伴有非自杀性自伤行为的抑郁障碍青少年患者的临床特征及心理韧性-抑郁双路径模型调查分析

doi:10.3969/j.issn.1006-5725.2025.24.005

Abstract

Abstract:

Objective To investigate the clinical characteristics of depressive disorders in adolescents with non-suicidal self-injury （NSSI） behaviors and to analyze the impact mechanism of childhood trauma on NSSI through a psychological resilience-depression dual-pathway model. Methods A case-control study was conducted involving 99 participants aged 12 ~ 18 years， comprising 51 individuals with depression and NSSI （KD group）， 24 healthy controls （NOR1 group）， and 24 patients with depression but without NSSI （NOR2 group）. The Childhood Trauma Questionnaire （CTQ）， Resilience Scale for Chinese Adolescents （RSCA）， and the 24-item Hamilton Depression Rating Scale （HAMD-24） were administered to assess childhood trauma， psychological resilience， and depressive symptom severity， respectively. Structural equation modeling was used to examine the mediating role of psychological resilience and the moderating effect of depression severity in the relationship between childhood trauma and NSSI. Results In the KD group， 84.3% of participants reported experiencing childhood trauma， with emotional neglect （64.7%） and physical neglect （50.1%） being the most prevalent types. Emotional neglect （r = 0.582， P < 0.001） and physical abuse （r = 0.464， P = 0.002） were significantly associated with NSSI behaviors. Mediation analysis indicated that psychological resilience partially mediated the relationship between childhood trauma and NSSI， such that trauma exposure indirectly increased NSSI risk through reduced psychological resilience， with this indirect effect accounting for 45.7% （95% CI： 15.3% ~ 48.1%， P < 0.01）. Moderation analysis further revealed that the effect of trauma on NSSI was more pronounced among individuals with high levels of depression （HAMD-24 ≥ 20）， where the association was statistically significant （β = 0.603， P < 0.01）. Conclusions This study reveals that childhood trauma， particularly emotional neglect and abuse， is highly prevalent （> 84%） among adolescents exhibiting depressive symptoms and NSSI. A moderated mediation model was constructed and validated， demonstrating that childhood trauma not only directly predicts NSSI but also exerts an indirect effect through diminished psychological resilience， with depressive symptoms serving as a dual moderator in both the direct and indirect pathways. These findings offer a multi-targeted foundation for clinical interventions， highlighting the importance of systematic trauma screening， the promotion of psychological resilience， and the active management of depressive symptoms.

Key words: childhood trauma, non-suicidal self-harm, psychological resilience, depressive disorder, structural equation model

CLC Number:

R749.94

Lifei CAI,Shibin WANG,Hua SHAO,Guowei LUO,Yuqing XIAO,Fujun. JIA. Clinical features and psychological resilience of adolescent patients with depressive disorder and non⁃suicidal self⁃harm behaviors： A survey analysis of the depressive dual⁃pathway model[J]. The Journal of Practical Medicine, 2025, 41(24): 3824-3833.

Figures/Tables 9

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References 34

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指标	KD（n = 51）	NOR1（n = 24）	NOR2（n = 24）	χ2/F值	P值
性别（女）	40（78.40）	16（66.70）	18（75.00）	1.19	0.54
年龄（x ± s）/岁	15.47 ± 1.68	14.46 ± 1.59	15.58 ± 1.59	3.78	0.51
户籍（农村）	19（37.30）	13（54.20）	5（20.80）	5.69	0.06
独生	22（43.10）	8（33.30）	7（29.20）	1.58	0.45
寄宿或走读（寄宿）	27（52.90）	7（29.20）	8（33.30）	4.84	0.09
留守	15（29.40）^△	0（0.00）^?#	7（29.20）^?	9.05	0.01
父母负面婚姻	28（54.90）^△#	1（4.20）^?#	6（25.00）^?△	19.87	< 0.001
家庭成员缺失	2（3.90）	0（0.00）	0（0.00）	1.92	1.00
情感忽视	33（64.70）^△#	1（4.20）^?#	6（25.00）^?△	28.00	< 0.001
躯体虐待	8（15.70）	0（0.00）	2（8.30）	4.53	0.10
情感虐待	24（47.10）^△#	0（0.00）^?	1（4.20）^?	26.60	< 0.001
性虐待	6（11.80）	0（0.00）	2（8.30）	0.96	0.28
躯体忽视	6（11.80）	2（8.30）	3（12.50）	4.35	0.34
心理韧性（x ± s）/分	65.71 ± 14.09^△	88.21 ± 11.32^?	80.88 ± 11.32^?△	43.43	< 0.001
抑郁症状（x ± s）/分	31.80 ± 9.33^△	2.46 ± 2.06^?	24.25 ± 7.18^?△	59.93	< 0.001

变量	KD组（n = 51）	KD1组（n = 43）	KD2组（n = 8）	U/χ2值
年龄/岁	15.3	16.0	14.5	143.00
女性/［例（%）］	40（78.4）	34（79.0）	6（75.0）	0.07
HAMD/分	31.80 ± 1.31	33.07 ± 1.27	25.00 ± 4.26	91.50^?
心理韧性/分	65.71 ± 1.97	64.35 ± 2.07	73.00 ± 5.51	119.50
NSSI/次数	17.40 ± 1.38	17.80 ± 1.50	15.70 ± 3.70	158.50

创伤类型	例数	NSSI
创伤类型	例数	r值	P值
情感忽视	33	0.582	< 0.001
躯体虐待	8	0.464	0.002
情感虐待	24	0.433	0.004
性虐待	6	0.069	0.659
躯体忽视	26	0.454	0.002

变量	M	SD	CTQ	HAMD	心理韧性	NSSI
CTQ	53.98	1.98	1
HAMD	33.07	1.27	0.441^??	1
心理韧性	64.35	2.07	-0.441^??	-0.235	1
NSSI	20.26	1.56	0.606^??	0.312^?	-0.772^??	1

效应	影响路径	Est	Std	Z值
直接效应	CTQ?NSSI	0.259	0.075	3.442^??
间接效应	CTQ?心理韧性	-0.461	0.143	-3.226^??
间接效应	心理韧性?NSSI	-0.473	0.072	-6.564^??
中介效应	CTQ?心理韧性?NSSI	0.218	0.075	2.895^??
总效应	CTQ?NSSI总体水平	0.477	0.095	4.993^??

Clinical features and psychological resilience of adolescent patients with depressive disorder and non⁃suicidal self⁃harm behaviors： A survey analysis of the depressive dual⁃pathway model

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变量	方程1（NSSI）			方程2（韧性）			方程1（NSSI）			方程2（NSSI）
变量	β	SE	t值	β	SE	t值	β	SE	t值	β	SE	t值
X1	0.25	0.06	3.73^??	-0.84	0.25	-3.25^??	0.25	0.07	3.46	-0.46	0.14	-3.22^??
M1										-0.12	0.07	-1.80^?
W1				-0.72	0.22	-3.24^??				0.60	0.10	5.82^??
X1：W1				0.01	0.00	2.71^??
M1：W1										-0.01	0.00	-6.97^??
间接效应				0.22	0.08	2.73^??				0.20	0.07	2.75^??
总效应				0.37	0.10	3.64^??				0.46	0.09	4.86^??

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