青少年抑郁障碍患者家庭功能与非自杀性自伤行为的关系

Association Between Family Functioning and Non-Suicidal Self-Injury Among Adolescents with Depressive Disorders

中文关键词:  抑郁障碍  青少年  家庭功能  非自杀性自伤

英文关键词:Depressive disorders  Adolescents  Family functioning  Non-suicidal self-injury

中文摘要:

      背景 家庭功能是影响青少年抑郁障碍患者非自杀性自伤（NSSI）的复杂因素之一，既往研究将家庭功能视为单一结构，可能掩盖了特定维度对NSSI风险的不同影响。目的 探讨青少年抑郁障碍患者家庭功能的各维度与NSSI行为之间的关系，以期为存在NSSI行为的青少年抑郁障碍患者家庭的心理干预提供精准靶点。方法 本研究为横断面研究，纳入2025年1月—7月哈尔滨市第一专科医院门诊及住院的、符合《精神障碍诊断与统计手册（第5版）》（DSM-5）抑郁障碍诊断标准的217例青少年患者为研究对象。采用自编问卷、汉密尔顿抑郁量表17项版（HAMD-17）以及家庭功能评定量表（FAD）进行评定。采用单因素Logistic回归分析家庭功能各维度与NSSI的关联性，采用多因素Logistic回归检验家庭功能各维度对NSSI的独立效应。按性别、年龄、居住地、家庭月收入、独生子女与否进行亚组分析，检验家庭功能维度与NSSI的交互作用。结果 共204例（94.01%）青少年抑郁障碍患者完成有效问卷调查，其中，134例（65.69%）存在NSSI行为（NSSI组），70例（34.31%）无NSSI行为（非NSSI组）。与非NSSI组相比，NSSI组HAMD-17评分更高[（20.87±7.73）分 vs. （17.71±7.07）分，t=8.096，P=0.005]。此外，NSSI组FAD总评分[（155.68±21.84）分 vs. （148.87±22.72）分，t=4.348，P=0.038）及问题解决维度评分[（2.54±0.49）分 vs. （2.34±0.51）分，t=7.399，P=0.007]均高于非NSSI组。上述组间差异均具有统计学意义 (P<0.05)。Logistic回归分析结果显示，FAD总评分和问题解决维度评分与NSSI风险相关（OR=1.014，95% CI：1.001~1.028，P=0.041；OR=2.241，95% CI：1.228~4.090，P=0.009），在调整了性别、年龄、现居住地、受教育程度、家庭月收入、独生子女与否后，FAD总评分与NSSI无关联（OR=1.010，95% CI：0.995~1.025，P=0.185）；问题解决维度与NSSI风险仍呈相关性（OR=2.000，95% CI：1.028~3.889，P=0.041）。亚组分析显示，在性别上，家庭功能问题解决与NSSI风险存在交互作用（P交互=0.003）。结论 家庭功能中的问题解决能力降低可能是青少年抑郁障碍患者发生NSSI行为的危险因素。

英文摘要:

      Background Family functioning represents a complex factor influencing non-suicidal self-injury (NSSI) among adolescents with depressive disorders. Previous studies have often treated family functioning as a monolithic construct, potentially obscuring the differential effects of specific dimensions on NSSI risk. Objective This study aimed to explore the relationship between various dimensions of family functioning and NSSI behaviors in adolescents with depressive disorders, thereby identifying precise targets for psychological interventions in families of affected youth. Methods In this cross-sectional study, 217 adolescent patients diagnosed with depressive disorders according to the 《Diagnostic and Statistical Manual of Mental Disorders(5th edition)》(DSM-5) were recruited from outpatient and inpatient departments at Harbin First Psychiatric Hospital between January and July 2025. Assessments included a self-designed questionnaire, the 17-item Hamilton Depression Rating Scale (HAMD-17), and the Family Assessment Device (FAD). Univariate logistic regression analyzed associations between FAD dimensions and NSSI, while multivariate logistic regression evaluated independent effects of these dimensions. Subgroup analyses stratified by sex, age, residence, monthly family income, and single-child status examined interaction effects between family functioning dimensions and NSSI. Results Among 204 participants (94.01%) completing valid questionnaires, 134 (65.69%) exhibited NSSI (NSSI group) and 70 (34.31%) did not (non-NSSI group). The NSSI group demonstrated significantly higher HAMD-17 scores (20.87±7.73vs. 17.71±7.07, t= 8.096, P= 0.005). Additionally, the NSSI group showed elevated FAD total scores (155.68±21.84 vs. 148.87±22.72, t= 4.348, P= 0.038) and problem-solving domain scores (2.54±0.49 vs. 2.34±0.51, t= 7.399, P= 0.007), with all intergroup differences being statistically significant (P< 0.05). Logistic regression indicated associations between FAD total scores (OR = 1.014, 95%CI: 1.001~1.028, P= 0.041) and problem-solving domain scores (OR=2.241, 95%CI: 1.228~4.090, P= 0.009) with NSSI risk. After adjusting for sex, age, residence, education level, monthly family income, and single-child status, the FAD total score was no longer associated with NSSI (OR=1.010, 95%CI:0.995~1.025, P= 0.185), whereas problem-solving domain remained correlated with NSSI risk (OR=2.000, 95%CI:1.028~3.889, P=0.041). Subgroup analysis revealed a significant interaction effect between sex and problem-solving domain on NSSI risk (P-interaction=0.003). Conclusion Impaired problem-solving capacity within family functioning may constitute a risk factor for NSSI behaviors in adolescents with depressive disorders.