Associations between child maltreatment and depressive symptoms among deaf and hearing adolescent students: A moderated mediation model

Background: Childhood maltreatment is a well-established risk factor for adolescent mental health issues, particularly depressive symptoms. Deaf adolescents face heightened vulnerability due to unique challenges such as communication barriers and social exclusion. However, little is known about how social exclusion mediates the relationship between childhood maltreatment and depression in this population, or how emotion regulation strategies moderate these effects. Objective: This study aimed to examine the associations between childhood maltreatment and depressive symptoms in deaf and hearing adolescents, with a focus on the mediating role of social exclusion and the moderating effects of cognitive reappraisal and expressive suppression. Participants and setting: A total of 2008 adolescent students (622 deaf, 1386 hearing) aged 12–23 years were recruited from six schools in China, including both mainstream and special education institutions. Methods: Participants completed self-report measures assessing childhood maltreatment, social exclusion, emotion regulation strategies (cognitive reappraisal and expressive suppression), and depressive symptoms. Correlation analysis was conducted to examine variable associations, and an exploratory network analysis supplemented the main analyses by visualizing group-specific relationships. The core hypothesis was tested using a moderated mediation model to examine whether social exclusion mediated the relationship between childhood maltreatment and depressive symptoms and whether emotion regulation moderated these pathways. Results: Deaf adolescents reported significantly higher levels of childhood maltreatment, social exclusion, expressive suppression, and depressive symptoms compared to their hearing peers (all p < .001). Social exclusion mediated the relationship between childhood maltreatment and depressive symptoms in both groups, with a stronger indirect effect among deaf students than hearing students. Expressive suppression moderated this relationship differently in the two groups: it exacerbated depressive symptoms among deaf students (β = 0.14, p = .002) but had a buffering effect among hearing students (β = −0.04, p = .04). Cognitive reappraisal showed limited protective effects in either group. Conclusions: These findings highlight social exclusion as a key mediator linking childhood maltreatment to depressive symptoms, particularly among deaf adolescents. Expressive suppression exacerbated depressive symptoms in deaf students but buffered symptoms among hearing peers, suggesting that interventions should specifically aim to reduce reliance on expressive suppression in deaf adolescents. Although cognitive reappraisal showed limited protective effects in the current study, it remains an important strategy warranting further exploration in targeted interventions.