抑郁障碍青少年自伤行为影响因素分析

杨春; 张瑞

doi:10.16835/j.cnki.1000-9817.2021.06.019

抑郁障碍青少年自伤行为影响因素分析

doi: 10.16835/j.cnki.1000-9817.2021.06.019

杨春¹,
张瑞^2, ,

1.
第904医院常州医疗区青少年儿童心理中心，江苏常州 213000
2.
第904医院常州医疗区军事精神医学科

详细信息

作者简介:
杨春(1984-)，女，安徽天长人，大学本科，主治医师，主要研究方向为青少年儿童心理行为障碍诊疗

通讯作者:
张瑞，E-mail：113487439@qq.com

中图分类号: B844.2 R179 R193
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- 被引次数: 0
出版历程
- 收稿日期: 2020-10-19
- 修回日期: 2021-02-09
- 网络出版日期: 2021-06-22
- 刊出日期: 2021-06-25

Associated factors of non-suicidal self-injury behavior in adolescents with depression disorder

YANG Chun¹,
ZHANG Rui^{2
, ,}

1.
Psychological Center for Teenagers and Children, 904 Hospital Changzhou Medical District, Changzhou(213000), Jiangsu Province, China

摘要

摘要: 目的探讨分析抑郁障碍青少年自伤行为影响因素，为开展临床干预和治疗提供参考。方法选取2015年1月至2017年1月在第904医院门诊就诊的80例14~18岁抑郁障碍青少年，采用艾森克人格问卷、父母养育方式量表、自伤行为评定量表进行问卷调查。结果男性抑郁障碍患者(76.74%)自伤行为报告率较女性高(54.05%)，母亲文化程度高的患者自伤行为报告率较高(77.78%)(χ²值分别为4.58，6.11，P值均 < 0.05)。存在自伤行为的患者内外向性因子得分(5.22±2.82)低于无自伤行为的患者(8.85±2.93)，神经质、精神质、掩饰性等因子得分[(14.53±3.94)(5.60±1.58)(12.94±0.54)]均高于无自伤行为的患者[(11.55±5.71)(3.13±1.43)(12.09±0.55)](t值分别为-5.37，2.74，6.82，6.31，P值均 < 0.05)；存在自伤行为的患者“父亲惩罚严厉”“父亲过分干涉”“父亲拒绝否认”“母亲拒绝否认”等因子得分[(21.57±4.65)(21.73±4.38)(14.25±5.08)(20.34±4.64)]均高于无自伤行为的患者[(18.50±7.53)(18.77±3.55)(11.58±2.97)(16.55±6.32)](t值分别为2.25，3.04，2.96，3.05，P值均 < 0.05)；Logistic回归分析结果显示，男性、母亲文化程度高及艾森克人格问卷中内外向性、神经质、精神质因子得分 < 38.5及 > 61.5分与抑郁障碍青少年患者发生自伤行为均呈正相关(OR值分别为1.99，2.31，1.71，2.52，1.98，P值均 < 0.05)。结论性别、母亲文化程度及症状自评为抑郁障碍青少年自伤行为的影响因素，应引起家庭、社会和学校的重视。
- 抑郁 /
- 精神障碍 /
- 自我伤害行为 /
- 精神卫生 /
- 回归分析 /
- 青少年
Abstract: Objective To explore associated factors of non-suicidal self-injury in adolescents with depression, and to provide a reference for clinical intervention and treatment. Methods A cross-sectional survey was conducted among 80 adolescents aged 14-18 years with depressive disorder who visited an outpatient clinic in the PLA 904nd Hospital from January 2015 to January 2017. Eysenck Personality Questionnaire(EPQ), Egma Minnenav Bsrdndosnauppforstran (EMBU), non-suicidal self-injury behavior rating scale were used to investigate them. Results Male patients with depression had more non-suicidal self-injury than female patients(76.74% vs. 54.05%), and patients with highly educated mothers had more non-suicidal self-injury(77.78%)(χ²=4.58, 6.11, P < 0.05). Self-injury behavior in patients with internal and external (E) the orientation factor score (5.22±2.82) was lower than the score of the patients without self-injury behavior(8.85±2.93)(t=-5.37, P < 0.05), neuroticism (N), while psychoticism (P) and hide(L) score [(14.53±3.94) (5.60±1.58) (12.94±0.54)] were higher than patients without self-injury behavior [(11.55±5.71) (3.13±1.43) (12.09±0.55)](t=2.74, 6.82, 6.31, P < 0.05); Factors such as "severe paternal punishment" "paternal excessive interference" "paternal refusal to deny" "maternal refusal to deny" and other factors in patients with non-suicidal self-injury [(21.57±4.65) (21.73±4.38) (14.25±5.08) (20.34±4.64)] were all higher than those without non-suicidal self-injury [(18.50±7.53) (18.77±3.55) (11.58±2.97) (16.55±6.32)](t=2.25, 3.04, 2.96, 3.05, P < 0.05); Logistic regression analysis showed that males, mothers with high educational level, and E, N, P (< 38.5 and > 61.5) were associated with non-suicidal self-injury behavior in adolescents with depression(OR=1.99, 2.31, 1.71, 2.52, 1.98, P < 0.05). Conclusion Gender, maternal education and symptom score were the important factors influencing non-suicidal self-injury.It is necessary to arouse the attention of the family, society and school.
- Depression /
- Mental disorders /
- Self-injurious behavior /
- Mental health /
- Regression analysis /
- Adolescent

