家庭、人际关系、童年创伤对首发青少年抑郁症非自杀性自伤行为的影响

Influence of family,interpersonal relationships and childhood trauma on non-suicidal self-injury in adolescents with first-episode depression

目的:探讨家庭、人际关系、童年创伤对首发青少年抑郁症非自杀性自伤(NSSI)行为的影响。方法:纳入110例首发青少年抑郁症患者,根据DSM-5将患者分为伴NSSI组(n=57)和不伴NSSI组(n=53)。采用抑郁自评量表(SDS)、焦虑自评量表(SAS)、人际关系综合诊断量表、儿童期创伤问卷评估患者情绪、人际及其他心理症状。采用Pearson相关分析法分析人际关系、儿童期创伤、焦虑、抑郁之间的关系。采用二元logistic回归分析NSSI的独立危险因素。通过Bootstrap方法评估中介效应。结果:两组性别、父母感情、与父母关系、与同学关系等方面比较,差异均有统计学意义(均P<0.05)。伴NSSI组交谈、交际、待人接物3个因子评分及总分,情绪虐待、性虐待、情绪忽视、躯体忽视评分及SAS和SDS评分均高于不伴NSSI组(均P<0.05)。Pearson相关分析显示,伴NSSI组交谈维度与情绪虐待、情绪忽视、躯体忽视均呈正相关关系(r分别为0.345、0.273、0.297,均P<0.05),不伴NSSI组情绪虐待与SDS评分、SAS评分呈正相关关系(r分别为0.302、0.290,均P<0.05)。Logistic回归分析显示,与父母关系、交际维度、性虐待均为NSSI的独立危险因素。抑郁在交际方面与NSSI行为之间存在中介效应。结论:伴NSSI青少年抑郁症患者可能经历更多童年创伤及不良的家庭人际关系,更不擅长处理人际关系和情绪问题;抑郁在交际方面与NSSI行为之间存在一定的间接效应,起到中介调节作用。

Objective:To explore the influence of family,interpersonal relationships and childhood trauma on non-suicidal self-injury(NSSI)in adolescents with first-episode depression.Methods:A total of 110 adolescent patients with first-episode depression were enrolled.According to DSM-5,the patients were divided into a group with NSSI(n=57)and a group without NSSI(n=53).Self-Dating Depression Scale(SDS),Self-Dating Anxiety Scale(SAS),Comprehensive Diagnostic Scale for Interpersonal Relationships and Childhood Trauma Questionnaire were used to evaluate the emotional,interpersonal and other psychological symptoms of patients.Pearson correlation analysis was used to analyze the relationship between interpersonal relationships,childhood trauma,anxiety and depression.Binary logistic regression was used to analyze the independent risk factors of NSSI.Mediation effects were evaluated through Bootstrap method.Results:There were statistically significant differences in gender,parental affection,and relationships with parents and classmates between the two groups(all P<0.05).In the group with NSSI,scores for the three factors of conversation,communication,and interpersonal relationships,as well as the total score,and scores for emotional abuse,sexual abuse,emotional neglect,and physical neglect,as well as SAS and SDS scores,were higher than those in the group without NSSI(all P<0.05).Pearson correlation analysis showed that in the group with NSSI,talking dimension was positively correlated with emotional abuse,emotional and physical neglect(r=0.345,0.273,and 0.297,respectively,all P<0.05),and emotional abuse was positively correlated with SDS score and SAS score(r=0.302,0.290,respectively,all P<0.05).Logistic regression analysis showed that relationship with parents,communication dimension,and sexual abuse were independent risk factors for NSSI.There were mediating effects between depression and NSSI in communication.Conclusion:Adolescent depression patients with NSSI may experience more childhood trauma and poor family interpersonal relationships,and are less adept at handling interpersonal and emotional issues.Depression plays an indirect role in the relationship between interpersonal communication and NSSI,serving as a mediating moderator.