目的 探讨叙事治疗对青少年抑郁症患者非自杀性自伤和焦虑、抑郁情绪的干预效果。 方法 采用抛掷硬币法将60例伴非自杀性自伤（non-suicidal self-injury, NSSI）的青少年抑郁症患者随机分配至干预组和对照组。对照组给予常规心理支持，干预组在常规心理支持的基础上进行个体叙事治疗（每周2次，每次60 min，共计3周）。采用青少年自我伤害问卷、儿童抑郁量表、儿童焦虑情绪筛查量表在干预前、干预结束时和干预结束后1个月对两组患者进行疗效评估。 结果 干预组26例、对照组29例患者参与全程研究。干预结束时和干预结束后1个月，干预组NSSI次数得分、NSSI水平、焦虑得分和抑郁得分均较干预前显著减少（P<0.017）。干预结束时和干预结束后1个月，干预组NSSI次数得分、NSSI程度得分、NSSI水平、焦虑得分和抑郁得分均显著低于对照组（P<0.05）。 结论 叙事治疗能有效减少青少年抑郁症患者的NSSI次数，缓解NSSI程度，且有助于缓解青少年抑郁症患者的焦虑和抑郁情绪。
Abstract
Objective To study the intervention effect of narrative therapy on non-suicidal self-injury (NSSI), as well as anxiety and depression symptoms in adolescents with depressive disorder. Methods Sixty adolescents with depressive disorder and NSSI were randomly assigned to either the intervention group or the control group using coin flipping. The control group received conventional psychological support, while the intervention group received individual narrative therapy in addition to the conventional psychological support (twice a week, 60 minutes per session, for a total of 3 weeks). Assessment of treatment efficacy was conducted using the Adolescent Self-Harm Questionnaire, Children's Depression Inventory, and Children's Anxiety and Mood Scale before the intervention, at the end of the intervention, and one month after the intervention for both groups. Results A total of 26 adolescents in the intervention group and 29 adolescents in the control group completed the entire study. At the end of the intervention and one month after the intervention, the intervention group showed a significant reduction in the NSSI frequency score, NSSI level, anxiety score, and depression score compared to before the intervention (P<0.017). Moreover, at the end of the intervention and one month after the intervention, the intervention group exhibited significantly lower NSSI frequency score, NSSI severity score, NSSI level, anxiety score and depression score compared to the control group (P<0.05). Conclusions Narrative therapy is effective in reducing NSSI frequency and alleviating NSSI severity, as well as anxiety and depression symptoms in adolescents with depressive disorder.
关键词
叙事治疗 /
非自杀性自伤 /
抑郁症 /
青少年
Key words
Narrative therapy /
Non-suicidal self-injury /
Depressive disorder /
Adolescent
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参考文献
1 Zetterqvist M. The DSM-5 diagnosis of nonsuicidal self-injury disorder: a review of the empirical literature[J]. Child Adolesc Psychiatry Ment Health, 2015, 9: 31. PMID: 26417387. PMCID: PMC4584484. DOI: 10.1186/s13034-015-0062-7.
2 Andrewes HE, Hulbert C, Cotton SM, et al. Relationships between the frequency and severity of non-suicidal self-injury and suicide attempts in youth with borderline personality disorder[J]. Early Interv Psychiatry, 2019, 13(2): 194-201. PMID: 28718985. DOI: 10.1111/eip.12461.
3 沈晓玲, 董再全, 罗珊霞, 等. 伴非自杀性自伤行为青少年抑郁症患者述情和家庭教育方式研究[J]. 神经疾病与精神卫生, 2020, 20(2): 101-105. DOI: 10.3969/j.issn.1009-6574.2020.02.005.
4 杨长婕, 符祖强, 顾爱华. 国内外抑郁症疾病负担研究: 文献计量分析[J]. 南京医科大学学报（社会科学版）, 2023, 23(3): 243-252. DOI: 10.7655/NYDXBSS20230307.
