家庭亲密度及适应性对青少年抑郁症患者自杀风险的影响:抑郁症状的中介与心理弹性的调节

The mediating role of depression and the moderating role of resilience:the effect of family cohesion and adaptability on suicide risk in adolescent patients with depression

中文关键词:  【】青少年抑郁症  自杀风险  抑郁  心理弹性  家庭亲密度及适应性  中介作用  调节效应

英文关键词:Adolescent depression  suicide risk  depression  psychological resilience  family intimacy and adaptability  mediating role  moderating effect

中文摘要:

      背景 自杀是青少年第二位死因，抑郁症患者自杀风险高达22.58%，家庭功能失衡已被证实是其重要影响因素。然而，现有研究多孤立探讨家庭亲密度及适应性、抑郁、心理弹性与自杀风险的两两关系，缺乏基于统一理论框架的整合机制分析。家庭亲密度及适应性影响自杀风险的中介路径及其调节边界尚不明确。资源保存理论提示，家庭亲密度及适应性作为社会资源，可能通过抑郁症状的中介作用影响自杀风险，而心理弹性作为个人资源可能调节这一路径。目的 探讨家庭亲密度及适应性对青少年抑郁症患者自杀风险的影响，以及抑郁症状的中介作用和心理弹性的调节作用，为自杀预防及干预提供理论依据。方法 采用横断面研究设计，连续选取2024年10月-2025年8月广州市某三级甲等精神专科医院的青少年抑郁症住院患者为研究对象。共纳入335例患者，均符合ICD-10抑郁症诊断标准。采用家庭亲密度及适应性量表FACES Ⅱ-CV、宗氏抑郁量表SDS、心理弹性量表CD-RISC、自杀行为问卷-修订版（SBQ-R）和简明国际精神神经访谈（MINI）自杀模块进行调查，将SBQ-R和MINI自杀模块的得分加权求和构建综合自杀风险指数。采用Process 4.1宏程序进行中介效应和调节效应分析。结果 335例青少年抑郁症患者的综合自杀风险指数得分为51.79（27.46，72.46），SBQ-R得分为15（11，17）分，MINI得分为14（6，23）分，家庭亲密度得分为56（47，67）分，家庭适应性得分为36（28，46）分，SDS得分为72（61，80）分，CD-RISC得分为39（29，48）分。家庭亲密度及适应性对自杀风险无直接效应(β=-0.056，P=0.06；β=-0.054，P=0.59）。抑郁在家庭亲密度与自杀风险间的完全中介效应显著(间接效应=-0.491，95%CI：-0.646~-0.352），效应占比为89.8%；抑郁在家庭适应性与自杀风险间的完全中介效应显著(间接效应=-0.442，95%CI：-0.603~-0.293），效应占比为89.1%。心理弹性显著调节家庭亲密度对抑郁的作用（交互项β=-0.006，P<0.01）及家庭适应性对抑郁的作用（交互项β=-0.007，P<0.05），即心理弹性水平越高，家庭亲密度及适应性对抑郁的负向预测作用越强。结论 青少年抑郁症患者属于自杀高风险人群，其家庭功能失衡，抑郁和心理弹性在青少年抑郁症患者家庭亲密度及适应性与自杀风险间的中介调节效应成立。

英文摘要:

      Background Suicide is the second leading cause of death in adolescents. The risk of suicide in patients with depression is as high as 22.58 %. Family function imbalance has been proved to be an important influencing factor. However, most of the existing studies have explored the relationship between family cohesion and adaptability, depression, resilience and suicide risk in isolation, lacking an integrated mechanism analysis based on a unified theoretical framework. The mediating path and regulatory boundary of family cohesion and adaptability affecting suicide risk are not clear. The conservation of resources theory suggests that family cohesion and adaptability as social resources may affect the risk of suicide through the mediating effect of depressive symptoms, while resilience as personal resources may regulate this path.Objective To explore the influence of family cohesion and adaptability on the risk of suicide in adolescents with depression, and the mediating effect of depressive symptoms and the moderating effect of resilience, so as to provide theoretical basis for suicide prevention and intervention. Methods A cross-sectional study design was used to select adolescent depression inpatients in a tertiary psychiatric hospital in Guangzhou from October 2024 to August 2025 by convenience sampling. A total of 335 patients were included, all of whom met the ICD-10 diagnostic criteria for depression. FACES II-CV, SDS, CD-RISC, SBQ-R and MINI suicide module were used to investigate the family cohesion and adaptability scale, Zong ''s depression scale, CD-RISC, suicide behavior questionnaire-revised (SBQ-R) and concise international neuropsychiatric interview (MINI) suicide module. The standardized scores of SBQ-R and MINI suicide module were added to construct a comprehensive suicide risk index. The Process 4.1 macro program was used to analyze the mediating effect and moderating effect.Results The comprehensive suicide risk index of 335 adolescents with depression was 51.79(27.46,72.46) points, SBQ-R score was 15(11,17) points, MINI score was 14(6,23) points, family cohesion score was 56(47,67) points, family adaptability score was 36(28,46) points, SDS score was 72(61,80) points, CD-RISC score was 39(29,48) points. Family cohesion and adaptability had no direct effect on suicide risk (β=-0.056, P=0.06;β=-0.054, P=0.59). The complete mediating effect of depression between family cohesion and suicide risk was significant ( indirect effect = ?0.491, 95%CI:?0.646 to ?0.352), accounting for 89.8%. The complete mediating effect of depression between family adaptability and suicide risk was significant (indirect effect=-0.442,95% CI : -0.603 to -0.293), and the effect accounted for 89.1%. Resilience significantly moderated the effect of family cohesion on depression ( interaction β=-0.006,P<0.01) and the effect of family adaptability on depression ( interaction β=-0.007,P<0.05), that is, the higher the level of resilience, the stronger the negative predictive effect of family cohesion and adaptability on depression. Conclusion Adolescent depression patients are at high risk of suicide, and their family function is imbalanced. The mediating and moderating effects of depression and resilience between family cohesion and adaptability and suicide risk in adolescent depression patients are established. [Funded by Guangzhou Psychosomatic Medicine Key Laboratory (number,SL2023A03J00421)]