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

Relationship between family functioning and non-suicidal self-injury behaviors in 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）行为的因素之一，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行为的差异化影响。目的 探讨青少年抑郁障碍患者家庭功能各维度与NSSI行为的关系，为存在NSSI行为的青少年抑郁障碍患者的家庭干预提供精准靶点。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或住院、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）进行调查。采用单因素Logistic回归分析家庭功能各维度与NSSI行为的关联，采用多因素Logistic回归检验家庭功能各维度对NSSI行为的独立效应。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［（20.97±7.50）分 vs.（17.79±6.95）分，t=8.705，P=0.004］，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］更高，差异均有统计学意义。Logistic回归分析结果显示，FAD总评分（OR=1.014，95% CI：1001~1.028，P=0.041）和问题解决维度评分（OR=2.241，95% CI：1.228~4.090，P=0.009）均是NSSI行为的危险因素。调整了性别、年龄、居住地、受教育程度、家庭月收入、是否为独生子女后，FAD总评分与NSSI行为的相关性无统计学意义（OR=1.010，95% CI：0.995~1.025，P=0.185），FAD问题解决维度评分与NSSI行为的相关性仍有统计学意义（OR=2.000，95% CI：1.028~3.889，P=0.041）。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 is one of the factors influencing non-suicidal self-injury （NSSI） behaviors in adolescents with depressive disorders. Previous studies have treated family functioning as a unitary construct， which may obscure the differential impacts of specific dimensions on NSSI behaviors.Objective To explore the relationships between various dimensions of family functioning and NSSI behaviors in adolescents with depressive disorders， aiming to provide precise targets for family-based interventions for adolescents with depressive disorders who exhibit NSSI behaviors.Methods In this cross-sectional study， 217 adolescent patients who were treated at the outpatient or inpatient department of The First Psychiatric Hospital of Harbin from January to July 2025 and met the diagnostic criteria for depressive disorders as stipulated in the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） were included as the research subjects. Assessments included a self-designed questionnaire， the Hamilton Depression Scale-17 item （HAMD-17）， and the Family Assessment Device （FAD）. Univariate Logistic regression analysis was employed to investigate the association between each dimension of family functioning and the NSSI behaviors， and multivariate Logistic regression was used to test the independent effect of each dimension of family functioning on the NSSI behaviors.Results A total of 204 cases （94.01%） of adolescent patients with depressive disorders completed the valid questionnaire survey. Among them， 134 cases （65.69%） exhibited NSSI behaviors （NSSI group）， and 70 cases （34.31%） did not exhibit NSSI behaviors （non-NSSI group）. Compared with the non-NSSI group， the NSSI group had a higher HAMD-17 score ［（20.97±7.50） vs. （17.79±6.95）， t=8.705， P=0.004］， a higher FAD total score ［（155.68±21.84） vs. （148.87±22.72）， t=4.348， P=0.038］， and a higher problem-solving dimension score ［（2.54±0.49） vs. （2.34±0.51）， t=7.399， P=0.007］. All the differences were statistically significant. The results of the Logistic regression analysis showed that the FAD total score （OR=1.014， 95% CI： 1.001–1.028， P=0.041） and the problem-solving dimension score （OR=2.241， 95% CI： 1.228–4.090， P=0.009） were both risk factors for NSSI behaviors. After adjusting for gender， age， residence， educational level， monthly family income， and whether being an only child， the correlation between the FAD total score and NSSI behaviors was not statistically significant （OR=1.010， 95% CI： 0.995–1.025， P=0.185）， while the correlation between the FAD problem-solving dimension score and NSSI behaviors remained statistically significant （OR=2.000， 95% CI： 1.028–3.889， P=0.041）.Conclusion Impaired problem-solving capacity within family functioning may constitute a risk factor for NSSI behaviors in adolescents with depressive disorders. ［Funded by Research Project of Heilongjiang Provincial Health Commission （number， 20240303090148， 20230303090154）］