反刍思维对首发抑郁症患者1年结局的影响:家庭功能的中介作用  

Effects of ruminative thinking on 1-year outcomes in patients with first-episode depression: the mediating role of family functioning

作　　者：刘莉莉 孔凡贞[1] 季彩芳 张知颖 庄烨 阮静 贾凤南 柳艳松 Liu Lili;Kong Fanzhen;Ji Caifang;Zhang Zhiying;Zhuang Ye;Ruan Jing;Jia Fengnan;Liu Yansong(Department of Clinical Psychology,Guangji Hospital of Suzhou City,Suzhou 215137,China)

机构地区：[1]苏州市广济医院临床心理科,苏州215137

出　　处：《中华行为医学与脑科学杂志》2022年第10期887-892,共6页Chinese Journal of Behavioral Medicine and Brain Science

基　　金：苏州市科技局关键技术应用研究(SS2019076);江苏省自然科学基金面上项目(BK20201177);江苏省卫生健康委科研项目(LGY2019013);苏州市心境障碍临床医学中心的项目(Szlcyxzx202109);苏州市护理学会科研项目(SZHL-A-202203);苏州市姑苏卫生人才科研项目(GSWS2021051);苏州市医学重点扶持学科项目(SZFCXK202103)。

摘　　要：目的探讨反刍思维与家庭功能是否能够预测首发抑郁症患者随访1年抑郁症水平, 家庭功能是否在反刍思维与抑郁水平之间起着中介作用。方法纳入符合入组要求的首发抑郁症患者65例, 所有被试均接受17项汉密尔顿抑郁量表(17-item Hamilton depression scale, HAMD-17)、反刍思维量表(rumination response scale, RRS)和家庭功能评定量表测验(family assessment device, FAD);所有被试接受1年的随访, 采用阶层线性回归分析与中介分析, 研究基线阶段的反刍思维与家庭功能对随访1年抑郁水平的预测作用。结果在基线阶段, 首发抑郁症患者的反刍思维、角色、情感介入、总的功能与随访1年抑郁水平存在显著正相关(分别为r=0.49, P<0.01;r=0.30, P=0.02;r=0.43, P<0.01;r=0.50, P<0.01)。基线阶段反刍思维、情感介入与总的功能可以预测随访1年抑郁水平(β=0.315, t=2.954, P=0.005;β=0.261, t=2.550, P=0.013;β=0.323, t=2.952, P=0.005)。中介分析显示, 情感介入与总的功能在基线阶段反刍思维与随访1年抑郁水平之间起着部分中介作用(情感介入点估计值=0.040, 95%CI=0.012~0.090;总的功能点估计值=0.066, 95%CI=0.017~0.143)。结论首发抑郁症患者基线阶段的反刍思维与家庭功能对随访1年抑郁水平有一定预测作用;家庭功能在基线阶段反刍思维与随访1年抑郁水平之间存在部分中介作用。Objective To investigate whether rumination and family functioning can predict the level of depression after 1 year of follow-up in patients with first-episode depression,and whether family functioning plays a mediating role between rumination and depression level.Methods Sixty-five patients with first-episode depression who met the enrollment requirements were included,and all subjects were assessed the 17-item Hamilton depression scale(HAMD-17),rumination response scale(RRS)and family assessment device(FAD).All subjects were followed up for 1 year,and the predictive effects of rumination and family functioning at baseline on the level of depression after 1 year of follow-up were investigated by hierarchical linear regression analysis and mediation analysis.Results At the baseline stage,rumination,role,affective involvement(AI)and general functioning(GF)were significantly positively associated with depression level after 1 year of follow-up in patients with first-episode depression(r=0.49,P<0.01;r=0.30,P=0.02;r=0.43,P<0.01;r=0.50,P<0.01;respectively).Rumination,AI and GF at the baseline stage predicted depression level after 1 year of follow-up(β=0.315,t=2.954,P=0.005;β=0.261,t=2.550,P=0.013;β=0.323,t=2.952,P=0.005).Mediation analysis showed that AI and GF partially mediated the relationship between rumination at baseline and depression level at 1 year follow-up(point estimate value for AI=0.040,95%CI=0.012-0.090);point estimate value for GF=0.066,95%CI=0.017-0.143).Conclusions Rumination and family functioning at baseline in first-episode depressed patients can predict the depression level at 1 year follow-up.Family functioning partly mediates the relationship between the baseline rumination and the depression level at 1 year follow-up.

关 键 词：抑郁症 反刍思维 家庭功能 中介分析 

分 类 号：R749.4[医药卫生—神经病学与精神病学]