山东省青少年阈下抑郁及精神病性体验与非自杀性自伤的关联

闵令桂; 刘小群; 尹训宝; 于悦; 王铮

doi:10.16835/j.cnki.1000-9817.2024035

山东省青少年阈下抑郁及精神病性体验与非自杀性自伤的关联

doi: 10.16835/j.cnki.1000-9817.2024035

1.
潍坊医学院心理学院，山东 261053
2.
中南大学湘雅公共卫生学院儿少卫生与妇幼保健系
3.
潍坊学院教师教育学院
4.
齐鲁师范学院教师教育学院

基金项目:

山东省教育科学“十四五”规划项目 2021YB048

湖南省哲学社会科学基金一般项目 22YBA013

详细信息

作者简介:
闵令桂(1987-)，女，山东济宁人，在读硕士，主要研究方向为儿童青少年心理健康

通讯作者:
王铮，E-mail: 492443882@qq.com

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R179 C913.5 B844.2
计量
- 文章访问数: 136
- HTML全文浏览量: 79
- PDF下载量: 29
- 被引次数: 0
出版历程
- 收稿日期: 2023-10-08
- 修回日期: 2023-12-17
- 网络出版日期: 2024-02-01
- 刊出日期: 2024-01-25

Association between subthreshold depression and psychotic-like experiences with non-suicidal self-injury among adolescents in Shandong Province

1.
School of Psychology, Weifang Medical University, Weifang(261053), Shandong Province, China

摘要

摘要: 目的探讨山东省青少年阈下抑郁和精神病性体验(PLEs)及其交互作用与非自杀性自伤(NSSI)行为的关联，为青少年NSSI的预防和早期干预提供参考依据。方法于2023年3—4月，采用分层整群随机抽样的方法，在山东省沿海和内陆分别各抽取2座城市中6 090名13~22岁大中学生施测。使用非自杀性自伤行为评定问卷、简式版社区心理体验评估问卷(CAPE-P8)、流调中心抑郁量表(CES-D)进行电子问卷调查，采用多因素Logistic回归分析青少年阈下抑郁和PLEs及其交互作用与NSSI的关联。结果青少年NSSI检出率为21.3%，单因素分析发现年龄在13~15岁青少年NSSI报告率最高(27.9%)，有阈下抑郁和PLEs者NSSI报告率分别为49.9%，30.7%。多因素分析结果显示，存在阈下抑郁青少年发生NSSI的风险是无抑郁青少年的3.47倍[OR值(95%CI)=3.47(2.68~4.50)]；有PLEs者发生NSSI的风险是未检出者的5.32倍[OR值(95%CI)=5.32(4.10~6.89)]，阈下抑郁与PLEs同时存在时发生NSSI的风险是均未检出者的18.47倍[OR值(95%CI)=18.47(14.75~23.13)](P值均 < 0.01)；超额危险度(RERI)、交互作用归因比(AP)和协同指数(S)分别为11.44, 0.61, 2.89，即阈下抑郁和PLEs对青少年NSSI的相加交互作用占比为61%。结论阈下抑郁和精神病性体验与青少年NSSI相关且存在相加交互作用。缓解青少年阈下抑郁并降低精神病性体验，对预防NSSI的发生具有积极作用。
- 阈下抑郁 /
- 精神病性体验 /
- 自我伤害行为 /
- 精神卫生 /
- 回归分析 /
- 青少年
Abstract: Objective To investigate the association between subthreshold depression, psychotic-like experiences (PLEs), and their interactions with non-suicidal self-injury (NSSI) in adolescents from Shandong, so as to provide a reference for the prevention and early intervention of NSSI in adolescents. Methods A random cluster sampling method was used to select a total of 6 090 adolescents aged 13-22 from two cities along the coast and inland of Shandong Province. Electronic surveys were administered using the Self-Injurious Behavior Questionnaire, Community Assessment of Psychic Experience-positive 8 items(CAPE-P8), and the Center for Epidemiological Studies Depression Scale(CES-D). The relationship between subthreshold depression, PLEs, and their interaction with NSSI was analyzed using multivariate Logistic regression. Results The detection rate of NSSI among adolescents was 21.3%. The highest NSSI reporting rate (27.9%) was found in the age group of 13-15 years.The NSSI reporting rates for those detected with subthreshold depression and PLEs were 49.9% and 30.7%, respectively. Multivariate analysis indicated that individuals with subthreshold depression were 3.47 times more likely to engage in NSSI [OR(95%CI)=3.47(2.68-4.50)]. Those identified with PLEs had 5.32 times higher risk of engaging in NSSI than those without such experiences [OR(95%CI)=5.32(4.10-6.89)]. When both subthreshold depression and PLEs coexist, the risk of engaging in NSSI was 18.47 times higher than in individuals with neither condition [OR(95%CI)=18.47(14.75-23.13)] (P < 0.01). The relative excess risk due to interaction (RERI), attributable proportion (AP), and synergy index (S) were 11.44, 0.61, and 2.89, respectively, indicating that the combined interaction of subthreshold depression and PLEs accounted for 61% of adolescent NSSI. Conclusions Subthreshold depression and psychotic-like experiences are associated NSSI in adolescents and exhibit an additive interaction. Alleviating subthreshold depression in adolescents and reducing psychotic experiences may play a positive role in preventing the occurrence of NSSI.
- Sub-threshold depression /
- Psychotic-like experiences /
- Self-injurious behavior /
- Mental health /
- Regression analysis /
- Adolescent
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

