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中华临床医师杂志(电子版) ›› 2025, Vol. 19 ›› Issue (09) : 633 -641. doi: 10.3877/cma.j.issn.1674-0785.2025.09.001

临床研究

儿童青少年首次抑郁发作的临床特征及非自杀性自伤的影响因素
高鉴兴, 马晶晶, 夏洁, 柯晓燕, 方慧()   
  1. 210029 南京,南京医科大学附属脑科医院儿童心理卫生研究中心
  • 收稿日期:2025-07-24 出版日期:2025-09-30
  • 通信作者: 方慧

Clinical characteristics of first-episode depression and factors associated with non-suicidal self-injury in children and adolescents

Jianxing Gao, Jingjing Ma, Jie Xia, Xiaoyan Ke, Hui Fang()   

  1. Child Mental Health Research Center, The Brain Hospital Affiliated to Nanjing Medical University, Nanjing 210029, China
  • Received:2025-07-24 Published:2025-09-30
  • Corresponding author: Hui Fang
引用本文:

高鉴兴, 马晶晶, 夏洁, 柯晓燕, 方慧. 儿童青少年首次抑郁发作的临床特征及非自杀性自伤的影响因素[J/OL]. 中华临床医师杂志(电子版), 2025, 19(09): 633-641.

Jianxing Gao, Jingjing Ma, Jie Xia, Xiaoyan Ke, Hui Fang. Clinical characteristics of first-episode depression and factors associated with non-suicidal self-injury in children and adolescents[J/OL]. Chinese Journal of Clinicians(Electronic Edition), 2025, 19(09): 633-641.

目的

分析儿童青少年首次抑郁发作门诊患者的临床特征和非自杀性自伤(NSSI)发生的风险以及保护因素。

方法

选取2020年1月~2023年12月期间首次在南京医科大学附属脑科医院儿童心理卫生研究中心门诊就诊的首发抑郁发作患者共441例,其中伴NSSI者313(71.0%)例,不伴NSSI者128(29.0%)例。采用儿童自我意识量表以及90项症状清单评估儿童青少年首次抑郁发作的临床症状,采用χ2检验、独立样本t检验比较伴有NSSI和不伴有NSSI的儿童青少年首次抑郁发作的临床特征的差异,运用Logistic回归进一步探索其影响因素。

结果

在SCL-90量表比较中,不伴NSSI组的躯体化(t=-5.342,P<0.001)、强迫(t=-3.430,P=0.001)、人际关系(t=-5.258,P<0.001)、抑郁(t=-5.673,P<0.001)、焦虑(t=-4.870,P<0.001)、敌对(t=-5.299,P<0.001)、恐怖(t=-3.292,P=0.001)、偏执(t=-5.000,P<0.001)、精神病性(t=-5.802,P<0.001)、其他(t=-5.854,P<0.001)均显著低于伴NSSI组。伴NSSI组与不伴NSSI组的自我意识量表比较中,不伴NSSI组的自我意识总分(t=3.635,P<0.001)、自我意识行为(t=4.765,P<0.001)、自我意识焦虑(t=2.462,P=0.014)、自我意识幸福与满足(t=3.414,P=0.001)均显著高于伴NSSI组。进一步的Logistic回归分析提示,女性(OR=2.033,95%CI:1.188~3.478)、躯体化(OR=1.040,95%CI:1.005~1.077)、人际关系(OR=1.064,95%CI:1.003~1.129)、精神病性(OR=1.076,95%CI:1.019~1.137)与抑郁患者的NSSI呈正相关;恐怖(OR=0.948,95%CI:0.900~0.999)、强迫(OR=0.908,95%CI:0.858~0.961)、自我意识行为(OR=0.902,95%CI:0.829~0.982)与抑郁患者NSSI呈负相关。

结论

首发儿童青少年抑郁发作出现NSSI的高危因素有女性、躯体化症状、人际关系敏感、精神病性症状,保护性因素有强迫症状、恐怖症状、自我意识行为。

Objective

To analyse the clinical characteristics of children and adolescents with first-episode depression who visited the outpatient clinic, as well as the risk of non-suicidal self-injury (NSSI) and protective factors.

Methods

A total of 441 patients with first-episode depression who visited the Child Mental Health Research Centre at Nanjing Brain Hospital affiliated with Nanjing Medical University between January 2020 and December 2023 were selected. Among them, 313 (71.0%) had NSSI and 128 (29.0%) did not. The Children's Self-Awareness Scale and the 90-item Symptom Checklist (SCL-90) were used to assess the clinical symptoms of these children and adolescents. Chi-square tests and independent t-tests were used to compare the differences in clinical characteristics between those with and without NSSI, and Logistic regression was further used to explore the influencing factors.

