求助和幻想的应对方式可以减轻童年期虐待经历和负性生活事件对医学生抑郁症状的影响

童年期虐待经历、近期生活事件和应对方式对医学生抑郁症状的影响

作者：陈亚东，蒋志成，荣璠，金正格，李若瑜，李书琴，万宇辉

来源：卫生研究

DOI: 10.19813/j.cnki.weishengyanjiu.2024.05.005.

Abstract

Objective To analyze the influence of childhood abuse experience, recent life events and coping styles on depression symptoms of medical students based on the model of “vulnerability-stress-coping”.

Methods A longitudinal study design was adopted to select freshmen from Hefei and Anqing in Anhui province by cluster sampling. A total of 4211 questionnaires were collected at baseline from November to December 2019. Follow-up surveys were conducted in November to December 2020, and a total of 3662 medical students were finally included in this study. The childhood trauma questionnaire, adolescent self-rating life events checklist, coping style questionnaire and self-rating depression scale were used to evaluate childhood abuse experience, recent life events, coping styles and depression symptoms of medical students. The PROCESS software model 1 (double interaction analysis) and model 3 (triple interaction analysis) were used to investigate the independent and interactive effects of childhood abuse experience, recent life events, and different coping styles on depressive symptoms of medical students during follow-up.

Results Among the 3662 medical students, 976 were male and 2686 were female, with an average age of (19.2+1.0) years. Spearman correlation analysis showed that childhood abuse experience, recent life events, self-blame, fantasy, problem avoidance, and rationalization coping style were positively related to depressive symptoms (P<0.05). The coping style of problem solving and seeking help was negatively related to depressive symptoms (P<0.05). In model 1, both childhood abuse experience (β=0.097, 95%CI: 0.065~0.129) and recent life events (β=0.102, 95%CI: 0.073~0.132) had a positive predictive effect on depressive symptoms, and they also had positive interaction on depressive symptoms(β=0.030, 95%CI: 0.025~0.004). In model 3, there was a negative interaction between childhood abuse, recent life events and seeking help (β=-0.034, 95%CI: -0.061~-0.007) or fantasy (β=-0.039, 95%CI: -0.065~-0.013) coping styles on depressive symptoms.Conclusions Childhood abuse experience and recent life events are the predisposition factors for depressive symptoms of medical students, and they can mutually promote depression, while seeking help and fantasy coping styles could weaken the promoting effects of both.

Keywords Childhood abuse; Life events; Coping style; Depression symptoms; Medical students

摘要

目的 基于“易感—应激—应对”模型，分析童年期虐待经历、近期生活事件和应对方式对医学生抑郁症状的影响机制。

方法 采用纵向研究设计，采用整群抽样方式于2019年11-12月选取安徽省合肥市、安庆市4211名大一新生开展基线调查，在2020年11-12月开展随访调查，最终有3662名医学生同时完成基线和随访调查。采用儿童期虐待问卷、青少年负性生活事件量表、应对方式问卷和抑郁自评量表分别评价童年期虐待经历、近期生活事件、应对方式以及医学生抑郁症状。应用PROCESS软件模型1（双重交互作用分析）和模型3（三重交互作用分析）探讨童年期虐待经历、近期生活事件、不同应对方式对医学生随访抑郁症状的独立和交互作用。

结果 3662名医学生中男生976名，女生2686名，平均年龄（19.2+1.0）岁。童年期虐待经历、近期生活事件和自责、幻想、退避、合理化的应对方式与基线和随访抑郁症状均存在正向关联（P<0.05），而解决问题、求助的应对方式与基线和随访抑郁症均状存在负向关联（P<0.05）。模型1中童年期虐待经历（β=0.097, 95%CI: 0.065~0.129）和近期生活事件（β=0.102, 95%CI: 0.073~0.132）均对抑郁症状有正向的预测作用，二者的交互项（β=0.030, 95%CI: 0.025~0.004）也与抑郁症状有正向关联。模型3中童年期虐待经历、近期生活事件和求助（β=-0.034, 95%CI: -0.061~-0.007）或幻想（β=-0.039, 95%CI: -0.065~-0.013）的应对方式三者对抑郁症状存在负向交互作用。

结论 童年期虐待经历，近期生活事件是医学生抑郁症状的易感性因素，同时二者可以相互促进作用于抑郁症状，而求助和幻想的应对方式能够弱化二者的促进作用。

关键词 童年期虐待；生活事件；应对方式；抑郁症状；医学生