【作者】 张凯；

【导师】 胡蕾；

【作者基本信息】 山东大学 ， 精神病与精神卫生学（专业学位）， 2022， 硕士

【摘要】 目的:本研究探索抑郁障碍患者的童年创伤、依恋关系与抑郁程度及躯体疼痛的关系,进一步通过调节效应检验分析依恋关系在童年创伤与躯体疼痛之间的调节作用。方法:选取成年抑郁障碍患者192例,入组后先由研究人员通过汉密尔顿抑郁量表(HRSD-17)进行抑郁严重程度的评估并完成人口统计学信息调查。符合入组标准后由患者完成童年创伤问卷(CTQ-SF),修订版成人依恋量表(RAAS),数字疼痛评分表(NRS)。选择SPSS 26.0为统计工具,对筛选后数据进行正态性检验,使用Mann-Whitney U检验比较两组非正态分布的连续型变量;呈正态分布的连续型变量采用独立样本t检验,而分类变量间的分布差异检验选用卡方检验。调节效应分析使用SPSS中PROCESS插件完成。结果:1.本研究192个样本中有57.30%的患者报告了疼痛症状。疼痛组患者的HRSD-17 得分明显高于无痛组(20.55±6.32 vs.17.31±6.32,P<0.001),双变量相关结果显示,疼痛评分与HRSD-17得分呈正相关(r=0.25,P<0.01)。2.有58.90%的患者经历了至少一种类型的童年创伤;疼痛组有68.20%的患者有至少一种童年创伤经历,频率显著高于无疼痛组(χ2=9.25,P＜0.001);疼痛组的童年创伤总分明显高于无疼痛组(46.77±14.01 vs.40.17±12.55,P＜0.001)。双变量相关显示,抑郁障碍患者的疼痛程度评分与童年创伤总分显著相关(r=0.25,P<0.01)。3.疼痛组的焦虑依恋维度得分显著高于无疼痛组的得分(Z=-2.62,P<0.01);亲近依恋维度得分显著低于无疼痛组(Z=-3.73,P<0.01);依赖依恋维度得分显著低于无疼痛组(t=2.45,P<0.01)。4.分别将三种依恋维度带入调节效应模型后,以焦虑依恋维度为调节变量时,调节变量与自变量的乘积项系数有统计学意义(b=-0.004,t=-2.37,P<0.01);进一步选择年龄,性别以及抑郁程度为控制变量,该模型的乘积项系数仍显著(b=-0.004,t=-2.55,P<0.05)。童年创伤对疼痛评分有显著的正向影响(b=0.03,t=2.55,P<0.01),而焦虑依恋减弱了童年创伤与躯体疼痛评分之间的关系。结论:1.躯体疼痛症状在抑郁障碍患者中是常见的,且疼痛症状与童年创伤经历、抑郁程度相关。2.抑郁障碍患者的童年创伤与躯体疼痛评分呈正相关关系,焦虑依恋调节了这种关系。3.对于有严重童年创伤经历的抑郁障碍患者,其一定程度的焦虑依恋与疼痛程度缓解有关。更多还原

【Abstract】 Objectives:This study explored the relationship between childhood trauma,attachment and depression level and somatic pain in patients with depressive disorders,further analyzed whether attachment plays a moderating role between childhood trauma and somatic pain through moderating effect test.Methods:A total of 192 adult patients with depression participated in this study;the level of depression was assessed by a psychiatric professional.Childhood trauma,pain symptoms,and attachment dimensions were tested by various questionnaires.The role of anxious attachment in the relationship between childhood trauma and pain symptoms was examined using the PROCESS Model 1 after controlling for the level of depression,age,and gender.Results:1.57.30%of the 192 patients in the sample of this study reported pain symptoms.Patients in the pain group had significantly higher HRSD-17 scores than the pain-free group(20.55±6.32 vs.17.31 ±6.32,P<0.001),and bivariate correlations showed a positive correlation between pain scores and HRSD-17 scores(r=0.25,P<0.01).2.Approximately 58.90%of the patients in the sample of this study experienced at least one type of childhood trauma;68.20%of the patients in the pain group experienced at least one type of childhood trauma,with a significantly higher frequency than the pain-free group(x2=9.25,P<0.001);the total childhood trauma score was significantly higher in the pain group than in the pain-free group(46.77±14.01 vs.40.17±12.55,P<0.001).Bivariate correlations showed that the total CTQ-SF score(r=0.25,P<0.01)were significantly associated with the level of pain ratings in depressed patients.3.The scores on the anxiety attachment dimension were significantly higher in the pain group than pain-free group(Z=-2.62,P<0.01);the scores on the close attachment dimension were significantly lower than pain-free group(Z=-3.73,P<0.01);and the scores on the dependency attachment dimension were significantly lower than pain-free group(t=2.45,P<0.01).4.Taking childhood trauma as the independent variable,pain ratings as the dependent variable,and anxiety attachment dimension as the moderating variable,the coefficient of the interaction term was significant(b=-0.004,t=-2.37,P<0.01);after controlling for depression level,age,and gender,the coefficient of the interaction term remained significant(b=-0.004,t=-2.55,P<0.05).Childhood trauma had a significant positive effect on pain ratings(b=0.03,t=2.55,P<0.01),while anxiety attachment attenuated the relationship between childhood trauma and somatic pain ratings.Conclusions:1.It is common for patients with depressive disorders to have somatic pain symptoms,and such pain symptoms were correlated with childhood traumatic experiences and depression levels.2.Childhood trauma showed a positive relationship with somatic pain ratings in depressed patients,which was attenuated by anxiety attachment as a moderating variable.3.For those depressed patients with severe childhood trauma experiences,a certain degree of anxiety attachment may alleviate pain levels.更多还原