Testing the Causal Model of Adolescent Psychological Distress Based on Childhood Abuse and Alexithymia with the Mediating Role of Sleep Quality

Document Type : Research Paper

Authors

1 MA in Psychology and Education of Exceptional Children, Department of Psychology, Faculty of Educational Sciences and Psychology, Mohaghegh Ardabili University, Ardabil, Iran

2 Department of Psychology, Faculty of Educational Sciences and Psychology, Mohaghegh Ardabili University, Ardabil, Iran

3 MA in Clinical Psychology, Department of Psychology, Faculty of Educational Sciences and Psychology, Mohaghegh Ardabili University, Ardabil, Iran

Abstract

The purpose of the present study was to test the causal model of adolescent psychological distress based on childhood abuse and alexithymi with the mediating role of sleep quality. This study was applied in terms of purpose, and descriptive in terms of structural equation correlation. The research population was all male and female students of the second year of secondary school in Mashhad in the academic year 1402-1403, and 352 of them were randomly selected. Data collection tools are psychological disturbance scales (DASS; Lovibond and Lovibond, 1995); Alexithymia (TAS; Bagby et al., 1994); Childhood Trauma Questionnaire (CTQ; Bernstein et al., 2003) and Sleep Quality Index (PSQI; Buysse et al., 1989). Mean and standard deviation were used to describe the findings, and Pearson correlation tests and structural equation models were used to infer information using SPSS-27 and AMOS-24 software. The results of this research showed that this research model has a favorable fit and that childhood abuse and alexithymia affect the psychological distress of adolescents both directly and indirectly through the mediation of sleep quality. These results can be used to design interventions aimed at preventing psychological distress.

