Abstract
BACKGROUND: Increasing suicidal thoughts and behaviors (STB) among adolescents raise social concerns and have a well-recognized association with sexual abuse (SA). However, research regarding the mechanisms explaining the association between SA and STB remains limited. OBJECTIVE: This study aims to examine the chained mediating effects of negative life events (NLE) and internet addiction (IA) between SA and STB among adolescents in China. METHODS: This cross-sectional study used data from the Science Database of the People Mental Health survey conducted between March 2013 and December 2022 by the National Population Health Data Center of the National Research Institute for Family Planning. Through stratified sampling, 20,893 adolescents were recruited from 16 Chinese provinces. After excluding samples with missing relevant variables, 10,664 (55.89%; aged 16-17.9 y; n=5826, 54.63% women) adolescents were included in the final analysis. STB was the outcome variable, with NLE and IA as mediators, all assessed via a questionnaire that was uniformly administered by trained investigators in school settings. The Pearson χ2 test was used to analyze the association between SA and STB. Using a combination of multiple linear regression and bootstrap testing, the study constructed a chain mediation model to explore how SA influences STB in adolescents through NLE and IA. RESULTS: The scores for SA, NLE, IA, and STB were 1.330 (SD 1.714), 51.960 (SD 23.822), 34.88 (SD 13.852), and 0.690 (SD 1.396), respectively. Multiple linear regression analysis indicated SA was associated with NLE (β=2.382, 95% CI 2.112-2.653; P<.001), IA (β=1.094, 95% CI 0.939-1.249; P<.001), and STB (β=0.135, 95% CI 0.119-0.151; P<.001). Mediation analysis revealed a significant direct association between SA and STB (74.81%; β=0.101, 95% CI 0.085-0.117; P<.001). Indirect effects constituted 25.19% of the total association (β=0.034, 95% CI 0.029-0.040; P<.001), comprised of 3 specific pathways: via NLE (11.85%; β=0.016, 95% CI 0.012-0.020; P<.001), via IA (10.37%; β=0.014, 95% CI 0.010-0.018; P<.001), and via the sequential pathway through NLE and then IA (2.96%; β=0.004, 95% CI 0.003-0.006; P<.001). CONCLUSIONS: Unlike previous research that examined them separately, this study reveals the chain mediation mechanism of NLE and IA in the relationship between SA and STB, providing a new research perspective on the complex evolution from early adversity to extreme outcomes. This research also provided clear direction and scientific evidence for the development of comprehensive suicide prevention strategies. Future efforts should focus on the prevention of SA and trauma intervention while simultaneously strengthening adolescents' cognitive reappraisal of negative events and guiding their online behavior.