摘要
目的
非自杀性自伤在青少年群体中很常见,中国对青少年自伤问题的关注仍不充分。本研究通过对青少年及其父母的问卷调查,探讨了青少年的自伤行为,及其与家庭、学业、情绪和自杀因素的关系。
方法
所有受试者均来自浙江大学医学院第一附属医院精神科。根据《精神障碍诊断与统计手册》第五版(DSM-5)的诊断标准,纳入诊断为重度抑郁障碍或双相情感障碍的青少年及其父母。共有70名青少年和59名家长参加了这项研究。研究人员收集了青少年自伤的人口学特征和相关信息,包括患者和家长报告的数据。采用斯皮尔曼秩相关分析计算自伤与其他因素的相关性。
结果
受试的青少年平均年龄为(16.1±2.4)岁。在有非自杀性自伤行为的青少年中,女性占35例(79.5%)。受试青少年中,38人(54.3%)报告了调查前一个月内的自伤行为,26人(37.1%)报告了在过去一年内5次以上的自伤行为,以上两项父母报告的数据分别为11人(18.6%)和4人(6.8%)。有绝望感(68.6%)、希望死亡(62.9%)、自杀念头(70.0%)以及希望意外结束生命(62.9%)想法的青少年比例较高,而父母报告的上述情绪障碍比例相对较低,分别为37.3%、23.7%、6.8%和11.9%。在与非自杀性自伤相关的因素中,不良的家庭关系、学习压力和情感问题如“悲伤时无人倾诉”、“心理痛苦无法理解”等,在受试青少年和家长的报告中都普遍存在。青少年报告的与“一个月内自伤行为”呈正相关的因素包括“绝望感”、“自杀念头”、“希望意外结束生命”和“由于预期中的死亡匆忙处理事务” (ρ分别为0.429、0.463、0.482和0.483,所有P<0.05)。值得注意的是,“希望死亡”和“希望意外结束生命”(ρ分别为0.407和0.407,所有P<0.05)也是“过去一年中自伤5次以上”的强正相关因素。在家长报告中,“绝望感”是唯一和“一个月内自伤行为”呈正相关的因素(ρ=0.261,P<0.05).
结论
有心境障碍的中国青少年实行非自杀性自伤行为的风险较高,且与自杀观念呈正相关。有非自杀性自伤的青少年的父母可能低估了这种情况,需要更重视这方面的情况。
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References
Borschmann R, Becker D, Coffey C, et al., 2017. 20-year outcomes in adolescents who self-harm: a population-based cohort study. Lancet Child Adolesc Health, 1(3): 195–202. https://doi.org/10.1016/S2352-4642(17)30007-X
Bresin K, Gordon KH, 2013. Changes in negative affect following pain (vs. nonpainful) stimulation in individuals with and without a history of nonsuicidal self-injury. Personal Disord, 4(1):62–66. https://doi.org/10.1037/a0025736
Fox KR, Franklin JC, Ribeiro JD, et al., 2015. Meta-analysis of risk factors for nonsuicidal self-injury. Clin Psychol Rev, 42:156–167. https://doi.org/10.1016/j.cpr.2015.09.002
Franklin JC, Hessel ET, Aaron RV, et al., 2010. The functions of nonsuicidal self-injury: support for cognitive-affective regulation and opponent processes from a novel psychophysiological paradigm. J Abnorm Psychol, 119(4):850–862. https://doi.org/10.1037/a0020896
Gandhi A, Luyckx K, Molenberghs G, et al., 2019. Maternal and peer attachment, identity formation, and non-suicidal self-injury: a longitudinal mediation study. Child Adolesc Psychiatry Ment Health, 13:7. https://doi.org/10.1186/s13034-019-0267-2
Geulayov G, Casey D, McDonald KC, et al., 2018. Incidence of suicide, hospital-presenting non-fatal self-harm, and community-occurring non-fatal self-harm in adolescents in England (the iceberg model of self-harm): a retrospective study. Lancet Psychiatry, 5(2):167–174. https://doi.org/10.1016/S2215-0366(17)30478-9
Glenn CR, Klonsky ED, 2013. Nonsuicidal self-injury disorder: an empirical investigation in adolescent psychiatric patients. J Clin Child Adolesc Psychol, 42(4):496–507. https://doi.org/10.1080/15374416.2013.794699
Guan K, Fox KR, Prinstein MJ, 2012. Nonsuicidal self-injury as a time-invariant predictor of adolescent suicide ideation and attempts in a diverse community sample. J Consult Clin Psychol, 80(5):842–849. https://doi.org/10.1037/a0029429
Hamza CA, Stewart SL, Willoughby T, 2012. Examining the link between nonsuicidal self-injury and suicidal behavior: a review of the literature and an integrated model. Clin Psychol Rev, 32(6):482–495. https://doi.org/10.1016/j.cpr.2012.05.003
