自动思维在抑郁症患者自我怜悯和心理痛苦间的中介作用

doi:10.3761/j.issn.0254-1769.2022.18.003

摘要/Abstract

摘要：

目的探讨抑郁症患者心理痛苦、自我怜悯和自动思维变量间的关联。方法采用便利抽样法,选取2020年10月—2021年11月南京市某三级甲等精神专科医院的263例住院抑郁症患者,以中文版Orbach & Mikulincer心理痛苦量表、中文版自我怜悯量表和自动思维问卷对患者进行调查。使用SPSS 25.0进行Pearson相关性分析和多元线性回归分析,选择SPSS宏程序PROCESS中的模型4进行中介效应分析。结果抑郁症患者的心理痛苦与自动思维呈显著正相关（P<0.001）,与自我怜悯呈显著负相关（P<0.001）。Bootstrap检验结果显示,自动思维在抑郁症患者自我怜悯和心理痛苦间的中介效应为-0.274（95%CI：-0.356~-0.203）,占总效应的59.6%。结论自动思维在自我怜悯和心理痛苦间起部分中介作用。护理人员应积极开展以影响心理痛苦路径为依据的干预策略,以达到降低抑郁症患者自杀、自伤发生率的目的。

关键词: 抑郁症, 心理痛苦, 自动思维, 自我怜悯, 中介效应, 精神障碍, 精神病护理学

Abstract:

Objective To explore the relationship between mental pain,self-compassion and automatic thoughts in depressed patients. Methods A total of 263 depressed inpatients were selected and tested by the Chinese version of the Orbach & Mikulincer Mental Pain Scale（OMMP）,Self-Compassion Scale-Chinese Version（SCS-C）,Automatic Thought Questionnaire（ATQ） between 2020 and 2021 from a tertiary psychiatric hospital through convenient sampling. SPSS 25.0 was employed for Pearson correlation analysis and multiple linear regression analysis,and we selected the Model 4 of SPSS PROCESS for mediating effect analysis. Results Mental pain was significantly positively correlated with automatic thoughts（P<0.001） and negatively associated with self-compassion（P<0.001）. The results of Bootstrap test showed that the mediating effect of automatic thoughts on the relationship between self-compassion and mental pain was -0.274（95%CI：-0.356~-0.203）,accounting for 59.6% of the total effect. Conclusion The automatic thoughts play a partial mediating role on the relationship between self-compassion and mental pain in depressed patients. Based on this path of mental pain,nurses should actively constitute intervention plans,in order to achieve the final goal of decreasing the incidence rate of suicide or self-injury in patients with depression.

Key words: Depression, Mental Pain, Automatic Thoughts, Self-Compassion, Mediating Effect, Mental Disorders, Psychiatric Nursing

成荫, 陈书燕, 赵威威, 卞诚, 严世锐, 张燕红. 自动思维在抑郁症患者自我怜悯和心理痛苦间的中介作用[J]. 中华护理杂志, 2022, 57(18): 2192-2197.

CHENG Yin, CHEN Shuyan, ZHAO Weiwei, BIAN Cheng, YAN Shirui, ZHANG Yanhong. Mediating effect of automatic thoughts on the relationship between self-compassion and mental pain in patients with depression[J]. Chinese Journal of Nursing, 2022, 57(18): 2192-2197.

图/表 4

表1 调查对象的一般资料（n=263）

Table 1 The sociodemographic characteristics of depressed patients（n=263）

表2 抑郁症患者心理痛苦影响因素的多元线性回归分析结果（n=263）

Table 2 The results of multiple linear regression analysis on the influencing factors of mental pain in depressed patients（n=263）

图1 自动思维的中介效应模型

Figure 1 Mediation model of automatic thoughts

表3 自动思维作为抑郁症患者自我怜悯影响心理痛苦中介变量的效应分析（n=263）

Table 3 Effect analysis of automatic thought as a mediator between mental pain and self-compassion in depressed patients（n=263）

