摘要
目的探讨伴非自杀性自伤(NSSI)行为的抑郁障碍青少年临床特征,基于心理韧性-抑郁双路径模型分析童年创伤对NSSI行为的影响机制。方法采用病例对照研究,纳入99例12~18岁受试者,分为伴NSSI的抑郁患者(KD组,51例)、健康对照(NOR1组,24例)和无NSSI的抑郁患者(NOR^(2)组,24例)。通过童年创伤问卷(CTQ)、心理韧性量表(RSCA)和汉密顿抑郁量表(HAMD-24)评估相关因素,并运用结构方程模型分析心理韧性的中介作用及抑郁的调节效应。结果KD组84.3%存在童年创伤,主要为情感忽视(64.7%)和躯体忽视(50.1%);情感忽视(r=0.582,P<0.001)和躯体虐待(r=0.464,P=0.002)与NSSI行为显著相关。心理韧性中介效应分析表明,童年创伤经历通过降低心理韧性水平间接增加NSSI行为风险,间接效应占比45.7%(95%CI:15.3%~48.1%,P<0.01)。抑郁调节效应显示,在高抑郁组(HAMD-24≥20分)中,创伤对NSSI的影响更显著(β=0.603,P<0.01)。结论本研究揭示了童年期创伤(尤其是情感忽视与虐待)在伴NSSI的抑郁青少年中高度普遍(>84%)。研究构建并验证了有调节的中介模型,发现童年期创伤不仅直接预测NSSI,还通过削弱心理韧性产生中介作用,而抑郁症状在该路径中起双重调节作用。研究结果为临床干预提供多靶点依据,需系统筛查创伤、着力提升心理韧性并积极治疗抑郁症状。
Objective To investigate the clinical characteristics of depressive disorders in adolescents with non-suicidal self-injury(NSSI)behaviors and to analyze the impact mechanism of childhood trauma on NSSI through a psychological resilience-depression dual-pathway model.Methods A case-control study was conducted involving 99 participants aged 12~18 years,comprising 51 individuals with depression and NSSI(KD group),24 healthy controls(NOR1 group),and 24 patients with depression but without NSSI(NOR^(2)group).The Child⁃hood Trauma Questionnaire(CTQ),Resilience Scale for Chinese Adolescents(RSCA),and the 24-item Hamilton Depression Rating Scale(HAMD-24)were administered to assess childhood trauma,psychological resilience,and depressive symptom severity,respectively.Structural equation modeling was used to examine the mediating role of psychological resilience and the moderating effect of depression severity in the relationship between childhood trauma and NSSI.Results In the KD group,84.3%of participants reported experiencing childhood trauma,with emotional neglect(64.7%)and physical neglect(50.1%)being the most prevalent types.Emotional neglect(r=0.582,P<0.001)and physical abuse(r=0.464,P=0.002)were significantly associated with NSSI behaviors.Mediation analysis indicated that psychological resilience partially mediated the relationship between childhood trauma and NSSI,such that trauma exposure indirectly increased NSSI risk through reduced psychological resilience,with this indirect effect accounting for 45.7%(95%CI:15.3%~48.1%,P<0.01).Moderation analysis further revealed that the effect of trauma on NSSI was more pronounced among individuals with high levels of depression(HAMD-24≥20),where the association was statistically significant(β=0.603,P<0.01).Conclusions This study reveals that childhood trauma,particularly emotional neglect and abuse,is highly prevalent(>84%)among adolescents exhibiting depressive symptoms and NSSI.A moderated mediation model was constructed and vali⁃dated,demonstrating that childhood trauma not only directly predicts NSSI but also exerts an indirect effect through diminished psychological resilience,with depressive symptoms serving as a dual moderator in both the direct and indirect pathways.These findings offer a multi-targeted foundation for clinical interventions,highlighting the importance of systematic trauma screening,the promotion of psychological resilience,and the active manage⁃ment of depressive symptoms.
作者
蔡丽飞
王诗镔
邵华
罗国伟
肖雨晴
贾福军
CAI Lifei;WANG Shibin;SHAO Hua;LUO Guowei;XIAO Yuqing;JIA Fujun(Department of Psychiatry,Guangdong Provincial Mental Health Center,Guangdong Provincial People's Hospital(Guangdong Academy of Medical Sciences),Southern Medical University,Guangzhou 510000,Guangdong,China;Department of Psychiatry and Psychology,Guangdong Provincial People's Hospital Ganzhou Hospital,Ganzhou Municipal Hospital,Ganzhou 341000,Jiangxi,China;不详)
出处
《实用医学杂志》
北大核心
2025年第24期3824-3832,共9页
The Journal of Practical Medicine
基金
广东省中医药局科研项目(编号:20222029)。
关键词
童年期创伤
非自杀性自伤
心理韧性
抑郁障碍
结构方程模型
childhood trauma
non-suicidal self-harm
psychological resilience
depressive disorder
structural equation model
