Abstract
Childhood sexual abuse (CSA) and bullying victimization are well-established risk factors for deliberate self-harm (DSH) and suicidal ideation (SI). Research ties aspects of self-concept, such as self-esteem, with victimization and self-harm. Yet, there is limited evidence of the role of multidimensional self-concept in the victimization-self-harm association. Using a longitudinal sample of 422 adolescent girls from a large midwestern city, 35% with recently substantiated CSA-exposure and 51% with recent bullying victimization at baseline, we examined pathways from CSA-exposure and bullying victimization to subsequent DSH and SI, with global self-worth and five subscales of self-concept as mediators (social competence, close friendships, physical appearance, scholastic competence, and behavioral conduct). Data was collected from 2012 to 2015. CSA-exposure directly increased the risk of both SI (B .50, SE .23, p < .05) and DSH (B .53, SE .22, p < 5), while global self-worth fully mediated the relationship between bullying victimization, SI (B .21, SE .07, 95% BCB-CI 1.17–1.95, p < .01), and DSH (B .15, SE .06, 95% BCB-CI 1.10–1.69, p < .05), We found no evidence of mediation for the subscales model. Both CSA-exposure and bullying victimization directly reduced specific subscales of self-concept, while behavioral conduct increased the risk of DSH. The role of self-concept in the bullying/self-harm association and the direct effects of CSA-exposure on self-harm highlight areas of need in social work practice, specifically the need to incorporate an emphasis on trusting relationships, overall well-being, and the reduction of shame into trauma-informed therapy and bullying prevention efforts.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data Availability
The datasets analyzed during the current study are not publicly available due to the sensitive nature of the research.
References
Achenbach, T. M. (1999). The Child Behavior Checklist and related instruments. In M. E. Maruish (Ed.), The use of psychological testing for treatment planning and outcomes assessment (2nd ed., pp. 429–466). Lawrence Erlbaum Associates Publishers.
Asparouhov, T., & Muthen, B. (2010). Weighted least squares estimation with missing data. Muthen & Muthen.
Bachman, J. G., O’Malley, P. M., Freedman-Doan, P., Trzesniewski, K. H., & Donnellan, M. B. (2011). Adolescent self-esteem: Differences by race/ethnicity, gender, and age. Self and Identity, 10(4), 445–473. https://doi.org/10.1080/15298861003794538
Barnes, J. E., Noll, J. G., Putnam, F. W., & Trickett, P. K. (2009). Sexual and physical revictimization among victims of severe childhood sexual abuse. Child Abuse & Neglect, 33(7), 412–420. https://doi.org/10.1016/j.chiabu.2008.09.013
Barth, J., Bermetz, L., Heim, E., Trelle, S., & Tonia, T. (2013). The current prevalence of child sexual abuse worldwide: A systematic review and meta-analysis. International Journal of Public Health, 58(3), 469–483. https://doi.org/10.1007/s00038-012-0426-1
Bilge-Johnson, S., Rabinovitch, A., & Fishel, H. (2013). Self-reported peer victimization and suicidal ideation in adolescent psychiatric inpatients: The mediating role of negative self-esteem. Clinical Child Psychology and Psychiatry. https://doi.org/10.1177/1359104513492747
Boulton, M. J., & Smith, P. K. (1994). Bully/victim problems in middle-school children: Stability, self-perceived competence, peer perceptions and peer acceptance. British Journal of Developmental Psychology, 12(3), 315–329. https://doi.org/10.1111/j.2044-835X.1994.tb00637.x
Bradshaw, C. P. (2013). Preventing bullying through Positive Behavioral Interventions and Supports (PBIS): A multitiered approach to prevention and integration. Theory into Practice, 52(4), 288–295. https://doi.org/10.1080/00405841.2013.829732
Brayden, R. M., Deitrich-MacLean, G., Dietrich, M. S., Sherrod, K. B., & Altemeier, W. A. (1995). Evidence for specific effects of childhood sexual abuse on mental well-being and physical self-esteem. Child Abuse & Neglect, 19(10), 1255–1262. https://doi.org/10.1016/0145-2134(95)00078-M
Cary, C. E., & McMillen, J. C. (2012). The data behind the dissemination: A systematic review of trauma-focused cognitive behavioral therapy for use with children and youth. Children and Youth Services Review, 34(4), 748–757. https://doi.org/10.1016/j.childyouth.2012.01.003
Chapman, P. L., & Mullis, R. L. (2000). Racial differences in adolescent coping and self-esteem. The Journal of Genetic Psychology, 161(2), 152–160. https://doi.org/10.1080/00221320009596702
Cipriano, A., Cella, S., & Cotrufo, P. (2017). Nonsuicidal self-injury: A systematic review. Frontiers in Psychology. https://doi.org/10.3389/fpsyg.2017.01946
Cronbach, L. J. (1951). Coefficient alpha and the internal structure of tests. Psychometrika, 16(3), 297–334. https://doi.org/10.1007/BF02310555
Davis, J. L., & Petretic-Jackson, P. A. (2000). The impact of child sexual abuse on adult interpersonal functioning: A review and synthesis of the empirical literature. Aggression and Violent Behavior, 5(3), 291–328.
