心理病理症状、应对方式及冲动控制在童年期虐待与中学生非自杀性自伤行为关联中的中介作用
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摘要
目的探讨心理病理症状、应对方式及冲动控制在童年期虐待与中学生自伤行为关联中的中介效应。方法采用分层整群抽样方法,于2013年11月—2014年1月选取郑州市、贵阳市9704名在校城乡初高中学生为研究对象,其中城镇4049名,农村5655名;初中5168名,高中4536名;男生4600名,女生5104名。采用儿童期虐待问卷(CTQ-SF)、青少年非自杀性自伤行为问卷、青少年亚健康多维评定问卷、特质应对方式问卷、Barratt冲动性量表第11版分别测量童年期虐待、非自杀性自伤、心理病理症状、应对方式和冲动控制情况,采用χ~2检验比较不同社会人口学特征间童年期虐待与非自杀性自伤行为检出率的差异,使用Pearson相关分析各指标间的关联,自举(Bootstrap)程序和PROCESS软件检验各中介变量的中介效应。结果 44.6%的中学生曾有过童年期虐待经历,其中女生高于男生(45.9%vs.43.1%),初中生高于高中生(47.3%vs.41.5%),差异均具有统计学意义(χ~2=7.558和32.433,P<0.01);但童年期虐待检出率在户口所在地之间差异无统计学意义。38.5%的中学生有过非自杀性自伤行为,其中女生低于男生(37.1%vs 40.1%),初中生高于高中生(41.4%vs.35.3%),差异均具有统计学意义(χ~2=9.151和37.955,P<0.01)。自评家庭经济状况中等的学生童年期虐待和非自杀性自伤行为的检出率均低于自评家庭经济状况较差和较高的学生,差异均具有统计学意义(χ~2=9.916和25.735,P<0.01)。心理病理症状、应对方式以及冲动控制评分分别与童年期虐待评分和中学生自伤行为频率显著相关(P<0.01);控制性别、年级、城乡、自评家庭经济状况后,心理病理症状、消极应对方式和积极应对方式及冲动控制在两者关联中的中介作用仍然具有统计学意义(P<0.01),各中介效应分别为33.41%、14.87%、0.49%和3.48%,四种中介因素的共同中介效应占总效应的52.24%。结论心理病理症状、应对方式及冲动控制在童年期虐待与非自杀性自伤的关联中存在部分中介效应,减少心理病理症状、消极应对方式及冲动行为的发生有助于预防和控制有童年期虐待中学生的自伤行为。
Objective To estimate the mediationl effects of psychological symptoms,coping styles and impulsiveness on relationship between childhood abuse and non-suicidal self-injuries( NSSI) among middle school students.Methods A total of 9704 participants( boys( 4600), girls( 5104); urban( 4049), rural( 5655); junior( 5168),senior( 4536)) were retained from all epidemiological study,involving students from junior and senior middle schools in Zhengzhou,Guiyang by random cluster sampling.The Childhood Trauma Questionnaire( CTQ-SF),Non-Suicidal Self-Injury Questionnaire,Multidimensional Sub-health Questionnaire of Adolescents( MSQA),Trait Coping Style Questionnaire( TCSQ) and Barratt Impulsiveness Scale( BIS-11) were used to measure childhood abuse assessment,NSSI frequency,psychological symptoms,coping styles and impulsiveness scores.Chi-square test was used to compare the frequency of childhood abuse and NSSI among different groups.Pearson's correlation analysis was used in analyzing the relationship,Bootstrap method and PROCESS software were applied to examine the mediationl effects.Results A total of 44.6% of middle school students had childhood abuse experiences,girls were higher than boys( 45.9% vs.43.1%),junior secondary students were higher than senior secondary students( 47.3% vs.41.5%),the differences were statistically significant( χ~2= 7.558 and 32.433; P < 0.01).However,there was no statistical significance in the residence area( P > 0.05).38.5% of high school students had NSSI,of which girls were lower than boys( 37.1% vs.40.1%),junior secondary students were higher than senior secondary students( 41.4% vs.35.3%),the differences were statistically significant( χ~2= 9.151 and 37.955; P <0.01).The middle of perceived family SES who the detection rate of childhood abuse and NSSI were lower than poor and high family SES, the differences were statistically significant( χ~2= 9.916 and 25.735; P < 0.01).The psychological symptoms,coping style and impulsiveness scores were related with childhood abuse scores and NSSI frequency respectively( P < 0.01).These mediating effects persisted after controlling for sex,grade,residence area and perceived family SES,the total mediationl effects was 52.24%,specific mediationl effect of psychological symptoms,negative and positive coping styles,impulsiveness was 33.41%,14.87%,0.49% and 3.48%( P < 0.01).Conclusion It suggests that psychological symptoms,coping styles,impulsiveness may play a partial mediating effect on the relationship between childhood abuse and NSSI among middle school students.The alleviating of psychological symptoms,negative coping style may contribute to the prevention and control of NSSI among middle school students who have experienced childhood abuse.