HTML全文

表 1 不同组别青少年NSSI报告率比较

Table 1. Comparison of NSSI reporting rates among different groups of adolescents

组别	选项	人数	NSSI人数	χ²值	P值
性别	男	3 849	827(21.5)	0.31	0.58
	女	2 241	468(20.9)
年龄/岁	13~15	1 271	354(27.9)	42.33	＜0.01
	16~18	1 076	220(20.4)
	19~22	3 743	721(19.3)
居住地	农村	3 473	710(20.4)	3.25	0.07
	城镇	2 617	585(22.4)
独生子女	是	1 694	368(21.7)	0.29	0.59
	否	4 396	927(21.1)
留守经历	是	335	103(30.7)	19.06	＜0.01
	否	5 755	1 192(20.7)
家庭结构	单亲	335	91(27.2)	7.65	0.06
	双亲	4 335	914(21.1)
	重组	127	26(20.5)
	大家庭	1 293	264(20.4)
家庭月收入/元	＜5 000	2 525	586(23.2)	10.17	＜0.01
	5 000~10 000	2 655	521(19.6)
	＞10 000	910	188(20.7)
父母文化程度	高中及以下	5 230	1 094(20.9)	4.14	0.13
	大学	772	176(22.8)
	大学以上	88	25(28.4)
PLEs	无	2 415	168(7.0)	489.33	＜0.01
	有	3 675	1 127(30.7)
抑郁状态	无	5 273	887(16.8)	463.39	＜0.01
	阈下抑郁	817	408(49.9)
注： ()内数字为报告率/%。

下载: 导出CSV

表 2 青少年阈下抑郁与PLEs与NSSI关联的Logistic回归分析(n=6 090)

Table 2. Logistic regression analysis of the association between subthreshold depression and PLEs with NSSI in adolescents (n=6 090)

自变量	选项	β值	标准误	Wald χ²值	P值	OR值(95%CI)
PLEs	有	1.67	0.14	159.20	< 0.01	5.32(4.10~6.89)
阈下抑郁	有	1.24	0.20	88.29	< 0.01	3.47(2.68~4.50)
PLEs×阈下抑郁		0.09	0.05	0.47	0.49	0.91(0.70~1.18)
阈下抑郁+PLEs	有阈下抑郁无PLEs	1.58	0.09	274.20	< 0.01	4.86(4.03~5.86)
	无阈下抑郁有PLEs	1.15	0.25	21.26	< 0.01	1.94(1.94~5.17)
	有阈下抑郁有PLEs	2.91	0.11	646.08	< 0.01	18.47(14.75~23.13)
注：相加交互项以“无阈下抑郁无PLEs”为参照。

下载: 导出CSV

参考文献(34)

