Childhood abuse and adolescent depression: Moderating roles of social support and friendship quality

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Zhichao Wang
Cite this article:  Wang, Z. (2023). Childhood abuse and adolescent depression: Moderating roles of social support and friendship quality. Social Behavior and Personality: An international journal, 51(1), e12136.


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In this study I examined the links between childhood abuse and adolescent depression, and the preventive value of social support and friendship quality. Participants were 470 adolescents from two middle schools in China, who completed the Childhood Trauma Questionnaire, the Social Support Rating Scale, the Friendship Quality Questionnaire, and the Center for Epidemiological Studies Depression Scale. The findings suggested that childhood abuse significantly and positively predicted adolescent depression, and that social support and friendship quality were protective factors. Specifically, higher degrees of social support and friendship quality can lessen the link between childhood abuse and depression. The results provide a reference for effectively improving the mental health of adolescents with a history of childhood abuse.

Adolescence is an important period of life development characterized by a high incidence of depression (Ge et al., 2006). Depression is a severe emotional disorder that impairs the ability of children and adolescents to develop physical, emotional, and social cognitive skills; it is characterized by sadness and lack of interest or happiness (Clark et al., 2012). It is most commonly linked to anxiety or other internalization issues, and at least one other disorder affects 40–70% of depressed children and adolescents (Rohde, 2008). Depression has adverse consequences for the social and emotional development of adolescents, including suicidal behavior, drug abuse, poor academic and work performance, and strained relationships with family and friends, which have a long-term detrimental effect on individual physical and mental development. Childhood depression is also associated with an increased risk of developing severe depression, anxiety, and substance abuse in adulthood (Jiang et al., 2022; McLeod et al., 2016). Therefore, depression in adolescents has attracted widespread attention in society. To predict and intervene appropriately, it is important to have a thorough understanding of the risk factors for and protective factors against depression.
 
Among the many factors that affect depression in adolescents, childhood abuse experience is considered significant (Alloy et al., 2006; Infurna et al., 2016; Mandelli et al., 2015). Childhood abuse includes all types of physical abuse, emotional abuse, sexual abuse, neglect, and exploitation of children for financial gain by those who have responsibility to raise, watch over, and care for them (World Health Organization, 1999). Adverse childhood experiences are widespread all over the world (Stoltenborgh et al., 2015) and seriously affect the physical and mental health of children and adolescents. Several studies have revealed that people who experience abuse during childhood are more likely to develop mental illnesses, particularly depression, and that most forms of abuse are strongly linked to clinical depressive symptoms in adolescence and adulthood (Abela & Skitch, 2007; Widom et al., 2007). Children who have suffered severe abuse may experience adverse health effects throughout their lifetime, including a greater risk of developing chronic illnesses and mental health conditions, as well as a general reduction in health-related quality of life (Hunt et al., 2017). Additionally, research has revealed that abused children are more likely to attempt suicide and develop depression throughout adolescence than they are once they reach adulthood (Brown et al., 1999; Dunn et al., 2013). Studies have shown that childhood abuse experience is strongly associated with depression, anxiety, and other emotional problems (Éthier et al., 2004; Kim & Cicchetti, 2006; Lee & Kim, 2014). From the discussion above, I put forward the following hypothesis:
Hypothesis 1: Childhood abuse will significantly and positively predict adolescent depression.
 
A person’s overall health is impacted by the state of their social connections (Santini et al., 2015). Social bonds are a more significant predictor of health than are a variety of biological and economic characteristics, according to 70-year follow-up research (Vaillant, 2008). Social support, which is regarded as one of the critical social elements influencing depression in individuals and has long been known to have a significant impact on mental health and well-being (Santini et al., 2015), entails feeling valued, cared for, and recognized (Thoits, 2011). Social support comes from a wide range of sources, including spiritual and material support and assistance from immediate family members, relatives, neighbors, friends, groups, organizations, and communities (Zou, 1999). The main effect hypothesis of social support states that whether or not the individual is in a state of stress, social support will have a positive impact on the individual (Cohen & Wills, 1985). It allows the individual to experience social reward, enhances their subjective well-being, promotes a positive psychological state, and reduces the sense of depression (Cohen, 2004). The classical buffer hypothesis of social support states that social support can lessen the damaging effects of stress on mental health (Cohen & Wills, 1985). Individuals who receive more social support from others can obtain more psychological and material resources in social networks to enhance their ability to cope with stress and emotional distress. At the same time, social support can improve people’s interpersonal interactions, which will aid in improving their mental health (Zhou et al., 2017). The findings related to these two mechanisms are more consistent in adults, whereas they differ more in studies of adolescents. Nonetheless, studies with adolescents have confirmed that social support has a significant negative predictive impact on depression (Li, 2021; Tian et al., 2014). In this study I focused on whether social support as a protective factor would weaken the association between childhood abuse and depression and its mechanisms. I therefore proposed the following hypothesis:
Hypothesis 2: Social support will moderate the relationship between childhood abuse and depression.
 