Objective To estimate the mediationl effects of psychological symptoms,coping styles and impulsiveness on relationship between childhood abuse and non-suicidal self-injuries( NSSI) among middle school students.Methods A total of 9704 participants( boys( 4600), girls( 5104); urban( 4049), rural( 5655); junior( 5168),senior( 4536)) were retained from all epidemiological study,involving students from junior and senior middle schools in Zhengzhou,Guiyang by random cluster sampling.The Childhood Trauma Questionnaire( CTQ-SF),Non-Suicidal Self-Injury Questionnaire,Multidimensional Sub-health Questionnaire of Adolescents( MSQA),Trait Coping Style Questionnaire( TCSQ) and Barratt Impulsiveness Scale( BIS-11) were used to measure childhood abuse assessment,NSSI frequency,psychological symptoms,coping styles and impulsiveness scores.Chi-square test was used to compare the frequency of childhood abuse and NSSI among different groups.Pearson's correlation analysis was used in analyzing the relationship,Bootstrap method and PROCESS software were applied to examine the mediationl effects.Results A total of 44.6% of middle school students had childhood abuse experiences,girls were higher than boys( 45.9% vs.43.1%),junior secondary students were higher than senior secondary students( 47.3% vs.41.5%),the differences were statistically significant( χ~2= 7.558 and 32.433; P < 0.01).However,there was no statistical significance in the residence area( P > 0.05).38.5% of high school students had NSSI,of which girls were lower than boys( 37.1% vs.40.1%),junior secondary students were higher than senior secondary students( 41.4% vs.35.3%),the differences were statistically significant( χ~2= 9.151 and 37.955; P <0.01).The middle of perceived family SES who the detection rate of childhood abuse and NSSI were lower than poor and high family SES, the differences were statistically significant( χ~2= 9.916 and 25.735; P < 0.01).The psychological symptoms,coping style and impulsiveness scores were related with childhood abuse scores and NSSI frequency respectively( P < 0.01).These mediating effects persisted after controlling for sex,grade,residence area and perceived family SES,the total mediationl effects was 52.24%,specific mediationl effect of psychological symptoms,negative and positive coping styles,impulsiveness was 33.41%,14.87%,0.49% and 3.48%( P < 0.01).Conclusion It suggests that psychological symptoms,coping styles,impulsiveness may play a partial mediating effect on the relationship between childhood abuse and NSSI among middle school students.The alleviating of psychological symptoms,negative coping style may contribute to the prevention and control of NSSI among middle school students who have experienced childhood abuse.
引文
[1]LIU X,CHEN H,BO Q G,et al.Poor sleep quality and nightmares are associated with non-suicidal selfinjury in adolescents[J].Eur Child Adolesc Psychiat,2017,26(3):271-279.
[2]LANG C M,SHARMA-PATEL K.The relation between childhood maltreatment and self-injury:a review of the literature on conceptualization and intervention[J].Trauma Violence Abuse,2011,12(1):23-37.
[3]WAN Yuhui,CHEN Jing,SUN Ying,et al.Impact of childhood abuse on the risk of non-suicidal selfinjury in mainland Chinese adolescents[J].PLo SOne,2015,10(6):e0131239.
[4]DI PIERRO R,SARNO I,PEREGO S,et al.Adolescent nonsuicidal self-injury:the effects of personality traits,family relationships and maltreatment on the presence and severity of behaviours[J].Eur Child Adolesc Psychiat,2012,21(9):511-520.
[5]LEVESQUE C,LAFONTAINE M F,BUREAU J F.The mediating effects of emotion regulation and dyadic coping on the relationship between romantic attachment and non-suicidal self-injury[J].J Youth Adolesc,2017,46(2):277-287.
