校园排斥对青少年自杀意念的影响：抑郁的中介作用及心理韧性的调节作用

Effect of campus exclusion on adolescent suicidal ideation： the mediating role of depression and the moderating role of resilience

中文关键词:  校园排斥  自杀意念  抑郁  心理韧性  青少年

英文关键词:Campus exclusion  Suicidal ideation  Depression  Resilience  Adolescents

中文摘要:

      背景 青少年自杀已成为广泛关注的公共卫生问题，自杀意念是自杀未遂或死亡的必要前提。研究表明，校园排斥、抑郁、心理韧性可能与个体自杀意念的产生密切相关。但目前缺乏纵向研究深入探讨各影响因素与自杀意念的关系。目的 探讨校园排斥对在校中学生自杀意念的影响，以及抑郁的中介作用和心理韧性的调节作用，以期为制定青少年自杀预防与干预策略提供参考。方法 使用纵向研究设计，于2023年11月选取山东省某地区一所初中和一所高中共21个班级（初中每年级4个班级、高中每年级3个班级）的1 226名在校学生为研究对象。采用青少年社会排斥量表（OES-A）、患者健康问卷抑郁量表（PHQ-9）以及青少年心理韧性量表（RSCA）进行评定，并在基线调查的三个月后再次进行PHQ-9自杀意念条目评定（两次自杀意念评定时间点分别记为T1、T2）。使用Spearman相关分析检验各量表评分之间的相关性。采用SPSS宏程序Process 4.2中的模型4和模型59分别检验抑郁在校园排斥与自杀意念之间的中介作用以及心理韧性在三条路径上的调节作用。结果 青少年OES-A评分与PHQ-9评分和T2自杀意念条目评分，PHQ-9评分与T2自杀意念条目评分均呈正相关（r=0.361、0.292、0.508，P均<0.01）。RSCA评分与OES-A评分、PHQ-9评分、T2自杀意念条目评分均呈负相关（r=-0.500、-0.676、-0.459，P均<0.01）。校园排斥正向预测T2自杀意念和抑郁（β=0.081、0.281，P均<0.01），抑郁正向预测T2自杀意念（β=0.108，P<0.01）。中介分析结果显示，抑郁部分中介了校园排斥与T2自杀意念的关系，效应值为0.030（95% CI：0.019~0.043，P<0.01），占总效应的37.35%。心理韧性对校园排斥与抑郁、校园排斥与T2自杀意念、抑郁与T2自杀意念均有调节作用（β=-0.059、-0.049、-0.062，P均<0.01）。结论 校园排斥、抑郁、心理韧性与中学生自杀意念之间是有调节的中介效应关系；心理韧性对这一中介模型的三条路径均有调节作用。

英文摘要:

      Background Suicide among adolescents has become a serious public health issue， with suicidal ideation serving as a necessary precursor to suicide attempts and death. Previous research suggests that campus exclusion， depression， and psychological resilience are closely associated with the development of suicidal ideation in individuals. However， there is a lack of longitudinal research to deeply explore the relationship between each influencing factor and suicidal ideation.Objective To explore the impact of campus exclusion on suicidal ideation among adolescents， as well as the mediating role of depression and the moderating role of resilience， so as to provide references for formulating strategies for preventing and intervening in adolescent suicide.Methods AUsing a longitudinal research design， in November 2023， 1 226 students from 21 classes （4 classes per grade in junior high school and 3 classes per grade in senior high school） from a junior high school and a senior high school in a certain area of Shandong Province were selected as the research subjects. The Ostracism Experience Scale for Adolescents （OES-A）， the Patients' Health Questionnaire Depression Scale-9 item （PHQ-9）， and the Resilience Scale for Chinese Adolescents （RSCA） were used for assessment. The PHQ-9 suicide ideation item was evaluated again three months after the baseline survey （the two suicide ideation evaluations were respectively denoted as T1 and T2 respectively. Spearman correlation analysis was used to examine the relationships among scale scores. Model 4 and model 59 in the SPSS macro program Process 4.2 were used to test the mediating effect of depression between school exclusion and suicide ideation， as well as the moderating effect of psychological resilience on the three paths.Results Correlation analysis showed that OES-A score was positively correlated with PHQ-9 score and suicidal ideation item score （T2）， and PHQ-9 score was also positively correlated with suicidal ideation item score （T2） （r=0.361， 0.292， 0.508， P<0.01）. RSCA score was negatively correlated with OES-A， PHQ-9， and suicidal ideation （T2） scores （r=-0.500， -0.676， -0.459， P<0.01）. Campus exclusion positively predicted suicidal ideation （T2） and depression （β=0.081， 0.281， P<0.01）， while depression positively predicted suicidal ideation （T2） （β=0.108， P<0.01）. The mediation analysis revealed an effect size of 0.030 （95% CI： 0.019~0.043， P<0.01）， accounting for 37.35% of the total effect. Psychological resilience moderated the relationships between campus exclusion and depression， campus exclusion and suicidal ideation （T2）， and depression and suicidal ideation （T2） （β=-0.059， -0.049， -0.062， P<0.01）.Conclusion A moderated mediation model exists among campus exclusion， depression， resilience， and adolescent's suicidal ideation. Psychological resilience moderates the associations between campus exclusion， depression and suicidal ideation across all three paths. ［Funded by Beijing Municipal Health Commission Clinical Research Excellence Program， （number， BRWEP2024W072130101）；Beijing Municipal Hospital Management Center Summit Program， （number， DFL20221701）］