临床青少年述情障碍与自杀意念的横断面研究——心理理论的中介作用及童年创伤的影响

A Cross-Sectional Study on Alexithymia and Suicidal Ideation in Clinical Adolescents—The Mediating Role of Theory of Mind and the Influence of Childhood Trauma

摘要: 目的：探讨临床青少年精神心理障碍患者述情障碍与自杀意念的临床关联，分析心理理论的中介效应及童年创伤的影响，为青少年自杀风险临床筛查、评估与干预提供依据。方法：选取2023年9~2024年9月合肥市第四人民医院儿童青少年心理科141例12~18岁临床就诊精神心理障碍患者为研究对象，采用童年创伤问卷(CTQ)、多伦多述情障碍量表(TAS-26)、心理理论图片故事任务、贝克自杀意念量表(BSS)进行临床测评，运用SPSS 27.0及PROCESS宏进行相关性、中介及链式中介分析。结果：述情障碍与自杀意念的总关联无统计学意义，述情障碍与自杀意念的关联可由心理理论显著解释；童年创伤与自杀意念的间接关联可通过“述情障碍与心理理论的链式关联”加以解释；核心关联路径不受性别、抑郁及焦虑症状严重程度影响，疾病病程仅在简化模型中存在调节作用。结论：本横断面研究证实，心理理论在临床青少年精神心理障碍患者述情障碍与自杀意念间发挥中介作用，童年创伤与自杀意念之间的关联可能部分通过述情障碍及心理理论得到解释，研究结果可为青少年自杀风险早期识别与临床干预提供临床参考。

Abstract: Objective: To investigate the clinical association between alexithymia and suicidal ideation in clinical adolescent patients with mental and psychological disorders, analyze the mediating effect of theory of mind and the influence of childhood trauma, so as to provide a basis for clinical screening, evaluation and intervention of suicide risk in adolescents. Methods: A total of 141 clinical patients aged 12 to 18 years with mental and psychological disorders were recruited from the Department of Child and Adolescent Psychology, Hefei Fourth People’s Hospital from September 2023 to September 2024. Clinical assessments were performed using the Childhood Trauma Questionnaire (CTQ), 26-item Toronto Alexithymia Scale (TAS-26), Theory of Mind Picture Story Task and Beck Scale for Suicide Ideation (BSS). Correlation analysis, mediation and chained mediation analysis were performed using SPSS 27.0 and PROCESS macro. Results: The overall association between affective dysthymia and suicidal ideation is not statistically significant; the association between dysphoric disorder and suicidal ideation can be significantly explained by psychological theory; the indirect link between childhood trauma and suicidal ideation can be explained by the “chain link between dysphoric disorder and psychological theory”; the core association pathway was not affected by gender, severity of depression, or anxiety symptoms, and disease course only moderated in simplified models. Conclusion: This cross-sectional study confirms that theory of mind mediates the association between alexithymia and suicidal ideation in clinical adolescent patients with mental and psychological disorders. The link between childhood trauma and suicidal ideation may be partly explained by affective disorder and psychological theory. The results can provide clinical references for early identification and clinical intervention of suicide risk in adolescents.