童年创伤、自尊、冲动/攻击性与双相障碍躁狂首发患者症状严重程度及自杀风险的相关性

赵世苗; 冯虹

doi:10.16766/j.cnki.issn.1674-4152.003170

童年创伤、自尊、冲动/攻击性与双相障碍躁狂首发患者症状严重程度及自杀风险的相关性

doi: 10.16766/j.cnki.issn.1674-4152.003170

赵世苗^,,
冯虹

绍兴市第七人民医院精神科，浙江绍兴 312000

基金项目:

浙江省医药卫生科技计划项目 2020RC131

详细信息

通讯作者:
赵世苗，E-mail：zhsoshimiao@126.com

中图分类号: R749.4
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- 文章访问数: 363
- HTML全文浏览量: 164
- PDF下载量: 9
- 被引次数: 0
出版历程
- 收稿日期: 2023-02-08
- 网络出版日期: 2023-10-19

Correlation between childhood trauma, self-esteem, impulsivity/aggression and the severity of symptoms and suicide risk in patients with bipolar mania

ZHAO Shimiao^,,
FENG Hong

Psychiatric Department of the Seventh People's Hospital of Shaoxing, Shaoxing, Zhejiang 312000, China

摘要

摘要: 目的以相关分析的方式评估双相障碍躁狂首发患者童年创伤、自尊、冲动性/攻击性与症状严重程度及自杀风险的关系。方法选取2020年6月—2022年12月于绍兴市第七人民医院就诊的双相障碍躁狂首发患者104例，按照躁狂严重程度以及自杀倾向分组，分别比较患者童年创伤问卷评分(CTQ)、自尊评分(SES)、冲动性(BIS-11)及攻击性(AQ-CV)评分情况；并分别分析上述指标与躁狂症状和自杀风险的相关性。结果躁狂严重程度分组组间各指标比较差异均有统计学意义(均P＜0.05)；自杀倾向严重程度分组组间童年创伤、冲动和攻击性指标比较差异有统计学意义(均P＜0.05)。相关分析显示，BRMS躁狂评分与CTQ问卷总分、情感忽视、情感虐待和性虐待维度评分相关系数分别为0.935、0.819、0.828和0.837；自杀行为问卷评分与BIS-11量表总分、认知冲动性、运动冲动性和无计划冲动性维度评分相关性分别为0.936、0.871、0.897和0.846；BRMS躁狂评分与攻击问卷总分呈高度相关(r=0.845)，各维度评分r值也均超过0.8。结论童年创伤会促进双相障碍首发躁狂患者的躁狂程度，该群体具有高攻击性，且其中冲动性可提高自杀倾向，应在治疗和干预中加以关注。
- 双相障碍躁狂首发 /
- 童年创伤 /
- 自尊 /
- 冲动性 /
- 攻击性 /
- 自杀风险
Abstract: Objective To evaluate the relationship between childhood trauma, self-esteem, impulsivity/aggression and symptom severity and suicide risk in patients with bipolar mania by correlation analysis. Methods A total of 104 first-episode manic patients with bipolar disorder in Shaoxing Seventh People's Hospital from June 2020 to December 2022 were selected and grouped according to the severity of mania and suicidal tendency. The scores of childhood trauma questionnaire (CTQ), self-esteem score (SES), impulsivity (BIS-11) and aggression (AQ-CV) were compared between groups. The correlation between the above indicators and manic symptoms and suicide risk was analyzed respectively. Results There were statistically significant differences in each index between the manic severity groups (all P<0.05). There were significant differences in childhood trauma, impulsivity and aggression between the groups of suicidal tendency severity (all P<0.05). Correlation analysis showed that the correlation coefficients between BRMS mania score and CTQ total score, emotional neglect, emotional abuse and sexual abuse were 0.935, 0.819, 0.828 and 0.837, respectively. The correlation between suicidal behavior questionnaire score and BIS-11 total score, cognitive impulsivity, motor impulsivity and unplanned impulsivity dimension scores were 0.936, 0.871, 0.897 and 0.846, respectively. The BRMS mania score was highly correlated with the total score of the aggression questionnaire (r=0.845), and the scores of each dimension were also more than 0.8. Conclusion Childhood trauma can promote the degree of mania in patients with bipolar disorder. This group is highly aggressive, and impulsiveness can increase suicidal tendency, which should be paid attention to in treatment and intervention.
- Bipolar disorder manic onset /
- Childhood trauma /
- Self-esteem /
- Impulsiveness /
- Aggressive /
- Suicide risk

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表 1 不同躁狂严重程度患者CTQ评分比较(分)

Table 1. Comparison of CTQ scores in patients with different manic severity (points)

组别	例数	情感忽视 (x±s)	躯体忽视 [M(P₂₅, P₇₅)]	情感虐待 [M(P₂₅, P₇₅)]	身体虐待 [M(P₂₅, P₇₅)]	性虐待 [M(P₂₅, P₇₅)]	总分 (x±s)
低躁狂症状组	59	8.05±2.42	5.00(5.00, 6.00)	5.00(5.00, 7.00)	6.00(5.00, 6.00)	5.00(5.00, 5.00)	32.55±5.29
高躁狂症状组	48	12.23±2.01	9.00(7.00, 11.00)	9.00(7.00, 11.00)	8.00(7.00, 10.00)	7.00(6.00, 8.00)	47.88±7.34
统计量		-9.544^a	-6.724^b	-7.077^b	-6.428^b	-8.117^b	-12.900^a
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001
注：^a为t值，^b为Z值。