Keywords

Main Subjects

References

Adib Rahnama, F., Afshari, A., & Farah Bijari, A. (2023). The Role of Child Maltreatment in Self-Control of Adolescents: The Moderating Role of Gender and Self-Compassion. Positive Psychology Research, 9(1), 47-64. (In Persian) doi: 10.22108/ppls.2023.135026.2356
AlRasheed, M. M., Al-Aqeel, S., Alkadir, A. M., Bin Shuqiran, K., Khurshid, F., AlRasheed, N. M., ... & BaHammam, A. S. (2022). The prevalence of psychological distress and its relationship to sleep quality in Saudi Arabia's general population during the COVID-19 pandemic. Frontiers in psychiatry, 12, 809040. doi: 10.3389/fpsyt.2021.809040. 
Alslman, E., Thultheen, I., Hamaideh, S. H., Nofal, B., Hamdan-Mansour, R., & Hamdan Mansour, A. (2024). The mediating effect of psychological distress and bullying victimization on the relationship between alexithymia and fibromyalgia among school adolescents. Mental Health and Social Inclusion, 28(5), 842-856. https://doi.org/10.1108/MHSI-09-2023-0096
Azami S, Zargar F, Sanei H, Iranpanah N. (2024). The mediating role of psychological distress and self-efficacy in explaining causal relationships between emotion regulation strategies and treatment adherence in coronary heart disease patients. Journal of Psychological Science. 23(135), 157-176. (In Persian) doi:10.52547/JPS.23.135.659
Ashrafi, H., Ansarin, K., Hasanzadeh, M., & Jouyban, A. (2018). Review on sleep disorders and their management. Medical Journal of Tabriz University of Medical Sciences, 40(2), 95-105. (In Persian)
Alikhani, M., Shoaa Kazemi, M., & Khalatbari, J. (2022). Predicting the parent-child relationship on behavioral disorders with empathy mediated in adolescents 12 to 15 years old. A new approach to children's education quarterly, 4(3), 153-161. (In Persian) doi: 10.22034/naes.2022.343358.1199
Bagby, R. M., Taylor, G. J., & Parker, J. D. (1994). The twenty-item Toronto Alexithymia Scale—II. Convergent, discriminant, and concurrent validity. Journal of psychosomatic research, 38(1), 33-40. doi: 10.1016/0022-3999(94)90006-x.
Barry, V., Stout, M. E., Lynch, M. E., Mattis, S., Tran, D. Q., Antun, A., ... & Kempton, C. L. (2020). The effect of psychological distress on health outcomes: A systematic review and meta-analysis of prospective studies. Journal of Health Psychology, 25(2), 227-239. doi: 10.1177/1359105319842931.
Belay, A. S., Guangul, M. M., Asmare, W. N., & Mesafint, G. (2021). Prevalence and associated factors of psychological distress among nurses in public hospitals, Southwest, Ethiopia: A cross-sectional study. Ethiopian Journal of Health Sciences, 31(6), 33-40. doi: 10.4314/ejhs.v31i6.21.
Babaei, S., Manesh, M. N., Abouzari, F., & Karami, S. (2023). The role of traumatic childhood experiences, mentalization and Alexithymia in predicting depression and suicidal thoughts in women suffering from the trauma of marital betrayal. Iranian Journal of Psychiatric Nursing (IJPN) Original Article, 10(6), 110-122. (In Persian) http://ijpn.ir/article-1-2117-fa.html
Besharat, M. A. (2013). Toronto Alexithymia Scale: Questionnaire, Instruction and Scoring (Persian Version).
Bernstein, D. P., Stein, J. A., Newcomb, M. D., Walker, E., Pogge, D., Ahluvalia, T., ... & Zule, W. (2003). Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child abuse & neglect, 27(2), 169-190. doi: 10.1016/s0145-2134(02)00541-0.
Bundy, D. A., de Silva, N., Horton, S., Patton, G. C., Schultz, L., Jamison, D. T., ... & Sawyer, S. M. (2018). Investment in child and adolescent health and development: key messages from Disease Control Priorities. The Lancet, 391(10), 687-699. doi: 10.1016/S0140-6736(17)32417-0.
Buysse, D. J., Reynolds III, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry research, 28(2), 193-213. doi: 10.1016/0165-1781(89)90047-4.
Chan, W. S. (2023). Sleep quality, sleep-related experiences, and dissociation in adult survivors of childhood trauma. Behavioral Sleep Medicine, 21(6), 659-670. doi: 10.1080/15402002.2022.2148669.
Chan, W. S., Lam, S. C. Y., Ng, A. S. Y., & Lobo, S. (2022). Daily Associations of Sleep Quality and Sleep Duration with Anxiety in Young Adults: The Moderating Effect of Alexithymia. Behavioral Sleep Medicine, 20(6), 787-797.  doi: 10.1080/15402002.2021.2016406.
