青少年非自杀性自伤行为与自杀行为关联的理论模型研究进展

非自杀性自伤行为(non-suicidal self-injury,NSSI)是一种不以自杀为目的地、直接地、故意伤害自己身体,而不被社会和文化所认可的行为,包括割伤、烧伤、打伤、烫伤、咬伤自己等多种形式[1-2].自杀行为是因为社会心理冲突而产生的一种蓄意终止自己生命、有目的、有计划的自我毁灭行为[3].NSSI和自杀行为是青少年致残和死亡的主要原因,现已成为影响青少年身心健康的重大公共卫生问题,两者紧密关联.国内外诸多研究证实了青少年NSSI和自杀行为的统计学关联[4-5],但对于两者关联的理论解释尚存在争议.本文对近年来青少年NSSI和自杀行为关联研究的主要理论模型进行综述,为深入研究的开展提供理论依据.     

累积家庭风险指数与青少年自伤行为分析

探究累积家庭风险指数与青少年自伤的函数关系及认知情绪调节在其中的中介作用,为有效预防青少年自伤提供参考.方法 整群抽取哈尔滨1所初中的422名学生为研究对象,采用自编家庭基本情况问卷、自伤问卷和认知情绪调节问卷进行调查.结果 50.9%的青少年存在1个及以上的家庭风险因素.结构方程模型分析表明,累积家庭风险能正向预测青少年自伤水平(P<0.01),且预测作用呈“正加速关系”,标准化路径系数r=0.35(P<0.01).自我责难和灾难化2种消极认知情绪调节策略在累积家庭风险对青少年自伤的影响中起部分中介作用,直接效应和中介效应分别为0.26,0.05.结论 累积家庭风险的数量达到某个临界值后,自伤水平将迅速增加,且路径以自我责难和灾难化2种消极认知情绪调节为部分中介及其作用机制.     

青少年饮酒与自伤行为关系

目的 探讨青少年饮酒行为与自伤行为的关系,为相关部门预防青少年饮酒与自伤行为提供参考依据.方法 使用饮酒行为问卷及自伤行为问卷收集饮酒与自伤信息,对四川省凉山州整群抽取的4所中学9 247名中学生进行调查.采用单因素和多因素Logistic回归分析,对饮酒行为和自伤行为关系进行分析.结果 在9 247名初高中学生中,尝...     

青少年非自杀性自伤行为评定问卷的编制及其信效度评价

编制适合我国使用的青少年非自杀性自伤行为评定问卷,并对其信效度进行评价,为更好地了解我国青少年非自杀性自杀行为提供工具.方法 自行编制青少年非自杀性自伤行为评定问卷.采用分层整群抽样方法,选取沈阳、郑州、南昌和深圳部分在校初、高中学生,共15 096人进行问卷调查.通过同质信度、分半信度、结构效度等评价问卷的信效度.选取合肥市某中学94名学生使用自残功能性评估问卷(Functional Assessment of Self-mutilation,FASM)作为校标问卷进行调查,考察问卷的效标关联效度.结果 青少年非自杀性自伤行为评定问卷分为行为问卷(12个条目)和功能问卷(19个条目)2部分.行为问卷的Cronbachα系数为0.921,分半信度为0.851,重测信度为0.843,累计方差贡献率为64.914%,与校标问卷FASM行为维度得分的相关系数r=0.833(P<0.01).功能问卷总分的Cronbach α系数为0.905,分半信度为0.786,重测信度为0.805,累计方差贡献率为53.871%,与校标问卷FASM功能维度得分的相关系数r=0.859(P<0.01).结论 青少年非自杀性自伤行为评定问卷具有较好的信效度,可作为我国青少年非自杀性自伤行为和功能的评定工具.     

青少年非自杀性自伤行为和网络成瘾的相关性

探讨青少年非自杀性自伤行为与网络成瘾的关系,为提升青少年健康,预防不良危险行为的发生提供科学依据.方法 采用随机整群抽样方法,抽取中国黑龙江、湖北、安徽、广东、云南5个省15 538名初中和高中生为研究对象,采用课题组编制的《青少年心理行为健康状况调查问卷》调查非自杀性自伤行为、网络成瘾行为、一般人口学特征、家庭情况及心理状况等.结果 调查前1年,被试非自杀性自伤行为、网络成瘾、可疑网络成瘾的自我报告率分别为28.7%,3.3%和29.9%.有无自伤行为组间孤独感和情绪管理得分差异均有统计学意义(t值分别为-22.35,25.62,P值均<0.05).单因素分析显示,非自杀性自伤行为与网络成瘾有相关性(P<0.05);在控制性别、民族、年级、独生子女、父亲文化程度、家庭类型、管教方式、情绪管理、孤独感等因素后,多因素Logistic回归分析显示,非自杀性自伤行为的各类型与网络成瘾各类型仍有相关性(OR=1.30~2.79),且网络成瘾者发生各类型NSSI风险均高于可疑网络成瘾者.结论 网络成瘾和可疑网络成瘾行为是非自杀性自伤行为的独立危险因子.加强对网络成瘾的预防可减少自伤行为的发生.     

