伴非自杀性自伤行为心境障碍青少年患者心理体验的质性研究

doi:10.3761/j.issn.0254-1769.2022.07.010

摘要/Abstract

摘要：

目的探讨心境障碍青少年患者在实施非自杀性自伤行为时的心理体验和内心感受,旨在为临床护理人员开展针对性的心理干预提供参考。方法采用目的抽样法,于2021年5月—7月对河南省某三级甲等精神病医院收治的11例康复期伴非自杀性自伤行为的心境障碍青少年患者进行半结构式深度访谈,采用Colaizzi 7步分析法分析、归纳、提炼资料。结果伴非自杀性自伤行为心境障碍青少年患者的心理体验和感受可归纳为4个主题：①非自杀性自伤前存在负性情绪,渴望得到理解与支持;②非自杀性自伤后出现获益感,希望得到关注与爱护;③父母及家庭给予的压力较大,得到的心理支持不足;④缺乏负性情绪的应对策略,渴望专业人员的帮助。结论临床护理人员应密切关注伴非自杀性自伤行为心境障碍青少年患者的情绪变化,做好心理的动态评估,构建以患者为中心的家庭干预系统,重视培养患者积极的应对策略,减少非自杀性自伤行为的发生,促进其身心健康。

关键词: 非自杀性自伤, 青少年, 心境障碍, 心理体验, 质性研究, 护理

Abstract:

Objective To explore the psychological experience of adolescents with mood disorder committing non-suicidal self-injury,so as to provide references for clinical nurses to carry out relevant preventive interventions. Methods Phenomenology in qualitative research was adopted,and 11 convalescent adolescents with mood disorder committing non-suicidal self-injury admitted to a tertiary psychiatric hospital in Henan Province from May to July 2021 were interviewed by semi-structured interviews,and the data was analyzed by Colaizzi seven-step method. Results 4 themes were extracted. Theme 1：negative emotions and psychological pain before non-suicidal self-injury,and they longed for understanding and support. Theme 2：after non-suicidal self-injury,they had a sense of benefit and hoped for attention and love. Theme 3：parents and family give them much pressure,and they get insufficient psychological support. Theme 4：they lack coping strategies for negative emotions and long for professional help. Conclusion Clinical nurses should pay close attention to the emotional changes of adolescents with mood disorder accompanied by non-suicidal self-injury,do well in psychological dynamic assessment,build a patient-centered family intervention system,attach importance to cultivating patients’ positive coping strategies,reduce the occurrence of non-suicidal self-injury and promote their psychosomatic health.

Key words: Non-Suicidal Self-Injury, Adolescents, Mood Disorder, Psychological Experience, Qualitative Research, Nursing Care

尚超娜, 王剑英, 宋涛, 张俊蕾, 张冬红. 伴非自杀性自伤行为心境障碍青少年患者心理体验的质性研究[J]. 中华护理杂志, 2022, 57(7): 827-833.

SHANG Chaona, WANG Jianying, SONG Tao, ZHANG Junlei, ZHANG Donghong. The psychological experience of adolescent patients with mood disorder accompanied by non-suicidal self-injury：a qualitative study[J]. Chinese Journal of Nursing, 2022, 57(7): 827-833.