Dentale, F., San Martini, P., De Coro, A., & Di Pomponio, I. (2010). Alexithymia increases the discordance between implicit and explicit self-esteem. Personality and Individual Differences, 49(7), 762–767. https://doi.org/10.1016/j.paid.2010.06.022
Dentale, F., Vecchione, M., Coro, A. D., & Barbaranelli, C. (2012). On the relationship between implicit and explicit self-esteem: The moderating role of dismissing attachment. Personality and Individual Differences, 52(2), 173–177. https://doi.org/10.1016/j.paid.2011.10.009
Devries, K. M., Mak, J. Y. T., Child, J. C., Falder, G., Bacchus, L. J., Astbury, J., & Watts, C. H. (2014). Childhood sexual abuse and suicidal behavior: A meta-analysis. Pediatrics, 133(5), e1331–e1344. https://doi.org/10.1542/peds.2013-2166
Duarte, T. A., Paulino, S., Almeida, C., Gomes, H. S., Santos, N., & Gouveia-Pereira, M. (2020). Self-harm as a predisposition for suicide attempts: A study of adolescents’ deliberate self-harm, suicidal ideation, and suicide attempts. Psychiatry Research, 287, 112553. https://doi.org/10.1016/j.psychres.2019.112553
Elliott, A. N., & Carnes, C. N. (2001). Reactions of nonoffending parents to the sexual abuse of their child: A review of the literature. Child Maltreatment, 6(4), 314–331. https://doi.org/10.1177/1077559501006004005
Finkelhor, D., & Browne, A. (1985). The traumatic impact of child sexual abuse: A conceptualization. American Journal of Orthopsychiatry, 55(4), 530–541. https://doi.org/10.1111/j.1939-0025.1985.tb02703.x
Font, S. A., Miyamoto, S., & Pinto, C. (2020). Child sexual abuse and exploitation in Pennsylvania. Center for Rural Pennsylvania. https://www.rural.palegislature.us/documents/reports/Child-Sexual-Abuse-and-Exploitation-2020.pdf
Freeman, A., Mergl, R., Kohls, E., Székely, A., Gusmao, R., Arensman, E., Koburger, N., Hegerl, U., & Rummel-Kluge, C. (2017). A cross-national study on gender differences in suicide intent. BMC Psychiatry, 17, 234. https://doi.org/10.1186/s12888-017-1398-8
Gillies, D., Christou, M. A., Dixon, A. C., Featherston, O. J., Rapti, I., Garcia-Anguita, A., Villasis-Keever, M., Reebye, P., Christou, E., Al Kabir, N., & Christou, P. A. (2018). Prevalence and characteristics of self-harm in adolescents: Meta-analyses of community-based studies 1990–2015. Journal of the American Academy of Child & Adolescent Psychiatry, 57(10), 733–741. https://doi.org/10.1016/j.jaac.2018.06.018
Godbout, N., Briere, J., Sabourin, S., & Lussier, Y. (2014). Child sexual abuse and subsequent relational and personal functioning: The role of parental support. Child Abuse & Neglect, 38(2), 317–325. https://doi.org/10.1016/j.chiabu.2013.10.001
Harter, S. (2012). The construction of the self: Developmental and sociocultural foundations (2nd ed., Vol. 440, p. 88). The Guilford Press.
