The Predictive Role Of Childhood Trauma And Peer Rejection On Non-suicidal Self-injurious In Adolescents With Depressive Disorder

ObjectivesTo analyse the relationship between general demographic data,depression level,childhood trauma,peer rejection and non-suicidal self-injurious(NSSI)behavior in adolescents with depressive disorders,identify independent risk factors for NSSI in adolescents with depressive disorders,constructe a predictive model for NSSI risk in adolescents with depressive disorders,and evaluate the model to determine whether the adolescent life environment based on childhood trauma and peer rejection have predictive value for NSSI behavior in adolescents with depressive disorders.MethodsFrom November 2020 to August 2022,convenience sampling was used to collect the relevant information of adolescent patients with depressive disorder who were outpatients and inpatients in Shandong Mental Health Center.A total of 302 adolescent depressive disorder patients with NSSI(the NSSI group)and 208 adolescent depressive disorder patients without NSSI(the non-NSSI group)were enrolled as the test data set(the test group),and the relevant data were used to construct the risk prediction model.A total of 97 adolescents with depressive disorder with NSSI and 103 adolescents with depressive disorder without NSSI were included as the validation dataset,and the relevant data were used for the validation of the model.The scores of Pediatric Depression Inventory(CDI),Childhood Trauma Questionnaire(CTQ)and Social Peer Exclusion Scale(SPR)were compared between the two groups.In the test group,binary Logistic regression analysis was performed with whether the patient had NSSI as the dependent variable and alternative predictors as the independent variable to screen out the independent influencing factors of NSSI behavior in adolescent patients with depression,and a prediction model was constructed according to the regression probability value.Based on the model of the test group,the regression equation was used to calculate the prediction probability value P of each subject’s NSSI behavior in the validation group.The prediction effect in the validation group was combined with the actual NSSI behavior of the subjects,and the test effect of the prediction model was evaluated by ROC curve.Results(1)The detection rate of NSSI behaviors in adolescent patients with depressive disorder in the test group was 59.2%,and the incidence of NSSI behaviors in subjects with positive family history was higher than that in subjects with negative family history,and the incidence of NSSI behaviors in subjects with normal parental marital status was lower,the differences were statistically significant(P<0.05).(2)The children’s Depression Scale score,Childhood Trauma Scale score and Peer Rejection scale score of the two groups in the test group were compared and analyzed.The total score and factor score of Childhood Depression Scale,Childhood Trauma Scale,Peer Rejection Scale of adolescent depressive disorder with NSSI were significantly higher than those of adolescent depressive disorder without NSSI(t=12.54,9.85,8.25,all P<0.001).The homogeneity test of the general demographic data and scale scores of the test group and the validation group showed that there was no significant difference between the two groups except for neglect in peer exclusion,indicating that the two groups had good homogeneity and comparability.The data of the validation group could be used to verify the model.(3)The results of binary logistic regression analysis showed that the negative self-esteem factor in CDI(OR=1.59,P<0.001),the emotional neglect factor in CTQ(OR=1.08,P=0.013),and the insult factor in SPR(OR=1.09,P=0.031)were independent risk factors for the implementation of NSSI behaviors in adolescents with depressive disorders.(4)In the test group,the area under the ROC curve was 0.84(95%CI=0.81 to 0.88,P<0.001),indicating that the prediction model could better distinguish patients with NSSI from those without,and the prediction model was good.The validation of the model was performed in the validation group,and the area under the ROC curve was 0.86(95%CI=0.80～0.91,P<0.001),and the model had a significant predictive effect.ConclusionsNegative self-esteem,childhood emotional neglect,and stigmatization by peers are risk factors for the implementation of NSSI behaviors in adolescents with depressive disorders,and the adolescent life environment formed based on childhood trauma and peer rejection experiences is of great value in predicting NSSI behaviors in adolescents with depressive disorders.