伴混合特征的抑郁障碍患者发生非自杀性自伤的危险因素分析

Risk factors for non-suicidal self-injury of depressive disorder patients with mixed features Yuan Xiaofei,

目的探讨抑郁障碍伴混合特征(DMX)患者发生非自杀性自伤(NSSI)的危险因素。方法选取2021年5月4日至2022年7月29日在首都医科大学附属北京安定医院抑郁症门诊就诊的100例DMX患者为研究对象,根据自我伤害行为问卷中近1年是否发生NSSI行为将患者分为NSSI组(n=39)和非NSSI组(n=61)。采用17项汉密尔顿抑郁量表(HAMD-17)、汉密尔顿焦虑量表(HAMA)、杨氏躁狂量表(YMRS)和哥伦比亚自杀量表(C-SSRS)4个他评量表评估患者的抑郁、焦虑、躁狂严重程度和自杀意念风险等级。采用患者健康问卷抑郁量表(PHQ-9)、广泛性焦虑障碍量表(GAD-7)和斯奈思-汉密尔顿快感量表(SHAPS)3个自评量表评估患者的抑郁、焦虑和快感缺失严重程度。采用多因素Logistic回归模型分析DMX患者发生NSSI的危险因素。结果两组患者年龄、居住方式、起病年龄、HAMD-17得分、PHQ-9得分、SHAPS得分以及自杀意念风险等级比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄小(OR=0.900,95%CI=0.829~0.977,P=0.012)、HAMD-17得分高(OR=1.361,95%CI=1.013~1.829,P=0.042)、SHAPS得分高(OR=1.147,95%CI=1.078~1.215,P<0.001)是DMX患者伴NSSI的危险因素。结论年龄小、抑郁程度重、快感缺失程度重是DMX患者NSSI发生的危险因素,在临床中应关注伴有此特征的DMX患者,尽早干预,以减少NSSI的发生。

Objective To explore the risk factors of non-suicidal self-injury(NSSI)in depressive disorder with mixed features(DMX).Methods A total of 100 patients with DMX who visited the Depression Clinic of Beijing Anding Hospital affiliated to Capital Medical University from May 4,2021 to July 29,2022 were selected as the research subject.Patients were divided into NSSI group(n=39)and non-NSSI group(n=61)based on whether NSSI occurred.The depression,anxiety,manic severity,and suicide ideation risk of patients were evaluated using four other-rating scales,including the 17-item Hamilton Depression Rating Scale(HAMD17),Hamilton Anxiety Scale(HAMA),Young Mania Rating Scale(YMRS),and Columbia Suicide Severity Rating Scale(C-SSRS).The severity of depression,anxiety,and anhedonia in patients was evaluated using three self-assessment scales,including the Patient Health Questionnare 9-item Scale(PHQ-9),Generalized Anxiety Disorder 7-item Scale(GAD-7),and Snaith-Hamilton Pleasure Scale(SHAPS).Multivariate Logistic regression model was used to analyze the risk factors for NSSI in patients with DMX.Results There was a statistically significant difference between the two groups in terms of age,residential pattern,age of onset,HAMD-17 score,PHQ-9 score,SHAPS score,and suicide ideation risk level(P<0.05).Multivariate Logistic regression analysis showed that young age[OR=0.900,95%CI(0.829,0.977),P=0.012],high HAMD-17 score[OR=1.361,95%CI(1.013,1.829),P=0.042],and high SHAPS score[OR=1.147,95%CI(1.078,1.215),P<0.001]were risk factors for NSSI in patients with DMXs.Conclusions Young age,severe depression,and severe anhedonia are risk factors for NSSI in patients with DMXs,and attention should be paid to DMX patients with this feature in the clinic and early intervention should be made to minimize the occurrence of NSSI.