青少年单双相抑郁患者欺凌受害与非自杀性自伤行为功能的关系:孤独感的作用路径

Relationship between peer victimization and non-suicidal self-injury functions in adolescents with unipolar and bipolar depression:the pathway of loneliness

背景非自杀性自伤(NSSI)行为已经成为影响青少年身心健康的公共卫生问题。欺凌受害是青少年出现NSSI行为的危险因素,探索欺凌受害与NSSI行为功能的关系及作用机制对预防NSSI行为的发生具有重要意义。目的探讨欺凌受害与青少年单双相抑郁患者NSSI行为功能的关系,以期为对青少年单双相抑郁患者NSSI行为的干预提供参考。方法采用多阶段分层抽样,选取全国14家精神专科医院收治的、符合《精神障碍诊断与统计手册(第5版)》(DSM-5)双相障碍抑郁发作或抑郁障碍诊断标准的患者940例。采用自伤功能评估量表中文版(C-FASM)、多维同伴受害量表(MPVS)、UCLA孤独感量表(UCLA-LS)、患者健康问卷抑郁量表(PHQ-9)进行调查。采用Pearson相关分析考查各量表评分之间的相关性;采用SPSS宏程序Process 4.0的模型4进行中介模型拟合与作用路径分析。结果共698例(74.26%)青少年单双相抑郁患者完成有效问卷调查,检出374例(53.58%)患者存在NSSI行为。伴NSSI行为的青少年单双相抑郁患者MPVS总评分与C-FASM功能问卷分量表中的情绪调节功能评分、寻求注意功能评分和社交回避功能评分均呈正相关(r=0.104、0.130、0.266,P<0.05或0.01),UCLA-LS评分与C-FASM功能问卷分量表中的情绪调节功能评分、寻求注意功能评分和社交回避功能评分均呈正相关(r=0.321、0.112、0.246,P<0.05或0.01);UCLA-LS评分与MPVS总评分呈正相关(r=0.241,P<0.01)。孤独感在欺凌受害与NSSI行为的情绪调节功能之间起完全中介作用,间接效应值为0.033(95%CI:0.019~0.050),效应量为73.33%;孤独感在欺凌受害与NSSI行为的社交回避功能之间起部分中介作用,间接效应值为0.016(95%CI:0.007~0.025),效应量为17.98%。结论孤独感可能是伴NSSI行为的青少年单双相抑郁患者欺凌受害与NSSI行为情绪调节功能及社交回避功能之间的作用路径。

Background Non-suicidal self-injury(NSSI)behavior has become a major public health concern and can have significant implications for the physical and mental health of adolescents.Peer victimization is a risk factor for adolesents to have NSSI behavior,so exploring the relationship and underlying mechanism between peer victimization and NSSI functions will provide a promising strategy for the prevention and intervention of NSSI behavior.Objective To investigate the relationship between peer victimization and NSSI functions in adolescents with unipolar and bipolar depression,so as to provide references for the intervention of NSSI behavior in adolescent patients with unipolar and bipolar depression.Methods Using multi-stage stratified sampling,940 adolescents with unipolar and bipolar depression who met the Diagnostic and Statistical Manual of Mental Disorders,fifth edition(DSM-5)criteria for bipolar depressive episodes or depressive disorders were selected from 14 psychiatric hospitals in China.All participations were assessed using Chinese version of the Functional Assessment of Self-Mutilation(C-FASM),Multidimensional Peer-Victimization Scale(MPVS),UCLA Loneliness Scale(UCLA-LS)and Patient Health Questionnaire-9 item(PHQ-9).Pearson correlation coefficient was to assess the correlation among above scales,and the model fit and path coefficients for mediation were analyzed with model 4 in Process 4.0 for SPSS.Results A total of 698(74.26%)adolescents with unipolar and bipolar depression completed the questionnaire survey.NSSI behavior was detected in 374 patients(53.58%).Among adolescents with unipolar and bipolar depression and NSSI behavior,MPVS total score was positively correlated with the scores of NSSI emotion regulation function,attention-seeking function and social avoidance function in C-FASM(r=0.104,0.130,0.266,P<0.05 or 0.01),UCLA-LS score also yielded a positive correlation with the scores of NSSI emotion regulation function,attention-seeking function and social avoidance function in C-FASM(r=0.321,0.112,0.246,P<0.05 or 0.01),and UCLA-LS score was positively correlated with MPVS total score(r=0.241,P<0.01).Loneliness demonstrated a complete mediating role in the relationship between peer victimization and emotion regulation function,with an indirect effect value of 0.033(95%CI:0.019~0.050)and an effect size of 73.33%.A partial mediating effect of loneliness was also observed for the relationship between peer victimization and social avoidance function,with an indirect effect value of 0.016(95%CI:0.007~0.025)and an effect size of 17.98%.Conclusion Loneliness may act as a mediator in the relationship between the peer victimization and the NISS emotion regulation and social avoidance functions in adolescents with unipolar and bipolar depression and NSSI behaviors.