成人抑郁障碍患者童年虐待与频繁噩梦的关系:躯体症状的中介效应与社会支持的调节作用

Relationship between childhood abuse and frequent nightmares in adults with depressive disorders: mediating effect of somatic symptoms and moderating role of social support

摘要

目的 探讨成人抑郁障碍患者童年虐待、躯体症状与频繁噩梦的关系,分析社会支持的调节作用及关键混杂因素的影响。 方法 采用方便抽样法选取成人抑郁障碍患者264例,采用儿童期虐待问卷(childhood trauma questionnaire-short form, CTQ-SF)、健康问卷躯体症状群量表(patient health questionnaire-15, PHQ-15)和社会支持评定量表(social support revalued scale, SSRS)等工具进行评估,采用SPSS 27.0 Process插件进行调节中介模型分析。 结果 相关性分析显示,噩梦频率与躯体症状(P<0.001)、童年虐待(P<0.01)呈正相关,社会支持与躯体症状(P<0.05)、童年虐待(P<0.001)呈负相关。躯体症状在童年虐待与噩梦间起完全中介作用( β=0.008 1, 95%CI:-0.004 8~0.021 0),社会支持显著强化中介路径前半段( β=0.010 4,P=0.010),高社会支持水平下(P<0.001)童年虐待对躯体症状效应较中低社会支持水平(P=0.019)提升。引入性别、药物使用等协变量后,社会支持的调节效应减弱(P=0.041)。女性、使用镇静催眠药物和吸烟独立预测躯体症状或噩梦频率。 结论 躯体症状是童年虐待影响噩梦频率的完全中介变量,社会支持对该路径具有调节作用,但受性别、药物等混杂因素干扰。临床干预需关注社会支持水平较高的患者群体,针对性缓解其躯体症状。

Abstract

Objective To investigate the associations among childhood maltreatment, somatic symptoms, and frequent nightmares in adults with depressive disorder, and to examine the moderating role of social support and the influence of key confounding factors. Methods A convenience sample of 264 adult patients diagnosed with depressive disorder was recruited. Participants completed the childhood trauma questionnaire-short form(CTQ-SF), the patient health questionnaire-15(PHQ-15), and the social support rating scale(SSRS). A moderated mediation model was tested using the SPSS 27.0 Process macro. Results Correlation analysis showed that nightmare frequency was positively correlated with somatic symptoms(P<0.001)and childhood maltreatment(P<0.01), whereas social support was negatively correlated with both somatic symptoms(P<0.05)and childhood maltreatment(P<0.001). Somatic symptoms fully mediated the association between childhood maltreatment and nightmare frequency( β=0.008 1, 95%CI: -0.004 8-0.021 0). Social support significantly strengthened the first half of the mediation pathway( β=0.010 4, P=0.010), with the effect of childhood maltreatment on somatic symptoms being greater at high levels of social support compared to medium-low levels. After adjusting for covariates-including sex, psychotropic medication use, and smoking-the moderating effect was attenuated to marginal significance(P=0.041). Female sex, use of sedative-hypnotic medications, and smoking may independently predict either somatic symptoms or nightmare frequency. Conclusion Somatic symptoms fully mediate the relationship between childhood maltreatment and nightmare frequency in adults with depressive disorder. Social support moderates this pathway, although this effect is partially confounded by factors such as sex and medication use. Clinical interventions should particularly target patients with high levels of social support to alleviate somatic symptoms.

关键词

抑郁障碍 / 童年虐待 / 社会支持 / 躯体症状 / 噩梦频率 / 有调节的中介模型

Key words

Depressive disorder / Childhood maltreatment / Social support / Somatic symptoms / Nightmare frequency / Moderated mediation model

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