In addition, peer relationships make unique and irreplaceable contributions to the social and emotional development of children and adolescents (Hartup, 1983). Peer relationships refer to everyday activities and cooperative relationships between children of the same or similar age, or to interpersonal relationships established and developed in the process of communication between individuals with similar levels of psychological development (Wentzel et al., 2004). Following Bronfenbrenner's (1979) ecosystem theory, family and peer groups are two significant microsystems that influence individual growth and adaptation (Tian et al., 2014; Wang et al., 2022). With an increase in age, individuals’ desire to pursue independence is strengthened and their dependence on their parents is reduced (B. B. Brown & Larson, 2009); thus, the role of peer support comes to the fore. When a close relationship is formed with friends, the role of friend support increases and may even exceed that of family support (Tian et al., 2014). Peer relationships become the most crucial form of social support for adolescents (Calvete et al., 2015). Friendship quality is a common indicator for measuring peer relationships (Yan & Li, 2021) and can well reflect the peer relationships of adolescents (Zhang et al., 2017). An important function of friendship is to provide emotional and social support (Bagwell & Schmidt, 2013). Numerous studies have revealed that youngsters and teenagers with strong friendships, compared to those with weak friendships, experience fewer behavioral issues (Burk & Laursen, 2005), lower depression and anxiety (La Greca & Harrison, 2005), lower loneliness, and higher self-esteem (Kingery et al., 2011). There is also a strong link between high-quality friendship and mental health (Tian et al., 2014; L. Zhao et al., 2013). Positive friendship quality can provide adolescents with emotional and social support, and effectively attenuate depression related to stressful situations (Wight et al., 2006). Emotionally positive friendship quality can significantly predict the reduction of individual depression (Demir & Urberg, 2004; Mounts et al., 2006; Prinstein, 2007; Schmidt & Bagwell, 2007). Additionally, high-quality friendship can alleviate the effect of an adverse family environment and low-quality peer relationships on children’s social and emotional adaptation (Newcomb & Bagwell, 1995). Childhood abuse is a severe form of adversity, and friendship quality may be a protective factor that attenuates its impact on adolescent mental health. I therefore proposed the following hypothesis:
Hypothesis 3: Friendship quality will moderate the relationship between childhood abuse and depression.
 
To sum up, earlier research focused solely on the impact mechanism of childhood abuse on adolescent depression (Dunn et al., 2013; Moretti & Craig, 2013). However, it is equally important to seek protective factors that could actively resist risk. Children who grow up in abusive environments do not usually receive appropriate support, understanding, and attention. Social support may compensate for the lack of care and attention they receive in early life, forming a protective factor that buffers the effects of abusive experiences on depression. Further, given the special significance of peer relationships in adolescent development, we examined the moderating role of friendship quality on the relationship between childhood abuse and depression separately from that of social support. On the basis of the above, I proposed the theoretical model shown in Figure 1.

Table/Figure

Figure 1. Theoretical Model in the Study

Method

Participants and Procedure

I referred to the results of a survey conducted prior to this study and included participants who had chosen “Yes” in answer to the question: “Have you ever been verbally abused, beaten, neglected, or ignored during your childhood?” The sample comprised 486 adolescents from two middle schools in Shandong Province, China, and 470 valid questionnaires were ultimately collected (rate of response = 96.7%). Respondents were aged between 12 and 18 years (M = 15.41, SD = 1.61) and there were 242 boys and 228 girls.

This study was approved by the Ethics Committee of Binzhou University, China. After obtaining the informed consent of the person in charge of the school and the students, the students’ questionnaires were completed in the class, as a unit. Several university students majoring in psychology or pedagogy administered the research program, explaining the purpose of the survey to the participants, how to complete the notes, and so forth. Participants were told that they could stop answering at any time if any question made them feel any discomfort. The students received appropriate support and care from the school’s psychological counselor to protect their safety if remembering abuse caused them to experience adverse effects on their mental health. The questionnaires were answered immediately and then collected by the assistants.

