稳定期精神分裂症患者童年创伤对攻击行为的影响:自尊与心理弹性的链式中介作用研究  

Effect of Childhood Trauma on Aggressive Behavior in Stable Schizophrenia Patients:the Chain Mediating Effect of Self-esteem and Resilience

作　　者：孙玉静[1] 张静[1] 宇虹[1] 周郁秋[1] 姜文龙 贾艳楠 SUN Yujing;ZHANG Jing;YU Hong;ZHOU Yuqiu;JIANG Wenlong;JIA Yannan(Harbin Medical University,Harbin 150081,China;Daqing Third Hospital,Daqing 163712,China)

机构地区：[1]哈尔滨医科大学,黑龙江省哈尔滨市150081 [2]黑龙江省大庆市第三医院,163712

出　　处：《中国全科医学》2023年第23期2899-2906,共8页Chinese General Practice

基　　金：国家自然科学基金资助项目(72074063);教育部人文社会科学基金资助项目(21YJCZH145)。

摘　　要：背景在各类精神疾病中,精神分裂症患者攻击行为发生率最高,攻击行为不仅扰乱医疗环境,也对家庭稳定和社会和谐造成巨大威胁。既往的回归分析研究表明童年创伤、自尊、心理弹性是精神分裂症患者攻击行为的影响因素,但当前较少有研究探讨上述4个变量之间的内在联系。目的构建链式中介模型探讨精神分裂症患者童年创伤、自尊、心理弹性及攻击行为的关系,阐明其内在作用机制。方法依据便利抽样原则,选取2021年3月—2022年7月在大庆市第三医院和赤峰市安定医院住院的稳定期精神分裂症患者为研究对象。对研究对象进行问卷调查,问卷内容包括一般情况调查表、阳性与阴性症状量表(PANSS)、童年创伤量表(CTQ-SF)、心理弹性量表(CDRISC)、自尊量表(SES)、攻击行为问卷(AQ),采用Pearson相关分析探讨CTQ-SF、CD-RISC、SES和AQ得分的相关性,并采用多元线性回归分析探究精神分裂症患者攻击行为的影响因素。采用AMOS 24.0进行链式中介模型的构建,并采用Bootstrap方法对所构建的链式中介模型进行中介效应检验。结果本研究共发放问卷310份,回收有效问卷300份,有效回收率为96.8%。患者PANSS、CTQ-SF、SES、CD-RISC、AQ平均得分为(18.4±3.7)、(49.7±13.5)、(26.9±6.9)、(55.2±15.5)、(84.3±19.8)分。多元线性回归分析结果显示,精神分裂症患者童年创伤[B=0.551,95%CI(0.421,0.681),P<0.001]、自尊[B=-0.661,95%CI(-0.908,-0.413),P<0.001]、心理弹性[B=-0.448,95%CI(-0.561,-0.335),P<0.001]是攻击行为的影响因素。Pearson相关分析结果显示,CTQ-SF得分与AQ得分呈正相关(r=0.695,P<0.01),与SES得分、CD-RISC得分呈负相关(r=-0.524,P<0.01;r=-0.565,P<0.01);SES得分与AQ得分呈负相关(r=-0.607,P<0.01),与CD-RISC得分呈正相关(r=0.522,P<0.01);CD-RISC得分与AQ得分呈负相关(r=-0.681,P<0.01)。链式中介模型检验结果显示模型的拟合度和适配度良好。Bootstrap分Background Among people with various mental illnesses,those with schizophrenia have the highest incidence of aggressive behavior,which not only disturbs the medical environment,but also poses a great threat to family stability and social harmony.Previous regression analysis studies have shown that childhood trauma,self-esteem and resilience are influencing factors of aggressive behavior in schizophrenia patients,but few studies have explored the internal relationship between these four variables.Objective To explore the relationship between childhood trauma,self-esteem,resilience and aggressive behavior in schizophrenic patients using a self-constructed chain mediation model,and to clarify its internal mechanism.Methods A convenience sample of stable schizophrenia inpatients were selected from Daqing Third Hospital and Chifeng Anding Hospital from March 2021 to July 2022.A survey was conducted with them using a questionnaire consisting of general information questionnaire,Positive and Negative Symptom Scale(PANSS),Childhood Trauma Questionnaire-Short Form(CTQ-SF),Connor-Davidson Resilience Scale(CD-RISC),Self-esteem Scale(SES),and Aggressive Questionnaire(AQ).Pearson correlation analysis was used to explore the correlation of AQ score with CTQ-SF,CD-RISC and SES scores.Multiple linear regression analysis was used to explore the influencing factors of aggressive behavior.AMOS 24.0 was used to construct the chain mediation model.The mediation effect of the chain mediation model was tested using Bootstrap method.Results Three hundred and ten cases attended the survey,and 300 of them(96.8%)who responded effectively were finally included for analysis.The average scores of PANSS,CTQ-SF,SES,CD-RISC and AQ were(18.4±3.7),(49.7±13.5),(26.9±6.9),(55.2±15.5)and(84.3±19.8),respectively.Multiple linear regression analysis showed that childhood trauma〔B=0.551,95%CI(0.421,0.681),P<0.001〕,self-esteem〔B=-0.661,95%CI(-0.908,-0.413),P<0.001〕and resilience〔B=-0.448,95%CI(-0.561,-0.335),P<0.001〕were influencing facto

关 键 词：精神分裂症 稳定期精神分裂症 童年创伤 自尊 心理弹性 攻击行为 中介分析 链式中介作用 

分 类 号：R749.3[医药卫生—神经病学与精神病学]