青少年非自杀性自伤行为的家庭影响因素分析

  目的  分析青少年非自杀性自伤行为(NSSI)的家庭影响因素, 为制定青少年自伤行为干预策略提供科学依据。  方法  采用分层随机整群抽样方法, 在黑龙江、安徽、湖北、云南、广东5省抽取15 623名11~20岁中学生为研究对象, 采用问卷评估青少年NSSI行为的频率, 以及家庭相关的影响因素。  结果  最近1年内至少发生1次以上自伤行为者占28.8%, 其中1~4次(偶有自伤行为)者占17.6%, 5次及以上(反复自伤行为)者占11.2%。单因素分析结果显示, 是否为独生子女、家庭类型、主要照料人文化程度、家庭教养方式、家庭人均月收入以及是否有精神疾病家族史与青少年偶有自伤行为及反复自伤行为均有相关性(χ2=6.30~12.16, P值均 < 0.05)。控制性别、年龄、年级、民族, 情绪管理、心理韧性、孤独感、社会支持等因素后, 是否独生子女、家庭教养方式仍与偶有自伤行为均呈正相关(OR值分别为1.11, 1.34, P值均 < 0.05);是否独生子女、主要照料人文化程度和家庭教养方式与反复自伤行为仍有相关性(OR值分别为1.19, 0.69, 1.57, P值均 < 0.05);以地区进行分层分析后显示, 各地区的青少年自伤行为的影响因素不全相同。  结论  独生子女、主要照料人文化程度等家庭因素可能与青少年自伤行为发生有关, 青少年自伤行为的家庭影响存在地区差异。     

青少年非自杀性自伤行为与抑郁症状的相关性

目的 探讨青少年非自杀性自伤(non-suicidal self-injury, NSSI)行为与抑郁症状的相关性,为针对性改善青少年身心健康提供理论依据。方法 采用随机整群抽样法在上海、乌鲁木齐、长沙、昆明4座城市选择共8 102名12～17岁青少年,采用流调中心用抑郁量表(CES-D)和青少年非自杀性自伤行为评定问卷调查被试者的抑郁症状以及NSSI行为发生情况。采用χ²检验、单因素分析以及Logistic回归分析对NSSI行为与抑郁症状的关系进行分析。结果 青少年NSSI总体检出率为24.6%,其中男生(23.1%)检出率低于女生(26.2%)(χ²=10.97,P<0.05),初中和高中总体检出率分别为24.7%和24.6%,差异无统计学意义(χ²=0.01,P>0.05)。伴NSSI组青少年抑郁症状总体检出率为49.7%,不伴NSSI组的检出率为17.7%,差异有统计学意义(χ²=808.80,P<0.01)。在不同性别和年龄段中,伴NSSI组(男生：44.0%,女生：54...     

抑郁障碍青少年自伤行为影响因素分析

目的 探讨分析抑郁障碍青少年自伤行为影响因素,为开展临床干预和治疗提供参考.方法 选取2015年1月至2017年1月在第904医院门诊就诊的80例14～18岁抑郁障碍青少年,采用艾森克人格问卷、父母养育方式量表、自伤行为评定量表进行问卷调查.结果 男性抑郁障碍患者(76.74％)自伤行为报告率较女性高(54.05％),...     

青少年抑郁症患者非自杀性自伤体验的质性研究

目的 了解非自杀性自伤(nonsuicidal self-injury, NSSI)青少年抑郁症患者使用切割工具自伤时的真实体验和感受,为提供针对性干预措施提供指导。方法 采用目的抽样法,于2021年11月—2022年5月对四川省成都市某三级甲等精神病专科医院收治的19例使用切割工具NSSI青少年抑郁症患者进行半结构式访谈,以诠释现象学分析法分析转录资料。结果 青少年抑郁症患者非自杀性自伤体验和感受可归纳为5个主题：外界干扰下滋生的自伤意念;思绪万千中的自伤行为;痛并快乐着的自伤体验;万里挑一的自伤工具;有爱、有责任,自伤行为有所减少。结论 青少年抑郁症患者非自杀性自伤行为受多方面因素影响。应根据此类患者特点提供有针对性护理措施,指导患者签署NSSI承诺书、教会患者掌握NSSI行为替代技巧、联合患者家属构建多维度社会支持平台。     