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表 1 不同特征抑郁障碍青少年自伤行为报告率比较

Table 1. Comparison of reported rates of non-suicidal self-injury behavior among adolescents with depression of different characteristics

组别	选项	人数	有自伤行为	χ²值	P值
性别	男	43	33(76.74)	4.58	0.03
	女	37	20(54.05)
家庭经济收入	高	41	24(58.54)	2.24	0.13
	低	39	29(74.36)
居住地	城镇	40	25(62.50)	0.50	0.48
	农村	40	28(70.00)
父亲文化程度	高	39	24(61.54)	0.76	0.39
	低	41	29(70.73)
母亲文化程度	高	45	35(77.78)	6.11	0.01
	低	35	18(51.43)
注： ()内数字为报告率/%。

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表 2 有无自伤行为抑郁障碍青少年艾森克人格问卷得分比较(x±s)

Table 2. Comparison of EPQ scores among adolescents with depression(x±s)

自伤行为	人数	内外向性	神经质	精神质	掩饰性	总分
有	53	5.22±2.82	14.53±3.94	5.60±1.58	12.94±0.54	35.12±3.47
无	27	8.85±2.93	11.55±5.71	3.13±1.43	12.09±0.55	41.25±5.11
t值		-5.37	2.74	6.82	6.31	-5.62
P值		< 0.01	< 0.05	< 0.05	< 0.05	< 0.01

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表 3 有无自伤行为抑郁障碍青少年患者EMBU得分比较(x±s)

Table 3. Comparison of EMBU scores in adolescents with depression(x±s)

自伤行为	人数	父亲					母亲					总分
自伤行为	人数	情感温暖理解	惩罚严厉	过分干涉	拒绝否认	过度保护	情感温暖理解	过分干涉与保护	拒绝否认	惩罚严厉	偏爱被试	总分
有	53	43.06±8.72	21.57±4.65	21.73±4.38	14.25±5.08	10.86±2.63	44.38±10.90	37.29±7.38	20.34±4.64	15.88±4.13	10.78±3.12	187.45±21.22
无	27	41.26±7.22	18.50±7.53	18.77±3.55	11.58±2.97	10.71±2.62	40.68±10.01	34.45±8.06	16.55±6.32	15.28±7.93	10.56±3.54	112.37±18.21
t值		0.92	2.25	3.04	2.96	0.24	1.48	1.58	3.05	0.45	0.29	14.68
P值		0.36	0.03	0.00	0.01	0.81	0.14	0.12	0.00	0.66	0.78	<0.01

