The Impact of Psychological Stress Response on Non-suicidal Self-injury Behaviors in Adolescents during COVID-19
-
摘要: 为了探究在新冠疫情期间学生群体的心理应激反应和非自杀性自伤行为的关系,以及消极应对方式的中介作用和情绪管理能力的调节作用,以线上问卷的形式,采用心理应激反应筛查问卷、简易应对方式问卷、情绪管理能力量表、非自杀性自伤行为功能评估工具,在疫情期间对国内1 955名学生进行调查. 结果显示:疫情期间学生的心理应激反应和自伤行为呈显著正相关;消极应对方式在心理应激反应和非自杀性自伤行为之间起部分中介作用;消极应对方式和非自杀性自伤行为的关系(中介效应的后半段路径)受到情绪管理能力的调节:情绪管理能力越强,消极应对方式对非自杀性自伤行为的正向预测作用越弱. 研究表明:心理应激反应和非自杀性自伤行为之间存在着有调节的中介效应,消极应对方式是其中的中介变量,情绪管理能力是其中的调节变量,后者能够降低前者对非自杀性自伤的影响.Abstract: To study the relationship between psychology stress response and non-suicidal self-injury behaviors, the mediating effect of negative coping style and the moderating effect of emotional management ability among students during the COVID-19 epidemic, the Psychological Stress Reaction Questionnaire, the Non-suicide Behavioral Assessment Tool, the Simplified Coping Style Questionnaire and the Emotion Management Questionnaire were employed to investigate the mental health of 1 955 students. The results showed that psychology stress response was significantly positively correlated to non-suicidal self-injury behaviors; negative coping style played a partial mediating role between psychology stress response and non-suicidal self-injury behaviors and the mediating effect was affected by emotional management ability. The relationship between negative coping style and non-suicidal self-injury behaviors (the second half of the mediation effect) was moderated by emotional management ability; the higher the emotional management ability of the subjects, the weaker effects of negative coping style on the positive prediction of non-suicidal self-injury behaviors. The research suggested that the relationship between psychology stress response and non-suicide self-injury behaviors was mediated, negative coping style played a partial mediating role between them, and emotional management ability can buffer the impact of negative coping style on non-suicide self-injury behaviors.
-
表 1 自伤发生率的不同人口学因素差异
Table 1. The different demographic factors in the incidence of self-injury
组别 人数 NSSI人数 χ2 性别 男 1 005 259 0.92 女 950 227 地区 疫情高发区 347 131 37.54*** 疫情低发区 1 680 355 户口所在地 城镇 1 164 280 0.99 乡村 791 206 目前状态 医疗机构隔离 26 11 22.17*** 在家或特定地点强制隔离 148 55 居家学习 1 572 383 恢复正常学习 209 37 独生子女情况 独生子女 1 030 222 12.74*** 非独生子女 925 264 家庭结构 小家庭 1 446 328 8.22* 大家庭 467 145 单亲或重组家庭 42 13 注:* * *表示P<0.001,* *表示P<0.01,*表示P<0.05. 下表同. 表 2 主要变量描述性统计相关关系
Table 2. The descriptive statistical correlation of main variables
变量 PSR EMA NSSI PCS NCS M SD PSR 1 3.36 4.59 EMA -0.63** 1 11.85 2.86 NSSI 0.49** -0.39** 1 0.58 1.27 PCS -0.16** 0.21** -0.12** 1 30.58 8.93 NCS 0.11** -0.03 0.11** 0.65** 1 16.59 6.84 注:M为平均值;SD为标准差;PSR为心理应激反应;EMA为情绪管理能力;NCS为消极应对方式;PCS为积极应对方式;NSSI为非自杀性自伤行为,下同。 表 3 中介模型分析
Table 3. The mediation model analysis
变量 模型1(NSSI) 模型2(NCS) 模型3(有中介的NSSI) β t β t β t PSR 0.43 20.81*** 0.16 2.97** 1.12 20.63*** NCS — — — — 0.05 2.42** R2 0.21 0.05 0.21 F 130.76*** 28.32*** 106.04*** 表 4 中介效应检验
Table 4. The mediating effect test
效应类型 效应值 Boot标准误(SE) Boot 95%的置信区间(CI) 相对效应/% 下限 上限 总效应 1.12 0.05 1.02 1.23 — 直接效应 1.11 0.05 1.01 1.22 92.50 间接效应 0.01 0.01 0.00 0.02 7.50 表 5 有调节的中介模型分析