Delgado-Sanchez, A., Brown, C., Charalambous, C., Sivan, M., & Jones, A. (2023). Trauma in childhood is associated with greater pain catastrophizing but not anxiety sensitivity: a cross-sectional study. Pain reports, 8(4), 108-119. doi: 10.1097/PR9.0000000000001083
Dimitriou, D., Le Cornu Knight, F., & Milton, P. (2015). The role of environmental factors on sleep patterns and school performance in adolescents. Frontiers in Psychology, 6(2), 15-28. doi: 10.3389/fpsyg.2015.01717.
Ditzer, J., Wong, E. Y., Modi, R. N., Behnke, M., Gross, J. J., & Talmon, A. (2023). Child maltreatment and alexithymia: A meta-analytic review. Psychological bulletin, 149(5), 311-326. doi: 10.1037/bul0000391.
Ekmekci Ertek, İ. R. E. M., İlhan, M. U. S. T. A. F. A., Uğraş Dikmen, A. S. İ. Y. E., & Gözükara, M. (2022). Prevalence and association of childhood traumas, dissociative experiences and post traumatic stress disorder. Gazi Medical Journal, 33(2), 20-38. doi: 10.12996/gmj.2022.32
Ebrahimi, L., & Almasi, M. (2023). The Role of Personality Traits, Alexithymia, and Cognitive Avoidance in Predicting Positive and Negative Emotions. Clinical Psychology and Personality, 21(1), 43-56. (In Persian) doi:10.22070/cpap.2023.15081.1137
Faraji, R., Babapour Khairuddin, J., & Bakhshipour Roudsari, A. (2023). The Mediating Role of Mental Rumination in the Relationship between Alexithymia, Impulsivity, Distress Tolerance, and Self-criticism with Self-injury. Journal of Psychological Studies, 19(1), 47-63. (In Persian) doi: 10.22051/psy.2023.42713.2739
Fang, S., Chung, M. C., & Wang, Y. (2020). The impact of past trauma on psychological distress: The roles of defense mechanisms and alexithymia. Frontiers in Psychology, 11(2), 42-58. https://doi.org/10.3389/fpsyg.2020.00992
Fang, X., Wu, Z., Wen, L., Zhang, Y., Wang, D., Yu, L., ... & Zhang, C. (2023). Rumination mediates the relationship between childhood trauma and depressive symptoms in schizophrenia patients. European Archives of Psychiatry and Clinical Neuroscience, 273(5), 1085-1094. doi: 10.1007/s00406-022-01525-2.
Gong, J., & Chan, R. C. (2018). Early maladaptive schemas as mediators between childhood maltreatment and later psychological distress among Chinese college students. Psychiatry research, 25(9), 493-500. doi: 10.1016/j.psychres.2017.11.019. 
Gilanifar, M., Ahi, Q., Kheirkhah, F., & Shahabizadeh, F. (2023). Testing the cognitive function model of patients with bipolar disorder in relation to traumatic experiences in childhood by the mediating role of affective lability emotion and expressed emotion. Journal of Psychology and Psychiatry, 10 (3), 104-118. (In Persian) doi: 10.32598/shenakht.10.3.104
Helmy, M., Ebrahim, A. H., Faqeeh, A., Engel, E., Ashraf, F., & Isaac, B. A. (2024). Relationship Between Alexithymia, Smartphone Addiction, and Psychological Distress Among University Students: A Multi-country Study. Oman Medical Journal, 39(1), 593-600. doi: 10.5001/omj.2024.50.
Huang, Y. H., Yang, C. M., Huang, Y. C., Huang, Y. T., & Yen, N. S. (2022). Do alexithymia and negative affect predict poor sleep quality? The moderating role of interoceptive sensibility. Plos one, 17(10), 27-39. https://doi.org/10.1371/journal.pone.0275359
Jamieson, D., Beaudequin, D. A., McLoughlin, L. T., Parker, M. J., Lagopoulos, J., & Hermens, D. F. (2020). Associations between sleep quality and psychological distress in early adolescence. Journal of Child & Adolescent Mental Health, 32(2), 77-86. doi: 10.2989/17280583.2020.1811288.
Janiri, D., Moccia, L., Dattoli, L., Pepe, M., Molinaro, M., De Martin, V., ... & Sani, G. (2021). Emotional dysregulation mediates the impact of childhood trauma on psychological distress: First Italian data during the early phase of COVID-19 outbreak. Australian & New Zealand Journal of Psychiatry, 55(11), 1071-1078. doi: 10.1177/0004867421998802.
John-Henderson, N. A. (2020). Childhood trauma as a predictor of changes in sleep quality in American Indian adults during the COVID-19 pandemic. Sleep health, 6(6), 718-722. doi: 10.1016/j.sleh.2020.09.001. 