图/表 1

参考文献 29

[1]	Brown RC, Plener PL. Non-suicidal self-injury in adolescence[J]. Curr Psychiatry Rep, 2017, 19(3):20. DOI URL
[2]	Halicka J, Kiejna A. Non-suicidal self-injury(NSSI) and suicidal:criteria differentiation[J]. Adv Clin Exp Med, 2018, 27(2):257-261. DOI PMID
[3]	李雅兰, 冉柳毅, 艾明, 等. 青少年抑郁症患者非自杀性自伤的系统性评价[J]. 中华行为医学与脑科学杂志, 2020, 29(6):567-571.
	Li YL, Ran LY, Ai M, et al. Systematic evaluation of non-suicidal self-injury in adolescent depressive patients[J]. Chin J Be-hav Med Brain Sci, 2020, 29(6):567-571.
[4]	Weintraub MJ, Van de Loo MM, Gitlin MJ, et al. Self-harm,affective traits,and psychosocial functioning in adults with depressive and bipolar disorders[J]. J Nerv Ment Dis, 2017, 205(11):896-899. DOI PMID
[5]	崔莹莹, 黄园园, 谌丁艳, 等. 深圳市中学生非自杀性自伤行为现状及影响因素调查[J]. 华南预防医学, 2018, 44(5):416-420.
	Cui YY, Huang YY, Chen DY, et al. Status and influencing factors of non-suicidal self-injury behaviors of middle school students in Shenzhen[J]. South China J Prev Med, 2018, 44(5):416-420.
[6]	张培, 梁旻璐, 王纯, 等. 心境障碍科青年人群住院患者非自杀性自伤行为的回顾性分析[J]. 临床精神医学杂志, 2021, 31(2):101-104.
	Zhang P, Liang ML, Wang C, et al. Retrospective analysis of the non-suicidal self-injury of the young hospitalized patients in the department of mood disorders[J]. J Clin Psychiatry, 2021, 31(2):101-104.
[7]	American Psychiatric Association. Diagnostic and statistical ma-nual of mental disorders(DSM-IV-TR)[M]. 5th ed. Arlington,VA:American Psychiatric Association, 2000.
[8]	世界卫生组织. ICD-10精神与行为障碍分类:临床描述与诊断要点[M]. 北京: 人民卫生出版社, 1993.
	World Health Organization. ICD-10 classification of mental and behavioral disorders:clinical description and key points of diagnosis[M]. Beijing: People’s Medical Publishing House, 1993.
[9]	苏林雁. 儿童精神医学[M]. 长沙: 湖南科学技术出版社, 2014: 52.
	Su LY. Child psychiatry[M]. Changsha: Hunan Science & Technology Press, 2014: 52.
[10]	Bagby RM, Ryder AG, Schuller DR, et al. The Hamilton Depression Rating Scale:has the gold standard become a lead weight?[J]. Am J Psychiatry, 2004, 161(12):2163-2177. DOI URL
[11]	Hamilton M. The assessment of anxiety states by rating[J]. Br J Med Psychol, 1959, 32(1):50-55. DOI URL
[12]	季梦婷, 杨艳. 描述性质性研究方法学的综述[J]. 解放军护理杂志, 2018, 35(11):32-35.
	Ji MT, Yang Y. A review of descriptive research methodology[J]. Nurs J Chin PLA, 2018, 35(11):32-35.
[13]	Englander M. The phenomenological method in qualitative psychology and psychiatry[J]. Int J Qual Stud Health Well-Being, 2016, 11:30682. DOI URL
[14]	叶铭惠, 胡颖颖, 何春雷, 等. 青少年服毒自杀患者心理体验的质性研究[J]. 中华护理杂志, 2021, 56(2):250-254.
	Ye MH, Hu YY, He CL, et al. The psychological experience of juvenile poisoning suicide patients:a qualitative study[J]. Chin J Nurs, 2021, 56(2):250-254.
[15]	Ferrey AE, Hughes ND, Simkin S, et al. The impact of self-harm by young people on parents and families:a qualitative study[J]. BMJ Open, 2016, 6(1):e009631. DOI URL
[16]	Morris C, Simpson J, Sampson M, et al. Cultivating positive emotions:a useful adjunct when working with people who self-harm?[J]. Clin Psychol Psychother, 2014, 21(4):352-362. DOI URL
[17]	王玉龙, 袁燕, 张家鑫. 消极情绪与留守青少年自伤:家庭功能与情绪表达的调节作用[J]. 中国临床心理学杂志, 2017, 25(1):75-78,81.
	Wang YL, Yuan Y, Zhang JX. Negative emotion and self-injury in left-behind adolescents:moderating effect of family functioning and emotion expression[J]. Chin J Clin Psychol, 2017, 25(1):75-78,81.
[18]	Langille DB, Asbridge M, Cragg A, et al. Associations of school connectedness with adolescent suicidality:gender differences and the role of risk of depression[J]. Can J Psychiatry, 2015, 60(6):258-267. DOI URL
[19]	Liu RT, Cheek SM, Nestor BA. Non-suicidal self-injury and life stress:a systematic meta-analysis and theoretical elaboration[J]. Clin Psychol Rev, 2016, 47:1-14. DOI URL
[20]	梁楷利, 胡蜀萍, 李玉星, 等. 中小学生非自杀性自伤行为家庭环境因素分析[J]. 现代预防医学, 2021, 48(2):304-307.
	Liang KL, Hu SP, Li YX, et al. Family environment factors of non-suicidal self-injury behaviors among primary and middle school students[J]. Mod Prev Med, 2021, 48(2):304-307.
[21]	Vanderminden J, Hamby S, David-Ferdon C, et al. Rates of neglect in a national sample:child and family characteristics and psychological impact[J]. Child Abuse Negl, 2019, 88:256-265. DOI URL
[22]	Bai S, Repetti RL. Short-term resilience processes in the family[J]. Fam Relat, 2015, 64(1):108-119. DOI URL
[23]	Emery AA, Heath NL, Rogers M. Parents’ role in early adolescent self-injury:an application of self-determination theory[J]. Sch Psychol Q, 2017, 32(2):199-211. DOI PMID
[24]	Fu X, Yang JX, Liao XL, et al. Parents’ attitudes toward and experience of non-suicidal self-injury in adolescents:a qualitative study[J]. Front Psychiatry, 2020, 11:651.
[25]	蔡立柏, 刘延锦, 孙箫音, 等. 青少年癫痫患者疾病感受和体验的质性研究[J]. 中华护理杂志, 2021, 56(1):86-91.
	Cai LB, Liu YJ, Sun XY, et al. A qualitative research on perceptions and experience of adolescents with epilepsy[J]. Chin J Nurs, 2021, 56(1):86-91.
[26]	尚正君, 严波, 李岳朋, 等. 自伤自杀预防控制技能在抑郁症患者中的应用效果[J]. 中国健康心理学杂志, 2020, 28(2):165-168.
	Shang ZJ, Yan B, Li YP, et al. Effect of skills of suicide prevention and control on patients with depression[J]. China J Heal Psychol, 2020, 28(2):165-168.
[27]	Brereton A, McGlinchey E. Self-harm,emotion regulation,and experiential avoidance:a systematic review[J]. Arch Suicide Res, 2020, 24(sup1):1-24.
[28]	Taylor PJ, Jomar K, Dhingra K, et al. A meta-analysis of the prevalence of different functions of non-suicidal self-injury[J]. J Affect Disord, 2018, 227:759-769. DOI URL
[29]	韩阿珠, 徐耿, 苏普玉. 中国大陆中学生非自杀性自伤流行特征的Meta分析[J]. 中国学校卫生, 2017, 38(11):1665-1670.
	Han AZ, Xu G, Su PY. A Meta-analysis of characteristics of non-suicidal self-injury among middle school students in mainland China[J]. Chin J Sch Heal, 2017, 38(11):1665-1670.