Among people with various mental illnesses, those with schizophrenia have the highest incidence of aggressive behavior, which not only disturbs the medical environment, but also poses a great threat to family stability and social harmony. Previous regression analysis studies have shown that childhood trauma, self-esteem and resilience are influencing factors of aggressive behavior in schizophrenia patients, but few studies have explored the internal relationship between these four variables.

To explore the relationship between childhood trauma, self-esteem, resilience and aggressive behavior in schizophrenic patients using a self-constructed chain mediation model, and to clarify its internal mechanism.

A convenience sample of stable schizophrenia inpatients were selected from Daqing Third Hospital and Chifeng Anding Hospital from March 2021 to July 2022. A survey was conducted with them using a questionnaire consisting of general information questionnaire, Positive and Negative Symptom Scale (PANSS) , Childhood Trauma Questionnaire-Short Form (CTQ-SF) , Connor-Davidson Resilience Scale (CD-RISC) , Self-esteem Scale (SES) , and Aggressive Questionnaire (AQ) . Pearson correlation analysis was used to explore the correlation of AQ score with CTQ-SF, CD-RISC and SES scores. Multiple linear regression analysis was used to explore the influencing factors of aggressive behavior. AMOS 24.0 was used to construct the chain mediation model. The mediation effect of the chain mediation model was tested using Bootstrap method.

Three hundred and ten cases attended the survey, and 300 of them (96.8%) who responded effectively were finally included for analysis. The average scores of PANSS, CTQ-SF, SES, CD-RISC and AQ were (18.4±3.7) , (49.7±13.5) , (26.9±6.9) , (55.2±15.5) and (84.3±19.8) , respectively. Multiple linear regression analysis showed that childhood trauma〔B=0.551, 95%CI (0.421, 0.681) , P<0.001〕, self-esteem〔B=-0.661, 95%CI (-0.908, -0.413) , P<0.001〕and resilience〔B=-0.448, 95%CI (-0.561, -0.335) , P<0.001〕 were influencing factors of aggressive behavior. Pearson correlation analysis revealed that CTQ-SF scores were positively correlated with AQ scores (r=0.695, P<0.01) and negatively correlated with SES scores and CTQ-SF scores (r=-0.524, P<0.01; r=-0.565, P<0.01) ; SES scores were negatively correlated with AQ scores (r=-0.607, P<0.01) and positively correlated with CD-RISC scores (r= 0.522, P<0.01) ; the CD-RISC score was negatively correlated with the AQ scores (r=-0.681, P<0.01) . The chain mediation model test results showed that the goodness-of-fit of the model was good. Bootstrap test showed that the 95%CI of each mediation path did not include 0, and the mediation effect was significant. The overall effect of childhood trauma on aggressive behavior was significant〔β=0.810, 95%CI (0.743, 0.871) , P<0.001〕. The indirect effect of childhood trauma on aggressive behavior, that is, acting through the mediators of self-esteem and resilience, was significant〔β=0.473, 95%CI (0.362, 0.598) , P<0.001〕. The direct effect of childhood trauma on aggressive behavior was significant〔β=0.377, 95%CI (0.179, 0.485) , P<0.001〕.

Self-esteem and resilience play a chain mediating role between childhood trauma and aggressive behavior in patients with schizophrenia. In the future, a risk prediction model of aggressive behavior in schizophrenia patients can be constructed to assess the risk of aggressive behavior, which is contributive to early identification and management of those at risk of aggression, thereby reducing or preventing the occurrence of aggressive behavior.