Measures

Childhood Trauma

To assess childhood abuse experience I used the Chinese version of the 28-item Childhood Trauma Questionnaire-Short Form (X. Zhao et al., 2005). A sample item is “I was physically abused.” Responses are rated on a 5-point Likert scale ranging from 1 = never to 5 = always. Cronbach’s alpha in this study was .78.
 

Social Support

To measure social support I used the Social Support Rating Scale (Xiao, 1994), which consists of three dimensions: subjective support (three items), objective support (four items), and utilization of support (three items). Sample items are “How much support and care do you get from family members?” (responses range from 1 = none to 4 = full support) and “How do you get help when you are in trouble?” (responses range from “I do not accept the help of others” to “I always turn to family, relatives, or organizations for help”). A higher score on the scale indicates a higher level of social support. In this study Cronbach’s alpha was .79.
 

Friendship Quality

To measure friendship quality I used the simplified version of the 18-item Friendship Quality Questionnaire (Parker & Asher, 1993). Sample items are “This friend makes me feel important and special” and “We often quarrel or fight.” Responses are rated on a 5-point Likert scale ranging from 1 = completely inconsistent to 5 = completely consistent. The higher the score, the higher is the quality of the friendship. Cronbach’s alpha in this study was .92.
 

Depression Scale

I used the Center for Epidemiological Studies Depression Scale (Radloff, 1977) to measure depression. The 20 items are rated on a 5-point Likert scale ranging from 1 = occasional or none to 5 = most of the time or continuous, with higher scores indicating more severe depressive symptoms. A sample item is “I feel my life is a failure.” Cronbach’s alpha in this study was .82.

Data Analysis

SPSS 23.0 was used for correlation analysis and regression analysis. Before conducting a statistical analysis, I checked the questionnaire for common method bias using Harman’s single-factor test. The amount of variance explained by the first main factor was 18.05%, which is less than the critical limit of 40%, indicating no serious common method bias existed.

Results

Descriptive Statistics and Correlation Analysis

Table 1 shows the mean, standard deviation, and correlation matrix of each variable. There was a significantly positive association between childhood abuse and depression. Further, social support and friendship quality were significantly and negatively correlated with depression.

 Table 1. Descriptive Statistics Results and Correlation Matrix

Table/Figure

Note. ** p < .01

Moderating Effects of Social Support and Friendship Quality

The moderating effects of social support and friendship quality on depression were investigated using hierarchical regression analysis. To avoid multicollinearity, all predictors included in the regression equations were centered, with corresponding statistical analyses conducted for social support and friendship quality, respectively. Childhood abuse and a moderating variable were included in the first layer; the product term was included in the second layer. According to the findings shown in Table 2, childhood abuse significantly and positively predicted depression, and social support and friendship quality, respectively, moderated the relationship between these variables. Further simple slopes test results revealed that under a low level of social support, childhood abuse significantly and positively predicted adolescent depression, β = .09, p < .05, whereas under a high level of social support, childhood abuse had no significant predictive effect on adolescent depression, β = .04, p > .05. Under the condition of low friendship quality, childhood abuse significantly and positively predicted adolescent depression, β = .23, p < .001, and under the condition of high friendship quality, childhood abuse also significantly and positively predicted adolescent depression, β = .21, p < .001, though the latter effect was less potent than the former. A simple effects analysis graph was drawn according to the regression equation taking the mean values of the independent variable and the moderator variable plus or minus one standard deviation (see Figures 2 and 3).

Table 2. Regression Analysis Results for Social Support and Friendship Quality

Table/Figure

Note. *** p < .001

Table/Figure

Figure 2. The Moderating Effect of Social Support on Childhood Abuse and Depression

Table/Figure

Figure 3. The Moderating Effect of Friendship Quality on Childhood Abuse and Depression

Discussion


In this study I found that childhood abuse significantly predicts adolescent depression, supporting Hypothesis 1. Consistent with previous studies, the psychological stress and burden caused by childhood abuse experiences can promote the occurrence of mental illness during adolescence (Hovens et al., 2010). In addition, according to previous research, people who have experienced childhood abuse are more likely to attempt suicide and have depression during adolescence than they are during adulthood (J. Brown et al., 1999; Dunn et al., 2013). Therefore, we need to pay particular attention to the mental health status of adolescents who have suffered childhood abuse and concentrate on securing resources to provide them with mental health services.

