青少年早期抑郁的发展及其与家庭、同伴和个体因素的关系
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摘要
抑郁是青少年早期普遍存在的消极情绪问题,青少年抑郁的持续存在不仅对个体当前的心理、社会和情绪健康具有较大的破坏性,而且这一状态还有可能扩展到整个青少年期甚至是成年期,增加其未来教育、就业以及适应性发展的危险性(Cohen, 1998; Santrok, 2001; Roza, Hofstra, van der Ende, & Verhulst, 2003)。青少年早期这一特殊的发展过渡阶段和抑郁本身的特点不仅增强了抑郁对个体的消极影响,同时也增加了青少年抑郁理论研究与实际干预的复杂性。已有研究多数关注焦虑和抑郁的共发性,关注具有抑郁临床水平的特殊群体,缺乏对抑郁状态的概念分梳,较少关注对过渡期普通青少年群体抑郁情绪或亚临床水平抑郁的研究。而且,少数关于儿童青少年抑郁的纵向研究也主要是基于西方文化背景的,我国学者多采用横断研究设计比较和分析了不同年龄阶段儿童青少年抑郁的发展差异及相关因素(Angold & Rutter, 1992; Lovibond, 1998; Hankin & Abramson,2001;刘凤瑜, 1997;阳德华,王耘,董奇, 2000),缺乏对青少年早期抑郁的纵向研究,无法系统地揭示青少年早期抑郁随年龄增长的发展变化、抑郁的预测因素及可能存在的性别差异。
     本论文以发展精神病理学视角和发展系统理论为理论框架,采用纵向研究设计,以个体中心和变量中心两种分析取向考察了青少年早期抑郁的发展特点、抑郁的预测因素及可能存在的性别差异。本论文共包含两项研究、四项子研究,研究1考察了青少年早期抑郁的发展特点,包含两项子研究,其中研究1-a采用个体中心的分析取向考察了青少年早期抑郁的发展特点,研究1-b采用变量中心的分析取向考察了青少年早期抑郁的发展特点;研究2考察了青少年早期抑郁的预测因素,其中研究2-a采用个体中心的分析取向描述了各轨迹亚组家庭、同伴和个体因素随年龄的变化趋势,并考察了上述因素对青少年早期抑郁亚组轨迹的预测作用及预测作用的性别差异;研究2-b采用变量中心的分析取向考察了青少年抑郁发展结果与家庭、同伴和个体各预测因素的关系,构建了各预测变量与青少年抑郁的统合结构模型,并考察了可能存在的性别差异。
     本论文的研究数据来自《儿童青少年社会行为的发展及其与学校适应关系的追踪研究》(2008~2011年)数据库,最终选取的1818名有效的青少年被试在2008(T1)、2009(T2)、2010(T3)、2011(T4)(即被试从5年级到8年级)连续四年均完成了问卷调查,其中男生918人,平均年龄14.33±0.35;女生900人,平均年龄14.26±0.34。1818名有效青少年被试中有1713名青少年的母亲完成了2008~2010年的母亲问卷调查。青少年完成的问卷包括青少年抑郁问卷、自我概念问卷、朋友关系问卷;母亲完成的问卷包括教养方式问卷以及包含家庭收入、父母职业、父母受教育水平的家庭社会经济地位测量指标。本论文采用Epdata3.1录入数据,运用SPSS13.0、Amos7.0、SAS 9.1、Mplus6.0软件对数据进行管理和统计分析。本论文主要的研究结果包括:
     1.个体中心取向的青少年早期抑郁发展特点及预测因素
     (1)青少年早期抑郁在一般发展轨迹上呈显著加速上升趋势,且男青少年的抑郁增长趋势比女青少年更为平缓。潜类别增长分析的结果表明,青少年早期抑郁存在四条异质性亚组发展轨迹:中低水平增长组、稳定的低水平组、增长-稳定的高水平组和无抑郁组。各轨迹亚组的人数分布比例分别为27.4%、49.2%、4.1%和19.3%。
     (2)对青少年11~14岁母亲教养方式、友谊质量、自我概念和抑郁水平变化趋势的描述发现,中低水平增长组和增长-稳定高水平组两个具有增长趋势亚组的青少年在自我概念、朋友陪伴、朋友工具性帮助、朋友情感支持、朋友亲密性、母亲温情引导、母亲鼓励成就上显著低于无抑郁亚组的青少年和稳定低水平亚组的青少年,而在朋友争吵和冲突、母亲控制惩罚教养和抑郁水平上显著高于无抑郁组和稳定低水平组的青少年。
     (3)青少年抑郁轨迹亚组与其先前的自我概念、朋友亲密性、朋友争吵和冲突有显著关联。与无抑郁亚组相比,自我概念水平越高,青少年归属于两个抑郁增长趋势亚组的可能性越低,而朋友争吵和冲突越多、朋友关系越亲密,青少年归属于具有抑郁增长趋势亚组的可能性则越大。
     2.变量中心取向的青少年早期抑郁发展特点及预测因素
     (1)青少年早期抑郁表现出中度以上的相对稳定性,而且女生群体的相对稳定性高于男生群体;在绝对水平上,青少年早期抑郁表现出随年龄增长而显著增加的趋势,且抑郁随年龄的增加表现出显著的性别差异:本研究中女青少年11岁抑郁水平显著低于男青少年,男女青少年12岁时的抑郁水平差异不显著,女青少年13岁时的抑郁以边缘显著的水平高于男青少年,女青少年14岁时抑郁水平显著高于男青少年。
     (2)本研究发现,青少年先前抑郁水平既可以直接预测其一年后的抑郁水平,也在母亲教养方式、友谊质量对后来抑郁水平的预测中起调节作用。即母亲教养方式和友谊质量对青少年后来抑郁的预测受其先前抑郁状态的调节。母亲教养方式和友谊质量对青少年的情绪适应是具有保护性作用还是充当了危险因素,与青少年先前的情绪状态有关。