Keles, B., McCrae, N., & Grealish, A. (2020). A systematic review: the influence of social media on depression, anxiety and psychological distress in adolescents. International journal of adolescence and youth, 25(1), 79-93. https://doi.org/10.1080/02673843.2019.1590851
Kim, H., Kim, S. H., Jang, S. I., & Park, E. C. (2022). Association between sleep quality and anxiety in Korean adolescents. Journal of Preventive Medicine and Public Health, 55(2), 173-186. doi: 10.3961/jpmph.21.498.
Kline, R. (2016). Data preparation and psychometrics review. Principles and practice of structural equation modeling (4th ed., pp. 64-96). New York, NY: Guilford.
Levin, R. I. (2011). Statistics for management. Pearson Education India.
Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour research and therapy, 33(3), 335-343. doi: 10.1016/0005-7967(94)00075-u.
Maheshwari, G., & Shaukat, F. (2019). Impact of poor sleep quality on the academic performance of medical students. Cureus, 11(4), 25-37. doi: 10.7759/cureus.4357.
Marino, C., Gini, G., Vieno, A., & Spada, M. M. (2018). The associations between problematic Facebook use, psychological distress and well-being among adolescents and young adults: A systematic review and meta-analysis. Journal of affective disorders, 22(6), 274-281. doi: 10.1016/j.jad.2017.10.007.
Mahmoudian, A., Memarinasab, Z., Farokhi, B., & Sabahi, P. (2022). The Mediating Role of Psychological Hardiness in the Relationship between Attachment Style and Psychological Distress during the COVID-19 Outbreak. Journal of Research in Behavioural Sciences, 20(3), 528-540. (In Persian) doi:  10.52547/rbs.20.3.528
Mahmoudi, M., Saberi, H., & Bashardoust, S. (2022). Predicting psychological distress based on childhood trauma with the mediating role of alexithymia. Advances in Cognitive Science, 24(3), 41-56. doi: 10.30514/icss.24.3.41
Mohammadbeigi, M., Taheri, A., Abolmaali, K. and Gharergozli, K. (2023). Presenting the Structural Model of Depression, Anxiety and Stress based on Childhood Trauma and Perceived Social support with the Mediation of Alexithymia in Patients with Epilepsy. Islamic lifestyle with a focus on health, 7(1), 275-287. (In Persian)
Moradian, S., & isanejad, O. (2023). Investigating the relationship between family support and psychological distress mediated by psychological flexibility in high school students in online classes. Psychological Models and Methods, 14(51), 97-112. (In Persian) doi: 10.30495/jpmm.2023.30859.3695
Mir Drikvand, F. (2023). Evaluation of Structural Model for Explaining Behavioral and Emotional Disorders in Children Who are Abused Based on Cognitive Flexibility and Adverse Childhood Experiences of Parents Mediated by Personal Self-Concept. Psychological Achievements, 30(1), 240-260. (In Persian) doi: 10.22055/psy.2022.40407.2821
Okano, K., Kaczmarzyk, J. R., Dave, N., Gabrieli, J. D., & Grossman, J. C. (2019). Sleep quality, duration, and consistency are associated with better academic performance in college students. NPJ science of learning, 4(1), 16-30. https://doi.org/10.1038/s41539-019-0055-z
Olivier, E., Morin, A. J., Langlois, J., Tardif-Grenier, K., & Archambault, I. (2020). Internalizing and externalizing behavior problems and student engagement in elementary and secondary school students. Journal of youth and adolescence, 49, 2327-2346. doi: 10.1007/s10964-020-01295-x.
Pensuksan, W. C., Lertmaharit, S., Lohsoonthorn, V., Rattananupong, T., Sonkprasert, T., Gelaye, B., & Williams, M. A. (2016). Relationship between poor sleep quality and psychological problems among undergraduate students in the Southern Thailand. Walailak journal of science and technology, 13(4), 235-248.
Qin, Z., Shi, L., Xue, Y., Lin, H., Zhang, J., Liang, P., ... & Zhang, C. (2021). Prevalence and risk factors associated with self-reported psychological distress among children and adolescents during the COVID-19 pandemic in China. JAMA network open, 4(1), 35-48. doi: 10.1001/jamanetworkopen.2020.35487.
Roberts, R. E., & Duong, H. T. (2017). Is there an association between short sleep duration and adolescent anxiety disorders?. Sleep Medicine, 30, 82-87.
Schäfer, I., & Fisher, H. L. (2011). Childhood trauma and psychosis-what is the evidence?. Dialogues in clinical neuroscience, 13(3), 360-365. doi: 10.31887/DCNS.2011.13.2/ischaefer.