[1]	TILTON-WEAVER L, LATINA D, MARSHALL S K. Trajectories of non-suicidal self-injury during adolescence[J]. J Adolesc, 2022, 95 (3): 437-453.
[2]	DE LUCA L, PASTORE M, PALLADINO B E, et al. The development of non-suicidal self-injury (NSSI) during adolescence: a systematic review and Bayesian Meta-analysis[J]. J Affect Disord, 2023, 339: 648-659. doi: 10.1016/j.jad.2023.07.091
[3]	AUERBACH R P, PAGLIACCIO D, ALLISON G O, et al. Neural correlates associated with suicide and non-suicidal self-injury in youth[J]. Biol Psychiatry, 2021, 89 (2): 119-133. doi: 10.1016/j.biopsych.2020.06.002
[4]	LAWRENCE H R, BALKIND E G, JI J L, et al. Mental imagery of suicide and non-suicidal self-injury: a Meta-analysis and systematic review[J]. Clin Psychol Rev, 2023, 103: 102302. doi: 10.1016/j.cpr.2023.102302
[5]	HERZOG S, CHOO T H, GALFALVY H, et al. Effect of non-suicidal self-injury on suicidal ideation: real-timemonitoring study[J]. Br J Psychiatry, 2022, 221: 485-487. doi: 10.1192/bjp.2021.225
[6]	袁勇, 干敏雷, 尹小俭, 等. 青少年非自杀性自伤行为与抑郁症状的相关性[J]. 中国学校卫生, 2023, 44 (5): 659-663. doi: 10.16835/j.cnki.1000-9817.2023.05.005 YUAN Y, GAN M L, YIN X J, et al. Correlation analysis between non-suicidal self-injury behavior and depressive symptoms in adolescents[J]. Chin J Sch Health, 2023, 44 (5): 659-663. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2023.05.005
[7]	CHEN T, FU W X, JI S F, et al. Relationship between borderline personality features, emotion regulation, and non-suicidal self-injury in depressed adolescents: a cross-sectional study[J]. BMC Psychiatry, 2023, 23(1): 293. doi: 10.1186/s12888-023-04800-1
[8]	VOLZ H P, STIRNWEIB J, KASPER S, et al. Subthreshold depression-concept, operationalisation and epidemiological data: a scoping review[J]. Int J Psychiatry Clin Pract, 2022, 27 (1): 92-106.
[9]	TUITHOF M, HAVE M T, VAN DORSSELAER S, et al. Course of subthreshold depression into a depressive disorder and its risk factors[J]. J Affect Disord, 2018, 241: 206-215. doi: 10.1016/j.jad.2018.08.010
[10]	LEE J Y, KIM H, KIM S Y, et al. Non-suicidal self-injury is associated with psychotic-like experiences, depression, and bullying in Korean adolescents[J]. Early Int Psychiatry, 2021, 15 (6): 1696-1704. doi: 10.1111/eip.13115
[11]	MARTIN G, THOMAS H, ANDREWS T, et al. Psychotic experiences and psychological distress predict contemporaneous and future non-suicidal self-injury and suicide attempts in a sample of Australian school-based adolescents[J]. Psychol Med, 2014, 45(2): 429-437.
[12]	STEENKAMP L R, DE NEVE-ENTHOVE N G M, JOÃO A M, et al. Psychotic experiences, suicidality and non-suicidal self-injury in adolescents: independent findings from two cohorts[J]. Schizophr Res, 2023, 257: 50-57. doi: 10.1016/j.schres.2023.05.006
[13]	LEE K W, CHAN K W, CHANG W C, et al. A systematic review on definitions and assessments of psychotic-like experiences[J]. Early Int Psychiatry, 2016, 10 (1): 3-16. doi: 10.1111/eip.12228
[14]	ME'SZA'ROS G, GYORI D, HORVA'Th L O, et al. Non-suicidal self-injury: its associations with pathological internet use and psychopathology among adolescents[J]. Front Psychiatry, 2020, 11: 814.
[15]	陈祉妍, 杨小冬, 李新影. 流调中心抑郁量表在我国青少年中的试用[J]. 中国临床心理学杂志, 2009, 17 (4): 443-445, 448. CHEN Z Y, YANG X D, LI X Y. Psychometric features of CES-D in Chinese adolescents[J]. Chin J Clin Psychol, 2009, 17 (4): 443-445, 448. (in Chinese)
[16]	张少华, 桑标, 潘婷婷, 等. 不同抑郁症状青少年调节不同强度情绪时策略选择的差异[J]. 心理科学, 2022, 45 (3): 574-583. ZHANG S H, SANG B, PAN T T, et al. Emotion regulation choice of intensity and valence in adolescents with different depressive symptoms[J]. J Psychol Sci, 2022, 45 (3): 574-583. (in Chinese)
[17]	王东方, 孙梦, 席畅, 等. 简式版社区心理体验评估问卷的性别和纵向等值性[J]. 中国临床心理学杂志, 2020, 28(1): 41-45. WANG D F, SUN M, XI C, et al. Gender and longitudinal measurement invariance of the Community Assessment of Psychic Experiences-positive Subscale[J]. Chin J Clin Psychol, 2020, 28(1): 41-45. (in Chinese)