The moderating effects analysis showed that social support moderates the relationship between childhood abuse and adolescent depression, supporting Hypothesis 2. Higher levels of social support can attenuate the risk relationship between childhood abuse and depression, and the depression scores of students with high social support were found to be significantly lower than those with low levels of social support in both low- and high-level abuse conditions. These results provide a basis for the main effects model of social support. Individuals who feel a high level of social support from their parents, families, and teachers not only gain satisfaction and help in economic and objectively practical terms, but also form their internal cognition through reflection and adjustment of social support to create a cognitive system that is more likely to develop positive cognition, healthy personality characteristics, and strong adaptation skills (Demaray & Malecki, 2002; Lakey & Cassady, 1990). The more social support individuals obtain, the more capable they are of quickly overcoming obstacles and effectively reducing the risk of early adverse experiences of depression. This finding provides insight for the prevention of and intervention in depression in adolescents, that is, providing adequate social support for children who have experienced abuse.

Additionally, I discovered that the link between depression and childhood abuse weakened when friendship quality was high, supporting Hypothesis 3. Although childhood abuse can significantly predict adolescent depression under both high and low conditions of friendship quality, the high friendship quality slope is of a lesser degree and the predictive power is relatively weaker, which reflects the buffering tendency of friendship quality on the impact of childhood abuse on depression. The findings of this study support the idea that friendship quality has a preventive effect on depression (Schmidt & Bagwell, 2007). Teenagers with adverse family experiences are more susceptible to peer influence and crave more emotional support and acceptance from peers (Gauze et al., 1996). Positive friendship quality means more companionship and encouragement, and provides teens with opportunities for intimacy, acceptance, and recognition (Boulton et al., 1999), which is lacking in adolescents who suffer from childhood abuse. High-quality friendship can also improve the self-esteem level of adolescents with childhood abuse experience, which can compensate for their low self-esteem due to chronic abuse in childhood, and provide effective coping strategies and a sense of security in social relationships (Sandler et al., 1989), so that adolescents perceive less depression. Each of the effects described above can relieve the impact of childhood abuse on depression and thereby decrease the occurrence and severity of depression.

This study has theoretical and practical significance. First, the findings enhance understanding of the mechanisms and protective factors underlying the relationship between childhood abuse and adolescent depression. Second, the experience of childhood abuse might increase teenagers’ level of depression. This requires us to pay special attention to how to reduce childhood abuse. I believe that more parent education is needed, and a parenting course would be of use to explore the construction of parent education and help parents reflect on the problems of their behavior and communication, thus enabling them to learn to express their emotions appropriately instead of beating, scolding, or neglecting their children. Education and clinical workers should maintain a particular sensitivity and vigilance for adolescents with childhood abuse experiences, to avoid serious consequences such as self-injury and suicide. Last, despite the fact that childhood experience is a fact that cannot be modified, educators can take advantage of the protective effects of social support and friendship quality, buffering the negative influence of childhood abuse by providing children with adequate social support and improving friendship quality by teaching adolescents interpersonal strategies and experiences.

This study also has some limitations. First, I used a cross-sectional research design and therefore cannot provide definitive answers on how different factors affect depression levels in adolescents over time. Longitudinal designs can be added in the future to obtain more robust empirical evidence of the effects of childhood abuse on depression levels in adolescents and the role of protective factors. Second, childhood abuse experiences and depression in this study were evaluated by retrospective self-report, so memory bias could not be avoided. Third, I explored the protective effects of only social support and friendship quality. According to the perspective of positive psychology, in the future more protective factors about how to reduce the negative impact of adverse childhood experiences on adolescent psychology could be explored.

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Calvete, E., Orue, I., & Hankin, B. L. (2015). A longitudinal test of the vulnerability-stress model with early maladaptive schemas for depressive and social anxiety symptoms in adolescents. Journal of Psychopathology and Behavioral Assessment, 37(1), 85–99.
 
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Table/Figure

Figure 1. Theoretical Model in the Study


 Table 1. Descriptive Statistics Results and Correlation Matrix

Table/Figure

Note. ** p < .01


Table 2. Regression Analysis Results for Social Support and Friendship Quality

Table/Figure

Note. *** p < .001


Table/Figure

Figure 2. The Moderating Effect of Social Support on Childhood Abuse and Depression


Table/Figure

Figure 3. The Moderating Effect of Friendship Quality on Childhood Abuse and Depression


The author declares that the research was conducted without any commercial or financial relationships that could be construed as a potential conflict of interest.

Zhichao Wang, School of Teacher Education, Binzhou University, 391 Huanghe Fifth Road, Binzhou City, Shandong Province, People’s Republic of China, 256600. Email: [email protected]

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