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青少年抑郁患者自伤或自杀的心理特征和疼痛耐受

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目的 探讨青少年抑郁障碍患者出现自伤或自杀的影响因素以及疼痛耐受度.方法 选取 2023年 1 月至 2024 年 5 月在云南省精神病医院和昆明市精神病院被确诊为抑郁障碍的 96 名青少年进行研究,30 d内有自伤或自杀行为的为案例组(n=61),30 d以上或无自伤或自杀行为的为对照组(n=35).采用健康问卷抑郁量表(PHQ-9)、米式边缘性人格障碍检测表(MSI-BPD)、房树人绘画测验(HTP)和哥伦比亚自杀严重程度评定量表(C-SSRS)评估调查.其中有 72 例用艾德堡HP-50 测痛仪器完成了对皮肤压痛阈值的测试 2 d内有自伤或自杀行为组n=12,2 d以上有自伤或自杀行为组n=60).结果 (1)两组性别、年龄分析显示差异有统计学意义(P<0.05),30 d以内组女性比例更高,年龄更小;(2)30 d以内组的PHQ-9 得分为(19.59±5.99)分、PHQ-9 第 9 题("有不如死掉或用某种方式伤害自己的念头")得分为(2.41±0.97)分、MSI-BPD得分为(7.43±1.61)分;30 d以上组的PHQ-9 得分为(10.89±7.99)分、PHQ-9 第 9 题得分为(1.00±1.11)分、MSI-BPD得分为(5.40±3.13)分,两组经独立样本t检验分析,结果显示其差异均有统计学意义(P<0.01);(3)在30 d以内组的房树人 47 项绘画特征中的 5 项绘画特征(重心偏移、头发不凌乱或无头发、无山、无太阳和无花草)出现的比例更高,其差异具有统计学意义(P<0.05);(4)96 例患者两组绘画特征在以 30 d内有无自伤自杀行为为因变量的二元逻辑回归分析中,无花草、PHQ-9 第 9 题得分是青少年抑郁症患者 30 d内出现自伤或自杀行为的危险因素(OR无花草=7.934、ORPHQ-9 第 9 题得分=3.554);(5)对72 例疼痛测试组中,2 d内出现自伤或自杀行为的青少年抑郁患者皮肤压痛阈值(8.83±4.27)N明显高于时间超过 2 d的患者(6.48±3.00)N,差异具有统计学意义(t=-2.201,P<0.05),且PHQ-9 第 9 题得分更高[(2.50±0.67)分VS(1.87±0.95)分],差异具有统计学意义(t=-2.201,P<0.05).结论 HTP绘画中无花草绘画特征、有更强的自杀意念或自杀企图是青少年抑郁症患者出现自伤或自杀行为的危险因素,2 d内自伤自杀患者比 2 d外自伤自杀患者的疼痛阈值更高.
Psychological Characteristics and Pain Tolerance of Adolescents with Depression Experiencing Self-injury or Suicidality
Objective To explore the influencing factors of self injury or suicide in adolescent patients with depression.Methods A total of 96 adolescents who were diagnosed with depressive disorder at Yunnan Psychiatirc Hospital and Kunming Psychiatirc Hospital from January 2023 to May 2024 were selected for the study.The case group consisted of 61 adolescents who had self-injury or suicidal behaviors within 30 days,while the control group consisted of 35 adolescents who had no self-injury or suicidal behaviors within at least 30 days.Assessments were performed using the Patient Health Questionnaire-9(PHQ-9),Millon Screening Inventory for Borderline Personality Disorder(MSI-BPD),House-Tree-Person Drawing Test(HTP),and the Columbia Suicide Severity Rating Scale(C-SSRS).Among these,72 subjects underwent skin pressure pain threshold testing using the Algometer HP-50,with 12 in the self-harm or suicide group within 2 days and 60 in the group beyond 2 days.Results(1)Analysis of gender and age between the two groups showed statistically significant differences(P<0.05),with a higher proportion of females and younger ages in the 30-day group;(2)The PHQ-9 score for the 30-day group was(19.59±5.99),with a score of(2.41±0.97)for item 9("Thoughts that it would be better to be dead or to hurt oneself in some way"),and an MSI-BPD score of(7.43±1.61).The scores for the group over 30 days were(10.89±7.99),(1.00±1.11)for item 9,and(5.40±3.13)for MSI-BPD.Independent samples t-test analysis showed significant differences(P<0.01);(3)In the 30-day group,five drawing characteristics from the 47 HTP characteristics(shift of center of gravity,hair not disheveled or no hair,no mountains,no sun,and no flowers or grass)were found to occur at a higher rate,with statistical significance(P<0.05);(4)In the binary logistic regression analysis of 96 patients with the 30-day suicide or self-injury behavior as the dependent variable,the absence of flowers and PHQ-9 question 9 score are the risk factors for adolescent depression patients to have self-injury or suicide behavior within 30 days(OR no flowers=7.934,OR score on PHQ-9 question 9=3.554).(5)Among the 72 subjects the skin pressure pain threshold for adolescents who exhibited self-injure or suicide behaviors within 2 days(8.83±4.27 N)was significantly higher than that for patients beyond 2 days(6.48±3.00 N),with statistical significance(t=-2.201,P<0.05).Additionally,the score for item 9 of the PHQ-9 was higher(2.50±0.67 vs 1.87±0.95),also showing statistical significance(t=-2.201,P<0.05).Conclusion The absence of flowers or grass in HTP painting,and stronger suicidal ideation or suicide attempt are risk factors for self-injury or suicidal behavior in adolescents with depression.Furthermore,those who self-injure or commit suicide within 2 days have a higher pain threshold compared to those beyond 2 days.

Adolescent depression disorderSelf-injure or suicidal behaviorHouse-tree-person testPainthreshold

许琳苑、赵华君、李超、苏燕、保石花、吴蕾、李青蔚、张炳奎

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昆明市精神病院医学康复科,云南 昆明 650231

昆明医科大学精神卫生附属中心老年精神病一科,云南 昆明 650224

青少年抑郁障碍 自伤或自杀行为 房树人绘画测验 压痛阈值

2025

昆明医科大学学报
昆明医学院

昆明医科大学学报

影响因子:0.829
ISSN:1003-4706
年,卷(期):2025.46(1)