同伴侵害对青少年抑郁发作患者非自杀性自伤的影响:自尊的中介作用

The effect of peer victimization on non-suicidal self-injury in adolescents with depressive episode:the mediation of self-esteem

目的 探讨青少年抑郁发作患者的自尊在同伴侵害与非自杀性自伤(NSSI)频率中的中介作用。方法 选取2021年1—12月在苏州市广济医院儿少精神科住院的142例青少年抑郁发作患者为研究对象,采用自残功能性评估量表(FASM)、罗森伯格自尊量表(RSES)、多维同伴侵害问卷(MPVS)与9项患者健康问卷(PHQ-9)对患者的NSSI行为、自尊程度、同伴侵害情况及抑郁程度进行调查。采用Spearman相关分析青少年抑郁发作患者同伴侵害、自尊与NSSI频率之间的相关性。采用PROCESS 3.0统计学软件进行中介效应检验。结果 青少年抑郁发作患者的NSSI检出率为76.8%(109/142)。NSSI组青少年抑郁发作患者的PHQ-9得分为(20.39±4.85)分,RSES得分为19.00(14.75,23.00)分,MPVS总分为16.00(4.00,32.00)分。NSSI组患者的同伴侵害及身体侵害、言语侵害、关系侵害、财物侵害各维度与NSSI频率呈正相关(r=0.432、0.303、0.407、0.387、0.278;P<0.01);自尊与NSSI频率呈负相关(r=-0.460,P<0.01)。中介检验结果显示,自尊在同伴侵害与NSSI频率间存在部分或完全中介作用,中介效应占比为31.9%~60.2%。结论 青少年抑郁发作患者自尊在同伴侵害与NSSI频率的关系中起到中介作用,提示应重视青少年抑郁发作患者的同伴侵害情况以及对低自尊进行干预,以减少NSSI行为的发生。

Objective To explore the mediating role of self-esteem in the relationship between peer victimization and the frequency of non-suicidal self-injury(NSSI) in adolescents with depressive episode.Methods A total of 142 adolescents with depressive episode hospitalized in the Department of Pediatric Psychology of Suzhou Guangji Hospital from January to December 2021 were recruited as the research subjects.Functional Assessment of Self-Mutilation(FASM),Rosenberg Self-Esteem Scale(RSES),Multidimensional Peer Victimization Scale(MPVS) and Patient Health Questionnaire-9(PHQ-9) were applied to investigated NSSI behavior,self-esteem level,peer victimization and depression level of the patients.Spearman correlation was used to analyze the correlation between peer victimization,self-esteem and NSSI frequency in adolescent depressive patients.PROCESS 3.0 was used for mediation effect test.Results The detection rate of NSSI among adolescents with depressive episode was 76.8%(109/142).The scores of PHQ-9,RSES and MPVS were(20.39±4.85),19.00(14.75,23.00) and 16.00(4.00,32.00),respectively,in NSSI group.The scores of peer victimization,physical victimization,verbal victimization,social manipulation and attacks on property were all positively correlated with NSSI frequency(r=0.432,0.303,0.407,0.387,0.278;P<0.01);while selfesteem was negatively correlated with NSSI frequency(r=-0.460,P < 0.01).The results of the intermediary test showed that self-esteem had a partial mediating effect between peer victimization and NSSI frequency,and the mediating effect accounted for 31.9%-60.2%.Conclusions The self-esteem has a partial mediating effect on the relationship between peer victimization and the frequency of NSSI in adolescents with depressive episode,suggesting that attention should be paid to peer victimization of adolescent depressive patients and the intervention of low self-esteem to reduce the occurrence of NSSI behavior.