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. 2025 Dec 16;25:4257. doi: 10.1186/s12889-025-25594-9

Effect of cumulative family risk on non-suicidal self-injury among Chinese adolescents: a longitudinal moderated mediation model

Yanfeng Xu 1,#, Chong Guo 2,✉,#, Banglin Yang 3
PMCID: PMC12709699  PMID: 41402750

Abstract

Background

Numerous factors have been explored that impact the development of Chinese adolescents’ non-suicidal self-injury (NSSI), yet the impact of cumulative family risk on NSSI and its underlying mechanism remains unclear.

Methods

A total of 891 adolescents participated in a follow-up study over a 12-month period. During this follow-up, they completed the Cumulative Family Risk Questionnaire, Effortful Control Scale, Zhong-Yong Thinking Style Scale, and Non-Suicidal Self-Injury Scale.

Results

The results indicated that (1) cumulative family risk was significantly and positively associated with NSSI in adolescents (β = 0.456, p < 0.001); (2) effortful control partially mediated the longitudinal relationship between cumulative family risk and NSSI (indirect effect = 0.180, bootstrap 95% CI [0.140, 0.226]), with the mediating effect accounting for 28.346% of the total effect; and (3) both the direct effect of cumulative family risk on NSSI (β = −0.161, p < 0.001) and the first part of the longitudinal mediating effect of effortful control (β = 0.105, p < 0.001) were moderated by the Zhong-Yong thinking style. Specifically, the Zhong-Yong thinking style moderated both the direct and indirect effects, with the effects weakest among Chinese adolescents with low levels of the Zhong-Yong thinking style.

Conclusion

The partially longitudinal mediating role of effortful control and the longitudinal moderating role of the Zhong-Yong thinking style in the relationship between cumulative family risk and NSSI were confirmed in Chinese adolescents. These findings offer empirical support for the development of targeted preventive strategies to address NSSI among Chinese adolescents in the future.

Keywords: Cumulative family risk, Effortful control, Zhong-Yong thinking style, Non-suicidal self-injury, Chinese adolescents

Introduction

Non-suicidal self-injury (NSSI) refers to behaviors in which individuals purposefully harm their bodies without intending suicide [1]. Examples include cutting the skin with a sharp object, hitting oneself, and burning oneself, with cutting being the most prevalent [2]. Adolescents are particularly vulnerable to NSSI, with domestic epidemiological surveys indicating a high prevalence among Chinese adolescents, ranging from 36% to 57% [3]. Although NSSI does not directly lead to death, research suggests that it heightens the risk of future suicidal ideation and behaviors among Chinese adolescents [4]. Additionally, NSSI is associated with emotional and behavioral problems such as anxiety, depression, substance abuse, and eating disorders [5]. Furthermore, NSSI has been observed to spread among peers, with adolescents imitating each other’s NSSI behaviors [6]. Given the serious threat that NSSI poses to the healthy development and psychosocial adaptation of Chinese adolescents, it is imperative to explore its underlying mechanisms to enable early intervention and reduce NSSI and suicidal behaviors.

Cumulative family risk and NSSI

According to ecosystem theory, the family represents the microsystem environmental component that most directly influences children’s development and is a significant contributor to NSSI among adolescents [7]. Several studies have explored how family factors influence NSSI among Chinese adolescents. For example, research has shown that family cohesion serves as a crucial mitigator of NSSI in ethnic minority adolescents, as low family intimacy may lead to maladjustment and, consequently, NSSI [8]. Another study revealed that maladaptive family functioning, such as a lack of support and poor communication, can induce negative emotions and feelings of shame or self-hatred in adolescents, thereby increasing the risk of NSSI [9]. However, adolescents often face the overlapping effects of multiple family risk factors in real life [10]. Cumulative risk theory posits that risk factors do not occur in isolation and that individuals may experience risk factors across different domains simultaneously, with high cumulative risk leading to potentially significant psychological and behavioral impacts [11]. Indeed, understanding the onset and development of NSSI among Chinese adolescents requires a comprehensive examination of multiple family risk factors. For example, Fergusson and Horwood identified several key family risk factors for children and adolescents, such as low socioeconomic status, parental marital status, parental mental health, and parenting style [12]. Additionally, Patwardhan reported that there are three main types of family risk: family structure, socioeconomic marginalization, and negative family interactions [13]. Individuals facing risks in one domain often encounter risks in other areas as well, and studying only one risk factor may lead to overextrapolation, exaggerating its effects [14]. Moreover, no single risk factor decisively influences the development of NSSI, and interventions targeting a single-family risk factor may be significantly less effective than less targeted interventions [11]. By comprehensively examining these various family risk factors, researchers and educators can gain a nuanced understanding of the complex interplay between family dynamics and NSSI in adolescents. This holistic approach is crucial for developing effective prevention and intervention strategies tailored to address the multifaceted needs of at-risk adolescents and their families. In this context, the impact of cumulative family risk on NSSI among Chinese adolescents is investigated.

Effortful control as a mediator

Previous studies of parental factors and NSSI focused primarily on mediating processes through the lenses of emotion, stress coping, and negative self-concepts. For example, Guérin-Marion reported that perceived parental stress triggered negative emotions in adolescents, resulting in mood dysregulation and thereby increasing the risk of NSSI [15]. Similarly, He demonstrated that parental phubbing increased the risk of NSSI, with emotional responses (such as anxiety) and coping styles (such as experiential avoidance) mediating this effect [16].

