青少年抑郁障碍患者的非自杀性自伤行为：内感受知觉及相关因素的影响

Non-suicidal self-injury behavior in adolescent patients with depressive disorders： the influence of interoceptive awareness and related factors

中文关键词:  青少年  抑郁障碍  非自杀性自伤  内感受知觉  相关性

英文关键词:Adolescents  Depressive disorder  Non-suicidal self-injury behaviors  Interoceptive awareness  Correlation

中文摘要:

      背景 非自杀性自伤（NSSI）行为是青少年抑郁障碍患者常见的临床表现。既往研究显示，内感受知觉可能参与NSSI行为的发生，但关于二者在青少年抑郁障碍患者中的研究有限。目的 分析青少年抑郁障碍患者NSSI行为与内感受知觉的相关性，考查青少年抑郁障碍患者NSSI行为的影响因素，以期为青少年抑郁障碍患者NSSI行为的预防及干预提供参考。方法 选取2022年12月—2024年6月合肥市第四人民医院收治的、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青少年患者125例。根据是否存在NSSI行为，将其分为伴NSSI行为组（n=60）和不伴NSSI行为组（n=65）。同期选取在该医院体检的健康青少年为对照组（n=40）。采用汉密尔顿抑郁量表17项版（HAMD-17）评定青少年抑郁障碍患者的抑郁症状，采用多维内感受觉知评估量表（MAIA-2）评定研究对象的内感受知觉水平。采用Pearson相关分析考查青少年抑郁障碍患者HAMD-17评分与MAIA-2评分的相关性。采用二元Logistic回归分析考查青少年抑郁障碍患者NSSI行为的影响因素。绘制受试者工作特征（ROC）曲线，验证MAIA-2评分对青少年抑郁障碍患者NSSI行为的预测价值。结果 三组的MAIA-2注意、不分心、不担心、注意调节、情绪觉察、躯体聆听维度评分及总评分比较，差异均有统计学意义（F=18.475、20.631、6.044、5.621、18.456、12.889、12.741，P均<0.01）。相关分析结果显示，青少年抑郁障碍患者MAIA-2总评分与HAMD-17总评分、体重因子评分及认知障碍因子评分均呈负相关（r=-0.315、-0.203、-0.278，P均<0.05）。二元Logistic回归分析结果显示，病程较长（OR=1.112，95% CI：1.043~1.206）、HAMD-17总评分较高（OR=2.071，95% CI：1.361~3.150）是青少年抑郁障碍患者NSSI行为的危险因素，MAIA-2总评分较高是青少年抑郁障碍患者NSSI行为的保护因素（OR=0.580，95% CI：0.407~0.828）。MAIA-2总评分对青少年抑郁障碍患者NSSI行为的预测价值较高（AUC=0.793）。结论 青少年抑郁障碍患者的NSSI行为与病程、抑郁症状严重程度及特定的内感受知觉模式密切相关，内感受知觉或许可预测其NSSI行为的发生。

英文摘要:

      Background Non-suicidal self-injury （NSSI） represents a prevalent clinical feature among adolescent patients with major depressive disorder. Existing research has suggested that interoceptive awareness might be linked to NSSI behaviors， but investigations into this association among adolescent patients with major depressive disorders remain limited.Objective To elucidate the correlation between NSSI behaviors and interoceptive awareness in adolescent patients with major depressive disorder， and to identify influencing factors of NSSI behaviors， in order to provide clinical prevention and treatment strategies.Methods A total of 125 adolescent patients who met the diagnostic criteria for major depressive disorder as outlined in the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） were recruited from the Fourth People's Hospital of Hefei from December 2022 to June 2024. These participants were subsequentially categorized into NSSI behavior group （n=60） and non-NSSI behavior group （n=65） based on the presence or absence of NSSI behaviors. Additionally， a control group comprising 40 healthy adolescents was concurrently assembled for comparison. The Hamilton Depression Scale-17 item （HAMD-17） was used to assess the depressive symptoms of adolescent patients with major depressive disorder， and the Multidimensional Assessment of Interoceptive Awareness version 2- Chinese （MAIA-2） was used to evaluate the interoceptive awareness level of all subjects. Pearson correlation analysis was employed to examine the correlation between HAMD-17 scores and MAIA-2 scores. Binary Logistic regression analysis was conducted to identify the influencing factors of NSSI behaviors in adolescent patients. Then the receiver operating characteristic （ROC） curve was drawn to verify the predictive efficacy of MAIA-2 scores for NSSI behaviors in adolescent patients with major depressive disorder.Results Significant differences were identified across six MAIA-2 subscales （noticing， not distracting， not worrying， attention regulation， emotional awareness， body listening） and the MAIA-2 total score among the three groups （F=18.475， 20.631， 6.044， 5.621， 18.456， 12.889， 12.741， P<0.01）. Correlation analysis underscored a notable negative correlation between the MAIA-2 total score and the HAMD-17 total score， as well as its scores on subscales pertaining to weight and cognitive impairment factors（r=-0.315， -0.203， -0.278， P<0.05）. Binary Logistic regression results indicated that longer disease duration （OR=1.112， 95% CI： 1.043–1.206） and higher HAMD-17 total score （OR=2.071， 95% CI： 1.361–3.150） were risk factors for NSSI behavior in adolescents with depressive disorder， while a higher MAIA-2 total score was a protective factor against NSSI behavior in this population （OR=0.580， 95% CI： 0.407–0.828）. The MAIA-2 total score demonstrated a relatively high predictive value for NSSI behaviors in adolescent patients with major depressive disorder （AUC=0.793）.Conclusion NSSI behaviors in adolescent patients with major depressive disorder are closely related to the disease course， severity of depression， and specific interoceptive awareness patterns. Moreover， interoceptive awareness may serve as a predictive indicator for the occurrence of their NSSI behaviors. ［Funded by the National Key Clinical Specialty Construction Project of China； Anhui Provincial Clinical Key Specialty Construction Project； the Hospital-Level Scientific Research Project of the Fourth People's Hospital of Hefei （number， HFSY2022YB07）］