目的 研究儿童青少年焦虑障碍和抑郁障碍患者非自杀性自伤(NSSI)行为的特点,为临床干预提供理论基础。方法 采用方便抽样方法,自2019年10月—2023年10月在上海市精神卫生中心儿童青少年心理咨询门诊抽样135例有自伤行为的受试者进行调查。使用渥太华自我伤害问卷测量自伤方式和动机,儿童抑郁筛查量表,儿童焦虑性情绪筛查量表,父母养育方式,童年创伤问卷,中学生应对方式问卷测量焦虑抑郁症状水平、养育环境及应对特点。采用独立样本t检验和χ2检验比较两组间差异。结果 共计135名9~17岁被试,其中焦虑障碍伴NSSI者37人,抑郁障碍伴NSSI者98人。相比于焦虑障碍组,儿童青少年抑郁障碍伴NSSI组更多的自伤部位为手臂(χ2=4.22, P=0.04)。抑郁障碍伴NSSI组切割方式检出率显著高于焦虑组(χ2=4.92, P=0.03),焦虑障碍伴NSSI组啃咬指甲的方式显著高于抑郁障碍伴NSSI组(χ2=5.11, P=0.02)。相比于焦虑障碍伴NSSI组,抑郁障碍伴NSSI患者的自伤动机中更多为了感觉寻求(P<0.05)。抑郁障碍伴NSSI组儿童青少年在童年期经历更多的情感忽视/虐待、躯体忽视/虐待(P<0.05),更少感受到父亲和母亲的情感温暖(P<0.05),更少使用问题解决应对方式(P<0.05)。结论 焦虑障碍和抑郁障碍伴NSSI儿童青少年自伤部位和自伤动机特点不同,干预时需要设计针对性方案。
Abstract
Objective To explore the characteristics of non-suicidal self-injury (NSSI) behaviors in children and adolescents with anxiety disorders and depressive disorders, in order to provide a theoretical basis for clinical interventions. Methods From October 2019 to October 2023, 135 subjects were investigated through convenience sampling method from the Child and Adolescent Psychological Counseling Clinic at the Shanghai Mental Health Center between October 2019 and October 2023.The Ottawa Self-Injury Questionnaire was used to measure self-injury methods and motivations.The Children′s Depression Inventory, the Screen for Child Anxiety Related Emotional Disorders, the Parental Bonding Instrument, the Childhood Trauma Questionnaire, and the Coping Style Questionnaire for Middle School Students were employed to assess levels of anxiety and depression, parenting environment, and coping characteristics.Independent sample t-tests and chi-square tests were used to compare differences between the two groups. Results A total of 135 participants aged 9 to 17 were included, with 37 having anxiety disorders accompanied by NSSI and 98 having depressive disorders accompanied by NSSI.Compared to the anxiety disorder group, the depressive disorder group with NSSI exhibited more detection rates of self-injury on the arms (χ2=4.22, P=0.04).The rate of cutting as a method of self-injury was significantly higher in the depressive disorder group with NSSI than in the anxiety disorder group (χ2=4.92, P=0.03), while nail-biting was significantly more common in the anxiety disorder group with NSSI than in the depressive disorder group with NSSI (χ2=5.11, P=0.02).Compared to the anxiety disorder group with NSSI, the depressive disorder group with NSSI had a higher motivation for sensation-seeking (P<0.05).The depressive disorder group with NSSI also experienced more emotional neglect/abuse and physical neglect/abuse during childhood, felt less emotional warmth from both parents, and used problem-solving coping strategies less frequently (P<0.05). Conclusions Children and adolescents with anxiety disorders and depressive disorders accompanied by NSSI exhibit different characteristics in terms of self-injury locations and motivations.Therefore, targeted intervention plans should be designed.
关键词
焦虑障碍 /
抑郁障碍 /
青少年 /
非自杀性自伤
Key words
anxiety disorder /
depressive disorder /
adolescent /
non-suicidal self-injury
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基金
科技创新2030(2022ZD0209100);徐汇区卫生健康委员会重要疾病联合攻关项目(XHLHGG202106);上海市卫生健康委员会技术标准项目(23DZ2203100);上海市卫生健康委员会卫生行业临床研究专项(20214Y0162);上海市精神卫生中心飞翔计划人才项目(2024-FX-04);上海市教委科研创新计划(2021-01-07-00-02-E0086);上海市加强公共卫生体系建设三年行动计划(2023—2025年)重点学科建设项目(GWVI-11.1-33)
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