Adak Ibrahim, Karakuş Oğuz Bilal, Ekinci Özalp, Alomari Omar, Çalışkan Alper, Bağçeli Elif Burcu, Gamlı İpek Süzer
Department of Child and Adolescent Psychiatry, University of Health Sciences Erenköy Mental Health and Neurological Diseases Training and Research Hospital, Istanbul, Turkey.
Department of Child and Adolescent Psychiatry, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey.
Clin Psychol Psychother. 2025 May-Jun;32(3):e70094. doi: 10.1002/cpp.70094.
Depression is a significant health issue among adolescents, often associated with decreased academic performance, self-harm and increased suicide attempts. Suicidal and self-harm behaviours are particularly concerning and are influenced by multiple factors beyond depression. This study aims to examine the factors contributing to suicidal behaviour and nonsuicidal self-harm in adolescents diagnosed with major depressive disorder (MDD).
This prospective study included adolescent patients aged 12-18 years diagnosed with MDD according to DSM-5 criteria, referred to our Child and Adolescent Psychiatry Clinic between 1 February 2023 and 1 August 2023. Participants with intellectual disability, autism spectrum disorder, schizophrenia or other psychotic disorders were excluded. Data collection tools included the Sociodemographic Data Form, Inventory of Statements About Self-Injury, Child Depression Inventory, Borderline Personality Inventory (BPI), Toronto Alexithymia Scale and Child and Youth Resilience Measure-12 (CYRM-12). Data were analysed using SPSS25.0.
Out of the 185 participants initially screened, 153 completed the study and were evenly divided into three groups: those who had never engaged in self-harm or attempted suicide (n = 51), those who had engaged in self-harm at least once but had not attempted suicide (n = 51) and those who had both engaged in self-harm and attempted suicide (n = 51). There were no significant differences in sociodemographic variables among the groups. Cutting was identified as the most common method of self-harm (84.3%), followed by scratching (72.5%). In terms of resilience, measured by the CYRM-12, the group with no history of self-harm or suicide attempts had significantly higher scores (M = 36.55) than the self-harm only group (M = 32.83) and the self-harm plus suicide attempt group (M = 31.03) (p < 0.001). For the BPI, the highest scores were observed in the group that had both engaged in self-harm and attempted suicide (M = 29.28), followed by the self-harm only group (M = 24.91) and the no self-harm or suicide group (M = 19.26) (p < 0.001).
Adolescents with MDD who exhibit suicidal or self-harm behaviours have higher borderline personality traits and alexithymia levels, and lower resilience compared to their counterparts without such behaviours. These findings suggest the importance of early identification and intervention targeting these factors to mitigate the risk of self-harm and suicidal behaviour in depressed adolescents.
抑郁症是青少年中的一个重要健康问题，常与学业成绩下降、自我伤害和自杀企图增加有关。自杀和自我伤害行为尤其令人担忧，且受到抑郁症以外的多种因素影响。本研究旨在探讨诊断为重度抑郁症（MDD）的青少年自杀行为和非自杀性自我伤害的影响因素。
这项前瞻性研究纳入了年龄在12至18岁之间、根据DSM-5标准诊断为MDD的青少年患者，这些患者于2023年2月1日至2023年8月1日转诊至我们的儿童和青少年精神病诊所。排除有智力障碍、自闭症谱系障碍、精神分裂症或其他精神障碍的参与者。数据收集工具包括社会人口统计学数据表、自我伤害陈述量表、儿童抑郁量表、边缘型人格量表（BPI）、多伦多述情障碍量表和儿童与青少年复原力测量量表-12（CYRM-12）。使用SPSS25.0对数据进行分析。
在最初筛查的185名参与者中，153名完成了研究，并被平均分为三组：从未有过自我伤害或自杀企图的参与者（n = 51）、至少有过一次自我伤害但未自杀企图的参与者（n = 51）以及既有自我伤害又有自杀企图的参与者（n = 51）。各组之间的社会人口统计学变量无显著差异。割伤被确定为最常见的自我伤害方式（84.3%），其次是抓伤（72.5%）。就CYRM-12测量的复原力而言，无自我伤害或自杀企图史的组得分（M = 36.55）显著高于仅自我伤害组（M = 32.83）和自我伤害加自杀企图组（M = 31.03）（p < 0.001）。对于BPI，既有自我伤害又有自杀企图的组得分最高（M = 29.28），其次是仅自我伤害组（M = 24.91）和无自我伤害或自杀组（M = 19.26）（p < 0.001）。
与没有此类行为的青少年相比，表现出自杀或自我伤害行为的MDD青少年具有更高的边缘型人格特质和述情障碍水平，以及更低的复原力。这些发现表明早期识别和针对这些因素进行干预对于降低抑郁青少年自我伤害和自杀行为风险的重要性。