Effortful control, a crucial aspect of an individual’s self-regulatory ability, offers a novel perspective on the relationship between parental factors and NSSI. Defined as an individual’s capacity to inhibit dominant responses and activate subdominant responses, including the ability to mobilize executive attention and regulate response tendencies [17], effortful control plays a significant role in an individual’s psychosocial adaptation [18]. According to self-control theory [19], family risk factors can influence an individual’s behavioral development by impacting their self-control ability. Effortful control, a component of self-control [20], is susceptible to the effects of family risk factors, such as parental conflict. Frequent and intense parental conflict, which disrupts family cohesion, often leads to negative emotions, as well as increased emotional distress and insecurity among adolescents [21]. These psychological states detrimentally affect adolescents’ development of effortful control. Previous research has corroborated the negative association between parental psychological control and adolescent effortful control, highlighting the detrimental impact of family dynamics on self-regulatory capacity [21]. Conversely, effortful control serves as a protective factor against NSSI in Chinese adolescents. Enhanced effortful control facilitates clear cognitive states, improved attentional focus, and better utilization of metacognitive strategies to regulate behaviors [22], thereby mitigating negative emotions and reducing the likelihood of engaging in problem behaviors [23]. A cross-sectional study also indicated that effortful control and deviant peer affiliation play significant chain-mediating roles in the relationship between parental psychological control and the externalizing of problem behaviors in adolescents [24]. Thus, adolescents with multiple family risk factors may experience a depletion of self-regulatory resources when confronted with negative emotions and psychological stress, leading to diminished effortful control and increased susceptibility to NSSI.

Zhong-Yong thinking style as a moderator

Despite exposure to cumulative family risks, not all adolescents develop NSSI. According to developmental contextualism, an individual’s physical and mental development is influenced by various environmental factors that interact systemically [25]. In recent years, the Zhong-Yong thinking style has garnered attention as a characteristic thinking style in Chinese culture. Confucianism influences the psychology and behavior of Chinese people in many aspects, such as their cognitive style, value orientation, and attitudes toward life. One of the core concepts of Confucianism, Zhong-Yong style is at the spiritual core of today’s society [25]. The idea of moderation has a long history but is often misunderstood as compromise, mediocrity, or a nonpersistent style of doing things [26]. However, the essence of Zhong-Yong thinking advocated by Confucius is “holding both sides” and “using the middle.” This means that when analyzing problems, we should consider opposing sides and find the most appropriate and suitable balance point between them. Thus, Zhong-Yong thinking does not mean accepting different views or methods without principles but rather making the most appropriate decision after comprehensively considering the situation [27]. The Zhong-Yong thinking style involves considering multiple perspectives on a matter and selecting a balanced approach that considers both the self and the broader context [28]. This cognitive style embodies a dialectical and comprehensive approach, facilitating effective perception and coping with complex interpersonal environments, thereby promoting overall harmony [29].

Research has indicated that the Zhong-Yong thinking style serves as an important tool for limiting maladaptive behaviors (such as emotional distress and suicidal risk) under adverse conditions [27, 30]. Moreover, it fosters positive psychological outcomes, including psychosocial adjustment and creative problem solving [31, 32]. The Zhong-Yong thinking style can help individuals reinterpret family risk factors and negative emotions in a positive light, thus minimizing their adverse effects. Additionally, it enables individuals to identify the potential positive outcomes of events, thereby reducing negative emotional responses and, consequently, the risk of NSSI among adolescents. As a source of stress, cumulative family risk can lead adolescents to experience negative emotions such as tension and fear while triggering maladaptive cognition [10]. To cope with these negative experiences, adolescents must regulate their emotions and cognition, which depletes their limited self-control resources and reduces their volitional control. However, adolescents that practice high levels of Zhong-Yong thinking tend to adopt moderate strategies and avoid extremes when facing cumulative family risk [33]. This approach helps conserve psychological resources, thereby supporting the development of their volitional control. The moderating role of Zhong-Yong thinking style can be conceptualized through two specific models: the stress-buffering model and the stress-vulnerability model [34]. According to the stress-buffering model, the Zhong-Yong thinking style may weaken the relationship between cumulative family risk and NSSI. This model suggests that the beneficial effects of the Zhong-Yong thinking style are strongest for adolescents who experience high levels of cumulative family risk. Consequently, this model supports confidence in the positive role of the Zhong-Yong thinking style, suggesting that interventions should focus on enhancing this thinking style in adolescents. Conversely, in the stress-vulnerability model, the positive effects of the Zhong–Yong thinking style are considered most pronounced for adolescents experiencing low levels of cumulative family risk. Thus, practices such as Zhong-Yong thinking may diminish their ability to counterbalance risks once cumulative family risk exceeds a certain threshold. In the context of this model, the positive role of the Zhong-Yong thinking style should be carefully evaluated, with a focus on mitigating cumulative family risk. Therefore, interventions should prioritize reducing adolescents’ cumulative family risk. In this study, different regulatory models based on the Zhong-Yong thinking style were examined, aligning with the recent emphasis on exploring regulatory effect models [35]. Understanding the role of the Zhong-Yong thinking style can aid in establishing targeted preventive interventions and identifying additional types of support needed for intervention target groups.

