青少年抑郁障碍患者自杀意念与童年创伤的关系研究:抑郁症状严重程度和低维生素D水平的双中介作用  

The Relationship between Suicidal Ideation and Childhood Trauma in Adolescents with Depressive Disorder:the Dual Mediating Effects of Depressive Symptom Severity and Low Vitamin D Levels

作　　者：赵丽丽[1] 刘乐伟 耿峰 莫大明 刘寰忠[2] ZHAO Lili;LIU Lewei;GENG Feng;MO Daming;LIU Huanzhong(School of Mental Health and Psychological Sciences,Anhui Medical University,Hefei 230032,China;Department of Psychiatry,Chaohu Hospital of Anhui Medical University,Hefei 238000,China;Department of Psychology and Sleep Medicine,the Second Affiliated Hospital of Anhui Medical University,Hefei 230000,China;Department of Child and Adolescent Psychology,Fourth People's Hospital of Hefei,Hefei 230000,China)

机构地区：[1]安徽医科大学精神卫生与心理科学学院,安徽省合肥市230032 [2]安徽医科大学附属巢湖医院精神科,安徽省合肥市238000 [3]安徽医科大学第二附属医院心理与睡眠医学科,安徽省合肥市230000 [4]安徽省合肥市第四人民医院儿少心理科,安徽省合肥市230000

出　　处：《中国全科医学》2025年第13期1614-1621,共8页Chinese General Practice

基　　金：国家临床重点专科建设项目(皖卫医秘[2019]267号);安徽省转化研究院科研基金项目(2022zhyx-B01)。

摘　　要：背景童年创伤是抑郁障碍患者自杀意念的危险因素,血浆维生素D水平也与自杀意念相关,而目前在青少年抑郁障碍患者中关于其相互关系的探究尚不足。目的探讨自杀意念与童年创伤的关系,并分析抑郁症状严重程度和低维生素D水平的中介作用。方法以2021年在安徽医科大学附属巢湖医院和合肥市第四人民医院就诊的青少年抑郁障碍患者为抑郁障碍组(n=168),以同期招募的无精神疾病史青少年为对照组(n=89)。采用儿童期虐待问卷(CTQ)、流调抑郁量表(CES-D)、自杀意念量表(PANSI)评估童年创伤、抑郁症状、自杀意念,同时检测血浆25-羟维生素D[25(OH)D]水平。比较抑郁障碍组青少年和对照组青少年在自杀意念、抑郁症状、童年创伤及维生素D水平之间的差异;采用Pearson相关分析检验各量表得分的相关性,并通过PROCESS宏程序分析抑郁和维生素D水平在童年创伤与自杀意念之间的中介作用。结果抑郁障碍组的PANSI得分、CTQ各分量表得分及总得分高于对照组(P<0.05),25(OH)D水平低于对照组(P<0.05)。Pearson相关分析显示,抑郁障碍组的PANSI得分与CTQ总分、CES-D得分、25(OH)D水平存在相关性(P<0.05),对照组的PANSI得分与CTQ总得分、CES-D得分存在相关性(P<0.05);与25(OH)D水平无相关关系(P>0.05)。中介效应分析显示:抑郁障碍组的CES-D得分和25(OH)D水平在CTQ总得分和PANSI得分之间发挥部分中介作用,中介效应占比分别为61.8%和5.3%;在CTQ情感虐待分量表得分和PANSI得分之间发挥部分中介作用,中介效应占比分别为58.9%和6.5%;在CTQ情感忽视分量表得分和PANSI得分之间发挥部分中介作用,中介效应占比分别为67.2%和5.6%;在CTQ躯体忽视分量表得分和PANSI得分之间发挥完全中介作用,中介效应占比为92.2%和7.8%。对照组的25(OH)D水平中介效应均不显著;CES-D得分在CTQ总得分与PANSI得分之间、CTQ情感虐待分量表得分和PBackground Childhood trauma is a risk factor for suicidal ideation in patients with depressive disorder,and plasma vitamin D level is also related to suicidal ideation.However,there is still insufficient research on the relationship between them in adolescent patients with depressive disorder.Objective To explore the relationship between suicidal ideation and childhood trauma and to analyze the mediating role of depressive symptom severity and low vitamin D levels.Methods Adolescent patients with depressive disorder who attended Chaohu Hospital of Anhui Medical University and the Fourth People's Hospital of Hefei City in 2021 were used as the depressive disorder group(n=168),and adolescents with no history of mental illness recruited during the same period were used as the control group(n=89).Childhood trauma,depressive symptoms,and suicidal ideation were assessed using the Childhood Abuse Questionnaire(CTQ),the Current Evaluation of Depression Scale(CES-D),and the Suicidal Ideation Scale(PANSI),and plasma 25-hydroxyvitamin D[25(OH)D]levels were also tested.Differences between adolescents with depressive disorders and control adolescents in suicidal ideation,depressive symptoms,childhood trauma,and vitamin D levels were compared;Pearson correlation analyses were used to test the correlation of scores on each scale,and the mediating roles of depression and vitamin D levels between childhood trauma and suicidal ideation were analyzed by the PROCESS macro program.Results Adolescents in the depressive disorder group had higher PANSI scores,CTQ subscale scores,and total scores than those in the control group(P<0.05),and lower 25(OH)D levels than those in the control group(P<0.5).Pearson correlation analyses showed that there were correlations between the PANSI scores and the CTQ total scores,the CES-D scores,and the 25(OH)D levels of adolescents in the depressive disorder group(P<0.05),and the PANSI scores of adolescents in the control group were correlated with total CTQ scores,CES-D scores(P<0.05),and no correlation

关 键 词：抑郁 青少年 自杀意念 童年创伤 骨化三醇 中介分析 

分 类 号：R749.42[医药卫生—神经病学与精神病学]