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| 青少年抑郁障碍患者校园欺凌与非自杀性自伤行为的关系:自尊和述情障碍的作用路径 |
| Relationship between school bullying and non-suicidal self-injury behaviors in adolescents with depressive disorders: the pathways of self-esteem and alexithymia |
| 投稿时间：2024-11-19 修订日期：2025-06-13 |
| DOI： |
| 中文关键词: 【】 青少年 校园欺凌 非自杀性自伤 述情障碍 自尊 |
| 英文关键词:Adolescent School bullying Non-suicidal self-injury Alexithymia Self-esteem |
| 基金项目:黑龙江省卫生健康委科研项目（项目名称：青少年非自杀性自伤风险预测模型构建及CBT干预研究，项目编号：20230303090154） |
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| 中文摘要: |
| 背景 青少年抑郁障碍患者非自杀性自伤（NSSI）行为的发生率较高，校园欺凌与NSSI行为之间存在相关关系，自尊和述情障碍又会影响NSSI行为，但四者间的作用机制尚不明确。 目的 探讨述情障碍和自尊在校园欺凌与青少年抑郁障碍患者NSSI行为之间的作用路径，以期为青少年抑郁障碍患者NSSI行为的干预提供参考。 方法 选取2023年7月—2024年10月于哈尔滨市第一专科医院就诊的青少年抑郁障碍患者335例。采用自编问卷、青少年非自杀性自伤评定问卷中的行为问卷（ANSAQ-B）、特拉华欺负受害量表（DBVS-S）、自尊量表（SES）、多伦多述情障碍量表（TAS-26）进行评定。采用Pearson相关分析考查各量表评分之间的相关性。采用R语言的“mediation”包分析调整性别和抑郁症状首发年龄混杂后述情障碍和自尊在校园欺凌与青少年抑郁障碍患者NSSI行为之间的作用路径。 结果 青少年DBVS-S评分、TAS-26评分与ANSAQ-B评分均呈正相关（r=0.408、0.417，P均<0.01）；SES评分和ANSAQ-B评分呈负相关（r=-0.300，P<0.01）。回归分析结果显示，校园欺凌、述情障碍可以正向预测青少年抑郁障碍患者NSSI行为（β=0.212、0.333，P均<0.01），自尊可以负向预测NSSI行为（β=-0.368，P<0.01）。述情障碍是校园欺凌与NSSI行为的作用路径，间接效应值为0.040（95% CI：0.018~0.069），效应量为17.25%。校园欺凌通过自尊对其NSSI行为的间接效应不显著（β=0.014，95% CI：-0.004~0.069，P=0.122）。结论 校园欺凌可以直接影响抑郁障碍青少年的NSSI行为，也可以通过述情障碍间接影响NSSI行为。 |
| 英文摘要: |
| Background The incidence of non-suicidal self-injury (NSSI) behavior is relatively high among adolescents with depressive disorders. There is a correlation between school bullying and NSSI behavior, and self-esteem and alexithymia also affect NSSI behavior. However, the mechanism of action among these four factors remains unclear. Objective To explore the effect path of alexithymia and self-esteem between school bullying and NSSI behaviors in adolescents with depressive disorders, in order to provide reference for the intervention of NSSI behaviors in adolescents with depressive disorders. Methods A total of 335 adolescent patients with depressive disorders who were treated in the First Psychiatric Hospital of Harbin from July 2023 to October 2024 were selected. Demographic questionnaire, Adolescent Non-suicidal Self-injury Assessment Questionnaire-Behavior (ANSAQ-B), Delaware Bullying Victimization Scale (DBVS-S), Self-Esteem Scale (SES) and Toronto Alexithymia Scale (TAS-26) were used to conduct a cross-sectional survey. Pearson correlation analysis was used to examine the correlation between the scores of each scale. Using the "mediation" package in R to analyze the pathways through which alexithymia and self-esteem mediate the relationship between school bullying and non-suicidal self-injury (NSSI) behavior in adolescents with depressive disorders, after adjusting for confounding factors such as gender and age of onset of depressive symptoms. Results DBVS-S score and TAS-26 score were positively correlated with ANSAQ-B score in adolescents (r=0.408 and 0.417, P<0.01). SES score was negatively correlated with ANSAQ-B score (r=-0.300, P<0.01). Regression analysis showed that school bullying and high level of alexithymia could positively predict NSSI behavior in adolescents with depressive disorders (β=0.212、0.333，all P<0.01), and self-esteem could negatively predict NSSI behavior(β=-0.368，P<0.01). Alexithymia was the effect path of school bullying and NSSI behaviors. The indirect effect value was 0.040 (95% CI: 0.018~0.069), and the effect size was 17.25%. The indirect effect of school bullying on NSSI behavior through self-esteem is not significant（β=0.014，95% CI：-0.004~0.069，P=0.122）. Conclusion Exposure to school bullying and high levels of alexithymia are important predictors of NSSI behavior in adolescents with depressive disorders, and school bullying may indirectly influence NSSI behavior through alexithymia. |
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