焦虑在青少年抑郁症伴非自杀性自伤行为中的近端作用及改良认知行为疗法的干预效果：一项生态瞬时评估研究[基金项目：江西省卫生健康委科技计划项目（项目名称：认知行为疗法对青少年抑郁症伴非自杀性自伤行为的治疗效果时变特征研究：基于生态瞬时评估法

The proximal role of anxiety in adolescent depression with non suicidal self harm behavior and the intervention effect of improved cognitive-behavioral therapy: an ecological transient assessment study

中文关键词:  【】青少年  抑郁症  生态瞬时评估法  非自杀性自伤行为  负性情绪

英文关键词:Adolescents  Depression  Ecological momentary assessment  Cognitive behavioral therapy  Non-suicidal self-injury behavior  Negative emotions

中文摘要:

      背景　近年来，青少年抑郁症的发病率不断上升，而非自杀性自伤（NSSI）行为在该人群中也日益凸显，可能增加其自杀风险，构成了严峻的公共卫生问题。焦虑、抑郁等负性情绪与NSSI行为密切相关，既往研究多依赖回顾性报告，难以动态捕捉情绪波动与NSSI行为的时序关联，且认知行为治疗（CBT）在干预NSSI行为时往往缺乏针对近端诱因的靶向设计。目的 采用生态瞬时评估（EMA）动态验证焦虑是青少年抑郁症患者非自杀性自伤（NSSI）行为的近端触发因子，并评估整合EMA数据的改良CBT对降低其焦虑及自伤欲望的效果。方法　采用前瞻性队列研究设计，选取2024年1月—12月在九江市第五人民医院治疗、符合《精神障碍诊断与统计手册（第5版）》（DSM-5）抑郁症诊断标准且存在NSSI行为史的青少年患者132例。采用智能手机EMA程序，对受试者进行连续14天的自然情境情绪监测。监测时间为每日10:00至22:00，每2小时随机推送一次评估。评定工具包括焦虑自评量表（SAS）和正性负性情绪量表（PANAS）中的负性情绪分量表，并实时记录NSSI行为及其发生前后的情绪状态。采用重复测量方差分析，比较NSSI行为发生前后各量表评分的动态变化。对完成EMA数据采集的83例受试者实施为期12周、每周1次的改良CBT。于干预前后，采用SAS评定焦虑水平，采用渥太华自我伤害调查表（OSI）评定自伤欲望。结果　 EMA数据显示，NSSI行为发生前1~2小时，SAS评分高于基线期[（56.19±11.06）分vs. （52.83±10.25）分，P<0.01]。SAS评分与NSSI行为评分呈正相关（r=0.460，P<0.01，95% CI：0.310~0.580）。接受改良CBT干预后，SAS评分[（52.30±8.10）分vs.（48.70±7.30）分，P<0.01，Cohen’s d=0.420]、OSI自伤冲动分量表评分[（12.80±2.70）分vs.（9.60±2.50）分，P<0.01，Cohen’s d=0.510]均低于干预前。结论 焦虑可能是青少年NSSI行为的近端触发因素，整合EMA数据的改良CBT可能有助于降低抑郁青少年的焦虑水平和自伤欲望。

英文摘要:

      【Abstract】 Background In recent years, the incidence rate of adolescent depression is rising, and non suicidal self injury (NSSI) behavior is also increasingly prominent in this population, which constitutes a serious public health problem. NSSI behavior is closely related to negative emotions such as anxiety and depression, and it may increase the risk of suicide. Existing research relies heavily on retrospective reports, making it difficult to dynamically capture the temporal correlation between emotional fluctuations and NSSI behavior. Additionally, cognitive-behavioral therapy (CBT) programs often lack targeted design for proximal triggers when intervening in NSSI behavior. Objective To dynamically verify anxiety as a proximal trigger factor for NSSI behavior using ecological momentary assessment (EMA), and to evaluate the effectiveness of improved cognitive-behavioral therapy (CBT) integrating EMA data in reducing anxiety and self injury desire. Methods A prospective cohort study design was adopted to select 132 adolescent patients who were treated at the Fifth People's Hospital of Jiujiang City from January 2024 to December 2024, met the diagnostic criteria for depression in the Diagnostic and Statistical Manual of Mental Disorders (5th edition) (DSM-5), and had a history of NSSI behavior. Using a smartphone EMA program to monitor participants' natural situational emotions for 14 consecutive days (10:00-22:00 daily, randomly pushed every 2 hours). The assessment tools include the Self Rating Anxiety Scale (SAS) and the Negative Affect Scale (PANAS) Negative Affect Scale to evaluate the immediate intensity of emotions such as anxiety, anger, and self disgust, and to record NSSI behavioral events and pre - and post emotional states in real time. Using repeated measures analysis of variance to compare the dynamic changes in emotional scores before and after NSSI behavior. Implement a modified CBT intervention once a week for 12 weeks on 83 subjects who completed EMA. Before and after intervention, SAS was used to assess anxiety levels, and Ottawa Self Injury Survey (OSI) was used to assess self harm desire.Results EMA data shows that 1-2 hours before NSSI behavior occurs, SAS scores are higher than baseline [(56.19±11.06) points vs. (52.83±10.25) points, P<0.01].The SAS score is positively correlated with the NSSI behavior score (r=0.460,P<0.01, 95% CI:0.310-0.580). After receiving the modified CBT intervention, the SAS score [(52.30±8.10) vs. (48.70±7.30), P<0.01, Cohen's d=0.420] and OSI Self Injury Impulsive Scale score [(12.80 ±2.70) vs. (9.60±2.50), P<0.01, Cohen's d=0.510] were both lower than before the intervention.Conclusion Anxiety may be a proximal trigger for non suicidal self injury (NSSI) behavior in adolescents, and an improved CBT protocol that integrates real-time emotional data may help reduce anxiety levels and self injury desires in depressed adolescents.