青少年抑郁症患者心理弹性影响因素的路径分析

doi:10.19723/j.issn.1671-167X.2024.05.009

摘要/Abstract

摘要：

目的: 探讨青少年抑郁症患者心理弹性的影响因素及其路径，旨在确定合理的防治措施，提高患者的心理弹性水平。方法: 本次调查为横断面研究，采取便利抽样方法，采用一般资料问卷、Connor-Davidson心理弹性量表(Connor-Davidson resilience scale，CD-RISC)、家庭功能评定量表(family assessment device，FAD)、社会支持评定量表(social support rating scale，SSRS)对焦作市第四人民医院门诊就诊的162例青少年抑郁症患者展开调查，采用单因素和多因素分析青少年抑郁症患者心理弹性的影响因素，采用Amos 22.0软件建立结构方程模型，分析影响因素的作用路径。结果: (1) 青少年抑郁症患者CD-RISC总分及坚韧性、力量性、乐观性评分均低于国内常模(P < 0.05)；(2)多元线性回归结果显示，体质量、童年创伤体验、家庭结构、家庭功能、父母教养方式、父母婚姻状况、社会支持、抑郁程度是青少年抑郁症患者心理弹性的影响因素；(3)模型显示，体质量、童年创伤体验、家庭结构、家庭功能、社会支持对青少年抑郁症患者的心理弹性有直接影响，亦可通过抑郁程度对青少年抑郁症患者的心理弹性产生间接影响(P < 0.05)。结论: 体质量、童年创伤体验、社会支持、抑郁程度等因素对青少年抑郁症患者的心理弹性有影响效应，建议学校管理者增加体育课程的课时和课程内容，做好心理援助，有助于提高青少年抑郁症患者的心理弹性水平。

关键词: 青少年, 抑郁, 心理弹性, 影响因素

Abstract:

Objective: To discuss the influencing factors of mental resilience in adolescents with depression, and to analyze the interaction between them by using path analysis, in order to determine the reasonable prevention and treatment measures for clinical practice and provide reference for the study of mental resilience in adolescents with depression. Methods: This survey adopted cross-sectional study and convenience sampling method. General information questionnaire, Connor-Davidson resilience scale (CD-RISC), family assessment device (FAD) and social support rating scale (SSRS) were used to investigate the general information, mental resilience level, family function and social support level of 162 adolescents with depression in Jiaozuo Fourth People ' s Hospital. Multiple linear regression was used to analyze the influencing factors of mental resilience in adolescents with depression. Structural equation model was established by Amos 22.0 software to analyze the influencing factors. Results: (1) The total score of CD-RISC and the scores of toughness, strength and optimism in adolescents with depression were lower than the domestic norm (P < 0.05). (2) The results of multiple linear regression showed that weight, childhood trauma experience, family structure, family function, parental rearing style, parental marital status, social support and depression degree were the influencing factors of psychological resilience of adolescents with depression (P < 0.05). (3) The model showed that weight, childhood trauma experience, family structure, family function and social support had direct effects on the mental resilience of adolescents with depression, and also had indirect effects on the mental resilience of adolescents with depression through the degree of depression (P < 0.05). Conclusion: In this study, we found that weight, childhood trauma experience, social support, depression degree and other factors have an effect on the psychological resilience of adolescents with depression. We suggest that school administrators increase the class time and course content of physical education courses, improve the mental health service system, strengthen mental health services for key groups, and formulate corresponding topics for timely counseling. At the same time, encourage them to actively participate in social practice activities, enhance self-confidence, and thus help to improve the level of psychological resilience of adolescents with depression.

Key words: Teenagers, Depression, Mental resilience, Influencing factors

中图分类号:

R749.4

王敏, 李倩. 青少年抑郁症患者心理弹性影响因素的路径分析[J]. 北京大学学报（医学版）, 2024, 56(5): 809-814.

Min WANG, Qian LI. Path analysis of influencing factors of mental resilience in adolescents with depression[J]. Journal of Peking University (Health Sciences), 2024, 56(5): 809-814.

