青少年抑郁障碍患者非自杀性自伤行为发生风险的列线图预测模型构建
Construction of a nomogram prediction model for the risk of non-suicidal self-injury behaviors in adolescents with depressive disorder
摘要
Abstract
Background Non-suicidal self-injury(NSSI)has become a public health concern of wide interest.Adolescents with depressive disorder are at high risk of NSSI behaviors.Previous studies have mostly focused on analyzing factors associated with NSSI behaviors,while research on developing visual models that are intuitive,quantifiable,and suitable for rapid clinical assessment is relatively limited.Objective To investigate the risk factors for NSSI behaviors in adolescents with depressive disorder,and to construct a nomogram prediction model for the risk of NSSI behaviors occurrence,so as to provide a quantitative tool for clinical rapid assessment of the occurrence risk of NSSI behaviors in this population.Methods A cross-sectional study was conducted.A total of 448 adolescent patients diagnosed with depressive disorder who attended the Mental Health Department of The Second Hospital,Lanzhou University from February to December 2025 and met the diagnostic criteria for depressive disorder as specified in the Diagnostic and Statistical Manual of Mental Disorders,fifth edition(DSM-5)were enrolled.All participants were randomly divided into the modeling group(n=313)and the validation group(n=135)at a ratio of 7∶3.Assessments were performed using the Self-rating Depression Scale(SDS),the Self-rating Anxiety Scale(SAS),the Barratt Impulsiveness Scale-11(BIS-11),the Childhood Trauma Questionnaire-short form(CTQ-SF),and the Pittsburgh Sleep Quality Index(PSQI).Binary Logistic regression analysis was applied to screen independent predictors of NSSI behaviors in the modeling group,and a nomogram was constructed accordingly.The receiver operating characteristic(ROC)curve,calibration curve,and decision curve analysis(DCA)were used to evaluate the discrimination,calibration and clinical utility of the model,respectively.Results Binary Logistic regression analysis revealed that younger age,female sex,higher SDS score,higher BIS-11 score,higher CTQ-SF score,and higher PSQI score were risk factors for NSSI behaviors in adolescent patients with depressive disorder(OR=0.816,2.671,1.131,1.030,1.064,1.102,P<0.05 or 0.01).The Hosmer-Lemeshow test of the nomogram prediction model constructed based on these six indicators showed a good fit(χ²=15.144,P=0.056).Model validation showed that the AUC was 0.895 for the modeling group and 0.891 for the validation group.The calibration curves suggested that the mean absolute errors between the actual values and the predicted values were 0.043 and 0.023,respectively.Decision curve analysis indicated that the model provided a clear net clinical benefit when the risk threshold was greater than 0.11.Conclusion The nomogram model based on six indicators(age,sex,depressive symptom severity,impulsivity,childhood trauma,and sleep quality)for predicting NSSI risk in adolescent patients with depressive disorder exhibits good discrimination,calibration,and clinical application value.关键词
青少年/抑郁障碍/非自杀性自伤/危险因素/预测模型/列线图Key words
Adolescents/Depressive disorder/Non-suicidal self-injury/Risk factors/Prediction model/Nomogram分类
医药卫生引用本文复制引用
张珊珊,李晓娥,江友锡,王昕,王琦,黄佩姗,黄天慧,董强利..青少年抑郁障碍患者非自杀性自伤行为发生风险的列线图预测模型构建[J].四川精神卫生,2026,39(4):309-317,9.基金项目
国家自然科学基金项目(项目名称:精准经颅磁刺激靶向调控奖赏网络干预青少年抑郁障碍非自杀性自伤行为成瘾特征的机制研究,项目编号:82560281) （项目名称:精准经颅磁刺激靶向调控奖赏网络干预青少年抑郁障碍非自杀性自伤行为成瘾特征的机制研究,项目编号:82560281）
甘肃省科技计划项目(项目名称:青少年抑郁障碍非自杀性自伤行为的机制探究:从炎症标志物到免疫响应的综合分析,项目编号:25JRRA618) （项目名称:青少年抑郁障碍非自杀性自伤行为的机制探究:从炎症标志物到免疫响应的综合分析,项目编号:25JRRA618）
甘肃省卫生健康行业科研项目(项目名称:青少年心理健康影响因素及干预对策研究,项目编号:GSWSKY2025-13) （项目名称:青少年心理健康影响因素及干预对策研究,项目编号:GSWSKY2025-13）
兰州大学第二临床医学院大学生创新创业训练计划项目(项目名称:青少年抑郁障碍患者非自杀性自伤行为临床预测模型的构建及评价,项目编号:20250050060) [Funded by National Natural Science Foundation of China(number,82560281) （项目名称:青少年抑郁障碍患者非自杀性自伤行为临床预测模型的构建及评价,项目编号:20250050060）
Gansu Provincial Science and Technology Program(number,25JRRA618) （number,25JRRA618）
Gansu Provincial Health Industry Research Project(number,GSWSKY2025-13) （number,GSWSKY2025-13）
The College Students'Innovation and Entrepreneurship Training Program of the Second Clinical Medical College of Lanzhou University(number,20250050060)] （number,20250050060）
