神经性厌食少年的情绪、冲动特点及与自伤自杀的关联

Psychological characteristics and risk factors of self-harm and suicide in adolescents with anorexia nervosa

目的：探讨神经性厌食少年情绪、冲动的特点及自伤自杀危险因素。方法：采用儿童多维焦虑量表中文版、流调用抑郁自评量表、认知情绪调节问卷中文版、Barratt冲动量表中文版,对39名符合疾病和有关健康问题的国际统计分类第十次修订有神经性厌食诊断标准的少年,以及78名年龄、性别相匹配的正常对照进行评定,并对两组间评定结果进行比较。同时采用青少年健康相关危险行为问卷对病例组和正常对照组的自伤行为、自杀观念、自杀未遂进行评定和比较,并将人口学资料及上述各量表总分（青少年健康相关危险行为问卷总分除外）引入logistic回归模型,分析自伤行为、自杀观念、自杀未遂的危险因素。结果：病例组流调用抑郁自评量表分高于对照组（P0.05）。病例组自伤行为、自杀观念、自杀未遂评分高于对照组（均P〈0.05、0.002、0.001）,存在自伤行为、自杀观念、自杀未遂的患儿比例分别为43.6%、41.0%、33.3%。Logistic回归分析未发现自伤行为的相关因素;冲动（OR=1.19,95%CI：1.04-1.37）与自杀观念相关联;且冲动（OR=1.15,95%CI：1.03-1.30）与自杀未遂相关联。结论：神经性厌食少年有明显较多的抑郁、灾难化思维、自伤行为、自杀观念及企图;冲动者更易出现自杀观念和自杀未遂。

Objective： To explore the trait of emotion and impulsiveness and risk factors of self-harm and suicide in adolescents with anorexia nervosa （AN）. Methods： Thirty-nine adolescents meeting the criteria of AN of ICD-10 and 78 normal controls（NC） matched in age and gender with patients were enrolled. They were assessed with Multidimensional Anxiety Scale for Children-Chinese Version （MASC-C）, Center for Epidemiological Survey- Depression Scale （CES-D）, Cognitive Emotion Regulation Questionnaire-Chinese Version （CERQ-C）, The Chinese Version of the Barratt Impulsiveness Scale, Ilth Version （BIS-II） and Questionnaire for Adolescents Health related Risk Behavior Inventory （AHRBI）. The difference of the emotion, impulsiveness between adolescents with AN and NC were analyzed and the risk factors of the self-harm, suicide ideation, suicide attempt in adolescents with AN were explored. Results： Compared to NC, the AN group had higher score of CES-D （ P = 0. 032） and catastrophizing （P = 0. 014）, and lower score of rumination （P 〈 0. 05）. There were no difference between two groups in the scores of MASC-C, CERQ-C and BIS-II （Ps 〉0. 05）. The AN group had more self-harm （43.6%, P 〈0. 05）, suicide ideation （41.0%, P 〈 0. 01） and suicide attempt （33.3 %, P 〈 0. 01） than AN group. Impulsiveness was significantly associated with suicide ideation （ OR = 1.19, 95% CI： 1.04 - 1.37） and suicide attempt （ OR = 1.15, 95% CI： 1.03 - 1.30）. Conclusions： Adolescents with anorexia nervosa have more depression, catastrophizing, self-harm, suicide ideation and behaviors. Patients with impulsiveness are more likely to have suicide ideation and suicide attempt.