Hiscock H, Neely RJ, Lei SK, et al., 2018. Paediatric mental and physical health presentations to emergency departments, Victoria, 2008–15. Med J Aust, 208(8):343–348. https://doi.org/10.5694/mja17.00434
Huang QQ, Zhang LS, 2016. Related factors to non-suicidal self-injury in college students. Chin Ment Health J, 30(8): 618–623 (in Chinese). https://doi.org/10.3969/j.issn.1000-6729.2016.08.011
Kerr PL, Muehlenkamp JJ, Turner JM, 2010. Nonsuicidal self-injury: a review of current research for family medicine and primary care physicians. J Am Board Fam Med, 23(2):240–259. https://doi.org/10.3122/jabfm.2010.02.090110
Lauw MSM, Abraham AM, Loh CBL, 2018. Deliberate self-harm among adolescent psychiatric outpatients in Singapore: prevalence, nature and risk factors. Child Adolesc Psychiatry Ment Health, 12:35. https://doi.org/10.1186/s13034-018-0242-3
Liu ZZ, Wang XT, Liu XC, et al., 2019. Non-suicidal self-injury and exposure to suicidal behaviors among Chinese adolescents: a longitudinal study. Chin J Epidemiol, 40(12): 1573–1577 (in Chinese). https://doi.org/10.3760/cma.jissn.0254-6450.2019.12.013
Mars B, Heron J, Klonsky ED, et al., 2019. Predictors of future suicide attempt among adolescents with suicidal thoughts or non-suicidal self-harm: a population-based birth cohort study. Lancet Psychiatry, 6(4):327–337. https://doi.org/10.1016/S2215-0366(19)30030-6
McMahon EM, Keeley H, Cannon M, et al., 2014. The iceberg of suicide and self-harm in Irish adolescents: a population-based study. Soc Psychiatry Psychiatr Epidemiol, 49(12):1929–1935. https://doi.org/10.1007/s00127-014-0907-z
McManus S, Gunnell D, Cooper C, et al., 2019. Prevalence of non-suicidal self-harm and service contact in England, 2000–14: repeated cross-sectional surveys of the general population. Lancet Psychiatry, 6(7):573–581. https://doi.org/10.1016/S2215-0366(19)30188-9
Moran P, Coffey C, Romaniuk H, et al., 2012. The natural history of self-harm from adolescence to young adulthood: a population-based cohort study. Lancet, 379(9812): 236–243. https://doi.org/10.1016/S0140-6736(11)61141-0
Morgan C, Webb RT, Carr MJ, et al., 2017. Incidence, clinical management, and mortality risk following self harm among children and adolescents: cohort study in primary care. BMJ, 359:j4351. https://doi.org/10.1136/bmj.j4351
Nock MK, Joiner TE, Gordon KH, et al., 2006. Non-suicidal self-injury among adolescents: diagnostic correlates and relation to suicide attempts. Psychiatry Res, 144(1):65–72. https://doi.org/10.1016/j.psychres.2006.05.010
O’Connor RC, Nock MK, 2014. The psychology of suicidal behaviour. Lancet Psychiatry, 1(1):73–85. https://doi.org/10.1016/S2215-0366(14)70222-6
Prinstein MJ, Heilbron N, Guerry JD, et al., 2010. Peer influence and nonsuicidal self injury: longitudinal results in community and clinically-referred adolescent samples. J Abnorm Child Psychol, 38(5):669–682. https://doi.org/10.1007/s10802-010-9423-0
Tan ACY, Rehfuss MC, Suarez EC, et al., 2014. Nonsuicidal self-injury in an adolescent population in Singapore. Clin Child Psychol Psychiatry, 19(1):58–76. https://doi.org/10.1177/1359104512467273
Tang J, Ma Y, Guo Y, et al., 2013. Association of aggression and non-suicidal self injury: a school-based sample of adolescents. PLoS ONE, 8(10):e78149. https://doi.org/10.1371/journal.pone.0078149