Hayes, A. F., Preacher, K. J., & Myers, T. A. (2010). Mediation and the estimation of indirect effects in political communication research. In Sourcebook for political communication research (1st ed.). Routledge.
Heerde, J. A., & Hemphill, S. A. (2019). Are bullying perpetration and victimization associated with adolescent deliberate self-harm? A Meta-Analysis. Archives of Suicide Research, 23(3), 353–381. https://doi.org/10.1080/13811118.2018.1472690
Houbre, B., Tarquinio, C., & Lanfranchi, J.-B. (2010). Expression of self-concept and adjustment against repeated aggressions: The case of a longitudinal study on school bullying. European Journal of Psychology of Education, 25(1), 105–123. https://doi.org/10.1007/s10212-009-0005-x
Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6(1), 1–55. https://doi.org/10.1080/10705519909540118
Kennedy, A. C., & Prock, K. A. (2018). “I still feel like I am not normal”: A review of the role of stigma and stigmatization among female survivors of child sexual abuse, sexual assault, and intimate partner violence. Trauma, Violence, & Abuse, 19(5), 512–527. https://doi.org/10.1177/1524838016673601
Kennedy, R. S. (2021). Bullying trends in the United States: A meta-regression. Trauma, Violence, & Abuse, 22(4), 914–927. https://doi.org/10.1177/1524838019888555
Kennedy, R. S., Font, S. A., Haag, A.-C., & Noll, J. G. (2021). Childhood sexual abuse and exposure to peer bullying victimization. Journal of Interpersonal Violence, 37(19–20), NP18589–NP18613. https://doi.org/10.1177/08862605211037420
Little, R. J. A. (1988). A test of missing completely at random for multivariate data with missing values. Journal of the American Statistical Association, 83(404), 1198–1202. https://doi.org/10.2307/2290157
Liu, R. T., Scopelliti, K. M., Pittman, S. K., & Zamora, A. S. (2018). Childhood maltreatment and non-suicidal self-injury: A systematic review and meta-analysis. The Lancet Psychiatry, 5(1), 51–64. https://doi.org/10.1016/S2215-0366(17)30469-8
Low, G., Jones, D., MaCleod, A., Power, M., & Duggan, C. (2000). Childhood trauma, dissociation and self-harming behaviour: A pilot study. British Journal of Medical Psychology, 73(2), 269–278. https://doi.org/10.1348/000711200160363
MacGinley, M., Breckenridge, J., & Mowll, J. (2019). A scoping review of adult survivors’ experiences of shame following sexual abuse in childhood. Health & Social Care in the Community, 27(5), 1135–1146. https://doi.org/10.1111/hsc.12771
MacKinnon, D. P., Lockwood, C. M., & Williams, J. (2004). Confidence limits for the indirect effect: Distribution of the product and resampling methods. Multivariate Behavioral Research, 39(1), 99–128. https://doi.org/10.1207/s15327906mbr3901_4
Mishna, F., Wiener, J., & Pepler, D. (2008). Some of my best friends—Experiences of bullying within friendships. School Psychology International, 29, 549–573. https://doi.org/10.1177/0143034308099201
Murthi, M., Servaty-Seib, H. L., & Elliott, A. N. (2006). Childhood sexual abuse and multiple dimensions of self-concept. Journal of Interpersonal Violence, 21(8), 982–999. https://doi.org/10.1177/0886260506290288
Muth, J. L., & Cash, T. F. (1997). Body-image attitudes: What difference does gender make? Journal of Applied Social Psychology, 27(16), 1438–1452. https://doi.org/10.1111/j.1559-1816.1997.tb01607.x
Ng, Q. X., Yong, B. Z. J., Ho, C. Y. X., Lim, D. Y., & Yeo, W.-S. (2018). Early life sexual abuse is associated with increased suicide attempts: An update meta-analysis. Journal of Psychiatric Research, 99, 129–141. https://doi.org/10.1016/j.jpsychires.2018.02.001
Noll, J. G. (2021). Child sexual abuse as a unique risk factor for the development of psychopathology: The compounded convergence of mechanisms. Annual Review of Clinical Psychology, 17, 439–464. https://doi.org/10.1146/annurev-clinpsy-081219-112621