Table 5. The moderated mediation model analysis
变量 模型1(NSSI) 模型2(NCS) 模型3(有调节的中介的NSSI) β t β t β t PSR 0.59 7.71*** 0.17 2.97** 0.57 7.79*** NCS — — — — 0.07 3.39*** EMA -0.17 -6.61*** — — -0.16 -6.34*** PSR*EMA -0.30 -5.37*** — — -0.28 -4.93*** NCS*EMA — — — — -0.07 -4.09*** R2 0.26 0.05 0.27 F 114.67*** 28.32*** 89.86*** 表 6 在情绪管理能力不同水平上的中介效应
Table 6. The mediating effect of emotional management ability on different levels
中介变量 调节变量 间接效应值(β) Boot标准误(SE) Boot95%的置信区间(CI) 下限 上限 NCS M-SD 0.03 0.01 0.01 0.05 M 0.01 0.01 0.00 0.03 M+SD -0.00 0.00 -0.01 0.01 -
[1] 刘艾祎, 伍新春. 自我同情对疫情所致创伤后消极心理反应的作用机制及干预策略[J]. 华南师范大学学报(社会科学版), 2020(4): 42-57. https://www.cnki.com.cn/Article/CJFDTOTAL-HNSB202004005.htmLIU A W, WU X C. Mechanism and related interventions of self-compassion on the negative psychological responses after pandemic[J]. Journal of South China Normal University (Social Science Edition), 2020(4): 42-57. https://www.cnki.com.cn/Article/CJFDTOTAL-HNSB202004005.htm [2] 胡燕, 许川勇, 王若彤, 等. 新冠疫情期间学生的心理应激反应对攻击性行为的影响: 一个有调节的中介[J]. 应用心理学, 2020, 27(1): 57-65. https://www.cnki.com.cn/Article/CJFDTOTAL-LKGP201403016.htmHU Y, XU C Y, WANG R T, et al. The effect of psychological stress on aggressive behavior during the COVID-19: a moderated mediation model[J]. China Journal of Applied Psychology, 2020, 27(1): 57-65. https://www.cnki.com.cn/Article/CJFDTOTAL-LKGP201403016.htm [3] LI S, WANG Y, XUE J, et al. The impact of COVID-19 epidemic declaration on psychological consequences: a study on active weibo users[J]. International Journal of Environmental Research and Public Health, 2020, 17(6): 1-9. [4] ORNELLl F, SCHUCH J B, SORDI A O, et al. "Pandemic fear" and COVID-19: mental health burden and strategies[J]. Brazilian Journal of Psychiatry, 2020, 42(3): 232-235. doi: 10.1590/1516-4446-2020-0008 [5] ASAMOW J R, PORTA G, SPIRITO A, et al. Suicide attempts and nonsuicidal self-injury in the treatment of resistant depression in adolescents: findings from the TORDIA study[J]. Journal of the American Academy of Child and Adolescent Psychiatry, 2011, 50(8): 772-781. doi: 10.1016/j.jaac.2011.04.003 [6] NOCK M K, JOINER T E, GORDON K H, et al. Non-suicidal self-injury among adolescents: diagnostic correlates and relation to suicide attempts[J]. Psychiatry Research, 2006, 144(1): 65-72. doi: 10.1016/j.psychres.2006.05.010 [7] WILKINSON P, KELVIN R, ROBERTS C, et al. Clinical and psychosocial predictors of suicide attempts and nonsuicidal self-injury in the Adolescent Depression Antidepressants and Psychotherapy Trial(ADAPT)[J]. American Journal of Psychiatry, 2011, 168(5): 495-501. doi: 10.1176/appi.ajp.2010.10050718 [8] 江光荣, 于丽霞, 郑莺, 等. 自伤行为研究: 现状, 问题与建议[J]. 心理科学进展, 2011, 19(6): 861-873. https://www.cnki.com.cn/Article/CJFDTOTAL-XLXD201106011.htmJIANG G R, YU L X, ZHENG Y, et al. The current status, problems and recommendations on non-suicidal self-injury in China[J]. Advances in Psychological Science, 2011, 19(6): 861-873. https://www.cnki.com.cn/Article/CJFDTOTAL-XLXD201106011.htm [9] 孙蒙, 史战明, 陈登国, 等. 