童年期逆境与青少年抑郁障碍失眠：思维反刍和抑郁症状的中介作用-现代医学

童年期逆境与青少年抑郁障碍失眠：思维反刍和抑郁症状的中介作用

作者：杨婷¹ 李立圆² 郭雨璇³ 黎珏希¹ 唐佩琪¹ 蒲婷¹ 左海汐⁴ 樊小夏³ 周波¹

单位：1. 西南医科大学附属医院心身医学科, 四川泸州 646000;
2. 四川省医学科学院·四川省人民医院四川省精神医学中心, 四川成都 610072;
3. 电子科技大学临床医学院, 四川成都 611731;
4. 川北医学院临床医学院, 四川南充 637000

关键词：失眠童年期逆境思维反刍抑郁青少年

分类号：R749.4

出版年·卷·期（页码）：2026·54·第三期（386-393）

摘要：

目的：旨在构建多重作用路径的结构方程模型，探索童年期虐待、校园欺凌、思维反刍及抑郁症状对青少年抑郁障碍患者失眠程度的综合作用机制，为制定科学干预策略提供依据。方法：2025年4月至10月采用便利抽样法于四川省精神医学中心招募242例青少年抑郁障碍患者，使用童年创伤问卷简版(CTQ-SF)、Olweus儿童欺负问卷(OBVQ)、反刍反应量表(RRS)、失眠严重程度指数量表(ISI)、患者健康问卷抑郁量表(PHQ-9)进行评定。采用偏最小二乘结构方程模型(PLS-SEM)构建模型。结果：童年期虐待、校园欺凌、思维反刍、抑郁症状、失眠程度两两间均呈正相关。最终模型中，抑郁症状与失眠程度正向关联(β =0.587, 95%CI 0.492～0.670, P<0.001)，而校园欺凌对失眠程度的直接路径存在边缘显著效应(β =0.108, 95%CI -0.003～0.212, P=0.047)。童年期虐待(β=0.094, 95%CI 0.053～0.137, P=0.006)和校园欺凌(β=0.080, 95%CI 0.048～0.116, P<0.001)可以分别通过思维反刍和抑郁症状的链式中介路径与失眠程度相关联，VAF值分别为32.9%、33.6%，均显示有部分中介效应。结论：抑郁症状与青少年抑郁障碍患者的失眠程度有正向关联，童年期虐待和校园欺凌可通过思维反刍和抑郁症状的链式中介路径与失眠程度相关联。

Objective: To construct a multi-path structural equation model to explore the comprehensive mechanism by which childhood maltreatment, school bullying, rumination, and depressive symptoms affect insomnia severity among adolescents with depressive disorders, so as to provide a basis for formulating scientific intervention strategies. Methods: From April 2025 to October 2025, a convenience sample of 242 adolescents with depressive disorders was recruited from Sichuan Center of Mental Health. Participants were assessed using Childhood Trauma Questionnaire-Short Form(CTQ-SF), Olweus Bully/Victim Questionnaire(OBVQ), Ruminative Response Scale(RRS), Insomnia Severity Index(ISI), and Patient Health Questionnaire-9(PHQ-9). A partial least squares structural equation model(PLS-SEM) was constructed for analysis. Results: Childhood maltreatment, school bullying, rumination, depressive symptoms, and insomnia severity were all significantly positively correlated with each other. In the final model, depressive symptoms were positively associated with insomnia severity(β=0.587, 95%CI 0.492-0.670, P<0.001), while the direct path from school bullying to insomnia severity showed a marginally significant effect(β=0.108, 95%CI -0.003-0.212, P=0.047). Childhood maltreatment(β=0.094, 95%CI 0.053-0.137, P=0.006) and school bullying(β=0.080, 95%CI 0.048-0.116, P<0.001) were associated with insomnia severity through a serial mediation pathway involving rumination and depressive symptoms. The variance accounted for(VAF) values were 32.9% and 33.6%, respectively, indicating partial mediation effects.Conclusion: Depressive symptoms are positively associated with insomnia severity in adolescents with depressive disorders. Childhood maltreatment and school bullying are linked to insomnia severity through a serial mediation pathway involving rumination and depressive symptoms.

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