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表 4 抑郁障碍青少年发生自伤行为影响因素的Logistic回归分析(n=80)

Table 4. Logistic regression analysis of the influence factors of non-suicidal self-injury on adolescents with depression(n=80)

自变量	β值	标准误	Wald χ²值	P值	OR值(OR值95%CI)
性别	0.76	0.25	14.58	< 0.01	2.13(1.32~3.44)
母亲文化程度	1.11	0.28	20.48	< 0.01	3.02(1.75~5.21)
EPQ得分 < 38及 > 65分	1.03	0.31	15.61	< 0.01	5.16(2.88~9.21)
EMBU得分	1.87	0.41	20.55	< 0.01	1.38(1.25~1.75)
注：性别以女为参照，母亲文化程度以低为参照，EPQ得分以38~65为参照。

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参考文献(14)

[1]	赵小红, 韩友霞. 行为活化对高校抑郁焦虑学生心理健康和行为习惯的影响[J]. 中国学校卫生, 2020, 41(7): 1036-1039, 1043. https://www.cnki.com.cn/Article/CJFDTOTAL-XIWS202007024.htm ZHAO X H, HAN Y X. Effects of behaviral activation on mental health and habitual behaviors among college students with depression and anxiety[J]. Chin J Sch Health, 2020, 41(7): 1036-1039, 1043. https://www.cnki.com.cn/Article/CJFDTOTAL-XIWS202007024.htm
[2]	汪小燕, 蒋志成, 徐慧琼, 等. 中学生童年期虐待与非自杀性自伤行为的关联[J]. 中国学校卫生, 2020, 41(4): 514-517. https://www.cnki.com.cn/Article/CJFDTOTAL-XIWS202004011.htm WANG X Y, JIANG Z C, XU H Q, et al. Relationship between childhood abuse experience and non-suicidal self-injury in middle school students[J]. Chin J Sch Health, 2020, 41(4): 514-517. https://www.cnki.com.cn/Article/CJFDTOTAL-XIWS202004011.htm
[3]	朱妍, 李淑英, 吕培培, 等. 青少年首发抑郁症患者前扣带回和杏仁核功能连接异常改变研究[J]. 中华行为医学与脑科学杂志, 2018, 27(6): 505-510. doi: 10.3760/cma.j.issn.1674-6554.2018.06.005 ZHU Y, LI S Y, LYU P P, et al. Abnormal changes of functional connectivity between anterior cingulate cortex and amygdala in adolescents patients with first-episode depression[J]. Chin J Behav Med Brain Sci, 2018, 27(6): 505-510. doi: 10.3760/cma.j.issn.1674-6554.2018.06.005
[4]	李淑英, 朱妍, 王源莉, 等. 青少年首发抑郁症患者默认网络的功能连接改变[J]. 中华医学杂志, 2017, 97(45): 3538-3542. doi: 10.3760/cma.j.issn.0376-2491.2017.45.005 LI S Y, ZHU Y, WANG Y L, et al. Dysfunctional resting-state connectivity of default mode network in adolescent patients with first-episode drug-naive major depressive disorder[J]. National Med J China, 2017, 97(45): 3538-3542. doi: 10.3760/cma.j.issn.0376-2491.2017.45.005
[5]	MUEHLENKAMP J J, XHUNGA N, BRAUSCH A M. Self-injury age of onset: a risk factor for NSSI severity and suicidal behavior[J]. Arch Suic Res, 2019, 23(4): 551-563. doi: 10.1080/13811118.2018.1486252
[6]	龚耀先. 艾森克个性问卷在我国的修订[J]. 心理科学通讯, 1984(4): 13-20, 67. https://www.cnki.com.cn/Article/CJFDTOTAL-XLKX198404003.htm GONG Y X. Revision of Eysenck Personality Questionnaire in China[J]. J Psycholog Sci, 1984(4): 13-20, 67. https://www.cnki.com.cn/Article/CJFDTOTAL-XLKX198404003.htm
