青少年抑郁症患者自杀行为的影响因素研究

Study on the influencing factors of suicidal behavior in adolescents with depression

目的探讨家庭及其他因素对青少年抑郁症患者自杀行为的影响。方法选取于2020年6月至2021年12月在荆门市第二人民医院儿童青少年心理科住院的126例青少年抑郁症患者进行横断面调查,根据近6个月内是否有自杀行为分为自杀组(n=76)及非自杀组(n=50)。采用一般情况调查表、患者健康问卷抑郁症状群量表(PHQ-9)、自杀意念自评量表(SIOSS)、家庭亲密度与适应性评定量表(FACESⅡ-CV)对两组患者的一般资料、抑郁程度、自杀意念、家庭分型进行比较。采用Spearman相关分析患者自杀行为与一般资料、PHQ-9、SIOSS、FACESⅡ-CV评分的相关性。采用二元Logistic回归模型对患者自杀行为的影响因素进行分析。结果自杀组饮酒者占40.8%(31/76),有精神疾病家族史者占27.6%(21/76),分别高于非自杀组的20.0%(10/50)、12.0%(6/50),差异有统计学意义(P<0.05)。自杀组患者PHQ-9评分、SIOSS总分、绝望因子评分及睡眠因子评分高于非自杀组[19.0(15.0,21.8)分比15.0(10.8,19.0)分、15.0(14.0,16.8)分比13.0(11.0,15.0)分、12.0(10.3,12.0)分比10.0(7.8,12.0)分、3.0(2.0,3.0)分比2.0(1.0,3.0)分],家庭亲密度评分低于非自杀组[50.5(43.3,57.0)分比57.5(48.8,65.5)分],差异均有统计学意义(P<0.05)。自杀组患者中极端型家庭占67.1%(51/76),高于非自杀组的44.0%(22/50),差异有统计学意义(P<0.05)。患者自杀行为与家庭亲密度呈负相关(r=-0.224,P<0.05),与PHQ-9评分、SIOSS总分、绝望因子评分、睡眠因子评分、饮酒、有精神疾病家族史呈正相关(r=0.346、0.373、0.361、0.324、0.206、0.217、0.186;P<0.05)。二元Logistic回归分析显示,饮酒(OR=3.066,95%CI=1.184~7.941)、家庭适应性高(OR=1.126,95%CI=1.034~1.227)、PHQ-9评分高(OR=1.197,95%CI=1.087~1.317)是青少年抑郁症患者自杀行为的危险因素(P<0.05),家庭亲密度高是自杀行为的保护因素(OR=0.878,95%CI=0.813~0.948)。结论青少年抑郁症患者自杀行为发生率较高,家庭分型更多见于“僵硬-松散”的极端型家庭,有饮酒行为、严重抑郁、家庭关系不良者更容易自杀。

Objective To explore the influence of family and other factors on suicidal behavior of adolescent depression patients.Methods A cross-sectional survey was conducted on 126 adolescent depression patients hospitalized in the Department of Child and Adolescent Psychology of Jingmen NO.2 People's Hospital from June 2020 to December 2021.The patients were divided into suicide group(n=76)and non-suicide group(n=50)according to whether they had committed suicide in the past 6 months.The general information questionnaire,Patient Health Questionnaire-9(PHQ-9),Self-Rating Idea of Suicide Scale(SIOSS),the Chinese version of Family Adaptability and Cohesion Scale,Second Edition(FACESⅡ-CV)were applied to compare general information,depression degree,suicidal ideation and family classification.Spearman was used to analyze the correlation between suicidal behavior and general data,PHQ-9,SIOSS,and FACESⅡ-CV scores.Binary Logistic regression model was used to analyze the influencing factors of suicidal behavior.Results The drinking rate and family history of mental illness in the suicide group[40.8%(31/76),27.6%(21/76)]were significantly higher than those in the non-suicide group[20.0%(10/50),12.0%(6/50)],and the differences were statistically significant(P<0.05).The scores of PHQ-9,SIOSS total score,despair and sleep factor in the suicide group were higher than those in the non-suicide group[19.0(15.0,21.8)vs 15.0(10.8,19.0);15.0(14.0,16.8)vs 13.0(11.0,15.0);12.0(10.3,12.0)vs 10.0(7.8,12.0);3.0(2.0,3.0)vs 2.0(1.0,3.0)],and the family cohesion score was lower than that in the non-suicide group[50.5(43.3,57.0)vs 57.5(48.8,65.5)],and the differences between the two groups were statistically significant(P<0.05).In the suicide group,the rate of extreme family[67.1%(51/76)]was significantly higher than that of the non-suicide group[44.0%(22/50)],and the difference between the two groups was statistically significant(P<0.05).The suicidal behavior was negatively correlated with family intimacy(r=-0.224,P<0.05),and positively correlated with PHQ-9 score,SIOSS total score,despair factor score,sleep factor score,drinking behavior,and having family history of mental illness(r=0.346,0.373,0.361,0.324,0.206,0.217,0.186;P<0.05).Binary Logistic regression analysis showed that alcohol consumption(OR=3.066,95%CI=1.184-7.941),high family adaptability(OR=1.126,95%CI=1.034-1.227),high PHQ-9 score(OR=1.197,95%CI=1.087-1.317)were the risk factors for suicidal behavior of adolescent depression patients(P<0.05),and high family intimacy was the protective factor for suicidal behavior(OR=0.878,95%CI=0.813-0.948).Conclusions Adolescent depression patients have a higher incidence of suicidal behavior.Family classifications are more common in"rigid-loose"extreme families.Alcoholic behavior,severe depression,and poor family relationships are more likely to commit suicide.