参考文献 34

[1]	WHO. Depression[EB/OL]. (2021-09-13)[2022-02-16]. https://www.who.int/news-room/fact-sheets/detail/depression.
[2]	Huang YQ, Wang Y, Wang H, et al. Prevalence of mental disorders in China:a cross-sectional epidemiological study[J]. Lancet Psychiatry, 2019, 6(3):211-224. DOI URL
[3]	成荫, 张燕红. 抑郁症病人心理痛苦测评工具的研究进展[J]. 护理研究, 2021, 35(6):1021-1026.
	Cheng Y, Zhang YH. Research progress on psychological pain assessment tool for depressed patients[J]. Chin Nurs Res, 2021, 35(6):1021-1026.
[4]	Shneidman ES. Suicide as psychache[J]. J Nerv Ment Dis, 1993, 181(3):145-147. PMID
[5]	吴才智, 王婷, 于丽霞, 等. 抑郁与自杀未遂的关系:心理痛苦的中介作用和社会联结感的调节作用[J]. 中国临床心理学杂志, 2020, 28(4):679-682,787.
	Wu CZ, Wang T, Yu LX, et al. Relationship between depression and attempted suicide:the mediating effect of psychache and moderating effect of social connectedness[J]. Chin J Clin Psychol, 2020, 28(4):679-682,787.
[6]	Li HH, Xie WZ, Luo XW, et al. Clarifying the role of psychological pain in the risks of suicidal ideation and suicidal acts among patients with major depressive episodes[J]. Suicide Life Threat Behav, 2014, 44(1):78-88. DOI URL
[7]	戴维·伯恩斯著. 伯恩斯新情绪疗法:最新完整版[M]. 李亚萍,译. 北京: 科学技术文献出版社, 2014.
	Burns DD. Feeling good:the new mood therapy[M]. Li YP translated. Beijing: Scientific and Technical Documents Publishing House, 2014.
[8]	吴志霞. 负性自动思维的因素分析及其在应激中的作用[D]. 杭州: 浙江大学, 2006.
	Wu ZX. Study on negative automatic thoughts in multi-factor system of stress[D]. Hangzhou: Zhejiang University, 2006.
[9]	朱迪S,. 贝克. 认知疗法基础与应用[M]. 北京: 中国轻工业出版社, 2019.
	Beck JS. Cognitive behavior therapy:basics and beyond[M]. Beijing: China Light Industry Press, 2019.
[10]	Neff KD. Self-compassion:an alternative conceptualization of a healthy attitude toward oneself[J]. Self Identity, 2003, 2(2):85-101. DOI URL
[11]	王本红, 李晓驷, 谢雯, 等. 住院抑郁症患者自我怜悯水平与其共情能力的关系[J]. 安徽医科大学学报, 2018, 53(9):1453-1456.
	Wang BH, Li XS, Xie W, et al. The relationship between self-compassion and empathy in patients with depression[J]. Acta Univ Med Anhui, 2018, 53(9):1453-1456.
[12]	Tylka TL, Russell HL, Neal AA. Self-compassion as a moderator of thinness-related pressures’ associations with thin-ideal internalization and disordered eating[J]. Eat Behav, 2015, 17:23-26. DOI URL
[13]	Arimitsu K, Hofmann SG. Cognitions as mediators in the relationship between self-compassion and affect[J]. Pers Individ Dif, 2015, 74:41-48. DOI URL
[14]	Smith CA, Lazarus RS. Emotion and adaptation[J]. Contemp Sociol, 1990, 21 (4):609-637. DOI URL
[15]	李峥, 邹海欧, 王凌云, 等. 社区老年人认知功能和抑郁情绪的纵向研究[J]. 中华护理杂志, 2020, 55(9):1394-1398. DOI
	Li Z, Zou HO, Wang LY, et al. Cognitive function and depression in community-dwelling elderly:a longitudinal study[J]. Chin J Nurs, 2020, 55(9):1394-1398.
[16]	方积乾, 陆盈. 现代医学统计学[M]. 北京: 人民卫生出版社, 2002.
	Fang JQ, Lu Y. Advanced medical statistics[M]. Beijing: People’s Medical Publishing House, 2002.
[17]	Kazdin AE. Evaluation of the Automatic Thoughts Questionnaire:negative cognitive processes and depression among children[J]. Psychol Assess, 1990, 2(1):73-79. DOI URL
[18]	汪向东, 王希林, 马弘. 心理卫生评定量表手册[M]. 增订版. 北京: 中国心理卫生杂志社, 1999.
	Wang XD, Wang XL, Ma H. Rating scales for mental health[M]. Updated version. Beijing: China Mental Health Press, 1999.
[19]	余彩云, 陈世民, 夏雪梅. 高职生儿童期创伤与负性自动思维和情绪表达性的关系[J]. 中国心理卫生杂志, 2021, 35(11):929-934.
