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、社交回避与苦恼的中介作用

The relationship between non-suicidal self-injury behaviors and self-stigma in adolescents with mood disorders: the mediating roles of self-esteem, social avoidance and distress

投稿时间：2024-11-27 修订日期：2025-05-07

DOI：

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 Chain mediation effect

基金项目:首都医科大附属北京安定医院芜湖医院(芜湖市第四人民医院)2022年院级课题项目(项目编号:kjxm202203)

作者	单位	地址
陶甜美	首都医科大学附属北京安定医院芜湖医院	安徽省芜湖市弋江区乌霞山东路1号
蒋巧	首都医科大学附属北京安定医院芜湖医院
罗佳^*	首都医科大学附属北京安定医院	.首都医科大学附属北京安定医院

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中文摘要:

目的:探讨青少年心境障碍伴非自杀性自伤行为（NSSI）患者自我病耻感的影响因素及自尊、社交回避与苦恼在NSSI与自我病耻感间的中介效应。方法:采用方便取样的横断面调查研究方法，选取204例青少年心境障碍患者进行青少年非自杀性自伤问卷（ANSSIQ）、精神疾病自我病耻感量表（ISMI）、自尊量表(RSES)、社交回避及苦恼量表（SADS）、社会支持评定量表（SSRS）的评估，采用多元线性回归分析青少年心境障碍伴NSSI患者自我病耻感的影响因素，并采用SPSS PROCESS宏程序的Model6模型检验自尊、社交回避与苦恼在NSSI严重程度与自我病耻感之间的中介效应。结果:青少年心境障碍伴NSSI组ISMI得分高于不伴NSSI组（P＜0.001）；伴NSSI 组患者的ISMI总分与ANSSIQ行为量表分、SADS总分呈显著正相关（r=0.32，r=0.64，p＜0.01），与RSES总分、SSRS总分呈显著负相关（r=-0.72，r=-0.55，P＜0.01）。多元线性回归分析结果显示回归方程显著（P＜0.001），其中NSSI严重程度（β=0.13，P＜0.05）、社交回避与苦恼（β=0.26，P＜0.01））显著正向预测ISMI总分，自尊水平（β=-0.44，P＜0.01）、社会支持（β=-0.17，P＜0.01）显著负向预测ISMI总分，以上变量共同解释自我病耻感60.5%的变异。自尊、社交回避与苦恼在NSSI严重程度与自我病耻感之间起部分中介作用，中介效应值为0.24，占总效应比例高达56%，其中由NSSI→自尊→自我病耻感的间接效应为0.16。结论:NSSI严重程度、自尊、社交回避与苦恼、社会支持是青少年心境障碍伴NSSI患者自我病耻感的重要影响因素。NSSI严重程度既可以直接作用于也可通过自尊、社交回避与苦恼间接作用于自我病耻感，尤其是自尊的中介作用。

英文摘要:

Objective To explore the influencing factors of self-stigma in adolescents mood disorders with non-suicidal self-injury behaviors (NSSI)and examine the chain mediating effect of self-esteem and social avoidance and distress between NSSI and self-stigma . Methods By convenience sampling method, 204 adolescents with mood disorders were evaluated by the Adolescent non-Suicidal Self-Injury Questionnaire(ANSSIQ), Internalized Stigma of Mental Illness Scale (ISMI), Rosenberg Self-Esteem Scale(RSES), Social Avoidance and Distress Scale (SADS), and Social Support Rating Scale (SSRS). Multiple linear regression was used to analyze the influencing factors of self-stigma in adolescent mood disorders with NSSI, and the SPSS PROCESS macro Model6 procedure was used to examine the mediating effects of self-esteem, social avoidance and distress on NSSI and self-stigma. Results ?The score of ISMI in mood disorder group with NSSI was higher than that without NSSI group (P < 0.001). The total ISMI score of patients with NSSI was significantly positively correlated with the ANSSIQ behavior scale score and SADS score (r=0.32, r=0.64, P < 0.01), and significantly negatively correlated with the total RSES score and SSRS score (r=-0.72, r=-0.55, P < 0.01). The results of multiple linear regression analysis showed that the regression equation was significant (P < 0.001), and NSSI severity (β=0.13, P < 0.05), social avoidance and distress (β=0.26, P < 0.01)) significantly predicted the total score of ISMI. Self-esteem level (β=-0.44, P < 0.01), social support (β=-0.17, P ＜0.01) significantly negatively predicted the total ISMI score, and these variables together explained 60.5% of the variation in self-stigma. Self-esteem, social avoidance and distress played a partial mediating role in the relationship between NSSI severity and self-stigma. The mediating effect was 0.24, accounting for 56% of the total effect. The indirect effect from NSSI→ self-esteem→self-stigma was 0.16. Conclusions NSSI severity, self-esteem, social avoidance and distress, and social support are important factors affecting self-stigma in adolescents with mood disorders associated with NSSI. The severity of NSSI can either directly affect self-stigma or indirectly affect through self-esteem, social avoidance and distress, especially the mediating role of self-esteem.

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