[7]	岳冬梅. 父母教养方式: EMBU的初步修订及其在神经症患者的应用[J]. 中国心理卫生杂志, 1993, 7(3): 97-101. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXWS199303000.htm YUE D M. Parent cultivation method: preliminary revision of EMBU and its application in patients with neurosis[J]. Chin Mental Health J, 1993, 7(3): 97-101. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXWS199303000.htm
[8]	黄颖, 覃青, 林琳, 等. 青少年重度抑郁患者自伤行为及危险因素研究[J]. 医学与哲学, 2020, 41(8): 43-46. https://www.cnki.com.cn/Article/CJFDTOTAL-YXZX202008010.htm HUANG Y, QIN Q, LIN L, et al. A study on status and risk factors of self-injury in major depressive disorder adolescents[J]. Med Philos, 2020, 41(8): 43-46. https://www.cnki.com.cn/Article/CJFDTOTAL-YXZX202008010.htm
[9]	王萍. 帕罗西汀联合无抽搐电休克治疗对难治性抑郁症的临床效果及认知功能的影响[J]. 临床医学研究与实践, 2018, 3(13): 46-47. https://www.cnki.com.cn/Article/CJFDTOTAL-YLYS201813019.htm WANG P. Effect of paroxetine combined with non-convulsive electrical shock treatment in refractory depression and its influence on cognitive function[J]. Clin Res Pract, 2018, 3(13): 46-47. https://www.cnki.com.cn/Article/CJFDTOTAL-YLYS201813019.htm
[10]	PAUL E H, MUSTAFA M H, SARAH H L, et al. Subcallosal cingulate deep brain stimulation for treatment-resistant depression: a multisite, randomised, sham-controlled trial[J]. Lancet Psychiatry, 2017, 4(11): 839. doi: 10.1016/S2215-0366(17)30371-1
[11]	胡燕, 徐慧琼, 万宇辉, 等. 安徽省中学生非自杀性自伤行为现状及其影响因素[J]. 中华疾病控制杂志, 2020, 24(8): 923-928. https://www.cnki.com.cn/Article/CJFDTOTAL-JBKZ202008012.htm HU Y, XU H Q, WAN Y H, et al. The status and influencing factors of non-suicidal self-injury among middle school students in Anhui Province[J]. Chin J Dis Control Prev, 2020, 24(8): 923-928. https://www.cnki.com.cn/Article/CJFDTOTAL-JBKZ202008012.htm
[12]	LIM K S, WONG C H, MCINTYRE R S, et al. Global lifetime and 12-month prevalence of suicidal behavior, deliberate self-harm and non-suicidal self-injury in children and adolescents between 1989 and 2018: a meta-analysis[J]. Int J Environ Res Public Health, 2019, 16(22): 4581. doi: 10.3390/ijerph16224581
[13]	JOLANTA M, LORI L P, WILLIAM F H, et al. Outcome expectations and osteoarthritis: association of perceived benefits of exercise with self-efficacy and depression[J]. Arthrit Care Res, 2017, 69(4): 491-498. doi: 10.1002/acr.22969
[14]	钟怡, 杨亚婷, 张叶蕾, 等. 童年创伤对青少年抑郁症患者非自杀性自伤行为的影响[J]. 中华精神科杂志, 2020, 53(6): 520-526. doi: 10.3760/cma.j.cn113661-20200107-00004 ZHONG Y, YANG Y T, ZHANG Y L, et al. Childhood trauma experiences and their impact on non-suicidal self-injury in adolescents with first episode depressive disorder[J]. Chin J Psychiatry, 2020, 53(6): 520-526. doi: 10.3760/cma.j.cn113661-20200107-00004