI and SI of CEA individuals. Many studies have regarded childhood abuse as a distal trigger of the maladaptive emotion-regulating strategies (13, 14). Individuals with childhood abuse experiences have deficits or difficulties in regulating their emotions (2, 15), which might further cause subsequent mental health problems (16, 17). For instance, recent empirical evidences suggested that emotion dysregulation works as a crucial mediating factor between CEA and suicidal thoughts or behaviors (18, 19). Therefore, how emotion regulation strategies work as the mediating mechanism between CEA and NSSI and SI is necessary to be further investigated.

As a maladaptive emotion regulation strategy, rumination is an significant risk factor for negative psychological outcomes. Rumination refers to recurring and intrusive thoughts about one’s suffering, its probable reasons, process and consequences of unpleasant feelings (20). It is common among adults who have experienced childhood adverse events (21). Unlike other kinds of strategies bringing up positive problem-solving, rumination is repetitive negative thinking and remains focused on negative experiences and emotions instead of taking action (22), and this strategy could result in adverse psychological outcomes and maladaptive thoughts or behaviors including SI and NSSI (23–25). However, few have demonstrated the mediating effects of rumination between CEA and SI and NSSI behaviors among Chinese college students (5, 26).

Instead of repetitively focusing on their distress and its reasons and outcomes, individuals may also tend to avoid or suppress their negative thoughts and moods. Experiential avoidance (EA) is an intent to avoid or run away from undesirable feelings or environment (27). It is characterized by unwillingness to get in touch with adverse experience and by taking action to suppress traumatic-related distress, urges, or emotions (16). People who have a history of abuse as children tend to adopt EA as an emotional regulation strategy to distract themselves from negative feelings or unwanted emotional experiences (13, 28). However, EA may cause people having more possibilities of psychopathology and higher risks of comorbid psychological outcomes such as NSSI and SI (29–31). Although a prior study on people with childhood sexual abuse histories suggested that EA was positively associated with NSSI and SI, few studies have explored EA’s effect on the relation between CEA and NSSI and SI. Therefore, whether EA might be likely linking the relation between CEA and NSSI and SI remains worth studying.

Consequently, the present study was designed to explore the impacts of CEA on NSSI and SI through rumination, EA and depression among Chinese college students. Based on the emotion regulation models and existing studies, it is hypothesized that Chinese college students emotionally abused as children might be more likely to engage in NSSI behaviors and have SI. Furthermore, we also hypothesized that rumination, EA and depression might be the linking factors in the association between CEA and NSSI and SI.

Our study found that males reported higher rates in SI and NSSI than females. However, previous studies showed no difference in rates of NSSI and SI between males and females, or that NSSI and SI were more common among females (48, 49). These discrepancies might caused by differences in samples, methods of measurement and particular definitions of NSSI and SI (50). In addition, our study demonstrated that high prevalence of NSSI was related to a significant risk of suicide. On the basis of the Three-Step Theory of Suicide, suicide capacity facilitates the transition from SI to suicide attempt (51). NSSI behaviors help to develop one’s abilities to overcome fear of death and access lethal means, which are risk factors for committing suicide (52).

This study explored the impacts of CEA on NSSI and SI through rumination, EA and depression among Chinese college students. An important finding of our study is 50.32% students had CEA experiences, of whom there were 7.9% reported SI and 31.70% reported NSSI behaviors, both higher than those without such experiences. There were positive associations between CEA and NSSI and SI, and students with CEA experiences reported more NSSI behaviors and SI. This result was consistent with prior researches (5, 53), suggesting that those emotionally abused as children had more vulnerability for suicidal thoughts or behaviors. Many studies have also regarded childhood trauma as a significant risk factor that could lead to psychological problems in adulthood (2, 13).

In line with prior studies, our study demonstrated that CEA was positively related to rumination and EA, which are maladaptive emotion regulation strategies (21, 26, 28). The ability of regulating emotion is developed in the circumstances of interpersonal emotional communication between caregivers and children at the early stage of life (54), but childhood trauma, especially repeated emotional abuse imposed on children by caregivers, hinders the learning of effective emotion-regulating skills (55). People with childhood abuse histories are more prone to have fewer adaptive emotion-regulating skills and more deficits or difficulties in identifying, understanding, and expressing their feelings (17).

As expected, our study also confirmed the mediating roles of rumination, EA and depression on the associations between CEA and NSSI and SI, indicating that maladaptive emotion-regulating strategies may be the underlying psychological processes leading to NSSI and SI of CEA individuals. These finding extends the literature by supporting the notion that emotion dysregulation plays a crucial mediating effect in the associations between CEA and suicidal thoughts or behaviors (18, 19). First, rumination is one linking factor in the relation between CEA and NSSI and SI. People who have been emotionally abused during childhood tend to ruminatively thinking their negative emotions, feelings, reasons and consequences of the traumatic events (21). On the basis of the Response Styles Theory, rumination is a risk factor for individuals’ mental health status (22). Instead of taking action to solve problems, these repetitive negative thoughts and emotion regulation style may result in more severe psychological outcomes and maladaptive thoughts or behaviors including depression, SI and NSSI (23, 24). Second, EA is another linking factor in the relations between CEA and NSSI and SI. For people with CEA experiences, EA is an emotional regulation strategy to distract themselves from negative emotions or unpleasant internal feelings or external circumstance (13, 28). However, EA could not only help people to shake off traumatic-related distress thoughts and emotions briefly but also in turn increases the risks of depression, NSSI behaviors and SI (56). Besides, EA following CEA may weaken with one’s ability to effectively solve problems. Therefore, as a maladaptive emotion-regulating strategy, EA might cause CEA individuals being more vulnerable to suicide-related thoughts and behaviors (29, 31).

In summary, this study demonstrates the impacts of CEA on NSSI and SI through rumination, EA and depression. These findings could help us further clarify of the relations between CEA, rumination, EA, depression, NSSI and SI. Therefore, subsequent studies are needed to verify if developing effective emotion-regulating strategies could be helpful to the intervention of suicidal thoughts or behaviors among people with emotional abuse experience in childhood.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

The studies involving human participants were reviewed and approved by the Ethics Committee for Scientific Research of the Third Affiliated Hospital of Zhengzhou University. The patients/participants provided their written informed consent to participate in this study.

WW made substantial contributions to the design of the work and wrote the manuscript. XW and GD did a lot of work in data collecting, statistics analysis, and revision of the manuscript. All the authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of work are appropriately investigated and resolved.

This work was supported by the PhD Research Startup Foundation of Third Affiliated Hospital of Zhengzhou University (Grant Number: BS20230106).

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.