伴与不伴非自杀性自伤行为的青少年抑郁障碍患者认知控制缺陷比较

Comparison of cognitive control deficits between adolescents with depressive disorder with and without non‑suicidal self-injury behavior

中文关键词:  非自杀性自伤  抑郁障碍  青少年  认知控制  Stroop任务  干扰效应

英文关键词:Non-suicidal self-injury  Depressive disorder  Adolescents  Cognitive control  Stroop task  Interference effect

中文摘要:

      背景 非自杀性自伤(NSSI)行为在青少年阶段发生率较高。既往研究多聚焦于NSSI行为与情绪调节、疼痛感知、奖赏机制及冲动性的关系，对NSSI行为发生与维持的认知机制探讨尚不充分。青少年正处于认知控制能力发展的关键时期，然而，伴NSSI行为的青少年抑郁障碍患者是否存在认知控制异常，目前仍不清楚。目的 揭示伴NSSI行为的青少年抑郁障碍患者认知控制的潜在缺陷。方法 采用病例对照研究，选取2024年11月—2025年5月就诊于兰州市第三人民医院、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(n=166)。根据是否伴有NSSI行为，将患者分为伴NSSI行为组(NSSI组，n=86)和不伴NSSI行为组(非NSSI组，n=80)。同期在西北地区五所公立中学选取经心理健康筛查的健康青少年作为对照组(n=71)。所有被试均完成色词Stroop任务，记录各组在一致条件与不一致条件下的正确率和反应时，并计算基于正确率和反应时的干扰效应。结果 在正确率方面，试次类型主效应有统计学意义(F=46.900，P<0.01，η_p²=0.160)，组别与试次类型的交互效应有统计学意义(F=3.390，P=0.035，η_p²=0.028)。在反应时方面，试次类型主效应有统计学意义(F=72.020、P<0.01、η_p²=0.240)，组别与试次类型的交互效应有统计学意义(F=6.400，P=0.002，η_p²=0.050)。简单效应分析结果显示，在一致与不一致条件下，NSSI组反应时均长于非NSSI组和对照组，非NSSI组的反应时长于对照组(P均<0.01)。三组基于反应时的干扰效应差异有统计学意义(H=10.231，P=0.006)，NSSI组干扰效应高于对照组(Z=3.012，P_adj=0.008)和非NSSI组(Z=2.453、P_adj=0.043)；三组基于正确率的干扰效应比较，差异无统计学意义(H=5.666、P=0.059)。结论 伴NSSI行为的青少年抑郁障碍患者存在超越抑郁症状本身的认知控制缺陷，尤其表现为冲突抑制能力受损。

英文摘要:

      Background Non?suicidal self?injury (NSSI) behavior is highly prevalent during adolescence. Previous studies have mainly focused on the relationship between NSSI behavior and emotional regulation, pain perception, reward mechanisms, and impulsivity. However, the cognitive mechanisms underlying the occurrence and maintenance of NSSI behavior have not been sufficiently explored. Adolescence is a critical period for the development of cognitive control. However, it remains unclear whether adolescents with depressive disorder accompanied by NSSI behavior have abnormal cognitive control. Objective To reveal the potential deficits in cognitive control among adolescents with depressive disorder accompanied by NSSI behavior. Methods This study was a case?control study including 166 adolescent patients who visited the Third People''s Hospital of Lanzhou from November 2024 to May 2025 and met the diagnostic criteria for depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM?5). According to whether they had NSSI behavior or not, patients were divided into the NSSI group (n=86) and the non?NSSI group (n=80). At the same time, healthy adolescents who passed mental health screenings in five public middle schools in the northwest region were selected as the control group (n=71). All participants completed the color?word Stroop task, and the accuracy rates and reaction time in congruent and incongruent conditions of each group were recorded, and the interference effect based on accuracy rates and reaction time was calculated. Results In terms of accuracy rate, the main effect of trial type was statistically significant (F=46.900, P<0.01, η_p²=0.160), and the interaction effect between group and trial type was also statistically significant (F=3.390, P=0.035, η_p²=0.028). In terms of reaction time, the main effect of trial type was statistically significant (F=72.020, P<0.01, η_p²=0.240), and the interaction effect between group and trial type was also statistically significant (F=6.400, P=0.002, η_p²=0.050). Simple effect analysis revealed that under both congruent and incongruent conditions, the reaction time of the NSSI group was longer than those of the non?NSSI group and the control group, and the reaction time of the non?NSSI group was also longer than that of the control group (P<0.01). There were statistically significant differences in the interference effects among three groups based on reaction time (H=10.231, P=0.006). The interference effect in the NSSI group was higher than that in the control group(Z=3.012, P_adj=0.008) and the non?NSSI group (Z=2.453, P_adj=0.043). There was no statistically significant difference in the interference effect among the three groups based on accuracy rate (H=5.666, P=0.059). Conclusion Adolescents with depressive disorder accompanied by NSSI behavior exhibit cognitive control deficits beyond depressive symptoms, particularly showing impaired conflict suppression ability.