双相障碍患者童年创伤的潜类别及其与心理弹性、功能结局的关系

钟丽霞; 李珠琳; 马若云; 吉彬彬; 赵娟娟; 林小玲

doi:10.16766/j.cnki.issn.1674-4152.004091

双相障碍患者童年创伤的潜类别及其与心理弹性、功能结局的关系

doi: 10.16766/j.cnki.issn.1674-4152.004091

1.
中山大学护理学院，广东广州 510080
2.
湖南中医药大学护理学院，湖南长沙 410208
3.
厦门医学院护理学院，福建厦门 361023

基金项目:

国家自然科学基金项目 71904213

详细信息

通讯作者:
林小玲，E-mail：lxlingg@126.com

中图分类号: R749 R395
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- 文章访问数: 7
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- 被引次数: 0
出版历程
- 收稿日期: 2024-10-28
- 网络出版日期: 2025-10-25

Latent class analysis of childhood trauma in patients with bipolar disorder and its relationship with resilience and functional outcomes

1.
School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong 510080, China

摘要

摘要: 目的探究双相障碍患者童年创伤的潜类别及心理弹性在该潜类别和功能结局(社会功能和生活质量)中的中介作用。方法便利选取2019年9月—2021年4月中山大学附属第三医院和广州市惠爱医院门诊及住院的272例双相障碍患者，采用一般资料调查表、儿童期创伤问卷、心理弹性量表、功能评估简表、12项健康相关生命质量简表、汉密尔顿抑郁量表-17项和杨氏躁狂量表进行调查。采用潜类别分析探索童年创伤的潜类别，采用协方差分析比较不同童年创伤潜类别患者心理弹性和功能结局的差异，采用中介分析探究心理弹性在童年创伤潜类别与功能结局间的中介作用。结果析出3个潜类别：低创伤组(n=152，55.9%)、高忽视组(n=48，17.6%)和高创伤组(n=72，26.5%)。该潜类别对心理弹性、社会功能和生活质量的主效应均显著(F=8.173、3.599、4.800，P＜0.001)。相对低创伤组，心理弹性在高忽视组与社会功能和生活质量间的相对中介效应分别为0.21(95% CI：0.08~0.34)和-0.21(95% CI：-0.34~-0.09)。结论双相障碍患者的童年创伤经历存在异质性，临床应关注其童年创伤特点，开展针对性干预，以改善患者功能结局。
- 双相障碍 /
- 童年创伤 /
- 功能结局 /
- 心理弹性 /
- 潜类别分析 /
- 中介分析
Abstract: Objective To explore latent classes of childhood trauma in patients with bipolar disorder (BD) and to examine the mediating effects of resilience in the relationship between latent classes and functional outcomes (psychosocial functioning and quality of life). Methods A total of 272 inpatients and outpatients with BD were recruited by convenience sampling from the Third Affiliated Hospital of Sun Yat-sen University and Guangzhou Huiai Hospital between September 2019 and April 2021. Participants were assessed by general information questionnaire, childhood trauma questionnaire short form, conner-davidson resilience scale, functioning assessment short test, 12 items short form health survey, 17-item Hamilton depression rating scale, and Young mania rating scale. Latent class analysis was used to explore the latent classes of childhood trauma, and covariance analysis was used to compare resilience and functional outcomes among patients with different latent classes of childhood trauma. Mediation analysis was used to investigate the mediating role of resilience between latent classes of childhood trauma and functional outcomes. Results Three distinct trauma classes were identified: "low trauma" (n=152, 55.9%), "high neglect" (n=48, 17.6%), and "high trauma" (n=72, 26.5%). The latent classes had a significant main effect on resilience, social function, and quality of life (F=8.173, 3.599, 4.800, all P < 0.001). Using the "low trauma" class as the reference, the mediating effects of resilience in the "high neglect" class on psychosocial function and quality of life were 0.21 (95% CI: 0.08 to 0.34) and -0.21 (95% CI: -0.34 to -0.09), respectively. Conclusion The childhood trauma among patients with bipolar disorder is heterogeneous. Identifying childhood trauma profiles and providing targeted intervention based on trauma characteristics and resilience levels may help improve the functional outcomes in patients.
- Bipolar disorder /
- Childhood trauma /
- Functional outcomes /
- Resilience /
- Latent class analysis /
- Mediation analysis

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图 1 双相障碍患者童年创伤潜类别条件概率图

Figure 1. Conditional probabilities of childhood trauma latent classes in patients with bipolar disorder

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图 2 心理弹性在童年创伤潜类别与功能结局间的中介作用

注：——表示路径显著，^aP＜0.05，^bP＜0.001。

Figure 2. Mediating effects of resilience between childhood trauma latent classes and functional outcomes

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表 1 双相障碍患者童年创伤潜类别拟合指标

Table 1. Fit indexes of latent classes based on childhood trauma in patients with bipolar disorder