[18]	王东方, 张雯, 王思思, 等. 青少年精神病性体验及其社会影响因素: 基于城乡差异的实证分析[J]. 中国临床心理学杂志, 2019, 27(2): 302-305, 355. WANG D F, ZHANG W, WANG S S, et al. Psychotic-like experiences and associated socio-demographic factors among adolescents: comparison between urban and rural areas[J]. Chin J Clin Psychol, 2019, 27(2): 302-305, 355. (in Chinese)
[19]	万宇辉, 刘婉, 郝加虎, 等. 青少年非自杀性自伤行为评定问卷的编制及其信效度评价[J]. 中国学校卫生, 2018, 39(2): 170-173. doi: 10.16835/j.cnki.1000-9817.2018.02.005 WAN Y H, LIU W, HAO J H, et al. Development and evaluation on reliability and validity of Adolescent Non-suicidal Self-injury Assessment Questionnaire[J]. Chin J Sch Health, 2018, 39(2): 170-173. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2018.02.005
[20]	STEVENSON M, NUNES T, SANCHEZ J, et al. EpiR: a R package for the analysis of epidemiological data[J]. R Package Vers, 2008, 1(1): 9-30.
[21]	ANDERSSON T, ALFREDSSON L, KALLBERG H, et al. Calculating measures of biological interaction[J]. Eur J Epidemiol, 2005, 20(7): 575-579. doi: 10.1007/s10654-005-7835-x
[22]	袁悦, 李楠, 任爱国, 等. 流行病学研究中相加和相乘尺度交互作用的分析[J]. 现代预防医学, 2015, 42(6): 961-965, 975. YUAN Y, LI N, REN A G, et al. Analysis of the application of the additive model and the multiplicative statistical model in biologial interaction[J]. Mod Prev Med, 2015, 42(6): 961-965, 975. (in Chinese)
[23]	苟双玉, 杜美杰, 刘晓容, 等. 中国青少年非自杀性自伤检出率的Meta分析[J]. 现代预防医学, 2023, 50(2): 263-271. GOU S Y, DU M J, LIU X R, et al. Meta-analysis of the detection rate of non-suicidal self-injury among Chinese adolescents[J]. Mod Prev Med, 2023, 50(2): 263-271. (in Chinese)
[24]	PLENER P L, SCHUMACHER T S, MUNZ L M, et al. The longitudinal course of non-suicidal self-injury and deliberate self-harm: a systematic review of the literature[J]. Borderline Person Disord Emot Dysregul, 2015, 2: 2. doi: 10.1186/s40479-014-0024-3
[25]	陈艳艳, 周恩媛, 王雨, 等. 大学生阈下抑郁的运动干预及其机制研究进展[J]. 中国医药导报, 2023, 20(14): 52-55, 64. CHEN Y Y, ZHOU E Y, WANG Y, et al. Research progress on exercise intervention and mechanism in college student subthreshold depression[J]. Chin Med Herald, 2023, 20(14): 52-55, 64. (in Chinese)
[26]	NOYES B K, MUNOZ D P, KHAN S K, et al. Is subthreshold depression in adolescence clinically relevant?[J]. J Affect Disord, 2022, 309: 123-130. doi: 10.1016/j.jad.2022.04.067
[27]	BERTHA E A, BALÁZS J. Subthreshold depression in adolescence: a systematic review[J]. Eur Child Adolesc Psychiatry, 2013, 22(10): 589-603. doi: 10.1007/s00787-013-0411-0
[28]	吴芳, 罗学荣, 杨孟思, 等. 初中生校园欺凌不同角色的精神病样体验[J]. 中国心理卫生, 2022, 36(9): 774-779. doi: 10.3969/j.issn.1000-6729.2022.09.009 WU F, LUO X R, YANG M S, et al. Psychotic-like experiences between different roles of school bullying among junior school students[J]. Chin Ment Health J, 2022, 36(9): 774-779. (in Chinese) doi: 10.3969/j.issn.1000-6729.2022.09.009
[29]	BURKE T A, FOX K, KAUTZ M, et al. Real-time monitoring of the associations between self-critical and self-punishment cognitions and nonsuicidal self-injury[J]. Behav Res Ther, 2021, 137: 103775. doi: 10.1016/j.brat.2020.103775
[30]	HONINGS S, DRUKKER M, GROEN R, et al. Psychotic experiences and risk of self-injurious behaviour in the general population: a systematic review and Meta-analysis[J]. Psychol Med, 2016, 46(2): 237-251. doi: 10.1017/S0033291715001841
[31]	KARCHER N R, LOEWY R L, SAVILL M, et al. Persistent and distressing psychotic-like experiences using adolescent brain cognitive development study data[J]. Mol Psychiatry, 2021, 27(3): 1490-1501.
[32]	AUNJITSAKUL W, MCGUIRE N, MCLEOD H J, et al. Candidate factors maintaining social anxiety in the context of psychotic experiences: a systematic review[J]. Schizophr Bull, 2021, 47(5): 1218-1242.
[33]	AHLBOM A, ALFREDSSON L. Interaction: a word with two meanings creates confusion[J]. Eur J Epidemiol, 2005, 20(7): 563-564.
[34]	KNOL M J, VANDERWEELE T J, GROENWOLD R H H, et al. Estimating measures of interaction on an additive scale for preventive exposures[J]. Eur J Epidemiol, 2011, 26(6): 433-438.