童年创伤与青少年心境障碍患者自我病耻感的关系:自尊、抑郁症状的中介作用  

Relationship between childhood trauma and self-stigma in adolescents with mood disorders:the mediating role of self-esteem,depressive symptoms

作　　者：陶甜美 查贵芳 蒋巧 郑欣 杨萍萍 陈方方 骆冰清 罗佳 Tao Tianmei;Zha Guifang;Jiang Qiao;Zheng Xin;Yang Pingping;Chen Fangfang;Luo Bingqing;Luo Jia(Department of Psychology,Wuhu Hospital,Beijing Anding Hospital,Capital Medical University,Wuhu 241000,China;Beijing Anding Hospital,Capital Medical University&National Clinical Research Centre for Mental Disorders&Beijing Key Laboratory for Mental Disorders,Beijing 100088,China;Advanced Innovation Center for Human Brain Protection,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京安定医院芜湖医院心理科,241000 [2]首都医科大学附属北京安定医院,国家精神心理疾病临床医学研究中心,精神疾病诊断与治疗重点实验室,100088 [3]首都医科大学人脑保护高精尖创新中心,北京100069

出　　处：《神经疾病与精神卫生》2025年第2期83-90,共8页Journal of Neuroscience and Mental Health

基　　金：2021年芜湖市卫健委项目(WHWJ2021y071);首都医科大附属北京安定医院芜湖医院2022年院级课题项目(kjxm202203)。

摘　　要：目的研究青少年心境障碍患者自我病耻感的影响因素,以及自尊、抑郁症状在童年创伤与自我病耻感之间的链式中介作用。方法采用方便抽样法,选取2022年11月—2023年11月于首都医科大学附属北京安定医院芜湖医院门诊及住院就诊的220例青少年心境障碍患者为研究对象。采用精神疾病自我病耻感量表(ISMI)、贝克抑郁自评量表(BDI)、罗森伯格自尊量表(RSES)、儿童期创伤问卷中文修订版本(CTQ-SF)评估患者的自我病耻感、抑郁症状、自尊水平和童年期创伤经历。采用多元线性回归分析青少年心境障碍患者自我病耻感的影响因素,采用Pearson相关分析自我病耻感、抑郁症状、自尊水平及童年期创伤经历的相关性。采用SPSS PROCESS宏程序的Model6模型进行中介效应检验。结果本研究共发放问卷220份,回收有效问卷204份,有效回收率92.7%。根据ICD-10诊断标准,将患者分为抑郁障碍组(n=126)和双相情感障碍抑郁发作组(n=78)。204例青少年心境障碍患者的ISMI评分为(74.44±14.45)分,BDI评分为(20.08±8.54)分,RSES评分为(20.62±5.34)分,CTQ-SF评分为(57.02±14.88)分。患者ISMI总分与BDI总分、CTQ-SF总分呈正相关(r=0.741、0.573;均P<0.01)。RSES总分与ISMI总分、BDI总分、CTQ-SF总分呈负相关(r=-0.759、-0.755、-0.491;均P<0.01)。青少年抑郁障碍患者组中,自尊水平和抑郁症状在童年期创伤经历和自我病耻感关系中发挥链式中介作用,中介效应值为0.27,占总效应量的55%。青少年双相情感障碍抑郁发作期患者组中,童年创伤不能直接预测自我病耻感(直接效应=0.15,95%CI:-0.03~0.32),中介效应只有1条路径显著:童年创伤→自尊→自我病耻感(间接效应=0.33,95%CI:0.17~0.51)。结论住院次数、病程、抑郁症状严重程度、童年创伤、自尊水平与青少年心境障碍患者自我病耻感有关;青少年抑郁障碍患者的童年创伤可直接影响自我病耻感Objective To explore the influencing factors of self-stigma in adolescents with mood disorders and the chain mediating role of self-esteem and depression symptoms between childhood trauma and self-stigma.Methods Convenience sampling was used to select 220 adolescents with mood disorders at Wuhu Hospital of Beijing Anding Hospital affiliated with Capital Medical University from November 2022 to November 2023 for the study.Internalized Stigma of Mental Illness Scale(ISMI),Beck Depression Inventory(BDI),Rosenberg Self-Esteem Scale(RSES),and Childhood Trauma Questionnaire-Short Form(CTQ-SF)were used to assess patients'self-stigma,depressive symptoms,self-esteem,and childhood trauma.Multiple linear regression was used to analyze the factors influencing self-stigma in adolescents with mood disorders,and Pearson correlation was used to analyze the correlation between self-stigma,depressive symptoms,self-esteem,and childhood trauma.Mediating effects were tested using the Model6 of the SPSS PROCESS macro program.Results A total of 220 questionnaires were sent out in this study,and 204 were effectively collected,with an effective recovery rate of 92.7%.According to the diagnostic criteria of ICD-10,the patients were classified into the depression disorder group(n=126)and the depressive episode of bipolar disorder group(n=78).ISMI,BDI,RSES and CTQ-SF scores of 204 adolescents with mood disorders were(74.44±14.45),(20.08±8.54),(20.62±5.34),(57.02±14.88),respectively.The patients'ISMI total scores were positively correlated with their BDI total scores and CTQ-SF total scores,and the differences were statistically significant(r=0.741,0.573;all P<0.01).RSES total score showed a statistically significant negative correlation with the ISMI total score,BDI total score,and CTQ-SF total score(r=-0.759,-0.755,and-0.491;all P<0.01).In the group of adolescents with depressive disorders,self-esteem and depressive symptoms played a chain-mediating role between childhood trauma and self-stigma,with a mediating effect value of 0.27,whi

关 键 词：青少年 心境障碍 自我病耻感 童年创伤 链式中介效应 

分 类 号：R749[医药卫生—神经病学与精神病学]