The present study

Prior research on family risk and NSSI has predominantly been based on cross-sectional designs [8]. Therefore, in this study, a longitudinal moderated mediation model, drawing on the cumulative risk model, self-control theory, and developmental contextualism, is established to investigate the dynamic relationship between cumulative family risk and NSSI. We tested this longitudinal model with a sample of Chinese adolescents because NSSI has become a serious problem among adolescents in China [2]. Additionally, owing to cultural differences, the prevalence of NSSI differs between Chinese and Western adolescents [3]. Family factors also vary significantly; for example, one core element of the traditional Chinese parenting model is “discipline for children,” which involves high levels of parental control [7]. Consequently, research findings regarding family risk and protective factors in Western adolescents may not apply to Chinese adolescents (see Fig. 1). On the basis of the results of our theoretical and empirical analyses, three hypotheses are proposed: (1) cumulative family risk is positively associated with Chinese adolescents’ NSSI; (2) effortful control plays a longitudinal mediating role in the relationship between cumulative family risk and NSSI; and (3) the Zhong-Yong thinking style moderates the direct effect of cumulative family risk on NSSI and the path from cumulative family risk to effortful control.

Fig. 1.

Fig. 1

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Theoretical models

Methods

Participants

In this study, a cluster sampling method was used to select adolescents from seven junior high schools in Puyang city, Henan Province. Data were collected at two time points: January 2023 (Time 1) and December 2023 (Time 2), with a 12-month interval between assessments. At Time 1, a total of 942 adolescents completed the Cumulative Family Risks Questionnaire and the Demographic Variable Information Questionnaire. The sample included 468 boys and 474 girls, with an average age of 12.750 years (standard deviation = 0.581 years). At Time 2, 891 adolescents completed the Effortful Control Questionnaire, Zhong-Yong Thinking Style Questionnaire, and Non-Suicidal Self-Injury Questionnaire. The sample included 440 boys and 451 girls aged 10–16, with an average age of 13.710 years (standard deviation = 1.078 years). However, there were no significant differences in sex [χ2 (1) = 0.531, p > 0.05] or age [t = 1.445, p > 0.05] between the Chinese adolescents who dropped out and those who continued to participate in our study. Additionally, the statistical analysis revealed no significant differences in cumulative family risk (t = 0.941, p > 0.05), effortful control (t = 1.311, p > 0.05), Zhong-Yong thinking style (t = − 0.766, p > 0.05), or NSSI (t = 0.518, p > 0.05) between the two groups. These results suggest that attrition did not result in systematic bias.

Measures

Cumulative family risk

Theoretically, all ecological factors can be included in the measurement of cumulative risk. However, give the study objectives and to ensure feasibility, only important risk factors closely related to developmental outcomes should be included [14]. In the research design stage, we systematically reviewed the literature on non-suicidal self-injury in families or parents and adolescents from the past three years and followed relevant study principles to screen for family cumulative risk factors [14]. The criteria were as follows: (1) Systematic: Guided by ecological systems theory, family-related risk factors were incorporated. (2) Typicality: Selected family risk factors reflected the actual situation for most families in China. (3) Relevance: The cumulative risk of the selected family factors was closely related to NSSI. Factors with small effects or obvious differences, such as parents’ occupational prestige, were excluded. (4) Uniqueness: It was ensured that family risk factors were unique and that overlap between two or more risk factors was limited. For example, parent‒child communication, which is encompassed by parent‒child attachment, was not selected as a risk factor. In summary, seven types of cumulative family risk were selected. The survey status of each cumulative family risk is explained below.

Parent‒child attachment

The Parent-Child Attachment Questionnaire developed by Yang was used to assess parent‒child attachment [36]. This questionnaire consists of 20 items divided into three dimensions: trust, communication, and alienation (e.g., “I am willing to listen to my parents’ opinions when I am worried about something”). The questionnaire is based on a 5-point scale ranging from 1 (totally disagree) to 5 (totally agree), with higher scores indicating greater levels of parent‒child attachment. Previous studies have validated the suitability of this scale for Chinese children [37]. In the present study, the questionnaire demonstrated good reliability, with a Cronbach’s alpha of 0.878.

Parental conflict

The Children’s Perception of Interparental Conflict Scale, developed by Chi and Xin, was used to assess children’s perceptions of parental conflict [38]. The scale consists of 17 items divided into three dimensions: conflict frequency, conflict intensity, and conflict resolution (e.g., “When my parents argue, they yell at each other”). The questionnaire is based on a 4-point scale ranging from 1 (never) to 4 (always), with higher scores indicating greater levels of parental conflict. Previous studies have confirmed the scale’s suitability for Chinese children [39]. In the current study, the scale demonstrated high reliability, with a Cronbach’s alpha of 0.904.

Family financial pressure

The Family Financial Difficulties Scale, developed by Wang, was used to assess family financial pressure and consists of 16 items [40] (e.g., “In the past year, my family did not have enough money to buy new clothes.”). Previous studies have validated this scale’s suitability for Chinese children [41]. The questionnaire is based on a 4-point scale ranging from 1 (never) to 4 (always), with higher scores indicating greater levels of family financial pressure. In the current study, the scale demonstrated good reliability, with a Cronbach’s alpha of 0.886.

Parenting style

The short-Egna Minnen Barndoms Uppfostran (s-EMBU) Questionnaire, developed by Jiang, was used to assess parenting style [42]. The questionnaire contains 21 items and is divided into three dimensions: rejection, emotional warmth, and overprotection (e.g., “My parents often get mad at me without me knowing the reason”). The questionnaire is based on a 4-point scale ranging from 1 (totally disagree) to 4 (totally agree). Previous studies have confirmed the scale’s suitability for Chinese children [43]. In this study, the Cronbach’s alpha values for the dimensions of rejection, emotional warmth, and overprotection were 0.884, 0.905, and 0.894, respectively.