非自杀性自伤与精神障碍关系研究进展[J]. 国际精神病学杂志, 2020, 47(1): 11-13, 24. https://www.cnki.com.cn/Article/CJFDTOTAL-GWYJ202001004.htm [10] AKRAM B, BATOOL M, RAFI Z, et al. Prevalence and predictors of non-suicidal self-injury among children with autism spectrum disorder[J]. Pakistan Journal of Medical Sciences, 2017, 33(5): 1225-1229. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5673738/ [11] SINCLAIR J, HAWTON K, GRAY A. Six year follow-up of a clinical sample of self-harm patients[J]. Journal of Affective Disorders, 2010, 121(3): 247-252. doi: 10.1016/j.jad.2009.05.027 [12] 唐记华, 王高华, 王晓萍, 等. 抑郁障碍青少年自伤行为、自杀观念相关因素剖析[J]. 中国心理卫生杂志, 2005, 19(8): 536-538. doi: 10.3321/j.issn:1000-6729.2005.08.011TANG J H, WANG G H, WANG X P, et al. Related factor analysis of juvenile depression with self-mutilative behavior and suicide ideation[J]. Chinese Mental Health Journal, 2005, 19(8): 536-538. doi: 10.3321/j.issn:1000-6729.2005.08.011 [13] KAESS M, HILLE M, PARZER P, et al. Alterations in the neuroendocrinological stress response to acute psychosocial stress in adolescents engaging in nonsuicidal self-injury[J]. Psychoneuroendocrinology, 2012, 37(1): 157-161. doi: 10.1016/j.psyneuen.2011.05.009 [14] STANLEY B, SHER L, WILSON S, et al. Non-suicidal self-injurious behavior, endogenous opioids and monoamine neurotransmitters[J]. Journal of Affective Disorders, 2010, 124(1/2): 134-140. http://europepmc.org/articles/PMC2875354/ [15] 邱秀芳, 张卫, 姚杜鹃. 高校教师的心理健康、应对方式及其关系研究[J]. 华南师范大学学报(社会科学版), 2007(3): 123-129. doi: 10.3969/j.issn.1000-5455.2007.03.022QIU X F, ZHANG W, YAO D J. College teacher's mental health: coping strategy and their relationship[J]. Journal of South China Normal University(Social Science Edition), 2007(3): 123-129. doi: 10.3969/j.issn.1000-5455.2007.03.022 [16] COYNE J C, GOTLIB I H. The role of cognition in depression: a critical appraisal[J]. Psychological Bulletin, 1983, 94(3): 472-505. doi: 10.1037/0033-2909.94.3.472 [17] 苏斌原, 张卫, 周梦培, 等. 大学生自杀潜在风险的识别和预警: 基于应激-易感模型[J]. 华南师范大学学报(社会科学版), 2015(3): 78-84. https://www.cnki.com.cn/Article/CJFDTOTAL-HNSB201503011.htm [18] 苏斌原, 叶苑秀, 张卫, 等. 新冠肺炎疫情不同时间进程下民众的心理应激反应特征[J]. 华南师范大学学报(社会科学版), 2020(3): 79-94. https://www.cnki.com.cn/Article/CJFDTOTAL-HNSB202003009.htm [19] 马煊, 陈龙, 裴华, 等. 应对方式, 人格特征与应激水平的关系[J]. 中国临床心理学杂志, 2004, 12(1): 48-49, 55. doi: 10.3969/j.issn.1005-3611.2004.01.015MA X, CHEN L, PEI H, et al. A study on relationship among coping, personality, and stress[J]. Chinese Journal of Clinical Psychology, 2004, 12(1): 48-49, 55. doi: 10.3969/j.issn.1005-3611.2004.01.015 [20] 于丽霞, 江光荣, 吴才智. 自伤行为的心理学评估与治疗[J]. 中国心理卫生杂志, 2011, 25(12): 937-941. doi: 10.3969/j.issn.1000-6729.2011.12.012YU L X, JIANG G R, WU C Z, et al. Psychological assessment and treatment of self-injury[J]. Chinese Mental Health Journal, 2011, 25(12): 937-941. doi: 10.3969/j.issn.1000-6729.2011.12.012 [21] 傅燕艳, 况荣华, 唐寒梅, 等. 青少年应对方式与非自杀性自伤关系的研究进展[J]. 南昌大学学报(医学版), 2018, 58(6): 94-97. https://www.cnki.com.cn/Article/CJFDTOTAL-JXYB201806023.htmFU Y Y, KUANG R H, TANG H M, et al. Research progress in relationship between coping styles and non-suicidal self-injury in adolescents[J]. Journal of Nanchang University(Medical Sciences), 2018, 58(6): 94-97. https://www.cnki.com.cn/Article/CJFDTOTAL-JXYB201806023.htm [22] 马向真, 王章莹. 