5 徐梦蓉. 抑郁障碍青少年生活事件、人格特征、情绪症状与非自杀性自伤的关系[D]. 济南: 山东大学, 2021.
6 高倩, 李晓敏, 孙王乐贤, 等. 叙事疗法对冠心病患者健康促进生活方式的影响[J]. 中华护理教育, 2019, 16(10): 787-791. DOI: 10.3761/j.issn.1672-9234.2019.10.017.
7 卢国慧. 分析叙事疗法对晚期癌症患者希望水平及心理状态的影响[J]. 中华肿瘤防治杂志, 2020, 27(S1): 287.
8 韩英. 叙事疗法应用于住院精神分裂症患者心理干预的效果评价[J]. 心理月刊, 2019, 14(13): 70. DOI: 10.19738/j.cnki.psy.2019.13.049.
9 钟国坚, 杨润莲, 容兆珍, 等. 叙事疗法技术在双相情感障碍抑郁发作患者中的应用[J]. 护理实践与研究, 2018, 15(16): 132-134. DOI: 10.3969/j.issn.1672-9676.2018.16.059.
10 Egnew TR. A narrative approach to healing chronic illness[J]. Ann Fam Med, 2018, 16(2): 160-165. PMID: 29531109. PMCID: PMC5847356. DOI: 10.1370/afm.2182.
11 Kiekens G, Hasking P, Claes L, et al. The DSM-5 nonsuicidal self-injury disorder among incoming college students: prevalence and associations with 12-month mental disorders and suicidal thoughts and behaviors[J]. Depress Anxiety, 2018, 35(7): 629-637. PMID: 29697881. DOI: 10.1002/da.22754.
12 Cullen KR, Klimes-Dougan B, Westlund Schreiner M, et al. N-acetylcysteine for nonsuicidal self-injurious behavior in adolescents: an open-label pilot study[J]. J Child Adolesc Psychopharmacol, 2018, 28(2): 136-144. PMID: 29053023. PMCID: PMC5831760. DOI: 10.1089/cap.2017.0032.
13 何现萍, 王皋茂, 宋京瑶, 等. 喹硫平联合舍曲林治疗青少年抑郁症伴非自杀性自伤行为的临床观察[J]. 临床精神医学杂志, 2021, 31(6): 464-467. DOI: 10.3969/j.issn.1005-3220.2021.06.012.
14 Kothgassner OD, Goreis A, Robinson K, et al. Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: a systematic review and meta-analysis[J]. Psychol Med, 2021, 51(7): 1057-1067. PMID: 33875025. PMCID: PMC8188531. DOI: 10.1017/S0033291721001355.
15 邹晓伟, 田洋丽, 刘利丹, 等. 焦点解决短程治疗非自杀性自伤的理念分析[J]. 医学与哲学, 2021, 42(24): 50-54. DOI: 10.12014/j.issn.1002-0772.2021.24.11.
16 许颖超, 孔凡贞, 庄烨, 等. 叙事护理在 1 例伴有非自杀性自伤青少年抑郁症病人中的应用[J]. 循证护理, 2023, 9(12): 2196-2199. DOI: 10.12102/j.issn.2095-8668.2023.12.019.
17 美国精神医学学会. 精神障碍诊断与统计手册[M]. 5版. 张道龙, 刘春宇, 张小梅, 等译. 北京: 北京大学出版社, 2015: 149-180.
18 美国精神医学学会. 精神障碍诊断与统计手册[M]. 5版. 张道龙, 刘春宇, 张小梅, 等译. 北京: 北京大学出版社, 2015: 787-788.
19 房莹. 接纳承诺疗法团体辅导对高职生非自杀式自伤的干预效果研究[D]. 武汉: 武汉体育学院, 2021.
20 吴莹莹, 吴霞. 叙事疗法对骨质疏松性椎体压缩骨折患者术后疼痛、负性情绪及生活质量影响[J]. 中国健康心理学杂志, 2021, 29(10): 1515-1519. DOI: 10.13342/j.cnki.cjhp.2021.10.016.