[6]AUERBACH R P,KIM J C,CHANGO J M,et al.Adolescent nonsuicidal self-injury:examining the role of child abuse,comorbidity,and disinhibition[J].Psychiat Res,2014,220(1-2):579-584.
[7]BOLEN R M,WINTER V R,HODGES L.Affect and state dysregulation as moderators of the relationship between childhood sexual abuse and nonsuicidal self-injury[J].J Interpers Violence,2013,28(1):201-228.
[8]TALIAFERRO L A,MUEHLENKAMP J J,BOROWSKY I W,et al.Factors distinguishing youth who report self-injurious behavior:a population-based sample[J].Acad Pediatr,2012,12(3):205-213.
[9]WAN Yuhui,HU Chuanlai,HAO Jiahu,et al.Deliberate self-harm behaviors in Chinese adolescents and young adults[J].Eur Child Adolesc Psychiat,2011,20(10):517-525.
[10]赵幸福,张亚林,李龙飞,等.中文版儿童期虐待问卷的信度和效度[J].中国临床康复,2005,9(20):105-107.
[11]陶芳标,胡传来,孙业桓,等.我国青少年亚健康多维评定问卷的编制与应用研究[J].中华疾病控制杂志,2008,12(4):309-314.
[12]汪向东,王希林,马弘.心理卫生评定量表手册[M].增订版.北京:中国心理卫生杂志社,1999:107-238.
[13]PATTON J H,STANFORD M S,BARRATT E S.Factor structure of the Barratt Impulsiveness Scale[J].J Clin Psychol,1995,51(6):768-774.
[14]ZHAO Xinshu,LYHCH J G,CHEN Qimei.Reconsidering Baron and Kenny:myths and truths about mediation analysis[J].J Cons Res,2010,37(2):197-206.
[15]陈瑞,郑毓煌,刘文静.中介效应分析:原理、程序、Bootstrap方法及其应用[J].营销科学学报,2013,9(4):120-135.
[16]HAYES A F.An introduction to mediation,moderation,and conditional process analysis:Aregression based approach[M].Mew York:Guilford Press,2013.
[17]ARENS A M,GAHER R M,SIMONS J S,et al.Child maltreatment and deliberate self-harm:a negative binomial hurdle model for explanatory constructs[J].Child Maltreat,2014,19(3-4):168-177.
[18]DUKE N N,PETTINGELL S L,MCMORRIS B J,et al.Adolescent violence perpetration:associations with multiple types of adverse childhood experiences[J].Pediatrics,2010,125(4):778-786.
[19]马双双,万宇辉,郝加虎.童年期不良经历与终身健康[J].卫生研究,2016,45(5):857-861.
[20]何婷婷,万宇辉,张澄.心理病理症状在童年期虐待与医学生非自杀性自伤行为关联中的中介作用[J].卫生研究,2016,45(2):204-210.
[21]AUERBACH R P,KIM J C,CHANGO J M.Adolescent nonsuicidal self-injury:examining the role of child abuse,comorbidity,and disinhibition[J].Psychiat Res,2014,220(1-2):579-584.
[22]陈静,万宇辉,陶芳标.青少年自伤行为发生的相关理论模型研究进展[J].中国学校卫生杂志,2014,35(11):1751-1754.
[23]SHENK C E,NOLL J G,CASSARLY J A.Amultiple mediational test of the relationship between childhood maltreatment and non-suicidal self-injury[J].J Youth Adolesc,2010,39(4):335-342.
[24]SMITH N B,STEELE A M,WEITZMAN M L.Investigating the role of self-disgust in nonsuicidal selfinjury[J].Arch Suicide Res,2015,19(1):60-74.
[25]ARENS A M,GAHER R M,SIMONS J S.Child maltreatment and deliberate self-harm among college students:testing mediation and moderation models for impulsivity[J].Am J Orthopsychiatry,2012,82(3):328-337.
[2]LANG C M,SHARMA-PATEL K.The relation between childhood maltreatment and self-injury:a review of the literature on conceptualization and intervention[J].Trauma Violence Abuse,2011,12(1):23-37.
[3]WAN Yuhui,CHEN Jing,SUN Ying,et al.Impact of childhood abuse on the risk of non-suicidal selfinjury in mainland Chinese adolescents[J].PLo SOne,2015,10(6):e0131239.
