四川精神卫生2025，Vol.38Issue(4)：333-339,7.DOI:10.11886/scjsws20241127002
青少年心境障碍患者非自杀性自伤行为与自我病耻感的关系:自尊、社交回避与苦恼的链式作用路径
Relationship between non-suicidal self-injury behavior and self-stigma in adolescents with mood disorder:the chained mediation role of self-esteem and social avoidance/distress
摘要
Abstract
Background Non-suicidal self-injury(NSSI)in adolescents is a serious global public health issue.Self-stigma is identified as a key factor hindering adolescents from seeking professional psychological help,while only a few studies have dealt with the self-stigma in adolescents with mood disorder exhibiting NSSI behavior.Objective To investigate the influencing factors of self-stigma among adolescents with mood disorder who exhibit NSSI behavior,and to examine the chained mediation role of self-esteem and social avoidance/distress in the relationship between NSSI behavior and self-stigma,with the aim of providing references for the detection and intervention of self-stigma in such patients.Methods A total of 220 consecutive adolescent patients with mood disorder who met"the International Classification of Diseases,Tenth Edition"(ICD-10)diagnostic criteria for depressive disorder or depressive episode of bipolar disorder and attended the Fourth People's Hospital of Wuhu from November 2022 to November 2023 were recruited.The Adolescent Non-suicidal Self-injury Assessment Questionnaire(ANSAQ),Internalized Stigma of Mental Illness(ISMI)Scale,Self-Esteem Scale(SES),and Social Avoidance/Distress Scale(SADS)were employed to assess the participants.Correlation among variables was evaluated using Pearson's correlation coefficient.Multivariate linear regression analysis was utilized to identify the factors influencing self-stigma among adolescent patients with mood disorder exhibiting NSSI.The proposed mediating hypotheses were tested using Model 6 in the SPSS Process macro(version 3.0).Results Valid responses were received from 204/220(92.73％)participants,including 153 cases with NSSI and 51 cases without NSSI.The NSSI(vs.no NSSI)group reported significantly higher scores on ISMI and SADS(t=-5.187,-4.564,P<0.01),and lower scores on SES(t=4.478,P<0.01).In the NSSI group,the total score of ISMI demonstrated a positive correlation with the total score of SADS and the behavioral questionnaire score in ANSAQ(r=0.644,0.316,P<0.01),and a negative correlation with the total score of SES(r=-0.724,P<0.01).Multivariate linear regression analysis revealed that NSSI severity(β=0.132,P<0.05)and social avoidance/distress(β=0.309,P<0.01)were found to be positive predictors of the self-stigma,whereas self-esteem(β=-0.493,P<0.01)was a significant negative predictor of the self-stigma.Additionally,self-esteem and social avoidance/distress partially mediated the relationship between NSSI and self-stigma,with a mediating effect of 0.237(95％CI:0.103～0.374),which constituted 55.89％of the total effect.The mediating effect included two paths:NSSI behavior→self-esteem→self-stigma(effect size was 0.163,95％CI:0.069～0.273)and NSSI behavior→self-esteem→social avoidance/distress→self-stigma(effect size was 0.063,95％CI:0.020～0.119).Conclusion The severity of NSSI can affect self-stigma in adolescents with mood disorders either directly through mediating self-esteem or indirectly through the chained mediation path of self-esteem and social avoidance/distress.关键词
青少年/心境障碍/自我病耻感/非自杀性自伤/链式中介效应Key words
Adolescent/Mood disorder/Self-stigma/Non-suicidal self-injury/Chained mediation effect分类
医药卫生引用本文复制引用
陶甜美,蒋巧,罗佳..青少年心境障碍患者非自杀性自伤行为与自我病耻感的关系:自尊、社交回避与苦恼的链式作用路径[J].四川精神卫生,2025,38(4):333-339,7.基金项目
芜湖市第四人民医院2022年科研项目(项目名称:青少年心境障碍患者病耻感与抑郁情绪、社会支持、童年期虐待的相关性研究,项目编号:kjxm202203)Funded by Scientific Research Projects of Wuhu Fourth People's Hospital in 2000(number,kjxm202203) （项目名称:青少年心境障碍患者病耻感与抑郁情绪、社会支持、童年期虐待的相关性研究,项目编号:kjxm202203）