Tschan T, Lüdtke J, Schmid M, et al., 2019. Sibling relationships of female adolescents with nonsuicidal self-injury disorder in comparison to a clinical and a nonclinical control group. Child Adolesc Psychiatry Ment Health, 13:15. https://doi.org/10.1186/s13034-019-0275-2
Victor SE, Hipwell AE, Stepp SD, et al., 2019. Parent and peer relationships as longitudinal predictors of adolescent non-suicidal self-injury onset. Child Adolesc Psychiatry Ment Health, 13:1. https://doi.org/10.1186/s13034-018-0261-0
Watanabe N, Nishida A, Shimodera S, et al., 2012. Deliberate self-harm in adolescents aged 12–18: a cross-sectional survey of 18 104 students. Suicide Life Threat Behav, 42(5):550–560. https://doi.org/10.1111/j.1943-278X.2012.00111.x
Weinberg A, Klonsky ED, 2012. The effects of self-injury on acute negative arousal: a laboratory simulation. Motiv Emot, 36(2):242–254. https://doi.org/10.1007/s11031-011-9233-x
Whitlock J, Eckenrode J, Silverman D, 2006. Self-injurious behaviors in a college population. Pediatrics, 117(6): 1939–1948. https://doi.org/10.1542/peds.2005-2543
World Health Organization, 2019. Suicide prevention. WHO Mental Health Home. https://www.who.int/health-topics/suicide#tab=tab_1
Acknowledgments
This work was supported by the National Key Basic Research Program of China (No. 2016YFC1307100) and the Program of Health and Family Planning Commission in Zhejiang Province (No. 2020KY548), China.
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Shaohua HU contributed to the conception and design of the study and provided administrative support. Yixin WANG, Jianbo LAI, Chanchan HU, Hongbo MENG, and Duo LYU participated in the collection and assembly of data. Yixin WANG and Duo LYU performed data analysis and interpretation. Yixin WANG and Jian-bo LAI were involved in the writing of the manuscript. All authors have given final approval of the manuscript for publication, and therefore have full access to all the data in the study and take responsibility for the integrity and security of the data.
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Yixin WANG, Jianbo LAI, Chanchan HU, Hongbo MENG, Duo LYU, and Shaohua HU declare that they have no conflict of interest.
This study was approved by the Hospital Ethics Committee of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5). Informed consent was obtained from participants for being included in the study.
Supplementary information
Self-injury questionnaire (adolescent version); Self-injury questionnaire (parent version)
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11585_2021_503_MOESM1_ESM.pdf
Non-suicidal self-harm is linked to suicidal thoughts in Chinese adolescents with mood disorders: a cross-sectional report
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Wang, Y., Lai, J., Hu, C. et al. Non-suicidal self-harm is linked to suicidal thoughts in Chinese adolescents with mood disorders: a cross-sectional report. J. Zhejiang Univ. Sci. B 22, 233–240 (2021). https://doi.org/10.1631/jzus.B2000679
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DOI: https://doi.org/10.1631/jzus.B2000679