Parental controls

The parental control questionnaire, developed by Wang, was used to assess parental control behaviors [44]. This questionnaire consists of 18 items divided into three dimensions: inducing guilt, withdrawal of love, and arbitrary power (e.g., “My parents told me that what they wanted me to do was what was best for me and that I shouldn’t have questions about it.”). The questionnaire is based on a 5-point scale ranging from 1 (totally disagree) to 5 (totally agree), with higher scores indicating greater levels of parental control. Previous studies have validated the scale’s suitability for Chinese children [7]. In this study, the Cronbach’s alpha for the scale was 0.931.

Parental emotional neglect

The Emotional Neglect Scale, developed by Chen, was used to assess children’s perceptions of parental emotional neglect. This scale contains 10 items (e.g., “My parents listened to me carefully.”) [45]. The questionnaire is based on a 5-point scale ranging from 1 (totally disagree) to 5 (totally agree), with higher scores indicating greater levels of parental emotional neglect. It has been validated for use with Chinese children in previous studies [34]. In this study, the Cronbach’s alpha for the scale was 0.922.

Parental maltreatment

The Parental Maltreatment Scale, developed by Zhao [46], was used to assess various forms of parental maltreatment. The scale includes four subscales: emotional abuse, physical abuse, sexual abuse, and physical neglect (e.g., “No one at home cares about my warmth or cold”). The questionnaire is based on a 5-point scale ranging from 1 (never) to 5 (always), with higher scores indicating greater levels of parental maltreatment. This scale has been validated for use with Chinese children in previous studies [47]. In this study, the Cronbach’s alpha for the scale was 0.893.

A widely used modeling method was used to construct a cumulative ecological risk index [11, 48]. For the risk variables parent‒child attachment and parenting style-emotional warmth, the 25th percentile score was used as the cutoff: scores < the 25th percentile were coded as 1 (at risk), and scores ≥ the 25th percentile were coded as 0 (no risk). For variables such as parental conflict, family financial pressure, parental controls, parental emotional neglect, parental maltreatment, parental style rejection, and parental style overprotection, the 75th percentile score was used as the cutoff: scores > the 75th percentile were coded as 1 (at risk), and scores ≤ the 75th percentile were coded as 0 (no risk).

Effortful control

The Effortful Control Questionnaire, developed by Ellis [49] and revised by Li [50], was used to assess effortful control. This questionnaire consists of 16 items and is divided into three dimensions: attentional control, inhibitory control, and activation control (e.g., “Even if the task is difficult, I will complete it on time.”). A 6-point Likert scale was used to rate the responses, with higher scores indicating a higher level of effortful control. The scale has been validated for use with Chinese children in previous studies [7]. In this study, the Cronbach’s alpha for the scale was 0.903.

Zhong-Yong thinking style

The Zhong-Yong Thinking Style Questionnaire, developed by Wu and Lin [51], was used to assess adolescents’ Zhong-Yong thinking style. This questionnaire includes 13 items and is divided into three dimensions: multiple thinking, integration, and harmony (e.g., “I am used to thinking about the same thing from many perspectives”). A 7-point Likert scale was employed, with higher scores indicating a higher level of Zhong-Yong thinking style. The scale has been validated for use with Chinese children in previous studies [30]. In this study, the Cronbach’s alpha was 0.932.

NSSI

The Non-Suicidal Self-Injury Questionnaire, developed by Feng [52], was used to assess non-suicidal self-injury among adolescents. This questionnaire comprises 18 items covering various forms of non-suicidal self-injury, such as stabbings, scratches, bites, and burns (e.g., “Intentionally tattooing words or patterns on the body”). The severity of self-injury is evaluated by multiplying the frequency and intensity of self-injury. The questionnaire is based on a 4-point scale ranging from 1 (never) to 4 (always), with higher scores indicating greater levels of parental maltreatment. Higher scores indicate a greater degree of non-suicidal self-injury. The scale has been validated for use with Chinese children in previous studies [53]. In this study, Cronbach’s alpha was 0.906.

Covariates

Previous studies have indicated that sex and age are correlated with NSSI among Chinese adolescents [3, 16]. Therefore, sex and age were included as control covariates in our statistical analyses. Sex was treated as a dichotomous variable, with males coded as 0 and females coded as 1.

Procedure

After informed consent was obtained from the participating adolescents and their guardians, group testing sessions were organized in classroom settings. Each class was assigned two examiners to facilitate the process. Before each test, the examiners provided detailed instructions and examples to ensure clarity and understanding, such as asking adolescents to fill out a questionnaire based on their real experiences in the past year. They also emphasized the importance of the survey in research aimed at understanding adolescent behaviors. The study required adolescents to complete two sets of questionnaires. In January 2023 (T1), participants completed the Cumulative Family Risk Questionnaire, which included the Parent-Child Attachment Questionnaire, Parental Conflict Questionnaire, Family Financial Pressure Questionnaire, Parenting Style Questionnaire, Parental Controls Questionnaire, Parental Emotional Neglect Questionnaire, and Parental Maltreatment Questionnaire. In December 2023 (T2), participants completed the Effortful Control Questionnaire, Zhong-Yong Thinking Style Questionnaire, and Non-Suicidal Self-Injury Questionnaire. Adolescents were assured of the confidentiality of their responses, emphasizing that all the data collected would be used solely for research purposes. Following the instructions, the participants independently responded to the questionnaire items since their own experiences and perceptions. As a token of appreciation for their participation, all the adolescents received a small gift consisting of a gel pen and a stationary bag.