	Yu CY, Chen SM, Xia XM. Relationship among childhood maltreatment,negative automatic thoughts and emotional expressivity in vocational college students[J]. Chin Ment Heal J, 2021, 35(11):929-934.
[20]	Neff KD. The development and validation of a scale to measure self-compassion[J]. Self Identity, 2003, 2(3):223-250. DOI URL
[21]	陈健, 燕良轼, 周丽华. 中文版自悯量表的信效度研究[J]. 中国临床心理学杂志, 2011, 19(6):734-736.
	Chen J, Yan LS, Zhou LH. Reliability and validity of Chinese version of Self-compassion Scale[J]. Chin J Clin Psychol, 2011, 19(6):734-736.
[22]	李倩倩, 董毅, 张逸寅, 等. 自我怜悯在抑郁症患者述情障碍与抑郁症状间的中介作用[J]. 中华疾病控制杂志, 2020, 24(11):1308-1314.
	Li QQ, Dong Y, Zhang YY, et al. The mediating effect of self-compassion between alexithymia and depressive symptoms in depression patients[J]. Chin J Dis Control Prev, 2020, 24(11):1308-1314.
[23]	Orbach I, Mikulincer M, Sirota P, et al. Mental pain:a multidimensional operationalization and definition[J]. Suicide Life Threat Behav, 2003, 33(3):219-230. DOI URL
[24]	周浩, 龙立荣. 共同方法偏差的统计检验与控制方法[J]. 心理科学进展, 2004, 12(6):942-950.
	Zhou H, Long LR. Statistical remedies for common method biases[J]. Adv Psychol Sci, 2004, 12(6):942-950.
[25]	Bolin JH. Hayes,andrew F. (2013). introduction to mediation,moderation,and conditional process analysis:a regression-based approach. New York:the guilford press[J]. J Educ Meas,2014, 51(3):335-337. DOI URL
[26]	温忠麟, 叶宝娟. 有调节的中介模型检验方法:竞争还是替补?[J]. 心理学报, 2014, 46(5):714-726.
	Wen ZL, Ye BJ. Different methods for testing moderated mediation models:competitors or backups?[J]. Acta Psychol Sin, 2014, 46(5):714-726. DOI URL
[27]	Fredrickson BL. The role of positive emotions in positive psychology. The broaden-and-build theory of positive emotions[J]. Am Psychol, 2001, 56(3):218-226. DOI PMID
[28]	王慧, 马辉, 刁凯丽, 等. 临床治愈抑郁症患者症状自评在负性自动思维与心理社会功能间的中介作用[J]. 中华行为医学与脑科学杂志, 2018, 27(12):1091-1095.
	Wang H, Ma H, Diao KL, et al. Mediating effect of self-evaluation of depressive symptoms on automatic thoughts and psychosocial function of patients with depression in remission[J]. Chin J Behav Med Brain Sci, 2018, 27(12):1091-1095.
[29]	Disner SG, Beevers CG, Haigh EAP, et al. Neural mechanisms of the cognitive model of depression[J]. Nat Rev Neurosci, 2011, 12(8):467-477. DOI PMID
[30]	梁光利, 左晓伟, 王成东. 抑郁症患者认知障碍与心理痛苦状况及其相关性研究[J]. 精神医学杂志, 2015, 28(4):251-253.
	Liang GL, Zuo XW, Wang CD. A related study of cognitive disorder and psychological distress in patients with depression[J]. J Psychiatry, 2015, 28(4):251-253.
[31]	Zou YM, Li HH, Shi C, et al. Efficacy of psychological pain theory-based cognitive therapy in suicidal patients with major depressive disorder:a pilot study[J]. Psychiatry Res, 2017, 249:23-29. DOI URL
[32]	徐华, 张燕红, 王兆芹, 等. 日记式心理教育在1例反复多次住院精神分裂症患者中的应用[J]. 中华护理杂志, 2018, 53(3):379-382.
	Xu H, Zhang YH, Wang ZQ, et al. The application of diary psychological education in the management of one repeated hospitalized patient with schizophrenia[J]. Chin J Nurs, 2018, 53(3):379-382.
[33]	Beck AT, Rush AJ, Shaw BF, et al. Cognitive therapy of depression[M]. New York: Guilford Press,1979.
[34]	李璐璐, 李小妹, 韩冬芳, 等. 乳腺癌患者心理痛苦轨迹及影响因素的纵向研究[J]. 中华护理杂志, 2020, 55(8):1140-1146. DOI
	Li LL, Li XM, Han DF, et al. A longitudinal study of identification and predication of psychological distress trajectories among breast cancer patients[J]. Chin J Nurs, 2020, 55(8):1140-1146.