图/表 5

表1

表2

不同临床特征青少年抑郁症患者CD-RISC总评分的比较"

Project	n	CD-RISC total score, ${\bar x}$±s	t/F	P
Gender			0.777	0.438
Male	48	56.13±4.48
Female	114	55.41±5.72
Age/years			1.701	0.091
14-16	68	56.42±4.69
17-18	94	55.04±5.37
Weight			16.538	＜0.001
Low weight	81	55.71±5.18
Normal weight	44	58.33±4.46
Overweight	37	52.20±4.20
Learning stage			1.286	0.279
Middle school	56	56.53±4.55
Senior middle school	90	55.12±5.63
Other	16	55.25±5.38
Place of residence			1.353	0.178
Cities and towns	102	56.03±4.41
Rural area	60	54.92±5.97
The only child			1.970	0.051
Yes	56	56.76±4.72
No	106	55.02±5.65
Parental upbringing style			17.087	＜0.001
Authoritative	37	60.96±6.35
Overindulgent type	60	54.52±4.61
Authoritarian style	33	52.83±5.78
Neglected type	32	54.38±4.56
Family function			59.015	＜0.001
General	55	50.52±4.41
Good	69	55.70±5.32
Excellent	38	62.86±6.65
Mother/father depression			1.171	0.243
Yes	50	54.85±4.52
No	112	55.96±5.98
Childhood trauma experience			9.660	＜0.001
Yes	55	50.03±4.41
No	107	58.49±5.67
Smoke			0.955	0.341
Yes	30	56.44±4.49
No	132	55.43±5.38
Drink			1.978	0.050
Yes	44	56.92±4.82
No	118	55.14±5.19
Parental marital status			54.031	＜0.001
Stable	86	59.66±6.85
Divorce/widow	33	55.09±5.67
Reorganized marriage	43	47.95±4.32
Family structure			54.912	＜0.001
Host family	10	40.51±4.11
Atavism family	43	51.60±4.72
Nuclear family	50	55.15±5.38
Third generation direct family	59	61.51±6.33
Social support			123.518	＜0.001
Low	53	48.48±3.88
Medium	65	55.81±4.67
High	44	63.94±5.95
Depression level			11.203	＜0.001
Moderate	137	57.13±4.12
Severe	25	47.35±3.35

表2

表3

表4

图1

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Items	Depressed adolescents (n=162), ${\bar x}$±s	Domestic norm (n=75), ${\bar x}$±s	t	P
Hardiness	27.50±3.38	43.89±6.12	26.493	＜0.001
Strength	18.01±3.13	27.36±4.29	18.930	＜0.001
Optimism	10.11±0.65	12.24±1.65	14.242	＜0.001
Total score	55.62±4.18	83.49±5.34	43.597	＜0.001

Independent variable	Partial regression coefficient	Standard error	Standardized regression coefficient	t	P
Weight	-3.628	-0.224	-0.134	-16.196	＜0.001
Childhood trauma experience	-0.250	-0.018	-0.075	-13.888	＜0.001
Family structure	0.500	0.042	0.081	11.905	＜0.001
Family function	-0.766	-0.075	-0.141	-10.213	＜0.001
Parental upbringing style	1.560	0.156	0.120	10.000	＜0.001
Parental marital status	0.850	0.031	0.294	27.420	＜0.001
Social support	0.595	0.048	0.198	12.396	＜0.001
Depression level	-3.600	-0.215	-0.011	-16.744	＜0.001

Influence factor	Direct effect	Indirect effect	Total effect
Weight	-0.072	-0.011	-0.083
Childhood trauma experience	-0.260	-0.158	-0.418
Family structure	0.050	0.003	0.053
Family function	-0.160	-0.122	-0.282
Parental upbringing style	0.191		0.191
Parental marital status	0.296		0.296
Social support	0.168	0.022	0.190
Depression level	-0.158		-0.158