The divergent pathways from child abuse to suicidal ideation and suicidal attempt: A longitudinal sequential mediation study of psychache and nonsuicidal self-injury among Chinese adolescents

BACKGROUND: Child abuse is a well-established risk factor for adolescent suicidality, yet the distinct affective and behavioral mechanisms leading to suicidal ideation (SI) versus suicidal attempts (SA) remain unclear. This study tests an integrated sequential mediation model in which psychache and nonsuicidal self-injury (NSSI) explain the divergent pathways from child abuse to SI and SA among Chinese adolescents. METHODS: A sample of 2259 Chinese adolescents (53.8% female; Mage = 15.11 years, SD = 1.57) was assessed across three waves at 6-month intervals. Longitudinal path analysis with bootstrap mediation tests was employed to examine the hypothesized pathways while controlling for baseline levels of the outcomes and covariates. RESULTS: Results indicated that psychache independently mediated the relationship between child abuse and SI. Moreover, the association between child abuse and SA was fully mediated by the sequential pathway through psychache and then NSSI, whereas the direct path from child abuse to SA via NSSI alone was not significant. Exploratory analyses further supported a sequential pathway from child abuse to SI through psychache and NSSI. The model explained 33.1% of the variance in SI and 17.1% in SA. CONCLUSIONS: This study integrates psychache and interpersonal-psychological theories within an ideation-to-action framework, suggesting that the link from child abuse to SI operates through affective distress, whereas progression to SA may involve the sequential combination of psychache and subsequent NSSI. These findings support stage-specific assessment and intervention strategies targeting psychological pain and self-injury behaviors among at-risk adolescents.