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表 2 不同躁狂严重程度患者SES及BIS-11评分比较(x±s，分)

Table 2. Comparison of SES and BIS-11 scores in patients with different manic severity(x±s, points)

组别	例数	自尊量表	Barratt冲动性人格量表
组别	例数	自尊量表	认知冲动性	运动冲动性	无计划冲动性	总分
低躁狂症状组	59	22.71±3.66	57.70±9.07	57.48±11.02	44.78±7.74	53.28±8.55
高躁狂症状组	48	20.69±4.29	67.64±6.27	70.16±7.07	55.53±6.62	64.44±5.79
t值		2.615	-6.675	-7.185	-7.751	-8.004
P值		0.010	＜0.001	＜0.001	＜0.001	＜0.001

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表 3 不同躁狂严重程度患者AQ-CV评分比较(分)

Table 3. Comparison of AQ-CV scores in patients with different manic severity (points)

组别	例数	语言攻击 (x±s)	身体攻击 (x±s)	愤怒 [M(P₂₅, P₇₅)]	敌意 (x±s)	指向自我攻击 (x±s)	总分 (x±s)
低躁狂症状组	59	13.98±1.47	23.22±2.49	19.00(17.00, 20.00)	21.02±2.24	12.16±2.46	59.95±6.95
高躁狂症状组	48	17.65±1.73	27.94±2.79	23.00(21.00, 25.00)	25.65±2.48	16.51±2.50	73.06±6.86
统计量		-11.882^a	-9.235^a	-7.093^b	-10.147^a	-9.064^a	-9.780^a
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001
注：^a为t值，^b为Z值。

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表 4 不同自杀风险患者CTQ评分比较(分)

Table 4. Comparison of CTQ scores in patients with different suicide risk (points)

组别	例数	情感忽视 (x±s)	躯体忽视 [M(P₂₅, P₇₅)]	情感虐待 [M(P₂₅, P₇₅)]	身体虐待 [M(P₂₅, P₇₅)]	性虐待 [M(P₂₅, P₇₅)]	总分 (x±s)
低自杀风险组	63	8.57±2.77	6.00(5.00, 8.00)	7.00(5.00, 8.00)	6.00(5.00, 7.00)	5.00(5.00, 6.00)	34.62±7.95
高自杀风险组	44	11.82±2.40	10.00(8.00, 11.00)	10.50(9.00, 12.00)	8.00(7.00, 10.00)	7.00(6.00, 8.00)	46.68±7.93
统计量		-6.293^a	-5.222^b	-5.438^b	-5.266^b	-5.414^b	-7.731^a
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001
注：^a为t值，^b为Z值。

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表 5 不同自杀风险患者SES及BIS-11评分比较(x±s，分)

Table 5. Comparison of SES and BIS-11 scores in patients with different suicide risk(x±s, points)

组别	例数	自尊量表	Barratt冲动性人格量表
组别	例数	自尊量表	认知冲动性	运动冲动性	无计划冲动性	总分
低自杀风险组	63	22.38±3.72	57.12±8.17	56.72±9.62	44.83±7.81	52.85±7.81
高自杀风险组	44	21.00±4.40	69.60±4.88	72.69±5.39	56.67±5.22	66.31±3.76
t值		1.752	-9.866	-10.945	-9.395	-11.852
P值		0.083	＜0.001	＜0.001	＜0.001	＜0.001

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表 6 不同自杀风险患者AQ-CV评分比较(分)

Table 6. Comparison of AQ-CV scores in patients with different suicide risk (points)

组别	例数	语言攻击 (x±s)	身体攻击 (x±s)	愤怒 [M(P₂₅, P₇₅)]	敌意 (x±s)	指向自我攻击 (x±s)	总分 (x±s)
低自杀风险组	63	14.57±2.04	23.84±3.08	19.00(18.00, 21.00)	21.73±2.90	12.71±2.96	61.94±8.48
高自杀风险组	44	17.23±2.07	27.59±2.91	22.50(20.25, 24.75)	25.16±2.76	16.20±2.59	71.70±7.86
统计量		-6.595^a	-6.335^a	-5.463^b	-6.140^a	-6.311^a	-6.033^a
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001
注：^a为t值，^b为Z值。

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表 7 BRMS躁狂评分、自杀行为问卷评分与童年创伤、自尊、冲动性、攻击性各量表评分的相关系数(r值)

Table 7. Correlation coefficients of BRMS mania score, suicidal behavior questionnaire score and childhood trauma, self-esteem, impulsivity and aggression scales (r value)

评估指标	童年创伤问卷						自尊量表	Barratt冲动性人格量表				Buss和Perry攻击问卷
评估指标	情感忽视	躯体忽视	情感虐待	身体虐待	性虐待	总分	自尊量表	认知冲动性	运动冲动性	无计划冲动性	总分	语言攻击	身体攻击	愤怒	敌意	指向自我攻击	总分
BRMS躁狂评分	0.819^a	0.788^b	0.828^b	0.716^b	0.837^b	0.935^a	-0.396^a	-0.396^a	0.642^a	0.712^a	0.692^a	0.870^a	0.828^a	0.831^b	0.829^a	0.816^a	0.845^a
自杀行为问卷评分	0.657^a	0.609^b	0.631^b	0.570^b	0.647^b	0.716^a	-0.265^a	-0.265^a	0.871^a	0.897^a	0.846^a	0.670^a	0.610^a	0.659^b	0.652^a	0.640^a	0.639^a
注：^a为正态分布计量资料，采用Pearson相关分析；^b为非正态分布计量资料, 采用Spearman相关分析。

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