Associations between childhood maltreatment and overt aggression in depressed adolescents: the mediating effect of alexithymia and insomnia
Bibliographic record
Abstract
Background Overt aggression may be associated with childhood maltreatment (CM), insomnia, and alexithymia, but the underlying mechanisms of these associations have not been fully explored in adolescents with major depressive disorder (MDD). Therefore, the present study aimed to deeply analyze the relationships between overt aggression and CM, insomnia, and alexithymia in adolescents with MDD, to reveal the mediating mechanisms, and to provide a theoretical basis for clinical interventions. Methods From January 2024 to March 2025, this study included 251 adolescents with MDD. The Modified Overt Aggression Scale (MOAS), the 17-item Hamilton Depression Rating Scale (HAMD-17), the Childhood Trauma Questionnaire (CTQ), the Insomnia Severity Index Scale (ISI), and the Toronto Alexithymia Scale (TAS-20) were used to assess the adolescents’ overt aggression, depression, CM, insomnia, and alexithymia. Additionally, we employed the PROCESS macro program to examine the mediating role of insomnia and alexithymia between CM and overt aggression. Results The prevalence of overt aggression in adolescents with MDD was 66.1%. The regression analyses showed that age (Beta = -0.761, t = -2.967, P = 0.003), depression (Beta = 0.183, t = 2.676, P = 0.008), CM (Beta = 0.132, t = 4.048, P < 0.001), and alexithymia (Beta = 0.092, t = 1.990, P = 0.048) were independent correlates of overt aggression. When CTQ subscale scores involved in the regression model, age (Beta = -0.829, t = -3.257, P = 0.001), depression (Beta = 0.184, t = 2.618, P = 0.009), emotional abuse (Beta = 0.372, t = 4.081, P < 0.001), and insomnia (Beta = 0.170, t = 2.054, P = 0.041) were independent correlates. Moreover, alexithymia and insomnia played a chain mediating role between CM and overt aggression. Conclusion The risk of overt aggression is significantly higher in depressed adolescents and is significantly associated with CM, insomnia, and alexithymia. Additionally, insomnia and alexithymia may play a mediating role between CM and overt aggression. Given these findings, comprehensive interventions for depressed adolescents with adverse childhood experiences, insomnia, and alexithymia, should be emphasized in clinical practice to effectively reduce their risk of overt aggression.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".