Data analysis

First, missing data were replaced via multiple imputations using SPSS 24.0, with five imputations performed [54]. Descriptive statistics (mean scores) and correlation analyses were also conducted using SPSS 24.0. Moderated mediation effects were tested using 5000 bootstrap samples to generate 95% confidence intervals. The SPSS macro-PROCESS was used with Model 4 to explore the mediating role of effortful control and Model 8 to assess the moderating role of the Zhong-Yong thinking style. Statistical significance was set at p < 0.05, and the bootstrap 95% CI did not include zero.

Results

Common method bias test

The Harman single-factor test was employed to assess common method bias in the two sets of measurement data [55]. The results indicated that for both measurements, the total number of factors with eigenvalues greater than 1 was 17. The variance explained by the first factor was 17.223%, which was less than 40%. Therefore, there was no evidence of common method bias. Additionally, given the interrelated nature of family risk factors, we conducted a Harman single-factor test for the cumulative family risk questionnaire. The total number of factors with eigenvalues greater than 1 was 11, and the variance explained by the first factor was 24.582%, which is also less than 40%. Thus, the cumulative family risk data did not exhibit common method bias.

Preliminary analyses

Table 1 displays the descriptive statistics, such as the means, standard deviations, and correlations among the main study variables. Cumulative family risk at Time 1 (T1) was positively correlated with NSSI at Time 2 (T2). Additionally, cumulative family risk at T1 was negatively correlated with both effortful control and the Zhong-Yong thinking style at T2. Effortful control at T2 was negatively correlated with NSSI at T2 and positively correlated with the Zhong-Yong thinking style at T2. Finally, the Zhong-Yong thinking style at T2 was negatively associated with NSSI at T2.

Table 1.

Means, standard deviations and correlations for the main study variables

Variables 1 2 3 4 5 6
1 Sex -
2 Age T1 −0.075* -
3 Cumulative family risk T1 −0.064 0.086** -
4 Effortful control T2 0.011 0.021 −0.445** -
5 Zhong-Yong thinking style T2 0.057 −0.099** −0.481** 0.491** - -
6 Non-suicidal self-injury T2 −0.039 −0.050 0.626** −0.603** −0.423** -
Mean 0.500 13.730 2.473 3.371 3.173 2.233
SD 0.499 1.081 0.994 0.913 0.684 1.258
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Sex: 0 = male, 1 = female; T1 = Time 1, T2 = Time 2

*p < 0.05

**p < 0.01

***p < 0.001

Longitudinal mediating effects of effortful control

As shown in Table 2, after controlling for sex and age, cumulative family risk at Time 1 (T1) was negatively associated with effortful control at Time 2 (T2) (β = −0.451, p < 0.001, bootstrap 95% CI [− 0.510, − 0.392]), which, in turn, negatively affected NSSI at T2 (β = −0.398, p < 0.001, bootstrap 95% CI [− 0.449, − 0.348]). In addition, the residual direct effect was significant (β = 0.456 p < 0.001, bootstrap 95% CI [0.405, 0.506]), which indicated that effortful control mediated the relationship between cumulative family risk and NSSI (indirect effect = 0.180, bootstrap 95% CI [0.140, 0.226]). The longitudinal mediating effect accounted for 28.346% of the total effect. These findings suggest that increased cumulative family risk is associated with reduced effortful control over time and that lower effortful control is, in turn, associated with higher levels of NSSI.

Table 2.

Longitudinal mediation analysis of effortful control

Outcomes Predictors β SE t 95% CI
NSSI T2 Sex −0.013 0.024 −0.252 [− 0.116, 0.089]
Age T1 −0.098 0.024 −4.054*** [− 0.146, − 0.051]
CFR T1 0.635 0.026 24.357*** [0.584, 0.686]
R 2 0.403
F 199.943
EC T2 Sex −0.028 0.060 −0.462 [− 0.146, 0.091]
Age T1 −0.055 0.028 −1.968* [0.000, 0.110]
CFR T1 −0.451 0.030 −14.957*** [− 0.510, − 0.392]
R 2 0.202
F 74.793
NSSI T2 Sex −0.024 0.046 −0.524 [− 0.115, 0.067]
Age T1 −0.076 0.022 −3.536*** [− 0.118, − 0.034]
CFR T1 0.456 0.026 17.577*** [0.405, 0.506]
EC T2 −0.398 0.026 −15.442*** [− 0.449, − 0.348]
R 2 0.530
F 249.710
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Cumulative family risk = CFR, effortful control = EC, non-suicidal self-injury = NSSI; Sex: 0 = male, 1 = female; T1 = Time 1, T2 = Time 2

*p < 0.05

**p < 0.01

***p < 0.001

Longitudinal moderating effects of Zhong–Yong thinking style

As shown in Table 3, after controlling for sex and age, cumulative family risk at T1 × Zhong-Yong thinking style at T2 was significantly and positively related to effortful control at T2 (β = 0.105, p < 0.001, bootstrap 95% CI [0.043, 0.167]). Simple slope analysis indicated that for Chinese adolescents with a weak Zhong-Yong thinking style at T2 (M − 1SD) (βsimple = − 0.374, p < 0.001), a greater degree of cumulative family risk at T1 was associated with a lower degree of effortful control at T2. However, for Chinese adolescents with a strong Zhong-Yong thinking style at T2 (M + 1SD), the effect of cumulative family risk at T1 on effortful control at T2 was weaker (βsimple = − 0.164, p < 0.001) (see Fig. 2). Hence, these results suggest that Zhong-Yong thinking style buffered the adverse impact of cumulative family risk on effortful control, which is consistent with the stress-buffering model.

