The Influence Of Interpersonal Relationship And Sleep Disturbance On Non-suicidal Self Injury In Adolescents With Depressive Disorder

Objective: To explore the effects of interpersonal relationships and sleep disturbances on non-suicidal self-injury（NSSI）in adolescent patients with first-onset depression.Methods: 84 adolescent depression patients were included.The existence of NSSI was evaluated by Adolescent Self-injury Questionnaire.The patients were divided into NSSI group（n = 45）and non NSSI group（n = 39）.All subjects used the Hamilton Depression scale-17（HAMD-17）and Hamilton Anxiety Scale（HAMA）to evaluate depression and anxiety symptoms.The interpersonal relationship of the sample was evaluated by the parent-child intimacy scale,peer relationship scale,and teacher-student relationship scale.Insomnia severity index（ISI）and nightmare experience questionnaire were used to evaluate the sleep status of the samples,and the results were compared between the groups.Binary logistic regression was used to analyze the independent risk factors of interpersonal relationships and sleep in NSSI.Pearson correlation analysis was used to analyze the relationship between NSSI and interpersonal relationships and sleep.The bootstrap method was used to verify the mediating role of emotion regulation ability between sleep and NSSI behavior in the NSSI group.Results: Among the 84 patients,45（53.6%）had NSSI behavior.Compared with the non-NSSI group,the NSSI group was lower than the non-NSSI group in father intimacy,mother intimacy,parent-child intimacy,peer acceptance,the total score of peer relationship,teacher-student relationship（intimacy）,teacher-student relationship（support）,and teacher-student relationship（satisfaction）;It was significantly higher than that without NSSI in terms of peer terror,inferiority complex,teacher-student relationship（conflict）,ISI（insomnia severity index）,nightmare experience and DERS（emotional regulation difficulty）（P < 0.05）.Logistic regression analysis showed that father intimacy（P = 0.007,or = 1.438,95% CI 1.10 ～ 1.87）,peer acceptance（P =0.008,or = 1.28,95% CI 1.07 ～ 1.53）,peer terror inferiority complex（P = 0.045,or =0.801,95% CI 0.65 ～ 1.00）and nightmare experience（P = 0.004,or = 0.93,95% CI:0.89 ～ 0.98）were independent risk factors of NSSI.Pearson correlation analysis showed that the NSSI score was negatively correlated with teacher-student relationship satisfaction,father intimacy,and mother intimacy;the HAMD score was positively correlated with teacher-student relationship（conflict）and peer terror inferiority complex,and negatively correlated with father intimacy;NSSI score was positively correlated with HAMA score;There is a significant positive correlation between NSSI,ISI,nightmare,HAMD,and HAMA.In addition,DERS（difficulty in emotion regulation）was positively correlated with each variable examined.Bootstrapping test of the significance of the mediating effect shows that the ratio of the mediating effect to the total effect is 31.84%Conclusion:（1）the incidence of NSSI in adolescent patients with depression is high,and the most commonly used way of self-injury is "deliberately scratching their skin with glass,knife,etc.".（2）NSSI in adolescent patients with depression is related to parent-child intimacy,peer relationship,teacher-student relationship,emotional regulation ability,insomnia symptoms,and nightmare experience.Father intimacy,peer acceptance,peer phobic inferiority complex,and nightmare experience are independent risk factors of NSSI.（3）Emotion regulation difficulty plays a mediating role between nightmare experience and NSSI behavior,and the mediating effect accounts for 31.84% of the total effect.（4）Sleep disorders affect the physiology,emotion,cognition,and behavior of NSSI adolescents.