首次住院的青少年抑郁障碍患者非自杀性自伤行为与冲动性的关系

Association between non-suicidal self-injury behavior and impulsivity in adolescent patients with depressive disorder in the first hospitalization

目的探讨伴有非自杀性自伤(NSSI)行为的青少年抑郁障碍患者在冲动性方面的特征,分析NSSI行为与冲动性的关系,以便早期识别有NSSI行为风险的患者并及时干预。方法采取顺序入组的方式,选取在深圳市康宁医院首次住院的青少年抑郁障碍患者共53例,根据《精神障碍诊断与统计手册(第5版)》(DSM-5)诊断标准评估患者有无NSSI行为,将患者分为伴NSSI行为组(n=30)和不伴NSSI行为组(n=23)。采用汉密尔顿抑郁量表17项版(HAMD-17)、青少年自我伤害问卷和Barratt冲动性量表(BIS-11)评定患者抑郁情绪、自伤严重程度和冲动性。结果伴NSSI行为组HAMD-17评分[(25.50±4.10)分vs.(21.43±4.64)分,t=3.379,P<0.01]、BIS-11运动冲动性[(51.67±15.95)分vs.(38.70±14.90)分,t=3.018,P<0.01]、认知冲动性[(52.75±13.22)分vs.(43.37±18.40)分,t=2.161,P<0.05]、无计划冲动性[(68.00±15.32)分vs.(50.76±21.35)分,t=3.424,P<0.01]及总评分[(57.42±11.08)分vs.(44.27±14.83)分,t=3.695,P<0.01]均高于无NSSI行为组,差异均有统计学意义。伴NSSI行为组青少年自我伤害问卷评分与BIS-11运动冲动性评分呈正相关(r=0.691,P<0.01)。二元Logistic回归分析显示,HAMD-17评分(β=0.172,OR=1.187,95%CI:1.007~1.400)和无计划冲动性(β=0.044,OR=1.045,95%CI:1.002~1.091)与青少年抑郁障碍患者NSSI行为有关(P均<0.05)。结论抑郁症状严重程度和无计划冲动性增加可能是青少年抑郁障碍患者NSSI行为的危险因素。

Objective To explore the characteristics of impulsivity in adolescent depressive disorder patients with nonsuicidal self-injury(NSSI)behavior,analyze the relationship between NSSI behavior and impulsivity,so as to identify patients with NSSI behavior and provide targeted intervention at early stages.Methods A total of 53 adolescent patients with depressive disorder who were hospitalized for the first hospitalization in Shenzhen Kangning Hospital were enrolled,diagnosed using Diagnostic and Statistical Manual of Mental Disorders,fifth edition(DSM-5).Thereafter,the adolescents were divided into NSSI group(n=30)and non-NSSI group(n=23).Hamilton Depression Scale-17 item(HAMD-17),Adolescents Self-Harm Scale and Barratt Impulsivity Scale(BIS-11)were used to evaluate the severity of depression,NSSI and impulsivity.Results Compared with the non-NSSI group,the NSSI group scored higher on HAMD-17[(25.50±4.10)vs.(21.43±4.64),t=3.379,P<0.01],motor impulsiveness of BIS-11[(51.67±15.95)vs.(38.70±14.90),t=3.018,P<0.01],cognitive impulsiveness[(52.75±13.22)vs.(43.37±18.40),t=2.161,P<0.05],non-planning impulsiveness[(68.00±15.32)vs.(50.76±21.35),t=3.424,P<0.01]and BIS-11[(57.42±11.08)vs.(44.27±14.83),t=3.695,P<0.01].Within NSSI group,the score of Adolescents Self-Harm Scale was positively correlated with the score of motor impulsiveness in BIS-11(r=0.691,P<0.01).Binary Logistic regression analysis showed that HAMD-17 score(β=0.172,OR=1.187,95%CI:1.007~1.400)and non-planning impulsiveness of BIS-11(β=0.044,OR=1.045,95%CI:1.002~1.091)were associated with NSSI in adolescent patients with depressive disorder(P<0.05).Conclusion The severity of depressive symptoms and non-planning impulsiveness may be risk factors for NSSI behavior in adolescent patients with depressive disorder.