| 李畅,张迎黎.青少年抑郁障碍患者非自杀性自伤行为诊断性预测模型的建立及验证[J].四川精神卫生杂志,2023,36(1):12-18.Li Chang,Zhang Yingli,Establishment and verification of a diagnostic prediction model for non-suicidal self-injury behaviors in adolescents with depressive disorder[J].SICHUAN MENTAL HEALTH,2023,36(1):12-18 |
| 青少年抑郁障碍患者非自杀性自伤行为诊断性预测模型的建立及验证 |
| Establishment and verification of a diagnostic prediction model for non-suicidal self-injury behaviors in adolescents with depressive disorder |
| 投稿时间：2022-08-11 |
| DOI：10.11886/scjsws20220811001 |
| 中文关键词: 抑郁障碍 非自杀性自伤 青少年 住院患者 诊断性临床预测模型 |
| 英文关键词:Depressive disorder Non-suicidal self-injury Adolescents Inpatients Diagnostic clinical prediction model |
| 基金项目:深圳市医学重点学科建设经费资助（项目编号：SZXK041） |
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| 中文摘要: |
| 目的 建立青少年抑郁障碍患者非自杀性自伤（NSSI）行为诊断性预测模型，以期对青少年抑郁障碍患者NSSI行为的早期识别提供参考。方法 回顾性分析2021年1月1日-12月31日在深圳市康宁医院儿少科住院的抑郁障碍患者（n=366）临床资料。根据《精神障碍诊断与统计手册（第5版）》（DSM-5）诊断标准，将患者分为伴NSSI行为组（n=289）和不伴NSSI行为组（n=77）。将366例患者按7∶3随机分为训练集（n=258）和验证集（n=108）。使用Logistic回归分析筛选青少年抑郁障碍患者NSSI行为的独立危险因素，建立预测模型。使用受试者工作特征（ROC）曲线下面积（AUC）评估训练集和验证集模型的区分度，使用校准曲线评估训练集和验证集模型的校准度，使用Homser-Lemeshow（HL）检验评估模型的拟合优度，使用临床决策分析（DCA）曲线评价模型的临床获益情况。结果 性别（β=1.734，OR=5.561，95% CI：2.678~11.964）、受教育程度（β=0.864，OR=2.737，95% CI：1.174~4.795）、自杀未遂史（β=0.932，OR=2.539，95% CI：1.253~5.144）、独生子女（β=0.745，OR=2.106，95% CI：1.029~4.311）、抑郁严重程度（β=0.056，OR=1.058，95% CI：1.025~1.092）是青少年抑郁障碍患者NSSI行为的独立危险因素（P<0.05或0.01）。训练集ROC曲线AUC=0.808（95% CI：0.746~0.870），验证集AUC=0.722（95% CI：0.581~0.864）。HL检验评估校准图后显示出较好的拟合度（P=0.561）。结论 性别、受教育程度、自杀未遂史、独生子女以及抑郁严重程度是青少年抑郁障碍患者NSSI行为的独立危险因素，构建的青少年抑郁障碍患者NSSI行为的诊断性临床预测模型具有良好的敏感性和特异性。 |
| 英文摘要: |
| Objective To establish a diagnostic prediction model for non-suicidal self-injury （NSSI） behaviors in adolescents with depressive disorder， in order to provide references for early identification of NSSI behaviors in them.Methods Retrospective analysis was performed on the clinical data of adolescents with depressive disorder （n=366） who were admitted to the Pediatric Department of Shenzhen Kangning Hospital from January 1 to December 31， 2021. According to the Diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） diagnostic criteria for NSSI， the patients were divided into comorbid NSSI group （n=289） and non-NSSI group （n=77）. The selected adolescents were randomly divided into a training set （n=258） and a verification set （n=108） in a 7∶3 ratio. Logistic regression analysis was used to screen the independent risk factors for NSSI behaviors in adolescents with depressive disorder， which served as the basis for prediction model. Finally， the receiver operating characteristic （ROC） curve was established and the area under curve （AUC） was calculated to evaluate the discrimination in the training set and validation set. Calibration curve was applied to evaluate the calibration degree of the model. The Homser-Lemeshow （HL） test was conducted to evaluate the goodness of fit of the model. And decision curve analysis （DCA） was performed to evaluate the clinical benefit of the model.Results Gender （β=1.734， OR=5.561， 95% CI： 2.678~11.964）， education level （β=0.864， OR=2.737， 95% CI： 1.174~4.795）， history of suicide attempts （β=0.932， OR=2.539， 95% CI： 1.253~5.144）， being an only child （β=0.745， OR=2.106， 95% CI： 1.029~4.311） and depression severity （β=0.056， OR=1.058， 95% CI： 1.025~1.092） were independent risk factors related to NSSI behaviors in adolescents with depressive disorder （P<0.05 or 0.01）. The AUC was 0.808 （95% CI： 0.746~0.870） in the training set， and was 0.722 （95% CI： 0.581~0.864） in the validation set. The prediction model showed good calibration with the HL test （P=0.561）.Conclusion Gender， education level， suicide attempt history， being an only child and depression severity are independent risk factors for NSSI behaviors in adolescents with depressive disorder， furthermore， the diagnostic clinical prediction model constructed using above factors for NSSI behaviors in adolescents with depressive disorder has displayed good sensitivity and specificity. |
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