Noll, J. G., Haag, A.-C., Shenk, C. E., Wright, M. F., Barnes, J. E., Kohram, M., Malgaroli, M., Foley, D. J., Kouril, M., & Bonanno, G. A. (2022). An observational study of Internet behaviours for adolescent females following sexual abuse. Nature Human Behaviour, 6(1), 74–87. https://doi.org/10.1038/s41562-021-01187-5
Norrington, J. (2021). Adolescent peer victimization, self-concept, and psychological distress in emerging adulthood. Youth & Society, 53(2), 273–295. https://doi.org/10.1177/0044118X20910938
Oktan, V. (2017). Self-harm behaviour in adolescents: Body image and self-esteem. Journal of Psychologists and Counsellors in Schools, 27(2), 177–189. https://doi.org/10.1017/jgc.2017.6
Olfson, M., Wall, M., Wang, S., Crystal, S., Bridge, J. A., Liu, S.-M., & Blanco, C. (2018). Suicide after deliberate self-harm in adolescents and young adults. Pediatrics, 141(4), e20173517. https://doi.org/10.1542/peds.2017-3517
Pearlin, L. I., Menaghan, E. G., Lieberman, M. A., & Mullan, J. T. (1981). The stress process. Journal of Health and Social Behavior, 22(4), 337–356. https://doi.org/10.2307/2136676
Peters, K. R., & Gawronski, B. (2011). Mutual influences between the implicit and explicit self-concepts: The role of memory activation and motivated reasoning. Journal of Experimental Social Psychology, 47(2), 436–442. https://doi.org/10.1016/j.jesp.2010.11.015
Preacher, K. J., Rucker, D. D., & Hayes, A. F. (2007). Addressing moderated mediation hypotheses: Theory, methods, and prescriptions. Multivariate Behavioral Research, 42(1), 185–227. https://doi.org/10.1080/00273170701341316
Rosenberg, M., Schooler, C., Schoenbach, C., & Rosenberg, F. (1995). Global self-esteem and specific self-esteem: Different concepts, different outcomes. American Sociological Review, 60(1), 141–156. https://doi.org/10.2307/2096350
Ryff, C. D., & Keyes, C. L. M. (1995). The structure of psychological well-being revisited. Journal of Personality and Social Psychology, 69, 719–727. https://doi.org/10.1037/0022-3514.69.4.719
Salihu, H. M., Dongarwar, D., Oduguwa, E., Atkinson, J. O., & Harris, T. B. (2022). Racial/ethnic disparity in suicidal ideation, suicide attempt and non-suicidal intentional self-harm among pregnant women in the United States. Journal of Immigrant and Minority Health, 24(3), 588–596. https://doi.org/10.1007/s10903-021-01260-1
Sansone, R. A., Sellbom, M., Chang, J., & Jewell, B. (2012). An examination of racial differences in self-harm behavior. Psychiatry Research, 200(1), 49–51. https://doi.org/10.1016/j.psychres.2012.05.021
Schacter, H. L., & Juvonen, J. (2015). The effects of school-level victimization on self-blame: Evidence for contextualized social cognitions. Developmental Psychology, 51(6), 841–847. https://doi.org/10.1037/dev0000016
Shenk, C. E., Noll, J. G., Griffin, A. M., Allen, E. K., Lee, S. E., Lewkovich, K. L., & Allen, B. (2016). Psychometric evaluation of the Comprehensive Trauma Interview PTSD Symptoms Scale following exposure to child maltreatment. Child Maltreatment, 21(4), 343–352. https://doi.org/10.1177/1077559516669253
Singh, S., Thompson, C. J., Kak, R., Smith, L. N., & Quainoo, N. (2021). Impact of body weight perceptions and electronic bullying on suicide-related risk behaviors among youth: Results from Youth Risk Behavior Surveillance System, 2015. Journal of School Health, 91(1), 29–36. https://doi.org/10.1111/josh.12974
Sowislo, J. F., & Orth, U. (2013). Does low self-esteem predict depression and anxiety? A meta-analysis of longitudinal studies. Psychological Bulletin, 139(1), 213–240. https://doi.org/10.1037/a0028931
Taber, K. S. (2018). The use of Cronbach’s alpha when developing and reporting research instruments in science education. Research in Science Education, 48(6), 1273–1296. https://doi.org/10.1007/s11165-016-9602-2