     (3)本研究构建了青少年抑郁与母亲教养方式、友谊质量、自我概念和个体先前抑郁水平的统合关系结构模型。其中,自我概念不仅在母亲教养方式、友谊质量对青少年后来抑郁的预测中起中介作用,而且这一中介变量也受青少年先前抑郁的调节。即青少年自我概念对其一年后抑郁的预测是有调节的中介效应。多样本比较的结果表明,这一有调节的中介作用在女生模型中拟合更好。
     上述结果体现和验证了青少年早期抑郁发展的稳定性和连续性,以及个体在与环境的动态关系中表现出的发展的多样化、可塑性和复杂性。本研究具有创新意义的研究发现主要有四点:其一,本研究描述了青少年早期抑郁发展的四条异质性亚组发展轨迹,表明青少年早期抑郁存在群体内的异质性或个体差异;其二,本研究揭示了青少年早期抑郁随年龄发展的性别差异,这一基于纵向数据分析的结果较之横断研究中关于青少年抑郁年龄和性别差异的研究结果更有说服力;其三,本研究发现,青少年先前的抑郁水平是其后来抑郁的直接预测因素,同时它也调节着母亲教养方式、友谊质量与其后来抑郁水平的关系。这一结论具有重要的研究和教育启示意义,环境中的保护性因素和危险因素是相对的,对先前不同抑郁水平的青少年而言,同一因素可能具有保护作用,也可能具有危险作用。在考察特定因素对个体发展结果的影响时,要考虑到这一因素与个体先前发展特点的交互作用关系。这一研究发现再次强调,个体先前发展特点与环境因素的良好拟合是个体适应性发展的关键;其四,本研究从变量关系上构建了青少年抑郁与母亲教养方式、友谊质量、自我概念及个体先前抑郁水平的统合关系结构模型,发现青少年自我概念对其后来抑郁的预测是有调节的中介效应。而且,这一统合模型在女青少年群体中更理想。另外,在关于青少年抑郁发展的相对稳定性上,本论文建议,除考虑个体在群体内相对位置的变化外,也应该考虑个体在亚群体(或轨迹亚组)内相对位置的变化。
     本论文关于青少年早期抑郁的发展特点及相关预测因素的探索,获得了一些有价值的研究发现,这些研究发现不仅拓展了国内已有关于青少年抑郁的横断研究,而且对青少年抑郁情绪发生发展规律和心理健康教育的理论构建、抑郁障碍的早期预防和青少年心理健康维护等均具有积极的理论价值和实践指导意义。另外,本论文由青少年报告其抑郁水平、自我概念、友谊质量,由母亲报告其教养方式,有利于在研究程序上避免共同方法效应。但本论文研究也存在一些局限性:其一,研究对象均来自省会城市,家庭社会经济地位普遍较高,在区域文化和家庭背景上具有较高的同质性,无法考察不利处境及处境的变化对青少年抑郁的影响;其二,研究变量较多,不仅给统计分析带来了较大的困难,也使得各变量之间的复杂关系难以梳理;其三,本研究采用了传统的中介作用检验方法和程序,这一方法目前受到新的质疑;因此,在未来的研究中,有必要扩大研究样本,适当减少研究变量,考虑采用更为科学的分析方法系统深入地探讨青少年抑郁与相关变量的关系机制及可能存在的性别差异。
Being a typical kind of internalizing problem, depression is pervasive duringearly adolescence. And early adolescence, a special transitional stage, is also adangerous factor for adolescents’depression. Depression during early adolescencewould bring poor prognosis, increasing the risk to education, employment and otherantisocial behaviors in the future. Existing researches mostly concerned about thecomorbidity of anxiety and depression, and the clinical level of depression ofadolescents, few researchers paid attention to depressive emotion of common group.In addition, those longitudinal studies about adolescents’depression were mainlybased on western cultural context, and most Chinese scholars studied thedevelopmental characteristics of adolescents’depression with cross-sectional studydesign. So it was an important issue to explore how depression changes with age, andhow environment factors interact with individual, and whether gender differencesexist by longitudinal design in our contemporary context.