Schmickler, J. M., Blaschke, S., Robbins, R., & Mess, F. (2023). Determinants of sleep quality: a cross-sectional study in university students. International Journal of Environmental Research and Public Health, 20(3), 2019-2028. doi: 10.3390/ijerph20032019.
Scott, A. J., Webb, T. L., Martyn-St James, M., Rowse, G., & Weich, S. (2021). Improving sleep quality leads to better mental health: A meta-analysis of randomised controlled trials. Sleep medicine reviews, 60, 101556. doi: 10.1016/j.smrv.2021.101556.
Sharp, J., & Theiler, S. (2018). A review of psychological distress among university students: Pervasiveness, implications and potential points of intervention. International Journal for the Advancement of Counselling, 40(3), 193–212.  https://doi.org/10.1007/s10447-018-9321-7
Shorey, S., Ng, E. D., & Wong, C. H. (2022). Global prevalence of depression and elevated depressive symptoms among adolescents: A systematic review and meta‐analysis. British Journal of Clinical Psychology, 61(2), 287-305. doi: 10.1111/bjc.12333.
Squires, F., Martin Hilber, A., Cordero, J. P., Boydell, V., Portela, A., Lewis Sabin, M., & Steyn, P. (2020). Social accountability for reproductive, maternal, newborn, child and adolescent health: A review of reviews. Plos one, 15(10), 23-37. https://doi.org/10.1371/journal.pone.0238776
Su, Y., D’Arcy, C., & Meng, X. (2020). Social support and positive coping skills as mediators buffering the impact of childhood maltreatment on psychological distress and positive mental health in adulthood: analysis of a national population-based sample. American journal of epidemiology, 189(5), 394-402. doi: 10.1093/aje/kwz275.
Salemi, M. H., & Khademi Ashkzari, M. (2023). The Role of Response Inhibition, Cognitive Control and Sleep Quality in Predicting the Symptoms of Male Adolescent Anxiety Disorders. Journal of Research in Behavioural Sciences, 21(1), 48-57. (In Persian) doi: 10.48305.21.1.48
Sahebi, A., Asghari, M. J., & Salari, R. S. (2005). Validation of depression anxiety and stress scale (DASS-21) for an Iranian population. Developmental Psychology. Iranian Psychologists, 1(4), 299-312. (In Persian)
Shamsi S., Ebrahimi moghadam H., & Abolmaali Alhoseini K. (2022). Presenting the Model of Structural Equations for Predicting Psychological Distress Based on Mindfulness and Personality Traits with the Mediating Role of Health-Related Quality of Life in Patients with Multiple Sclerosis. RJMS, 29 (10), 10-23. (In Persian) http://rjms.iums.ac.ir/article-1-7772-fa.html
Sepehrmanesh, Z. (2023). The relationship between mental health and sleep quality in students of Kashan University of Medical Sciences in the academic year of 1994-93. Occupational Medicine, 14 (4) :36-45. (In Persian) doi: 10.18502/tkj.v14i4.12312
Siavashi Siahi, M., Bagherzadeh, R., & Ravanipour, M. (2023). Investigating sleep quality and related factors in adolescents in Bushehr in 2020. Journal of Pediatric Nursing, 9(3), 11-24. (In Persian) doi: 10.22034/JPEN.9.3.11
Tavoli, A., Doustmohammadi, F., & Karami, Z. (2023). The mediating role of mother's alexithymia in the relation between perceived parenting styles and maternal-fetal attachment in pregnant mothers. The Women and Families Cultural-Educational, 18(65), 137-160. (In Persian) doi: 20.1001.1.26454955.1402.18.65.4.4
Taylor, G. J. (1984). Alexithymia: concept, measurement, and implications for treatment. The American Journal of Psychiatry, 141(6), 725–732. doi: 10.1176/ajp.141.6.725.
World Health Organization. (2020). Child Maltreatment. World Health Organization.
Zarei, S., & Hemati, A. (2022). The Meadiating Role of Maladaptive Perfectionism and Rumination in the Relationship between Family Functioning and Strssful Life Events with Sleep Quality in University Students. Rooyesh-e-Ravanshenasi Journal (RRJ), 11(9), 21-32. (In Persian) doi: 20.1001.1.2383353.1401.11.9.3.6
Journal of Modern Psychological Researches
Volume 20, Issue 77
April 2025
Pages 115-129

Files

History

  • Receive Date: 02 July 2024
  • Revise Date: 24 July 2024
  • Accept Date: 28 July 2024

Share

How to cite

Statistics