| 陶甜美,蒋巧,罗佳.青少年心境障碍患者非自杀性自伤行为与自我病耻感的关系：自尊、社交回避与苦恼的链式作用路径[J].四川精神卫生杂志,2025,(4):333-339.Tao Tianmei,Jiang Qiao,Luo Jia,Relationship between non-suicidal self-injury behavior and self-stigma in adolescents with mood disorder： the chained mediation role of self-esteem and social avoidance/distress[J].SICHUAN MENTAL HEALTH,2025,(4):333-339 |
| 青少年心境障碍患者非自杀性自伤行为与自我病耻感的关系：自尊、社交回避与苦恼的链式作用路径 |
| Relationship between non-suicidal self-injury behavior and self-stigma in adolescents with mood disorder： the chained mediation role of self-esteem and social avoidance/distress |
| 投稿时间：2024-11-27 |
| DOI：10.11886/scjsws20241127002 |
| 中文关键词: 青少年 心境障碍 自我病耻感 非自杀性自伤 链式中介效应 |
| 英文关键词:Adolescent Mood disorder Self-stigma Non-suicidal self-injury Chained mediation effect |
| 基金项目:芜湖市第四人民医院2022年科研项目（项目名称：青少年心境障碍患者病耻感与抑郁情绪、社会支持、童年期虐待的相关性研究，项目编号：kjxm202203） |
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| 中文摘要: |
| 背景 青少年非自杀性自伤（NSSI）行为是全球性的严峻公共卫生问题，而自我病耻感是阻碍青少年寻求专业帮助的关键因素，但目前国内针对伴有NSSI行为的青少年心境障碍患者自我病耻感的研究相对有限。目的 探讨伴NSSI行为的青少年心境障碍患者自我病耻感的影响因素以及自尊、社交回避与苦恼在NSSI行为与自我病耻感之间的链式作用路径，以期为此类患者自我病耻感的识别与干预提供参考。方法 连续选取2022年11月—2023年11月在芜湖市第四人民医院治疗的、符合《国际疾病分类（第10版）》（ICD-10）抑郁障碍或双相障碍抑郁发作诊断标准的青少年患者为研究对象（n=220）。采用青少年非自杀性自伤行为评定问卷（ANSAQ）中的行为量表、精神疾病自我病耻感量表（ISMI）、自尊量表（SES）、社交回避与苦恼量表（SADS）进行评定。采用Pearson相关分析伴NSSI行为的青少年心境障碍患者各量表评分之间的相关性。采用多元线性回归分析探索伴NSSI行为的青少年心境障碍患者自我病耻感的影响因素。采用SPSS 宏程序Process 3.0的模型6检验自尊、社交回避与苦恼在NSSI行为与自我病耻感之间的链式作用路径。结果 共204例（92.73%）青少年心境障碍患者完成有效问卷调查，其中伴NSSI行为者153例（75.00%）、不伴NSSI行为者51例（25.00%）。伴NSSI行为组ISMI和SADS总评分均高于不伴NSSI行为组（t=-5.187、-4.564，P<0.01），伴NSSI行为组SES总评分低于不伴NSSI行为组（t=4.478，P<0.01），差异均有统计学意义。伴NSSI行为的青少年心境障碍患者ISMI总评分与SADS总评分、ANSAQ行为量表评分均呈正相关（r=0.644、0.316，P均<0.01），与SES总评分呈负相关（r=-0.724，P<0.01）。多元线性回归分析结果显示，NSSI行为严重程度（β=0.132，P<0.05）、社交回避与苦恼（β=0.309，P<0.01）可正向预测自我病耻感，自尊水平（β=-0.493，P<0.01）可负向预测自我病耻感。自尊、社交回避与苦恼在NSSI行为与自我病耻感之间起部分中介作用，效应值为0.237（95% CI：0.103~0.374），效应量为55.89%；其中NSSI行为→自尊→自我病耻感的间接效应值为0.163（95% CI：0.069~0.273）；NSSI行为→自尊→社交回避与苦恼→自我病耻感的间接效应值为0.063（95% CI：0.020~0.119）。结论 青少年心境障碍患者的NSSI行为既可以直接影响自我病耻感，也可通过自尊的独立作用路径或自尊、社交回避与苦恼的链式作用路径影响自我病耻感。 |
| 英文摘要: |
| Background Non-suicidal self-injury （NSSI） in adolescents is a serious global public health issue. Self-stigma is identified as a key factor hindering adolescents from seeking professional psychological help， while only a few studies have dealt with the self-stigma in adolescents with mood disorder exhibiting NSSI behavior.Objective To investigate the influencing factors of self-stigma among adolescents with mood disorder who exhibit NSSI behavior， and to examine the chained mediation role of self-esteem and social avoidance/distress in the relationship between NSSI behavior and self-stigma， with the aim of providing references for the detection and intervention of self-stigma in such patients.Methods A total of 220 consecutive adolescent patients with mood disorder who met "the International Classification of Diseases， Tenth Edition"（ICD-10） diagnostic criteria for depressive disorder or depressive episode of bipolar disorder and attended the Fourth People's Hospital of Wuhu from November 2022 to November 2023 were recruited. The Adolescent Non-suicidal Self-injury Assessment Questionnaire （ANSAQ）， Internalized Stigma of Mental Illness （ISMI） Scale， Self-Esteem Scale （SES）， and Social Avoidance/Distress Scale （SADS） were employed to assess the participants. Correlation among variables was evaluated using Pearson's correlation coefficient. Multivariate linear regression analysis was utilized to identify the factors influencing self-stigma among adolescent patients with mood disorder exhibiting NSSI. The proposed mediating hypotheses were tested using Model 6 in the SPSS Process macro （version 3.0）.Results Valid responses were received from 204/220 （92.73%） participants， including 153 cases with NSSI and 51 cases without NSSI. The NSSI （vs. no NSSI） group reported significantly higher scores on ISMI and SADS （t=-5.187， -4.564， P<0.01）， and lower scores on SES （t=4.478， P<0.01）. In the NSSI group， the total score of ISMI demonstrated a positive correlation with the total score of SADS and the behavioral questionnaire score in ANSAQ （r=0.644， 0.316， P<0.01）， and a negative correlation with the total score of SES （r=-0.724， P<0.01）. Multivariate linear regression analysis revealed that NSSI severity （β=0.132， P<0.05） and social avoidance/distress （β=0.309， P<0.01） were found to be positive predictors of the self-stigma， whereas self-esteem （β=-0.493， P<0.01） was a significant negative predictor of the self-stigma. Additionally， self-esteem and social avoidance/distress partially mediated the relationship between NSSI and self-stigma， with a mediating effect of 0.237 （95% CI： 0.103~0.374）， which constituted 55.89% of the total effect. The mediating effect included two paths： NSSI behavior→self-esteem→self-stigma （effect size was 0.163， 95% CI： 0.069~0.273） and NSSI behavior→self-esteem→social avoidance/distress→self-stigma （effect size was 0.063， 95% CI： 0.020~0.119）.Conclusion The severity of NSSI can affect self-stigma in adolescents with mood disorders either directly through mediating self-esteem or indirectly through the chained mediation path of self-esteem and social avoidance/distress.［Funded by Scientific Research Projects of Wuhu Fourth People's Hospital in 2000（number，kjxm202203）］ |
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