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
计量
- 文章访问数: 138
- HTML全文浏览量: 47
- PDF下载量: 5
- 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

HTML全文

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。

下载: 导出CSV

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

下载: 导出CSV

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。

下载: 导出CSV

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。

下载: 导出CSV

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

下载: 导出CSV

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。

下载: 导出CSV

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。

下载: 导出CSV

参考文献(22)

[1]	宋彩云, 柳贵芳, 孙华风. 渐进式引导护理与高级共情护理技术对双向情感障碍躁狂发作患者的效果分析[J]. 国际医药卫生导报, 2021, 27(22): 3581-3584. doi: 10.3760/cma.j.issn.1007-1245.2021.22.039 SONG C, LIU G, SUN H F. Application of progressive guided nursing and advanced empathic nursing techniques in patients with bipolar disorder and manic episode[J]. International Medicine and Health Guidance News, 2021, 27(22): 3581-3584. doi: 10.3760/cma.j.issn.1007-1245.2021.22.039
[2]	张瑞环, 何旭, 姚震, 等. 中药联合心境稳定剂治疗双相情感障碍的系统评价[J]. 中医药导报, 2021, 27(7): 165-172, 185. https://www.cnki.com.cn/Article/CJFDTOTAL-HNZB202107036.htm ZHANG R H, HE X, YAO Z, et al. Systematic Evaluation of Traditional Chinese Medicine combined with Mood Stabilizer in the Treatment of Bipolar Disorder[J]. Guiding Journal of Traditional Chinese Medicine and Pharmacy, 2021, 27(7): 165-172, 185. https://www.cnki.com.cn/Article/CJFDTOTAL-HNZB202107036.htm
[3]	李堃. 双相情感障碍发作间歇期的护理配合措施及效果[J]. 中国医药指南, 2022, 20(11): 49-52. doi: 10.15912/j.cnki.gocm.2022.11.055 LI K. Measures and Effect of Nursing Cooperation in the Intermission Period of Bipolar Disorder[J]. Guide of China Medicine, 2022, 20(11): 49-52. doi: 10.15912/j.cnki.gocm.2022.11.055
[4]	房萌, 刘珊珊, 尹冬青, 等. 女性双相情感障碍住院患者高自杀风险的相关因素分析[J]. 神经疾病与精神卫生, 2022, 22(7): 500-504. https://www.cnki.com.cn/Article/CJFDTOTAL-JBJS202207008.htm FANG M, LIU S S, YIN D Q, et al. The analysis of related factors of high suicide risk in female inpatients with bipolar disorder[J]. Journal of Neuroscience and Mental Health, 2022, 22(7): 500-504. https://www.cnki.com.cn/Article/CJFDTOTAL-JBJS202207008.htm
[5]	芦云平, 崔伟, 于超, 等. 伴精神病性症状躁狂首发双相障碍Ⅰ型患者疾病特征及长期功能预后[J]. 中国神经精神疾病杂志, 2022, 48(1): 34-39. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSJJ202201006.htm LU Y P, CUI W, YU C, et al. Diseases features and long-term functional prognosis in first-episode manic bipolar disorder-Ⅰ patients with psychotic symptoms[J]. Chinese Journal of Nervous and Mental Diseases, 2022, 48(1): 34-39. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSJJ202201006.htm
[6]	左甜甜, 王康程, 胡宇飞, 等. 童年创伤与同伴环境对青少年抑郁症患者非自杀性自伤行为的预测作用[J]. 中华精神科杂志. 2022, 55(4): 272-280. ZUO T T, WANG K C, HU Y F, et al. The predictive role of childhood trauma and peer environment on non-suicidal self-injurious behavior in adolescents with depression[J]. Chinese Journal of Psychiatry. 2022, 55(4): 272-280.
