Effects of Cyberbullying Victimization on Non-Suicidal Self-Injury in Adolescents with Depressive Disorders: A Chain Mediation Model of Alexithymia and Anxiety

Adolescents with depressive disorders exhibit higher rates of cyberbullying victimization (CBV) and non-suicidal self-injury (NSSI) compared with their healthy peers; however, the association between CBV and NSSI and its underlying psychosocial mechanisms remain unclear. This study investigated the effect of CBV on NSSI in adolescents with depressive disorders and examined the mediating roles of alexithymia and anxiety. A total of 1,032 adolescents with depressive disorders, aged 12 to 18 years (mean age = 15.01 ± 1.62), completed questionnaires. Pearson correlation analyses and structural equation modeling were conducted. Significant correlations were observed among CBV, alexithymia, anxiety, and NSSI (all p < 0.001). A significant total indirect effect was identified in the association between CBV and NSSI (β = 0.045, p < 0.001), accounting for 35.2 percent of the total effect. Anxiety functioned as an independent mediator (β = 0.039, p < 0.001), whereas alexithymia alone did not show a significant indirect effect. Moreover, a significant chain-mediated effect of alexithymia and anxiety was observed (β = 0.003, p = 0.023). These findings revealed that CBV may exacerbate NSSI among adolescents with depressive disorders, with anxiety functioning as an independent mediator. Alexithymia may intensify anxiety symptoms, which further contribute to NSSI. Anti-bullying education and interventions targeting alexithymia and anxiety should be implemented to reduce the risk of NSSI in this population.