青少年强迫障碍发病相关因素的病例对照研究

A Case-Control Study on Factors Related to the Onset of Obsessive-Compulsive Disorder in Adolescents

摘要: 目的：探讨青少年强迫障碍(OCD)发病的相关因素，重点分析家庭环境、父母教养方式、负性生活事件、认知信念及情绪特质对青少年OCD的影响，并检验认知和情绪特质在家庭、生活事件因素与OCD之间的中介作用。方法：采用病例对照研究设计，选取2023年1月至2025年12月西南康复医院收治的青少年OCD患者110例作为病例组，同期选取年龄、性别匹配的社区健康青少年110例作为对照组。采用耶鲁–布朗强迫量表(Y-BOCS)、家庭环境量表(FES-CV)、父母教养方式量表(EMBU)、青少年生活事件量表(ASLEC)、强迫信念问卷(OBQ-44)和状态–特质焦虑问卷(STAI)进行评估。比较两组在各量表上的差异，并行Pearson相关分析和中介效应检验。在核心中介模型基础上，补充对各家庭相关变量分别建模的敏感性分析，并将家庭经济状况纳入协变量进行控制。结果：病例组Y-BOCS总分为(24.63 ± 6.82)分。病例组在FES-CV、EMBU、OBQ-44、STAI各维度上的差异模式与前文一致。病例组ASLEC总分及人际关系、学习压力、受惩罚、健康适应、其他事件各因子评分均显著高于对照组(P < 0.01)，负性生活事件总频次和主观应激强度也高于对照组(P < 0.01)。相关分析显示，负性生活事件、家庭因素、认知信念、特质焦虑与强迫症状两两相关。中介效应分析表明，强迫信念在家庭因素与强迫症状之间起完全中介作用，生活事件通过强迫信念和特质焦虑的双重中介路径影响OCD症状。对各家庭相关变量分别建模的敏感性分析显示，亲密度、矛盾性、情感表达、母亲拒绝否认及母亲情感温暖均呈现显著的间接效应模式，与合成指数结果一致；在控制家庭经济状况后，核心中介效应依然显著。结论：不良家庭环境、负性生活事件与不当父母教养方式是青少年OCD的重要远端风险因素，其影响通过强迫信念这一认知特质得以传递。研究结果支持对青少年OCD开展以家庭为基础、聚焦认知信念和应激管理的综合干预策略。

Abstract: Objective: To investigate the related factors of adolescent obsessive-compulsive disorder (OCD), focusing on the effects of family environment, parenting styles, negative life events, cognitive beliefs, and emotional traits, and to test the mediating role of cognitive and emotional traits in the relationship between family factors, life events and OCD. Methods: A case-control study was conducted with 110 adolescent OCD patients recruited from Southwest Rehabilitation Hospital (January 2023 to December 2025) as the case group, and 110 age- and gender-matched healthy adolescents from the community as the control group. All participants were assessed using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Family Environment Scale (FES-CV), Egna Minnen av Barndoms Uppfostran (EMBU), Adolescent Self-Rating Life Events Checklist (ASLEC), Obsessive Beliefs Questionnaire (OBQ-44), and State-Trait Anxiety Inventory (STAI). Differences between the two groups were compared, and Pearson correlation analysis and mediation effect testing were conducted. Sensitivity analyses were performed by modeling each family-related variable separately and by including family economic status as a covariate. Results: The Y-BOCS total score in the case group was 24.63 ± 6.82. The pattern of differences between the case group and the control group across all dimensions of the FES-CV, EMBU, OBQ-44, and STAI was consistent with the findings described above. The case group showed significantly higher ASLEC total scores and factor scores across interpersonal relationships, academic pressure, punishment, health adaptation, and other events (P < 0.01), with more frequent negative life events and greater subjective stress impact (P < 0.01). Correlation analysis revealed significant intercorrelations among life events, family factors, obsessive beliefs, trait anxiety, and OCD symptoms. Mediation analysis demonstrated that obsessive beliefs fully mediated the relationship between family factors and OCD symptoms, while life events influenced OCD symptoms through a dual mediation pathway involving both obsessive beliefs and trait anxiety. Sensitivity analyses confirmed that the indirect effects remained significant when each family variable was modeled separately, and the core mediation effects remained robust after controlling for family economic status. Conclusion: Dysfunctional family environment, negative parenting styles, and negative life events serve as important distal risk factors for adolescent OCD, and their effects are transmitted through obsessive beliefs as a cognitive trait. The findings support family-based intervention strategies targeting both obsessive beliefs and stress management in adolescents with OCD.