[7]	SLYEPCHENKO A, ALLEGA O R, LENG X M, et al. Association of functioning and quality of life with objective and subjective measures of sleep and biological rhythms in major depressive and bipolar disorder[J]. Aust N Z J Psychiatry, 2019, 53(7): 683-696. doi: 10.1177/0004867419829228
[8]	周绍宇, 靳西龙, 冯振晓, 等. 碳酸锂缓释片治疗双相情感障碍的躁狂发作的疗效探讨[J]. 中国药物与临床, 2019, 19(19): 3282-3285. https://www.cnki.com.cn/Article/CJFDTOTAL-YWLC201919006.htm ZHOU S Y, JIN X L, FENG Z X, et al. Effect of lithium carbonate sustained release tablets on manic episode of bipolar disorder[J]. Chin Remed Clin, 2019, 19(19): 3282-3285. https://www.cnki.com.cn/Article/CJFDTOTAL-YWLC201919006.htm
[9]	何文知, 温健, 王瑶, 等. 失眠在中学生童年创伤与自杀风险之间的中介作用[J]. 中华行为医学与脑科学杂志, 2022, 31(4): 359-365. https://cpfd.cnki.com.cn/Article/CPFDTOTAL-OGSF202209001338.htm HE W Z, WEN J, WANG Y, et al. Mediating effect of insomnia in the relationship between childhood trauma and suicide risk in middle school students[J]. Chinese Journal of Behavioral Medicine and Brain Science, 2022, 31(4): 359-365. https://cpfd.cnki.com.cn/Article/CPFDTOTAL-OGSF202209001338.htm
[10]	曹华, 汪志君, 杨玲, 等. 童年创伤对青少年网络成瘾的影响: 自我隐瞒的中介作用[J]. 中华行为医学与脑科学杂志, 2021, 30(9): 811-816. https://cdmd.cnki.com.cn/Article/CDMD-12121-1023007727.htm CAO H, WANG Z J, YANG L, et al. The effect of childhood trauma on adolescent Internet addiction : the mediating role of self-concealment[J]. Chinese Journal of Behavioral Medicine and Brain Science, 2021, 30(9): 811-816. https://cdmd.cnki.com.cn/Article/CDMD-12121-1023007727.htm
[11]	杨秀英, 李晓梅, 甘宇, 等. 自尊在抑郁症患者童年期创伤与攻击行为间的中介作用[J]. 中华行为医学与脑科学杂志, 2020, 29(4): 351-352, 355. YANG X Y, LI X M, GAN Y, et al. The mediating effect of self-esteem between childhood trauma and aggressive behavior in patients with major depressive disorder[J]. Chinese Journal of Behavioral Medicine and Brain Science, 2020, 29(4): 351-352, 355.
[12]	王孝艳, 李凤丹, 都继微. 女性护士冲动性人格与自杀意念间的关系: 社会支持的中介作用[J]. 中国实用护理杂志, 2020, 36(34): 2641-2645. https://www.cnki.com.cn/Article/CJFDTOTAL-WANT202304012.htm WANG X Y, LI F D, DU J W. The relationship between impulsive personality and suicide ideation of female nurses: the mediating role of social support[J]. Chinese Journal of Practical Nursing, 2020, 36(34): 2641-2645. https://www.cnki.com.cn/Article/CJFDTOTAL-WANT202304012.htm
[13]	陈程, 陈方方, 汪莲籽, 等. 大学生情绪失调和特质愤怒在童年期虐待与攻击行为间的链式中介作用[J]. 中华行为医学与脑科学杂志, 2021, 30(7): 621-626. CHEN C, CHEN F F, WANG L Z, et al. A chain mediating model of emotion dysregulation and trait anger in the relationship between childhood abuse and aggressive behavior within the undergraduate students[J]. Chinese Journal of Behavioral Medicine and Brain Science, 2021, 30(7): 621-626.
[14]	张森, 白宏英, 李倩倩, 等. 深髓静脉征与脑小血管病影像学标志物相关性及危险因素研究[J]. 中国全科医学, 2023, 26(6): 681-686. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX202306004.htm ZHANG S, BAI H Y, LI Q Q, et al. Total Deep Medullary Veins Score in Cerebral Small Vessel Disease: Association with Imaging Markers and Factors Related to Its Elevation[J]. Chinese General Practice, 2023, 26(6): 681-686. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX202306004.htm
