应对方式在抑郁症患者童年创伤与抑郁严重程度间的中介作用

The mediating role of coping style between childhood trauma and depression severity in patients with depression

目的探究童年创伤及其维度对抑郁症患者抑郁严重程度的影响,以及应对方式的中介作用。方法2020年10月至2022年8月,采用自编一般情况调查表、汉密尔顿抑郁量表、中文版儿童期虐待问卷和特质应对方式问卷对87例抑郁症患者开展横断面调查。采用SPSS 26.0进行描述性分析、相关分析,采用AMOS 24.0统计软件构建结构方程模型,采用PROCESS 4.1宏程序分析消极应对方式在童年创伤各维度与抑郁严重程度间的中介作用,并采用Bootstrap法进行中介效应验证。结果(1)抑郁症患者汉密尔顿抑郁量表得分为(33.32±8.18)分;童年创伤总分为40(34,52)分,其中情感虐待为8(6,12)分,躯体虐待为5(5,6)分,性虐待为5(5,6)分,情感忽视为12(9,17)分,躯体忽视为8(6,10)分;积极应对方式为25(19,31)分,消极应对方式为35(30,37)分。抑郁症患者抑郁严重程度与情感虐待、情感忽视、躯体忽视、童年创伤总分、消极应对方式呈正相关(r=0.31~0.56,均P<0.01),与积极应对方式呈负相关(r=-0.35,P<0.01)。(2)积极应对方式在童年创伤及情感虐待、情感忽视维度和抑郁严重程度间无中介作用。消极应对方式在童年创伤及情感虐待、情感忽视维度和抑郁严重程度间起部分中介作用,分别占总效应的23.24%(0.135/0.581)、33.94%(0.299/0.881)、23.62%(0.227/0.961)。结论童年创伤及情感虐待与情感忽视维度不仅能直接影响抑郁症患者抑郁严重程度,还能通过消极应对方式间接影响抑郁症患者抑郁严重程度。

Objective To explore the effects of childhood trauma and its subtypes on the severity of depression in patients with depression,and the mediating role of coping style.Methods The self-administered general information questionnaire,Hamilton depression scale(HAMD),the Chinese version of childhood trauma questionnaire,and trait coping style questionnaire were used to survey 87 patients with depression from October 2020 to August 2022.SPSS 26.0 was used for descriptive and correlation analyses,AMOS 24.0 statistical software was used for structural equation modelling,PROCESS 4.1 macro program was used for mediating effect analysis,and Bootstrap method was used for mediating effect testing.Results(1)The HAMD score of depressed patients was(33.32±8.18),the total childhood trauma score was(40(34,52)),with the subscale scores of emotional abuse(8(6,12)),physical abuse(5(5,6)),sexual abuse(5(5,6)),emotional neglect(12(9,17)),physical neglect(8(6,10)),respectively.The score of positive coping style was(25(19,31)),and negative coping style was(35(30,37)).The HAMD score was positively correlated with emotional abuse,emotional neglect,physical neglect,total childhood trauma score,and negative coping style(r=0.31-0.56,all P<0.01),and negatively correlated with positive coping style(r=-0.35,P<0.01).(2)Positive coping style had no mediating effect between childhood trauma,emotional abuse,affective neglect subtypes and the severity of depression.The negative coping style played partial mediating roles between childhood trauma,emotional abuse,emotional neglect subtypes and the severity of depression,accounting for 23.24%(0.135/0.581),33.94%(0.299/0.881)and 23.62%(0.227/0.961)of the total effect,respectively.Conclusion Childhood trauma and its subtypes of emotional abuse and emotional neglect can not only directly but also indirectly through negative coping styles affect the severity of depression in depressed patients.