     This thesis was to explore the developmental characteristics and relevantinfluencing factors of adolescents’depression that were derived from adolescentsself-report by individual-centered and variable-centered analytical orientations in alongitudinal design. The perspective of developmental psychopathology anddevelopmental systemism theories were used as theoretical framework. This thesiscontained two studies. Study 1 was designed to investigate the developmentalcharacteristics of adolescents’depression, including two sub-studies, in which study1-a was to explore the average trajectory and heterogeneous subgroup trajectories ofdepression by individual-centered orientation, and study 1-b was to examine theStability and change with age of depression during early adolescence byvariable-centered analytic orientation; Study 2 was designed to investigate thepredictors of depression during early adolescence, containing two sub-studies, inwhich study 2-a was to describe the developmental trends of maternal parenting, friendship quality, self-concept and previous depression and examine whether theabove variables could explain the variance of the subgroup trajectories usingindividual-centered orientation, and study 2-b was to examine the relationshipbetween depression and maternal parenting, friendship quality, self-concept andprevious depression by variable-centered orientation. Gerder difference would beanalysed in the studies mentioned above.
     Data used in this thesis was derived from the database of a longitudinal researchproject of development of the social behavior of children and adolescents and itsrelation to the school adjustment. Eventually 1818 anticipants who completedquestionnaires from 2008 (T1) to 2011 (T4) were selected as effective formal ones,including 918 boys with average age of 14.33±0.35, and 900 girls with average age of14.26±0.34. Depression Inventory of Youth Self Report (YSR), Self-ConceptQuestionnaire, Friend Relationship Questionnaire were administered on adolescents,and mothers completed the questionnaire of Parenting Style and the index of familySocio-Economic Status measures containing monthly income, parental occupation,parental educational level. Epdata3.1 procedure and SPSS13.0、Amos7.0, SAS 9.1,Mplus6.0 software packages were used to log and to analyze the data. The majorfindings were as followes:
     (1) Depression during early adolescence showed an increasing growth. Thereexisted four heterogeneous sub-groups developmental trajectories by latent classgrowth analysis: the low growth, the low stable, an increasing-stable high-level andnon-depressed sub-group. The distribution ratio of anticipants was 27.4%, 49.2%,4.1% and 19.3%, respectively.
     (2) Adolescents with increasing depression scored lower on self-concept, friendcompanionships, friend affective support and maternal warmth parenting than thosenon-depression ones, and stable low-level sub-group of adolescents reported moreannoyance and conflict between friends.
     (3) The higher level of self-concept adolescents had, the greater possibilityadolescents were distributed to no-depression sub-group trajectory. The moreannoyance and conflict existed between friends, the greater possibility thatadolescents would be classified into subgroups with increasing trend of depression.Friend intimacy could increase the possibility that adolescents belong to subgroupswith increasing trend of depression rather than no-depression one.
     (4) The previous level of depression was not only a direct predictor variable, butalso was a moderating one. Specifically, the previous depression of adolescents couldpredict significantly their following depression, and could moderate the relationshipbetween maternal parenting style and friendship quality and the following depression.
     (5) The integrated structure of relations model was constructed to describe thecomplex relationship between adolescents’depression and maternal parenting style,friendship quality, self-concept and the previous depression, within which theself-concept not only played a mediator between maternal parenting style, friendshipquality and adolescents’following depression, but also was moderated by adolescents’previous depression. That is, the self-concept was a moderated-mediating variable foradolescents’following depression.
     In this thesis, there were still some limitations. Firstly, anticipants in this studywere mostly from families with high socioeconomic status, which made it impossibleto investigate how disadvantaged environment and the changes of environmentalfactors influence adolescents’depression across time. Secondly, too many variablesincluded in this study not only increased the difficulties in statistical analysis, but alsomade it difficult to explore the complex relationship between adoldescents’depressionand the environment factors. As such, it was necessary to use more scientific andeffective motheds to examine the relathionship between depression during earlyadolescence and the selected environmental factors in a sample from different familysocioeconomic status in the next step.
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