[15]	冯雪. 现状-背景-评估-建议护理沟通模式对双相情感障碍躁狂发作患者躁狂水平的影响[J]. 山西医药杂志, 2022, 51(3): 354-356. https://www.cnki.com.cn/Article/CJFDTOTAL-SXYY202203042.htm FENG X. Effect of Status-Background-Assessment-Recommendation Nursing Communication Model on Mania Level in Patients with Bipolar Disorder Manic Episode[J]. Shanxi Medical Journal, 2022, 51(3): 354-356. https://www.cnki.com.cn/Article/CJFDTOTAL-SXYY202203042.htm
[16]	朱肖飞. 喹硫平+碳酸锂对双相情感障碍躁狂患者认知功能的影响: 评《精神障碍患者家属手册》[J]. 中国国境卫生检疫杂志, 2021, 44(5): 382. https://www.cnki.com.cn/Article/CJFDTOTAL-GJWJ202105028.htm ZHU X F. Effects of Quetiapine + Lithium Carbonate on Cognitive Function in Patients with Bipolar Disorder Mania - Review of 'Handbook for Family Members of Patients with Mental Disorders'[J]. Chinese Journal of Frontier Health and Quarantine, 2021, 44(5): 382. https://www.cnki.com.cn/Article/CJFDTOTAL-GJWJ202105028.htm
[17]	崔亚楠, 黄云衡, 郭雅如, 等. 情感虐待对青少年失眠的中介模型分析[J]. 中华全科医学, 2023, 21(3): 454-457, 472. doi: 10.16766/j.cnki.issn.1674-4152.002906 CUI Y N, HUANG Y H, GUO Y R, et al. A mediation model analysis of emotional abuse on adolescent insomnia[J]. Chinese Journal of General Practice, 2023, 21(3): 454-457, 472. doi: 10.16766/j.cnki.issn.1674-4152.002906
[18]	谢军, 耿峰, 董毅, 等. 抑郁症患者童年期虐待与自我病耻感水平的相关性研究[J]. 中华全科医学, 2019, 17(7): 1171-1173. doi: 10.16766/j.cnki.issn.1674-4152.000893 XIE J, GENG F, DONG Y, et al. The correlational study between childhood trauma and self-stigma in depression[J]. Chinese Journal of General Practice, 2019, 17(7): 1171-1173. doi: 10.16766/j.cnki.issn.1674-4152.000893
[19]	曾宝尔. 大学生自杀行为与风险决策的关系研究[D]. 广州: 南方医科大学, 2019. ZENG B R. Research on the relationship between suicidal behavior and risk decision-making among college students[D]. Guangdong : Southern Medical University, 2019.
[20]	赵杰, 刘泱慧, 马雄英, 等. 双相障碍躁狂发作患者反应抑制能力的研究[J]. 临床精神医学杂志, 2019, 29(4): 217-220. https://www.cnki.com.cn/Article/CJFDTOTAL-LCJS201904001.htm ZHAO J, LIU Y H, MA X Y, et al. Study on the ability of response inhibition in bipolar disorder patients with manic episode[J]. Journal of Clinical Psychiatry, 2019, 29(4): 217-220. https://www.cnki.com.cn/Article/CJFDTOTAL-LCJS201904001.htm
[21]	周淼, 钟瑞, 王清, 等. 精神分裂症患者社交焦虑与正念和自尊的关系[J]. 中国心理卫生杂志, 2022, 36(9): 734-738. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXWS202209002.htm ZHOU M, ZHONG R, WANG Q, et al. Relationship among social anxiety, mindfulness and self-esteem in patients with schizophrenia[J]. Chinese Mental Health Journal, 2022, 36(9): 734-738. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXWS202209002.htm
[22]	马澜毓, 罗震雷, 许博洋. 女性服刑人员攻击性与儿童期性虐待的关系[J]. 中国心理卫生杂志, 2022, 36(10): 869-876. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXWS202210009.htm MA L Y, LUO Z L, XU B Y. Relationship between aggression and childhood sexual abuse in female prisoners[J]. Journal of Clinical Psychiatry, 2022, 36(10): 869-876. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXWS202210009.htm