21 迈克尔·怀特. 叙事疗法实践地图（修订版）[M]. 李明, 曹杏娥, 党静雯, 译. 重庆: 重庆大学出版社, 2019: 39-41.
22 WhiteM, EpstonD. 故事、知识、权力: 叙事治疗的力量[M]. 廖世德, 译. 上海: 华东理工大学出版社, 2013: 31-52.
23 冯玉. 青少年自我伤害行为与个体情绪因素和家庭环境因素的关系[D]. 武汉: 华中师范大学, 2008.
24 王凯, 苏林雁, 朱焱, 等. 儿童焦虑性情绪障碍筛查表的中国城市常模[J]. 中国临床心理学杂志, 2002, 10(4): 270-272. DOI: 10.3969/j.issn.1005-3611.2002.04.009.
25 俞大维, 李旭. 儿童抑郁量表（CDI）在中国儿童中的初步运用[J]. 中国心理卫生杂志, 2000, 14(4): 225-227. DOI: 10.3321/j.issn:1000-6729.2000.04.003.
26 Gao Y, Wang H, Liu X, et al. Associations between stressful life events, non-suicidal self-injury, and depressive symptoms among Chinese rural-to-urban children: a three-wave longitudinal study[J]. Stress Health, 2020, 36(4): 522-532. PMID: 32369249. DOI: 10.1002/smi.2954.
27 郝阳, 吕行, 安献丽, 等. 应激性生活事件与青少年非自杀性自伤: 有调节的中介效应[J]. 中华疾病控制杂志, 2022, 26(6): 668-672, 690. DOI: 10.16462/j.cnki.zhjbkz.2022.06.009.
28 Rahman F, Webb RT, Wittkowski A. Risk factors for self-harm repetition in adolescents: a systematic review[J]. Clin Psychol Rev, 2021, 88: 102048. PMID: 34119893. DOI: 10.1016/j.cpr.2021.102048.
29 Hawton K, Bale L, Brand F, et al. Mortality in children and adolescents following presentation to hospital after non-fatal self-harm in the multicentre study of self-harm: a prospective observational cohort study[J]. Lancet Child Adolesc Health, 2020, 4(2): 111-120. PMID: 31926769. DOI: 10.1016/S2352-4642(19)30373-6.
30 Simon GE, Shortreed SM, Rossom RC, et al. Effect of offering care management or online dialectical behavior therapy skills training vs usual care on self-harm among adult outpatients with suicidal ideation: a randomized clinical trial[J]. JAMA, 2022, 327(7): 630-638. PMID: 35166800. PMCID: PMC8848197. DOI: 10.1001/jama.2022.0423.
31 胡义秋, 曾子豪, 彭丽仪, 等. 亲子关系和父母教育卷入对青少年抑郁、自伤和自杀意念的影响: 挫败感和人生意义感的作用[J]. 心理学报, 2023, 55(1): 129-141.
32 林丽华, 甘明星, 郭治斌, 等. 心理虐待与忽视对青少年非自杀性自伤行为的影响: 有调节的中介效应[J]. 中国临床心理学杂志, 2020, 28(6): 1140-1143. DOI: 10.16128/j.cnki.1005-3611.2020.06.012.
33 Jalali F, Hashemi SF, Hasani A. Narrative therapy for depression and anxiety among children with imprisoned parents: a randomised pilot efficacy trial[J]. J Child Adolesc Ment Health, 2019, 31(3): 189-200. PMID: 31805840. DOI: 10.2989/17280583.2019.1678474.
34 Slabbert A, Hasking P, Notebaert L, et al. The role of distress tolerance in the relationship between affect and NSSI[J]. Arch Suicide Res, 2022, 26(2): 761-775. PMID: 33084535. DOI: 10.1080/13811118.2020.1833797.
基金
科技创新2030-“脑科学与类脑研究”重大项目（2022ZD0209100）。
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