辩证行为疗法治疗青少年抑郁症伴非自杀性 自伤行为的随机对照研究

Efficacy of Dialectical Behavior Therapy in Adolescents with Depression and Non-Suicidal Self-Injury: A Randomized Controlled Trial

摘要: 目的：探讨辩证行为疗法(DBT)联合常规草酸艾司西酞普兰片药物对青少年抑郁症伴非自杀性自伤行为(NSSI)的临床疗效。方法：选取2025年4月至2025年12月于重庆市长寿区精神卫生中心就诊的60例12~18岁青少年抑郁症伴NSSI患者，采用随机数字表法分为研究组和对照组，每组30例。对照组给予草酸艾司西酞普兰片药物治疗，研究组在对照组基础上联合DBT干预。于治疗前及治疗后2、4、8周采用汉密尔顿抑郁量表17项版本(HAMD-17)、汉密尔顿焦虑量表(HAMA)、渥太华自伤量表(OSI)评估临床症状；采用临床总体印象量表(CGI)评估疗效，副反应量表(TESS)及生化指标评估安全性。结果：治疗后两组HAMD-17、HAMA、OSI评分均较治疗前显著下降(P < 0.05)，研究组各量表评分下降幅度显著优于对照组(P < 0.05)；两组不良事件发生率差异无统计学意义(P > 0.05)。结论：在为期8周的观察中，DBT作为一种附加疗法联合草酸艾司西酞普兰，在改善青少年抑郁症伴NSSI患者的抑郁焦虑症状、减少自伤行为方面显示出优于单用药物的短期疗效，且安全性良好。

Abstract: Objective: To investigate the clinical efficacy of dialectical behavior therapy (DBT) combined with escitalopram oxalate in adolescents with depression and non-suicidal self-injury (NSSI). Methods: Total of 60 adolescent patients aged 12~18 years with depression and NSSI, treated at the Mental Health Center of Changshou District, Chongqing, from April 2025 to December 2025, were enrolled in this study. Patients were randomly divided into a study group and a control group using a random number table method, with 30 cases in each group. The control group received escitalopram oxalate, while the study group received DBT intervention in addition to the same pharmacological treatment. Clinical symptoms were assessed using the 17-item Hamilton Depression Rating Scale (HAMD-17), Hamilton Anxiety Rating Scale (HAMA), and Ottawa Self-Injury Inventory (OSI) before treatment and at 2, 4, and 8 weeks after treatment. Efficacy was evaluated using the Clinical Global Impression Scale (CGI), and safety was assessed using the Treatment Emergent Symptom Scale (TESS) and biochemical indicators. Results: After treatment, HAMD-17, HAMA, and OSI scores in both groups decreased significantly compared with baseline (P < 0.05). The reduction in scores in the study group was significantly greater than that in the control group (P < 0.05). There was no statistically significant difference in the incidence of adverse events between the two groups (P > 0.05). Conclusion: Within a 8-week observation period, DBT as an adjunctive therapy to escitalopram oxalate demonstrated superior short-term efficacy in improving depressive and anxiety symptoms and reducing NSSI behaviors in adolescents with depression and NSSI compared with medication alone, with a favorable safety profile. However, the long-term effects warrant further investigation through extended follow-up studies.