青少年抑郁症患者非自杀性自伤行为与功能及其相关因素Behavior and functions of non-suicidal self-injury (NSSI) and related factors in adolescents with depression
何强;王康程;杨楹;刘树苗;蒋忠良;汪芷伊;刘金同;
摘要(Abstract):
目的:了解青少年抑郁障碍患者非自杀性自伤(NSSI)行为与功能及其相关因素。方法:纳入符合精神障碍诊断与统计手册第5版(DSM-5)抑郁障碍诊断标准的门诊、住院患者(伴NSSI患者89例、不伴NSSI患者74例)163例,年龄、性别匹配的正常对照107例。采用儿童抑郁量表(CDI)评估患者抑郁程度,儿童孤独量表(CLS)评估患者孤独感,挫败感量表(DS)评估患者学业挫败感、渥太华自伤量表(OSI)评估患者NSSI行为及功能,采用logistic回归分析探讨NSSI行为与各变量间的关联,采用多重线性回归分析实施NSSI各功能与各变量的关联。结果:伴NSSI患者组的CDI、CLS、DS评分均高于不伴NSSI抑郁组和正常对照组。女性、学业挫败感得分高是实施NSSI的危险因素(OR=2.75、1.06)。CDI中的负性情绪得分与OSI中的内部情绪调节得分、外部情绪调节得分、寻求刺激因子得分呈正向关联(β=0.29~0.33);CDI人际问题得分与OSI中的社交影响因子得分呈正向关联(β=0.21);非独生子女的OSI寻求刺激因子得分更高(β=0.23)。结论:青少年抑郁障碍患者学业挫败感程度较高者可能更易发生NSSI。以外部情绪调节为NSSI主导功能的患者最多,负性情绪和人际问题可能是患者实施NSSI功能的相关因素。
关键词(KeyWords): 抑郁障碍;青少年;非自杀性自伤;孤独感;学业挫败感
基金项目(Foundation): 国家自然科学基金(32000760);; 山东省医药卫生科技发展计划项目(202003091014);; 中国博士后科学基金面上项目(2019M662433);; 山东省博士后创新项目(239735)
作者(Authors): 何强;王康程;杨楹;刘树苗;蒋忠良;汪芷伊;刘金同;
参考文献(References):
- [1] 美国精神医学学会.精神障碍诊断与统计手册(第5版)[M].北京:北京大学出版社,2015.
- [2] Nock MK.Why do people hurt themselves?New insights into the nature and functions of self-injury[J].Curr Dir Psychol Sci,2009,18(2):78-83.
- [3] Swannell SV,Martin GE,Page A,et al.Prevalence of nonsuicidal self-injury in nonclinical samples:systematic review,meta-analysis and meta-regression[J].Suicide Life Threat Behav,2014,44(3):273-303.
- [4] Hawton K,Saunders K,Topiwala A,et al.Psychiatric disorders in patients presenting to hospital following self-harm:a systematic review[J].J Affect Disord,2013,151(3):821-830.
- [5] Fan YY,Liu J,Zeng YY,et al.Factors associated with non-suicidal self-Injury in Chinese adolescents:a meta-analysis[J].Front Psychiatry.2021,12:747031.doi:10.3389/fpsyt.2021.747031.
- [6] Steptoe A,Shankar A,Demakakos P,et al.Social isolation,loneliness,and all-cause mortality in older men and women[J].Proc Natl AcadSci USA,2013,110(15):5797-5801.
- [7] Lasgaard M,Goossens L,Bramsen RH,et al.Different sources of loneliness are associated with different forms of psychopathology in adolescence[J].J ResPers,2011,45(2):233-237.
- [8] 凌秾喜,梁昌权,唐京雄,等.中学生抑郁症患者非自杀性自伤行为现状及危险因素分析[J].医学理论与实践,2021,34(10):1774-1776.
- [9] Klonsky ED.The functions of deliberate self-injury:a review of the evidence[J].Clin Psychol Rev,2007,27(2):226-239.