Results

In the comparison of SCL-90 questionnaire scores, the group without NSSI had significantly lower scores of somatisation (t=-5.342, P<0.001), obsessive-compulsive symptoms (t=-3.430,P=0.001), interpersonal relationships(t=-5.258, P<0.001), depression (t=-5.673, P<0.001), anxiety (t=-4.870, P<0.001), hostility (t=-5.299, P<0.001), phobia (t=-3.292, P=0.001), paranoia (t=-5.000, P<0.001), psychoticism (t=-5.802, P<0.001), and other (t=-5.854, P<0.001) than the non-NSSI group. In the comparison of Children's Self-Awareness Scale scores between the two groups, the total self-awareness score (t=3.635, P<0.001), as well as the scores of self-awareness behaviour (t=4.765, P<0.001), self-awareness anxiety (t=2.462, P=0.014), and self-awareness happiness and satisfaction (t=3.414, P=0.001), was significantly higher in the non-NSSI group than in the group with NSSI. Further Logistic regression analysis indicated that female gender (odds ratio [OR]=2.033, 95% confidence interval [CI]: 1.188~3.478), somatisation (OR=1.040, 95%CI: 1.005~1.077), interpersonal relationships (OR=1.064, 95%CI: 1.003~1.129), and psychoticism (OR=1.076, 95%CI: 1.019~1.137) were positively associated with NSSI in patients with depression, while horror (OR=0.948, 95%CI: 0.900~0.999), obsessive-compulsive symptoms (OR=0.908, 95%CI: 0.858~0.961), and self-awareness behaviour (OR=0.902, 95%CI: 0.829~0.982) were negatively associated with NSSI.

Conclusion

High-risk factors for NSSI in children and adolescents with first-episode depression include female gender, somatisation symptoms, interpersonal sensitivity, and psychotic symptoms. Protective factors include obsessive-compulsive symptoms, phobic symptoms, and self-conscious behaviour.

表1 伴NSSI组与不伴NSSI组的人口学资料比较
表2 伴NSSI 组与不伴NSSI 组的SCL-90比较(
±s
表3 伴NSSI组与不伴NSSI组的自我意识比较(
±s
表4 伴NSSI组与不伴NSSI组的不同程度抑郁SCL-90比较(
±s
项目 抑郁发作不伴NSSI组 抑郁发作伴NSSI组 t
轻度抑郁(n=75)
SCL-90总分 173.40±53.25 176.03±47.25 -0.226
SCL-90躯体化 16.86±5.82 18.43±6.84 -1.061
SCL-90强迫 22.97±6.60 22.45±6.16 0.354
SCL-90人际关系 18.74±7.09 19.73±6.04 -0.648
SCL-90抑郁 27.83±9.99 26.45±8.19 0.657
SCL-90焦虑 18.97±7.15 18.85±6.92 0.075
SCL-90敌对 13.86±5.92 13.25±5.21 0.473
SCL-90恐怖 12.06±4.45 12.95±5.02 -0.809
SCL-90偏执 11.71±4.26 12.68±4.46 -0.950
SCL-90精神病性 17.34±6.39 17.58±5.63 -0.167
SCL-90其他项目总分 13.06±5.25 13.68±4.23 -0.564
中度抑郁(n=70)
SCL-90总分 222.48±44.79 244.07±55.35 -1.736
SCL-90躯体化 22.24±6.51 24.73±9.30 -1.242
SCL-90强迫 28.55±5.60 28.29±6.97 0.166
SCL-90人际关系 24.14±6.53 26.81±6.40 -1.703
SCL-90抑郁 36.21±8.68 40.00±9.74 -1.678
SCL-90焦虑 26.83±6.39 28.05±7.53 -0.711
SCL-90敌对 15.83±5.02 19.20±6.08 -2.449*
SCL-90恐怖 17.03±6.55 16.88±5.54 0.108
SCL-90偏执 13.52±4.45 16.46±4.73 -2.628*
SCL-90精神病性 22.07±5.71 25.68±6.81 -2.333*
SCL-90其他项目总分 16.07±3.83 17.98±5.53 -1.603
重度抑郁(n=296)
SCL-90总分 294.56±61.90 318.44±60.36 -2.786**
SCL-90躯体化 32.84±10.36 36.66±10.92 -2.500*
SCL-90强迫 34.89±7.40 35.97±7.05 -1.077
SCL-90人际关系 31.27±7.48 33.47±6.68 -2.277*
SCL-90抑郁 47.64±9.79 51.99±8.88 -3.393**
SCL-90焦虑 33.73±7.89 36.62±8.23 -2.505*
SCL-90敌对 20.94±5.65 23.08±5.05 -2.930**
SCL-90恐怖 21.84±6.80 22.64±6.96 -0.812
SCL-90偏执 19.67±5.58 20.75±5.04 -1.486
SCL-90精神病性 30.11±8.29 33.37±8.11 -2.988**
SCL-90其他项目总分 21.63±5.18 23.88±4.93 -3.204**
表5 伴NSSI组与不伴NSSI组的不同程度抑郁自我意识比较(
±s
表6 NSSI危险因素回归分析
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