Abstract: Objective To explore the influence of childhood trauma and perceived stress in adolescents with anxiety depression disorder(ADD), in order to provide evidence for clinical psychotherapy of adolescents with ADD. Methods From January 2020 to January 2021, a total of 120 adolescents with ADD, who were first hospitalized in Hangzhou Seventh People's Hospital, were divided into ADD group and non-ADD group according to the anxiety/somatization factor score of Hamilton Depression Scale-17(HAMD₁₇), with 60 patients in each group. HAMD₁₇, Childhood Trauma Questionnaire (CTQ-SF) and Chinese Perceived Stress Scale (CPSS) were used to measure the level of depression, childhood trauma and perceived stress. Then the differences of the two groups were compared, and the relationship model among the level of anxiety depression, childhood trauma and perceived stress in ADD group was analyzed. Results 1) There were no significant differences between ADD group and non-ADD group in age, gender, only child or not, years of education and course of depression (P>0.05). 2) The total scores of HAMD₁₇, emotional abuse, emotional neglect, physical abuse, the total score of childhood trauma, tension, loss of control and the total score of perceived stress in the ADD group were significantly higher than those in non-ADD group (t=3.558, 11.374, 5.333, 4.080, 7.796, 8.829, 11.854, 13.276, P<0.01). 3) The total score of HAMD₁₇ in ADD group was positively correlated with the total score of childhood trauma, tension, loss of control and the total score of perceived stress (r=0.415 - 0.590, P<0.01); the total score of childhood trauma in ADD group was positively correlated with tension, loss of control and the total score of perceived stress (r=0.306 - 0.390, P<0.01). 4) Perceived stress had a direct pathway effect on anxiety depression in ADD group (β=0.81, P<0.001), and childhood trauma had an indirect pathway effect on anxiety depression through perceived stress in ADD group (β=0.567, P<0.001). Conclusions Adolescents with anxiety depression disorder have more traumatic experiences in childhood and higher perceived stress level. Perceived stress not only has a direct effect on anxiety depression, but also completely mediates the influence of childhood trauma on anxiety depression.

Key words: anxiety depression disorder, childhood trauma, perceived stress, adolescent

摘要： 目的 探讨童年期创伤与知觉压力对青少年焦虑性抑郁障碍(ADD)的影响,为青少年ADD的临床心理治疗提供数据支持。方法 2020年1月—2021年1月首发入住杭州市第七人民医院青少年抑郁障碍患者120例,根据汉密尔顿抑郁量表-17(HAMD₁₇)焦虑/躯体化因子得分分为焦虑性抑郁障碍组(ADD组)和非焦虑性抑郁障碍组(nADD组),每组各60例。分别运用HAMD₁₇、童年期创伤问卷(CTQ-SF)、中文版压力知觉量表(CPSS)测量抑郁水平、童年期创伤和知觉压力水平,比较两组之间的差异,并分析ADD组童年期创伤与知觉压力对焦虑性抑郁的影响模式。结果 1)ADD组与nADD组在年龄、性别、是否独生子女、受教育年限及抑郁病程方面的差异无统计学意义(P>0.05);2)ADD组HAMD₁₇总分、情感虐待、情感忽视、躯体虐待、童年期创伤总分、紧张感、失控感及知觉压力总分高于nADD组,差异有统计学意义(t=3.558、11.374、5.333、4.080、7.796、8.829、11.854、13.276,P<0.01);3)ADD组HAMD₁₇总分与童年期创伤总分、紧张感、失控感及知觉压力总分呈正相关(r=0.415~0.590,P<0.01);ADD组童年期创伤总分与紧张感、失控感及知觉压力总分呈正相关(r=0.306~0.390,P<0.01);4)ADD组知觉压力对焦虑性抑郁有直接路径影响效应(β=0.81,P<0.001),童年期创伤通过知觉压力对焦虑性抑郁有间接路径影响效应(β=0.567,P<0.001)。结论 焦虑性抑郁障碍青少年存在较多的童年期创伤经历和较高的知觉压力水平,知觉压力对焦虑性抑郁不仅具有直接影响,而且在童年期创伤对焦虑性抑郁的影响关系中起着完全中介作用。

关键词: 焦虑性抑郁, 童年期创伤, 知觉压力, 青少年