- [10]Nock MK.Self-injury[J].Annu Rev ClinPsychol,2010,6:339-363.doi:10.1146/annurev.clinpsy.121208.131258.
- [11]Edmondson AJ,Brennan CA,House AO.Non-suicidal reasons for self-harm:a systematic review of self-reported accounts[J].J Affect Disord,2016,191:109-117.doi:10.1016/j.jad.2015.11.043.
- [12]Andover MS,Morris BW.Expanding and clarifying the role of emotion regulation in nonsuicidal self-injury[J].Can J Psychiatry,2014,59(11):569-575.
- [13]黄悦勤.医学科研中随机误差控制和样本量确定[J].中国心理卫生杂志,2015,29(11):874-880.
- [14]王利刚,罗静,高文斌.儿童抑郁量表在中国农村儿童中的应用[C].第十二届中国科协年会论文集,2010:1-6.
- [15]吴文峰,卢永彪,谭芙蓉,等.儿童抑郁量表中文版在中小学生中的信效度[J].中国心理卫生杂志,2010,24(10):775-779.
- [16]高金金,陈毅文.儿童孤独量表在1~2年级小学生中的应用[J].中国心理卫生杂志,2011,25(5):361-364.
- [17]唐华,王甦平,龚睿婕,等.挫败感量表对医学生焦虑抑郁态的信效度评估[J].上海交通大学学报(医学版),2019,39(1):84-88.
- [18]张芳,程文红,肖泽萍,等.渥太华自我伤害调查表中文版信效度研究[J].上海交通大学学报(医学版),2015,35(3):460-464.
- [19]徐梦蓉,刘树苗,陈洁,等.抑郁障碍青少年生活事件、情绪症状与非自杀性自伤行为的关系[J].精神医学杂志,2020,33(6):420-423.
- [20]Gandhi A,Luyckx K,Goossens L,et al.Association between non-suicidal self-injury,parents and peers related loneliness,and attitude towards aloneness in flemish adolescents:an empirical note[J].PsycholBelg,2018,58(1):3-12.
- [21]Audenaert K,Van Laere K,Dumont F,et al.Decreased frontal serotonin 5-HT 2a receptor binding index in deliberate self-harm patients[J].Eur J Nucl Med,2001,28(2):175-182.
- [22]Price J,Sloman L,Gardner R Jr,et al.The social competition hypothesis of depression[J].Br J Psychiatry,1994,164(3):309-315.
- [23]Russell K,Rasmussen S,Hunter SC.Does mental well-being protect against self-harm thoughts and behaviors during adolescence?A six-month prospective investigation[J].Int J Environ Res Public Health,2020,17(18):6771.doi:10.3390/ijerph17186771.
- [24]Taylor PJ,Jomar K,Dhingra K,et al.A meta-analysis of the prevalence of different functions of non-suicidal self-injury[J].JAffect Disord,2018,227:759-769.doi:10.1016/j.jad.2017.11.073.
- [25]Slabbert A,Hasking P,Notebaert L,et al.The role of distress tolerance in the relationship between affect and NSSI[J].Arch Suicide Res,2020:1-15.doi:10.1080/13811118.2020.1833797.
- [26]林琳,杨亚楠,杨洋,等.大学生人际关系对自伤行为的影响:负性情绪的中介作用[J].黑龙江高教研究,2020,(9):146-150.
- [27]黄垣成,赵清玲,李彩娜.青少年早期抑郁和自伤的联合发展轨迹:人际因素的作用[J].心理学报,2021,53(5):515-526.
- [28]张小远,俞守义,赵久波,等.独生子女与非独生子女大学生心理健康状态和素质的对照研究[J].南方医科大学学报,2007,27(4):482-484.
- [29]Wang Q,Wang H,Liu X.Loneliness,non-suicidal self-injury,and friendship quality among Chinese left-behind adolescents:the role of parent-child cohesion[J].J Affect Disord,2020,271:193-200.doi:10.1016/j.jad.2020.03.112.