类别数	AIC	BIC	aBIC	Entropy	LMRT(P)	BLRT(P)	类别概率
1	1 650.203	1 668.232	1 652.379				1.000
2	1 470.977	1 510.641	1 475.763	0.759	＜0.001	＜0.001	0.544\|0.456
3	1 431.387	1 492.686	1 438.784	0.869	＜0.001	＜0.001	0.559\|0.176\|0.265
4	1 429.437	1 512.371	1 439.444	0.882	0.024	＜0.001	0.099\|0.125\|0.577\|0.199
5	1 435.045	1 539.613	1 447.662	0.901	0.108	0.500	0.015\|0.095\|0.206\|0.125\|0.559

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表 2 双相障碍患者人口学和疾病特征在不同童年创伤潜类别上的差异

Table 2. Differences in demographic and disease characteristics of patients with bipolar disorder across latent classes of childhood trauma

项目	例数(n=272)	低创伤组(n=152)	高忽视组(n=48)	高创伤组(n=72)	统计量	P值
BMI[例(%)]					5.261^c	0.511
＜18.50	53(19.5)	26(17.1)	10(20.8)	17(23.6)
18.50~	123(45.2)	68(44.7)	20(41.7)	35(48.6)
24.00~	67(24.6)	43(28.3)	13(27.1)	11(15.3)^a
＞28.00	29(10.7)	15(9.9)	5(10.4)	9(12.5)
受教育程度[例(%)]					11.889^d	0.064
小学及以下	14(5.2)	6(3.9)	5(10.4)	3(4.2)
初中	64(23.5)	29(19.1)	14(29.2)	21(29.2)
高中/中专	113(41.5)	63(41.4)	22(45.8)	28(38.9)
大学及以上	81(29.8)	54(35.5)	7(14.6)	20(27.8)
首次发病年龄[M(P₂₅, P₇₅)，岁]	20.00(16.00, 26.00)	21.00(16, 27)	19.50(16.00, 27.50)^a	19.00(15.00, 24.00)	4.804^d	0.091
发作次数[M(P₂₅, P₇₅)，次]	4.00(2.00, 6.00)	4.00(2.00, 6.00)	5.00(3.00, 7.00)	6.00(3.00, 11.00)^a	7.859^d	0.020
HAMD-17评分[M(P₂₅, P₇₅)，分]	6.00(2.00, 10.00)	6.00(2.00, 9.00)	7.00(5.00, 11.75)^a	6.00(3.00, 11.75)	5.435^d	0.066
YMRS评分[M(P₂₅, P₇₅)，分]	4.00(2.00, 9.00)	4.00(1.00, 8.00)	3.50(2.00, 7.00)	5.00(3.00, 10.00)^ab	5.542^d	0.063
注：^c为χ²值，^d为H值。与低创伤组比较，^aP＜0.05；与高忽视组比较，^bP＜0.05。

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表 3 不同类别双相障碍患者心理弹性和功能结局比较

Table 3. Comparison of resilience and functional outcomes in different classes of patients with bipolar disorder

维度	童年创伤潜类别的主效应		校正后得分(x±s，分)
维度	F值	P值	低创伤组(n=152)	高忽视组(n=48)	高创伤组(n=72)
心理弹性	8.173	＜0.001	58.77±1.77	44.76±3.18^a	59.43±2.60^b
坚韧性	8.743	＜0.001	29.78±0.99	21.81±1.79^a	30.57±1.46^b
力量性	6.329	0.002	19.21±0.56	15.43±1.00^a	19.65±0.82^b
乐观性	5.745	0.004	9.77±0.32	7.52±0.58^a	9.20±0.47^b
社会功能	3.599	0.029	14.94±1.12	19.59±2.01^a	19.54±1.65^a
自主生活	0.421	0.657	2.26±0.20	2.54±0.36	2.55±0.30
职业功能	0.187	0.829	4.15±0.35	4.53±0.63	4.43±0.51
认知功能	3.186	0.043	2.89±0.28	4.10±0.50^a	3.85±0.41
财务问题	3.261	0.040	1.25±0.14	1.72±0.25	1.85±0.21^a
人际关系	8.980	＜0.001	3.27±0.31	5.12±0.56^a	5.41±0.46^a
休闲时间	2.191	0.114	1.12±0.12	1.58±0.22	1.45±0.18
生活质量	4.800	0.009	33.24±0.49	30.43±0.89^a	31.31±0.73^a
躯体健康	1.790	0.169	63.38±1.58	57.23±2.84	61.27±2.32
心理健康	5.325	0.005	58.87±1.68	49.62±3.02^a	51.11±2.47^a
注：协变量为BMI、受教育程度、首次发病年龄、发作次数、HAMD-7评分和YMRS评分。与低创伤组比较，^aP＜0.05；与高忽视组比较，^bP＜0.05。

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表 4 心理弹性的相对中介效应

Table 4. The relative mediating effects of resilience

路径	相对间接效应		相对直接效应
路径	效应值	95% CI	效应值	95% CI
高忽视组→心理弹性→社会功能	0.21	0.08~0.34	0.10	-0.20~0.45
高创伤组→心理弹性→社会功能	-0.01	-0.11~0.09	0.31	0.04~0.61
高忽视组→心理弹性→生活质量	-0.21	-0.34~-0.09	-0.18	-0.43~0.08
高创伤组→心理弹性→生活质量	0.01	-0.08~0.11	-0.27	-0.49~-0.04
注：参照组为低创伤组。

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