Table 3.

Longitudinal moderating role of the Zhong-Yong thinking style on NSSI

Outcomes Predictors β SE t 95% CI
EC T2 Sex −0.059 0.036 −1.049 [− 0.170, 0.051]
Age T1 0.054 0.027 2.036* [0.002, 0.107]
CFR T1 −0.269 0.032 −8.443*** [− 0.332, − 0.207]
ZYTS T2 0.380 0.032 11.833 [0.317, 0.442]
CFR T1 × ZYTS T2 0.105 0.032 3.302** [0.043, 0.167]
R 2 0.313
F 80.800
NSSI T2 Sex 0.000 0.046 0.003 [− 0.089, 0.090]
Age T1 −0.049 0.022 −2.242* [− 0.091, − 0.006]
EC T2 −0.371 0.027 −13.636*** [− 0.425, − 0.318]
CFR T1 0.442 0.027 16.453*** [0.389, 0.495]
ZYTS T2 −0.049 0.028 −1.753 [− 0.104, 0.006]
CFR T1 × ZYTS T2 −0.161 0.026 −6.219*** [− 0.212, − 0.110]
R 2 0.550
F 180.059
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Cumulative family risk = CFR; effortful control = EC; Zhong-Yong thinking style = ZYTS; non-suicidal self-injury = NSSI. Sex: 0 = male, 1 = female; T1 = Time 1, T2 = Time 2

*p < 0.05

**p < 0.01

***p < 0.001

Fig. 2.

Fig. 2

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Conditional effect of Chinese adolescents’ effortful control at T2 as a function of cumulative family risk at T1 and Zhong-Yong thinking style at T2

Moreover, cumulative family risk at T1 × Zhong-Yong thinking style at T2 was negatively associated with NSSI at T2 (β = −0.161, p < 0.001, bootstrap 95% CI [− 0.212, − 0.110]). Simple slope analysis revealed that for Chinese adolescents with a weak Zhong-Yong thinking style at T2 (M − 1SD), a greater degree of cumulative family risk at T1 was associated with a greater degree of NSSI at T2 (βsimple = 0.603, p < 0.001). However, for Chinese adolescents with a strong Zhong-Yong thinking style at T2 (M + 1SD), the effect of cumulative family risk at T1 on NSSI at T2 was weaker (βsimple = 0.281, p < 0.001) (see Fig. 3). Hence, cumulative family risk was a much stronger predictor of NSSI for Chinese adolescents with a low level of Zhong-Yong thinking. This moderating effect indicates that a strong Zhong-Yong thinking style may limit the negative impact of family risk on adolescents’ effortful control and NSSI, which is consistent with the stress-buffering model. In addition, Table 4 presents the direct effects of cumulative family risk on non-suicidal self-injury across different levels of the Zhong-Yong thinking style, as well as the mediating effects of effortful control with effect size, SE, t, and 95% CI at the M-SD and M + SD levels for the Zhong-Yong thinking style.

Fig. 3.

Fig. 3

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Conditional effects of Chinese adolescents’ NSSI at T2 as a function of cumulative family risk at T1 and Zhong-Yong thinking style at T2

Table 4.

The direct effect of cumulative family risk on NSSI at different levels of Zhong-Yong thinking style and the mediating effect of effortful control

Level of Zhong-Yong thinking style Effect size SE t 95% CI
M-SD Direct effect 0.603 0.037 16.469 [0.531, 0.675]
Mediating effect −0.374 0.043 −8.620 [− 0.459, − 0.289]
M + SD Direct effect 0.281 0.038 7.398 [0.206, 0.356]
Mediating effect −0.164 0.047 −3.532 [0.256, 0.073]
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Discussion

Overall, these findings highlight the complex interplay among family dynamics, effortful control, and the Zhong-Yong thinking style in shaping NSSI in Chinese adolescents. Understanding these relationships can inform targeted interventions aimed at preventing and addressing NSSI among Chinese adolescents. Interventions should focus on enhancing effortful control and promoting the Zhong-Yong thinking style, particularly for those exposed to cumulative family risk.

Cumulative family risk and NSSI

The present findings support Hypothesis 1, indicating that cumulative family risk has a significant influence on adolescents’ NSSI, which is consistent with previous findings [8, 9]. The family is the first environment for adolescents, and a “comfortable space” within the family, as mentioned by Li [14], underscores the importance of a supportive and nurturing family context for adolescent development. However, when family environments are characterized by neglect, conflict, or other adverse factors, adolescents may feel emotionally neglected and rejected, increasing their vulnerability to negative emotions and psychological distress. For example, parental behaviors such as excessive mobile phone use during parent‒child interactions can contribute to feelings of emotional neglect and exacerbate adolescents’ distress [56]. Additionally, Allen highlighted self-injury as a means of seeking help and preventing abandonment, shedding light on the complex motivations underlying NSSI in the context of cumulative family risk [57]. Adolescents may resort to self-injury as a way of communicating their distress and garnering support from their families, albeit maladaptively. The notion that individuals facing cumulative risk may be more inclined to adopt short-term coping strategies, including NSSI, underscores the urgency of addressing family dynamics and providing adolescents with more adaptive coping mechanisms [58]. In summary, the discussion underscores the intricate interplay among the family environment, adolescent psychological well-being, and non-suicidal self-injury. Addressing cumulative family risk and fostering supportive family environments are critical steps for preventing and addressing NSSI in Chinese adolescents.

