青少年抑郁障碍患者非自杀性自伤行为与冲动性和情绪调节的关系

Relationship between non-suicidal self-injury behaviors， impulsivity， and emotional regulation in adolescents with depressive disorder

中文关键词:  青少年  非自杀性自伤  抑郁障碍  冲动性  情绪调节

英文关键词:Adolescents  Non-suicidal self-injury  Depressive disorder  Impulsivity  Emotional regulation

中文摘要:

      背景 青少年抑郁障碍患者常伴有非自杀性自伤（NSSI）行为，对其身心健康影响严重。冲动性和情绪调节能力是影响NSSI行为的关键因素，但目前关于伴NSSI行为的青少年抑郁障碍患者冲动性和情绪调节能力对其NSSI行为作用机制的研究仍不足，限制了有效干预策略的制定。目的 探究伴与不伴NSSI行为的青少年抑郁障碍患者冲动性及情绪调节能力的差异，分析伴NSSI行为的青少年抑郁障碍患者的NSSI行为与冲动性及情绪调节能力之间的关联。方法 连续纳入2023年10月—2024年8月在无锡市精神卫生中心儿少精神科病区住院、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青少年患者为研究对象（n=184）。根据DSM-5对NSSI的诊断标准，将患者分为伴NSSI行为组（n=108）和不伴NSSI行为组（n=76）。采用Barratt冲动性量表第11版（BIS-11）、情绪调节问卷（ERQ）、青少年自我伤害问卷及青少年自杀意念量表（PANSI）进行评定。运用Spearman相关分析探讨伴NSSI行为组的青少年自我伤害问卷评分与BIS-11和ERQ评分的相关性。采用多元线性回归分析考查伴NSSI行为组冲动性和情绪调节能力对NSSI行为的影响。结果 与不伴NSSI行为组相比，伴NSSI行为组BIS-11非计划冲动性（Z=-4.181，P<0.01）、行动冲动性（t=4.944，P<0.01）、认知冲动性（Z=-3.392，P<0.01）及总评分（t=4.763，P<0.05）更高，ERQ认知重评维度评分（t=-4.094，P<0.05）和总评分（Z=-2.299，P<0.05）更低，ERQ表达抑制维度评分（Z=-3.019，P<0.05）更高。相关分析结果显示，伴NSSI行为组的青少年自我伤害问卷评分与BIS-11中的行为冲动性因子评分呈正相关（r_s=0.434，P<0.05）。多元回归分析显示，行动冲动性因子（B=0.855，P<0.05）是伴NSSI行为组自伤行为的关联因素，可解释总变异的22.30%。结论 伴NSSI行为的青少年抑郁障碍患者可能存在更高的冲动性水平及更差的情绪调节能力。其中，行动冲动性可能在其NSSI行为的发生中具有重要作用。

英文摘要:

      Background Adolescents with depressive disorder often engage in non-suicidal self-injury （NSSI） behaviors， which severely impacts their physical and mental health. Impulsivity and emotional regulation are key factors influencing NSSI behaviors. However， research on the mechanisms through which impulsivity and emotional regulation affect NSSI behaviors in adolescent depressive disorder patients with NSSI remains insufficient， limiting the development of effective intervention strategies.Objective To explore the differences in impulsivity and emotion regulation abilities between adolescent patients with depressive disorder accompanied by and without NSSI behaviors， and to analyze the association between NSSI behaviors and impulsivity and emotion regulation abilities in adolescent patients with depressive disorder accompanied by NSSI behaviors.Methods A total of 184 adolescents hospitalized in the child and adolescent psychiatry department of Wuxi Mental Health Center from October 2023 to August 2024， who met the diagnostic criteria for depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5）， were consecutively enrolled as study subjects. Based on the diagnostic criteria for NSSI in DSM-5， patients were divided into NSSI group （n=108） and non-NSSI group （n=76）. The Barratt Impulsiveness Scale-11 （BIS-11）， the Emotion Regulation Questionnaire （ERQ）， the Adolescent Self-Harm Questionnaire， and the Positive and Negative Suicide Ideation （PANSI） were used for assessment. Spearman correlation analysis was employed to explore the correlation between the scores of the Adolescent Self-Harm Questionnaire and the scores of BIS-11 and ERQ in the NSSI group. Multiple regression analysis was conducted to examine the effects of impulsivity and emotion regulation on NSSI behaviors in the NSSI group.Results Compared to the non-NSSI group， the NSSI group showed significantly higher scores in BIS-11 non-planned impulsivity （Z=-4.181， P<0.05）， action impulsivity （t=4.944， P<0.05）， cognitive impulsivity （Z=-3.392， P<0.05）， and total score （t=4.763， P<0.05）， and lower scores in the cognitive reappraisal of ERQ （t=-4.094， P<0.05） and total score （Z=-2.299， P<0.05）， and higher scores in the expression inhibition of ERQ （Z=-3.019， P<0.05）. The correlation analysis results showed that the score of the adolescent self-harm questionnaire in the NSSI group was positively correlated with the behavioral impulsivity factor score in the BIS-11 （r=0.434， P<0.05）. Multiple regression analysis indicated that action impulsivity factor was a significant correlate of self-injury behaviors in the NSSI group （B=0.855， P<0.05）， explaining 22.30% of the total variance.Conclusion Adolescent patients with depressive disorder accompanied by NSSI behaviors exhibit higher levels of impulsivity and poorer emotional regulation abilities. Action impulsivity may play a significant role in the mechanism of NSSI behaviors. ［Funded by Wuxi Municipal Health Commission Research Project （number， Q202320）］