论情绪管理的概念界定[J]. 东南大学学报(哲学社会科学版), 2012, 14(4): 58-61, 127. doi: 10.3969/j.issn.1671-511X.2012.04.011MA X Z, WANG Z Y. The definition of emotion management[J]. Journal of Southeast University(Physiology and Social Science), 2012, 14(4): 58-61, 127. doi: 10.3969/j.issn.1671-511X.2012.04.011 [23] CHAPMAN A L, GRATZ K L, BROWN M Z. Solving the puzzle of deliberate self-harm: the experiential avoidance model[J]. Behaviour Research and Therapy, 2006, 44(3): 371-394. doi: 10.1016/j.brat.2005.03.005 [24] O'CONNOR R C, FRASER L, WHYTE M C, et al. A comparison of specific positive future expectancies and global hopelessness as predictors of suicidal ideation in a prospective study of repeat self-harmers[J]. Journal of Affective Disorders, 2008, 110(3): 207-214. doi: 10.1016/j.jad.2008.01.008 [25] SLEE N, GARNEFSKI N, SPINHOVEN P, et al. The influence of cognitive emotion regulation strategies and dpression severity on deliberate self-harm[J]. Suicide and Life-Threatening Behavior, 2008, 38(3): 274-286. doi: 10.1521/suli.2008.38.3.274 [26] HAYES A F. Introduction to mediation, moderation, and conditional process analysis: a regression-based approach[M]. New York: The Guilford Press, 2017. [27] HASKING P, WHITLOCK J, VOON D, et al. A cognitive-emotional model of NSSI: using emotion regulation and cognitive processes to explain why people self-injure[J]. Cognition and Emotion, 2016, 31(8): 1543-1556. [28] TATNELL R, HASKING P, LIPP O V, et al. Emotional responding in NSSI: examinations of appraisals of positive and negative emotional stimuli, with and without acute stress[J]. Cognition and Emotion, 2017, 32(6): 1304-1316. http://www.ncbi.nlm.nih.gov/pubmed/29202639 [29] 郑全全, 陈树林, 郑胜圣, 等. 中学生心理应激的初步研究[J]. 心理科学, 2001, 24(2): 212-213. doi: 10.3969/j.issn.1671-6981.2001.02.028 [30] GUNTHERT K C, COHEN L H, ARMELI S. The role of neuroticism in daily stress and coping[J]. Journal of Personality and Social Psychology, 1999, 77(5): 1087-1100. doi: 10.1037/0022-3514.77.5.1087 [31] ZOMER L. The relationships among emotional intelligence, gender, coping strategies, and well-being inthe management of stress in close interpersonal relationships and the workplace[D]. Toronto: University of Toronto, 2012. [32] 杜继淑, 王飞飞, 冯维. 大学生情绪管理能力与心理健康的关系研究[J]. 中国特殊教育, 2007(9): 75-80. https://www.cnki.com.cn/Article/CJFDTOTAL-ZDTJ200709018.htmDU J S, WANG F F, FENG W. Study of the relationship of college students' emotional management competence and psychological health[J]. Contemporary Youth Research, 2007(9): 75-80. https://www.cnki.com.cn/Article/CJFDTOTAL-ZDTJ200709018.htm [33] 南晓薇, 余毅震, 杨奕, 等. 中学生攻击性与移情情绪管理能力的关系[J]. 中国学校卫生, 2014, 35(3): 339-345. https://www.cnki.com.cn/Article/CJFDTOTAL-XIWS201403010.htmNAN X W, YU Y Z, YANG Y, et al. Aggression, empathy and emotional regulation among middle school students[J]. Chinese Journal of School Health, 2014, 35(3): 339-345. https://www.cnki.com.cn/Article/CJFDTOTAL-XIWS201403010.htm -