Longitudinal mediating role of effortful control

The findings of this study underscore the longitudinal mediating role of effortful control in the relationship between cumulative family risk and NSSI in Chinese adolescents, supporting Hypothesis 2. This investigation offers a novel perspective by examining how cumulative family risk influences NSSI through the lens of effortful control, complementing previous research that focused predominantly on emotional, stress-coping, and negative self-related mechanisms [16, 59]. According to self-control theory, family factors play a crucial role in shaping an individual’s self-control system, with effortful control being one of its fundamental components [20]. For example, if parents exercise psychological control over their children rather than rationally guiding them, the interaction with parents undermines adolescents’ sense of autonomy and competence, hindering the development of their effortful control [60]. Similarly, parental neglect may result in adolescents lacking the necessary structure and discipline for self-regulation, further impeding the development of effortful control [61]. Researchers have also noted that the external emotional connections formed by family relationships can promote the development of adolescents’ self-regulation abilities [62]. The greater the self-regulation ability of adolescents is, the easier it is to mitigate the effects of cumulative family risk, thereby reducing the risk of NSSI. In other words, to cope with the negative emotions and cognitions associated with cumulative family risk, an individual must consume already limited psychological energy or willpower resources. Insufficient control resources can lead to maladaptive behaviors [63]. If an individual achieves a high level of effortful control, they actively regulate their negative emotions and thoughts, enabling them to quickly shift from negative states, cope with stress appropriately, and reduce the possibility of NSSI. In summary, cumulative family risk may be associated with a decline in adolescent effortful control, thereby increasing susceptibility to NSSI.

Longitudinal moderating role of Zhong-Yong thinking style

The findings of this study provide evidence for the longitudinal moderating role of the Zhong-Yong thinking style in the relationship between cumulative family risk and NSSI, confirming Hypothesis 3. The Zhong-Yong thinking style embodies a dialectical approach to thinking and rational action orientation, enabling individuals to effectively perceive and cope with complex interpersonal environments, ultimately achieving a state of inner–outer harmony [64]. Adolescents with high levels of Zhong-Yong thought are adept at adopting harmonious and adaptive strategies when confronted with cumulative family risk. They can flexibly adjust their perspectives to evaluate emotional events and respond effectively to changes in the external environment [65]. Research also indicates that the Zhong-Yong thinking style helps individuals view cumulative family risk from a dynamic and positive perspective, facilitating a shift from an emotion-based ‘hot’ processing system to a cognitive-based ‘cold’ processing system and the achievement of self-control behavior [66, 67]. In addition, the Zhong-Yong thinking style emphasizes achieving balance through self-restraint [68], a characteristic closely aligned with the core principle of effortful control. Reflection and self-restraint are also integral aspects of cultivating the “moderate self.” By reflecting on specific events, individuals can avoid excessive self-obsessions and approach the world and its challenges with a calm mindset [69]. Thus, when adolescents encounter cumulative environmental (e.g., family) risk, the Zhong-Yong thinking style helps them manage stress with a balanced perspective; it aids in conserving psychological resources by controlling impulses and reducing unnecessary depletion of these resources, thereby fostering the development of effortful control and further reducing vulnerability to NSSI. The Zhong-Yong thinking style operates within the framework of a stress-buffering model, acting as a protective practice against the detrimental effects of cumulative family risk [32]. For example, in cases with adverse parenting practices or a harsh upbringing, adolescents with a high level of Zhong-Yong thinking are more likely to reinterpret negative experiences, alleviate negative emotions, and make constructive behavioral choices to regulate themselves, thereby reducing their propensity for NSSI. In summary, the Zhong-Yong thinking style serves as a valuable resource for attenuating the influence of cumulative family risk on adolescents’ NSSI by promoting adaptive coping strategies and rational decision-making.

