心理理论能力对首次住院青少年抑郁障碍患者非自杀性自伤行为的影响  

Effect of theory of mind on non-suicidal self-injury behavior in adolescent patients with depressive disorder for the first hospitalization

作　　者：黄方珺 刘铁榜[1,2] Huang Fangjun;Liu Tiebang(Anhui Medical University Shenzhen Mental Health Clinical College,Hefei 230032,China;Shenzhen Kangning Hospital,Shenzhen Mental Health Center,Shenzhen 518000,China)

机构地区：[1]安徽医科大学深圳精神卫生临床学院,合肥230032 [2]深圳市康宁医院,深圳市精神卫生中心,深圳518000

出　　处：《中华行为医学与脑科学杂志》2022年第11期990-995,共6页Chinese Journal of Behavioral Medicine and Brain Science

基　　金：广东省高水平临床重点专科项目(深圳市配套建设经费)(SZGSP013)。

摘　　要：目的探讨伴有非自杀性自伤(non-suicidal self-injury,NSSI)行为的青少年抑郁障碍患者的心理理论能力特征,分析NSSI行为和心理理论能力之间的关系,以便早期识别有NSSI行为风险的患者并及时给予干预。方法选取2021年5月至10月在深圳市康宁医院首次入院的青少年抑郁障碍患者54例,通过DSM-5将其分为伴NSSI组(n=31)和不伴NSSI组(n=23)。所有入组对象采用汉密尔顿焦虑量表14项(Hamilton anxiety rating scale,HAMA-14)、汉密尔顿抑郁量表17项(Hamilton depression rating scale,HAMD-17)评估焦虑、抑郁症状;采用暗示任务(hinting task)、Yoni心理理论任务、眼区测验(reading the mind in the eyes test,RMET)评估心理理论受损情况。采用SPSS 22.0软件中的Logistic回归分析探究心理理论能力对首次住院的青少年抑郁障碍患者NSSI行为的影响。结果伴NSSI组患者在HAMA-14[(21.48±4.92)分,(16.35±5.61)分]、HAMD-17[(25.61±4.08)分,(21.43±4.64)分]分值均高于不伴NSSI组,差异有统计学意义(t=3.57,3.51,均P<0.05)。伴NSSI组患者在暗示任务[(16.10±2.84)分,(18.17±1.15)分]、RMET任务[(21.61±2.58)分,(23.61±3.07)分]、Yoni二阶认知测试[(18.90±3.70)分,(20.96±2.72)分]、Yoni二阶情感测试[(28.84±3.93)分,(31.04±3.04)分]分值低于不伴NSSI组,均差异有统计学意义(t=-3.68,-2.59,-2.27,-2.24,均P<0.05)。二元Logistic回归分析显示心理理论能力情感成分(解码成分)(β=-0.306,OR=0.736,95%CI=0.552~0.982,P=0.037)、认知成分(推理成分)(β=-0.485,OR=0.616,95%CI=0.396~0.957,P=0.031)均与首次住院的青少年抑郁障碍患者的NSSI行为有关。结论心理理论能力情感成分(解码成分)和认知成分(推理成分)受损程度增加可能是青少年抑郁障碍患者NSSI行为发生的危险因素。Objective To explore the characteristics of theory of mind(TOM)ability of adolescent depressive disorder patients with non-suicidal self-injury(NSSI)behavior,and analyze the relationship between NSSI behavior and TOM,so as to identify patients with NSSI behavioral risk early and give timely intervention.Methods A total of 54 adolescent patients with depressive disorder who were hospitalized for the first time in Shenzhen Kangning Hospital from May to October 2021 were enrolled.They were divided into NSSI group(n=31)and non-NSSI group(n=23)according to DSM-5.Hamilton anxiety rating scale-14 item(HAMA-14)and Hamilton depression rating scale-17 item(HAMD-17)were used to evaluate the severity of anxiety and depression.Hinting task,Yoni task and reading the mind in the eyes test(RMET)were used to test TOM of the two groups.Binary Logistic regression analysis in SPSS 22.0 was used to explore the influence of TOM ability on NSSI behavior of adolescents with depressive disordor.Results Compared with patients in non-NSSI group,patients in NSSI had significantly higher scores of HAMA-14(21.48±4.92 vs 16.35±5.61,t=3.57,P<0.05)and HAMD-17(25.61±4.08 vs 21.43±4.64)(t=3.51,P<0.05).The patients in NSSI group had lower scores on the hinting task(16.10±2.84 vs 18.17±1.15,t=-3.68,P<0.05),RMET task(21.61±2.58 vs 23.61±3.07)(t=-2.59,P<0.05),and second-order cognitive TOM((18.90±3.70)vs(20.96±2.72),t=-2.27,P<0.05)and second-order affective TOM(28.84±3.93 vs 31.04±3.04)(t=-2.24,P<0.05)in Yoni task than those in non-NSSI group.Binary Logistic regression analysis showed effective TOM(β=-0.306,OR=0.736,95%CI=0.552-0.982,P=0.037)and cognitive TOM(β=-0.485,OR=0.616,95%CI=0.396-0.957,P=0.031)were associated with non-suicidal self-injury in patients with depressive disorder.Conclusion The increased impairment of the emotional component(decoding component)and cognitive component(reasoning component)of TOM may be risk factors for the occurrence of NSSI behavior in adolescent depressive disorder patients.

关 键 词：抑郁障碍 青少年 非自杀性自伤 心理理论 

分 类 号：R749.4[医药卫生—神经病学与精神病学]