家庭亲密度及适应性对住院青少年抑郁症患者自杀风险的影响：抑郁症状的中介作用与心理弹性的调节作用

Effect of family cohesion and adaptability on suicide risk in adolescent inpatients with depression： the mediating role of depressive symptoms and the moderating role of resilience

中文关键词:  青少年  抑郁症  自杀风险  心理弹性  家庭亲密度  家庭适应性

英文关键词:Adolescents  Depression  Suicide risk  Resilience  Family cohesion  Family adaptability

中文摘要:

      背景 自杀是青少年的第二大死因，抑郁症患者自杀风险较高。家庭功能失衡是自杀的重要影响因素，但各变量之间的作用机制尚不明确。目的 探讨家庭亲密度及家庭适应性对住院青少年抑郁症患者自杀风险的影响，并分析抑郁症状的中介作用和心理弹性的调节作用，以期为住院青少年抑郁症患者自杀的预防及干预提供参考。方法 连续纳入2024年10月—2025年8月于广州市某三级甲等精神专科医院住院治疗的、符合《国际疾病分类（第10版）》（ICD-10）抑郁症诊断标准的335例青少年患者为研究对象。采用家庭亲密度和适应性量表中文版（FACES Ⅱ-CV）、抑郁自评量表（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）自杀模块进行评定，并构建综合自杀风险指数。采用SPSS宏程序Process 4.1中的模型4和模型7分别进行中介效应和调节效应检验。结果 相关分析结果显示，SDS评分与综合自杀风险指数呈正相关（r_s=0.663，P<0.01），与FACES Ⅱ-CV家庭亲密度维度和家庭适应性维度评分以及CD-RISC评分均呈负相关（r_s=-0.448、-0.386、-0.576，P均<0.01）。抑郁症状在家庭亲密度与自杀风险之间起完全中介作用，间接效应值为-0.491（95% CI：-0.646~-0.352），效应量为89.76%；抑郁症状在家庭适应性与自杀风险之间也起完全中介作用，间接效应值为-0.442（95% CI：-0.603~-0.293），效应量为89.11%。心理弹性可调节家庭亲密度对抑郁症状的影响（β=-0.006，P<0.01）及家庭适应性对抑郁症状的影响（β=-0.007，P<0.05）。结论 住院青少年抑郁症患者的抑郁症状可能在家庭亲密度及家庭适应性与自杀风险之间起完全中介作用，心理弹性调节了中介路径的前半段。

英文摘要:

      Background Suicide is the second leading cause of death in adolescents. Patients with depression have a high risk of suicide， and family dysfunction is an important contributing factor of suicide. However， the mechanisms among these variables remain unclear.Objective To explore the influence of family cohesion and adaptability on the risk of suicide in adolescent inpatients with depression， and the mediating effect of depressive symptoms and the moderating effect of resilience， so as to provide references for suicide prevention and intervention.Methods A total of 335 adolescent inpatients with depression were consecutively enrolled from October 2024 to August 2025 in a tertiary Grade A psychiatric hospital in Guangzhou. All participants met the diagnostic criteria for depression in the International Classification of Diseases， tenth edition （ICD-10）. They were assessed using the Family Adaptability and Cohesion Scale Ⅱ-Chinese Version （FACES Ⅱ-CV）， the Self-rating Depression Scale （SDS）， the Connor-Davidson Resilience Scale （CD-RISC）， the Suicidal Behaviors Questionnaire-Revised （SBQ-R） and the suicide module of the Mini-International Neuropsychiatric Interview （MINI）. A comprehensive suicide risk index was constructed. Model 4 and model 7 in the SPSS macro program Process 4.1 were used to test the mediating effect and the moderating effect， respectively.Results Correlation analysis revealed that the SDS score was positively correlated with the composite suicide risk index （r_s=0.663， P<0.01） but negatively correlated with the family cohesion and adaptability dimensions scores of the FACES II-CV and the CD-RISC score （r_s=-0.448， -0.386， -0.576， P<0.01）. Depressive symptoms fully mediated the association between family cohesion and suicide risk， with an indirect effect of -0.491 （95% CI： -0.646–-0.352）， accounting for 89.76% of the total effect. Depressive symptoms also fully mediated the association between family adaptability and suicide risk， with an indirect effect of -0.442 （95% CI： -0.603–-0.293）， accounting for 89.11% of the total effect. Resilience significantly moderated the effect of family cohesion on depressive symptoms （β=-0.006， P<0.01） and the effect of family adaptability on depressive symptoms （β=-0.007， P<0.05）.Conclusion In adolescent inpatients with depression， depressive symptoms may play a fully mediating role in the relationships between family cohesion/family adaptability and suicide risk， respectively， and resilience moderated the first stage of this mediating pathway. ［Funded by Guangzhou Science and Technology Plan Project （number， 2024A03J0299）］