Theoretical and practical implications

First, the results enrich the cumulative risk model, self-control theory, and the stress-buffering model. These findings reveal the influence of the cumulative risk model and NSSI on adolescent development and aid in understanding the relationship between the cumulative risk model and NSSI from the perspective of effortful control. Additionally, the consistency of the Zhong-Yong thinking style with stress-buffering theory highlights the importance of its positive role. The findings of this study underscore several key implications for preventing and intervening in NSSI among adolescents: (1) Cumulative family risk is a significant factor in the development of adolescent NSSI. Efforts should be focused on reducing family risk factors to prevent and improve adolescent NSSI. Such strategies could include organizing home–school sports games to increase parent‒child companionship time and promote emotional connections between parents and children. Additionally, developing parent‒child mental health education courses can help parents identify risk factors in the family and create a respectful, friendly, and equal family atmosphere. (2) Effortful control is a fundamental mechanism through which cumulative family risk influences NSSI. Interventions such as group counseling and cognitive‒behavioral therapy can enhance adolescents’ willpower and self-regulation skills. Teachers can use positive psychology methods to improve adolescents’ effortful control by helping them establish clear goals and plans. Schools can develop targeted effortful control training courses because of cumulative family risk factors. For example, teaching adolescents’ emotional regulation and emotional self-efficacy can help them manage emotions, reducing the likelihood of NSSI in response to family risk. (3) The Zhong-Yong thinking style mitigates the negative effects of cumulative family risk. The thinking style is a skill that can be developed through special training [70], so the Zhong-Yong thinking style can also be trained and cultivated. In the context of Chinese culture, intervention courses can be designed around the connotations and dimensions of the Zhong-Yong thinking style. For example, integrating ancient Chinese poetry into intervention courses can subtly promote moderate thinking. Public welfare lectures on mental health, group psychological counseling, and modern teaching techniques can also be employed to cultivate the flexibility of Zhong-Yong thinking, thereby reducing the risk of adolescent NSSI. Notably, although the Zhong-Yong approach was associated with a stress-buffering model in this study and was shown to reduce the negative impact of cumulative family risk on effortful control, its effect is not without limitations. Previous studies have noted that some seemingly positive psychological traits may incur “resilience costs” in high-risk situations [71, 72]. The Zhong-Yong thinking style emphasizes self-restraint and interpersonal harmony, which may prompt adolescents to suppress their emotions and sacrifice individual needs to maintain external adaptation when facing stress, which may increase their psychological burden over time [31]. Therefore, intervention practices should avoid emphasizing the improvement of individual advantages alone and should be focused more on the systematic reduction of external ecological risk to achieve comprehensive support for adolescent mental health.

Limitations and future directions

Several limitations of this study should be addressed in future research. First, while the family risk factors selected are typical and representative, they do not encompass all potential risks. Future studies could include additional factors, such as sibling pressure, to further test these findings. Second, data collection was limited to two time points, thus restricting the ability to establish a causal relationship between cumulative family risk and NSSI in Chinese adolescents. Future research should span multiple time points (three or more) to better capture the dynamic relationships among cumulative family risk, effortful control, Zhong-Yong thinking style, and NSSI over time. For example, the effects of the Zhong-Yong thinking style might evolve, and more data could help explore both immediate and delayed impacts. Third, this study focused exclusively on middle school students, which may limit the generalizability of the findings to other adolescent populations. Additionally, since the study was based on Chinese adolescents, the applicability of the results to adolescents from other cultural backgrounds remains uncertain. Future research should include participants from diverse age groups, such as high school students, and different cultural backgrounds to better understand the relationship between cumulative family risk factors and NSSI. Fourth, baseline levels of effortful control and non-suicidal self-injury were not controlled for in the analyses. Failing to account for these baseline levels may impact the interpretation of the results and limit the strength of causal inferences. Future research should include control for the baseline levels of these variables to assess the corresponding causal relationships more accurately. Finally, the use of self-report measures may introduce biases, such as underreporting effects or social desirability effects. Future studies should consider combining data from multiple sources, such as self-reports, peer reports, parental reports, teacher reports, and laboratory assessments (e.g., using the Implicit Association Test to measure the level of Zhong-Yong thinking style). This approach could be helpful for refining findings and enhancing the validity of the results. Addressing these limitations in future research will contribute to a more comprehensive understanding of the complex interplay among cumulative family risk, effortful control, Zhong-Yong thinking style, and NSSI among adolescents. This, in turn, will facilitate the development of more effective prevention and intervention strategies for mitigating NSSI among adolescents.

Conclusion

Although much attention has been given to adolescents’ NSSI, less focus has been placed on the effects of cumulative family risk, effortful control, and Zhong-Yong thinking style on adolescents’ NSSI within a longitudinal moderated mediation model. In the present study, cumulative family risk is identified as a significant factor in the development of adolescents’ NSSI, with this effect being partially mediated by effortful control over time. Importantly, we found evidence supporting the direct effect of cumulative family risk on Chinese adolescents’ NSSI. Additionally, the direct effect of cumulative family risk on NSSI and the first part of the mediating effect of effortful control were moderated longitudinally by Zhong-Yong thinking style. Interventions should therefore focus on enhancing adolescents’ effortful control and Zhong-Yong thinking styles to mitigate the negative impact of cumulative family risk on NSSI.

Acknowledgements

Gratitude is extended to the adolescents who graciously participated in this study, as well as to the school principals and teachers whose unwavering support was invaluable throughout the research process.

Authors’ contributions

Authors’ contributionsYanfeng Xu: Conceptualization, Study designing, Methodology, Investigation, Paper writing.Chong Guo: Supervision, Writing-Review & Editing, Paper editing.Banglin Yang: Methodology, Formal analysis, Paper writing, Paper editing.

Funding

This work was supported by the Special Commissioned Project on High-Quality Development of Basic Education under the Fujian Provincial Education Science Planning Program (Project No.: FJJKWT24-002), with support from the Dewang Institute for Basic Education Research. This work was sponsored by the Joint Funds for the innovation of science and Technology, Fujian province (Grant No.: 2024Y9552), Fujian provincial health technology project (Grant No.: 2019-2-13) and Special Research Fund of Fujian Maternity and Child Health Hospital (Grant No.: YCXQ18-444, YCXM20-54).

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

All procedures performed in the present study were approved by the Human Research Protection Committee at Fujian Normal University (Number: PSY240069) and were in accordance with the ethical standards of the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all the participants and parents for publication.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Footnotes

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Yanfeng Xu and Chong Guo co-first authors.

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Associated Data

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Data Availability Statement

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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