非自杀性自伤与儿童性虐待相关性的Meta分析

Relationship between non-suicidal self-injury and childhood sexual abuse: a meta-analysis

目的系统评价非自杀性自伤(non-suicidal self-injury,NSSI)与儿童性虐待(child sexual abuse,CSA)之间的关联性,为非自杀性自伤行为发生的防控提供参考。方法计算机检索Pub Med,Embase,CNKI和Wan Fang Data数据库,搜集国内外关于NSSI与CSA关联的原始研究。英文检索词包括:NSSI,self-mutilation,self-injury,self-harm,non-suicidal self-injury,self-injurious behavior,self-destructive behavior,self-damaging behavior,self-harm behavior,self-harming behavior,selfmutilative behavior,deliberate self-harm;sexual abuse,sex abuse等;中文检索词包括非自杀性自伤,自(我)伤(害),自残,自虐,性虐待。检索时限均为建库至2016年7月31日。由2名研究者独立进行文献筛选、资料提取和评价纳入研究的偏倚风险评估后,采用STATA 14.0软件进行Meta分析。结果共纳入37篇文章,总样本量49 221例,其中NSSI组3 927例,非NSSI组40 814例。Meta分析结果显示,NSSI组的CSA比例高于对照组(OR=3.95,95%CI=3.30~4.74);亚组分析显示,遭受CSA的男性发生NSSI的风险大于女性(OR=4.28,95%CI=2.78~6.59);社区人群、亚洲人群以及无精神病风险人群的NSSI与CSA的相关性较大(OR值分别为4.45,5.31,4.60,95%CI值分别为2.86~6.94,3.20~8.79,3.38~6.26)。结论 NSSI和CSA之间具有相关性,且在性别、样本来源、研究地区间存在一定差异。

Objective To systematically review the relationship between non-suicidal self-injury（ NSSI） and childhood sexual abuse（ CSA）,and to provide basis for the prevention of NSSI. Methods Pub Med, Embase, CNKI and Wan Fang Data was used to search papers published before July 31, 2016 regarding the relationship between NSSI and CSA. The retrieual words were NSSI,Self-mutilation,self-injury,self-harm,non-suicidal self-injury,self-injurious behavior,self-destructive behavior,self-damaging behavior,self-harm behaivor,self-harming behavior,self-mutitative behaivor,deliberate self-harm,sexual abuse,sex abuse,ect. Two researchers reviewed literature, extracted data and evaluated bias of included studies independently. Statistical analysis was conducted in Stata 14.0. Results A total of 37 cross-sectional studies involving 49 221 participants were included for detailed evaluation.Meta-analysis suggested that CSA survivors increased the occurrence of NSSI（ OR = 3.95, 95%CI = 3.30-4.74）. Additionally, males CSA survivors were more likely to conduct NSSI compared with females（ OR = 4.28, 95%CI = 2.78-6.59）. CSA survivors from community sample, Asian, without mental disorders have the highest risk of NSSI engagement（ OR = 4.45, 95%CI = 2.86-6.94）; Asian（ OR = 5.31, 95%CI = 3.20-8.79）; no mental disorder（ OR = 4.60, 95%CI = 3.38-6.26）. Conclusions Individuals with childhood sexual abuse experiences have a higher risk of NSSI, association differs in gender, area and sample sources.