[4]DI PIERRO R,SARNO I,PEREGO S,et al.Adolescent nonsuicidal self-injury:the effects of personality traits,family relationships and maltreatment on the presence and severity of behaviours[J].Eur Child Adolesc Psychiat,2012,21(9):511-520.
[5]LEVESQUE C,LAFONTAINE M F,BUREAU J F.The mediating effects of emotion regulation and dyadic coping on the relationship between romantic attachment and non-suicidal self-injury[J].J Youth Adolesc,2017,46(2):277-287.
[6]AUERBACH R P,KIM J C,CHANGO J M,et al.Adolescent nonsuicidal self-injury:examining the role of child abuse,comorbidity,and disinhibition[J].Psychiat Res,2014,220(1-2):579-584.
[7]BOLEN R M,WINTER V R,HODGES L.Affect and state dysregulation as moderators of the relationship between childhood sexual abuse and nonsuicidal self-injury[J].J Interpers Violence,2013,28(1):201-228.
[8]TALIAFERRO L A,MUEHLENKAMP J J,BOROWSKY I W,et al.Factors distinguishing youth who report self-injurious behavior:a population-based sample[J].Acad Pediatr,2012,12(3):205-213.
[9]WAN Yuhui,HU Chuanlai,HAO Jiahu,et al.Deliberate self-harm behaviors in Chinese adolescents and young adults[J].Eur Child Adolesc Psychiat,2011,20(10):517-525.
[10]赵幸福,张亚林,李龙飞,等.中文版儿童期虐待问卷的信度和效度[J].中国临床康复,2005,9(20):105-107.
[11]陶芳标,胡传来,孙业桓,等.我国青少年亚健康多维评定问卷的编制与应用研究[J].中华疾病控制杂志,2008,12(4):309-314.
[12]汪向东,王希林,马弘.心理卫生评定量表手册[M].增订版.北京:中国心理卫生杂志社,1999:107-238.
[13]PATTON J H,STANFORD M S,BARRATT E S.Factor structure of the Barratt Impulsiveness Scale[J].J Clin Psychol,1995,51(6):768-774.
[14]ZHAO Xinshu,LYHCH J G,CHEN Qimei.Reconsidering Baron and Kenny:myths and truths about mediation analysis[J].J Cons Res,2010,37(2):197-206.
[15]陈瑞,郑毓煌,刘文静.中介效应分析:原理、程序、Bootstrap方法及其应用[J].营销科学学报,2013,9(4):120-135.
[16]HAYES A F.An introduction to mediation,moderation,and conditional process analysis:Aregression based approach[M].Mew York:Guilford Press,2013.
[17]ARENS A M,GAHER R M,SIMONS J S,et al.Child maltreatment and deliberate self-harm:a negative binomial hurdle model for explanatory constructs[J].Child Maltreat,2014,19(3-4):168-177.
[18]DUKE N N,PETTINGELL S L,MCMORRIS B J,et al.Adolescent violence perpetration:associations with multiple types of adverse childhood experiences[J].Pediatrics,2010,125(4):778-786.
[19]马双双,万宇辉,郝加虎.童年期不良经历与终身健康[J].卫生研究,2016,45(5):857-861.
[20]何婷婷,万宇辉,张澄.心理病理症状在童年期虐待与医学生非自杀性自伤行为关联中的中介作用[J].卫生研究,2016,45(2):204-210.
[21]AUERBACH R P,KIM J C,CHANGO J M.Adolescent nonsuicidal self-injury:examining the role of child abuse,comorbidity,and disinhibition[J].Psychiat Res,2014,220(1-2):579-584.
[22]陈静,万宇辉,陶芳标.青少年自伤行为发生的相关理论模型研究进展[J].中国学校卫生杂志,2014,35(11):1751-1754.
[23]SHENK C E,NOLL J G,CASSARLY J A.Amultiple mediational test of the relationship between childhood maltreatment and non-suicidal self-injury[J].J Youth Adolesc,2010,39(4):335-342.
[24]SMITH N B,STEELE A M,WEITZMAN M L.Investigating the role of self-disgust in nonsuicidal selfinjury[J].Arch Suicide Res,2015,19(1):60-74.
[25]ARENS A M,GAHER R M,SIMONS J S.Child maltreatment and deliberate self-harm among college students:testing mediation and moderation models for impulsivity[J].Am J Orthopsychiatry,2012,82(3):328-337.