Taliaferro, L. A., & Muehlenkamp, J. J. (2015). Risk factors associated with self-injurious behavior among a national sample of undergraduate college students. Journal of American College Health, 63(1), 40–48. https://doi.org/10.1080/07448481.2014.953166
Turner, H., Finkelhor, D., & Ormrod, R. (2009). The effects of adolescent victimization on self-concept and depressive symptoms. Child Maltreatment, 15, 76–90. https://doi.org/10.1177/1077559509349444
Turner, H. A., Finkelhor, D., & Ormrod, R. (2010). Poly-victimization in a national sample of children and youth. American Journal of Preventive Medicine, 38(3), 323–330. https://doi.org/10.1016/j.amepre.2009.11.012
van Geel, M., Goemans, A., & Vedder, P. (2015). A meta-analysis on the relation between peer victimization and adolescent non-suicidal self-injury. Psychiatry Research, 230(2), 364–368. https://doi.org/10.1016/j.psychres.2015.09.017
van Geel, M., Vedder, P., & Tanilon, J. (2014). Relationship between peer victimization, cyberbullying, and suicide in children and adolescents: A meta-analysis. JAMA Pediatrics, 168(5), 435. https://doi.org/10.1001/jamapediatrics.2013.4143
Vandenberg, R. J., & Lance, C. E. (2000). A review and synthesis of the measurement invariance literature: Suggestions, practices, and recommendations for organizational research. Organizational Research Methods, 3(1), 4–70. https://doi.org/10.1177/109442810031002
Wang, S., Xu, H., Zhang, S., Wan, Y., & Tao, F. (2020). Mediating effects of self-esteem in the relationship between childhood maltreatment and non-suicidal self-injury among adolescents: The roles of sex and only-child status. Social Science & Medicine, 249, 112847. https://doi.org/10.1016/j.socscimed.2020.112847
Weierich, M. R., & Nock, M. K. (2008). Posttraumatic stress symptoms mediate the relation between childhood sexual abuse and nonsuicidal self-injury. Journal of Consulting and Clinical Psychology, 76(1), 39–44. https://doi.org/10.1037/0022-006X.76.1.39
Wichstrøm, L. (1995). Harter’s self-perception profile for adolescents: Reliability, validity, and evaluation of the question format. Journal of Personality Assessment, 65(1), 100.
Wichstrøm, L. (2009). Predictors of non-suicidal self-injury versus attempted suicide: Similar or different? Archives of Suicide Research, 13(2), 105–122. https://doi.org/10.1080/13811110902834992
Wild, L. G., Flisher, A. J., & Lombard, C. (2004). Suicidal ideation and attempts in adolescents: Associations with depression and six domains of self-esteem. Journal of Adolescence, 27(6), 611–624. https://doi.org/10.1016/j.adolescence.2004.03.001
Xu, M., Macrynikola, N., Waseem, M., & Miranda, R. (2020). Racial and ethnic differences in bullying: Review and implications for intervention. Aggression and Violent Behavior, 50, 101340. https://doi.org/10.1016/j.avb.2019.101340
Zhong, M., Huang, X., Huebner, E. S., & Tian, L. (2021). Association between bullying victimization and depressive symptoms in children: The mediating role of self-esteem. Journal of Affective Disorders. https://doi.org/10.1016/j.jad.2021.07.016
Funding
This research was funded in part by grants from the National Institutes of Health R01HD052533 and P50HD089922.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors have no conflicts of interest or competing interests.
Ethical Approval
Approval was obtained from the Institutional Review Board at the Hospital where the data was collected. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.
Informed Consent
Informed Consent was collected from all participants in the study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Kennedy, R.S., Panlilio, C.C., Mullins, C.A. et al. Does Multidimensional Self-Concept Mediate the Relationship of Childhood Sexual Abuse and Bullying Victimization on Deliberate Self-Harm and Suicidal Ideation Among Adolescent Girls?. Child Adolesc Soc Work J (2023). https://doi.org/10.1007/s10560-023-00947-8
Accepted:
Published:
DOI: https://doi.org/10.1007/s10560-023-00947-8