青少年非自杀性自伤发病机制及治疗研究进展

非自杀性自伤(non-suicide self-injury, NSSI)高发于青少年人群,严重威胁其身心健康,是未来发生自杀的重要预测因子,已成为全球公共卫生关注的热点。目前对青少年NSSI的研究尚处于起步阶段,其形成过程复杂,发病机制尚不完全明确,治疗方面的相关研究较少。研究将从遗传学、神经生物学、神经影像学及社会心理学多视角对青少年NSSI的发病机制及治疗研究进行阐述,旨在为改善青少年NSSI提供理论依据。     

A research agenda for licensing and certification testing validation studies

The set of articles appearing in this issue of Evaluation & the Health Professions provides an in-depth examination of the validation process for licensing and certification test score decisions. The winter 1990 issue of Educational Measurement: Issues and Practice also contains an excellent set of articles about licensing and certification tests. These special editions are much needed because these kinds of testing programs are increasing in numbers and aim to ensure public safety, promote growth of professions, and positively affect the careers of persons dedicated to serving in these professions. This article will comment on issues raised by the authors of these articles. But before doing this, a context is described that affects these issues.     

Consolidating a research agenda for vaccine mandates

A workshop on mandatory vaccination was pitched to the World Public Health Congress in 2019 and the resultant special issue was pitched to Vaccine in 2020. During this project, the COVID-19 pandemic pushed vaccine policy to the forefront of global public health policy, and the imposition of vaccine mandates prompted a new wave of scholarship in the field. This introductory article employs the heuristic of Lasswell’s (1956) policy cycle to synthesise the findings of the articles in the special issue. It considers the temporal lifetime of mandates and highlights findings regarding: the emergence of mandates as a policy option, public support and policy instrument design, what matters in the implementation of mandates, and what we can learn from evaluating them. The second half of the paper categorizes the included papers in terms of what aspects of mandates they study and the methods they employ to do so, in order to formulate a guide for future researchers of vaccine mandates. Scholars study either speculative or existing mandates – research can address several stages of the policy cycle or just one of them, ranging from attitudinal research to implementation studies and impact studies. Historical and contextual studies that take deep dives into a particular mandate are a much needed resource for studying emerging mandates, too, and scoping and framework- building work will undoubtedly be valuable in understanding and appreciating the wealth of knowledge production in this growing field. This special issue can serve as a roadmap for a consolidation of this interdisciplinary research agenda, and provide a helpful resource for decisionmakers at this historical juncture.     

Thinking about think tanks in health care: a call for a new research agenda

Little sociological attention has been given to the role of think tanks in health policy and planning. Existing work in political science and public administration tends to define and categorise think tanks and situate them as a disinterested source of policy expertise. Despite the increasingly visible presence of think tanks in the world of health care, such work has done little to reveal how they operate, by whom and to what ends. Our article seeks to redress this firstly by examining why they have remained relatively hidden in academic analyses and secondly by advocating an interpretive approach that incorporates think tanks within the wider landscape of health policy and planning. In contrast to most existing literature, an interpretive approach acknowledges that much of the messy business of healthcare policy and planning remains hidden from view and that much can be gleaned by examining the range of organisations, actors, coalitions, everyday activities, artefacts and interactions that make up the think tank stage and that work together to shape health policy and planning. Given the paucity of research in this area, we urge the medical sociology community to open the field to further academic scrutiny.     

Actor-network theory and the OSCE: formulating a new research agenda for a post-psychometric era

The Objective Structured Clinical Examination (OSCE) is a ubiquitous part of medical education, although there is some debate about its value, particularly around possible impact on learning. Literature and research regarding the OSCE is most often situated within the psychometric or competency discourses of assessment. This paper describes an alternative approach: Actor-network-theory (ANT), a sociomaterial approach to understanding practice and learning. ANT provides a means to productively examine tensions and limitations of the OSCE, in part through extending research to include social relationships and physical objects. Using a narrative example, the paper suggests three ANT-informed insights into the OSCE. We describe: (1) exploring the OSCE as a holistic combination of people and objects; (2) thinking about the influences a checklist can exert over the OSCE; and (3) the implications of ANT educational research for standardisation within the OSCE. We draw from this discussion to provide a practical agenda for ANT research into the OSCE. This agenda promotes new areas for exploration in an often taken-for-granted assessment format.     

Establishing local priorities for a health research agenda

Aim/Background

To describe the two‐stage prioritization process being used by the UK National Institute for Health Research''s Collaboration for Leadership in Applied Health Research and Care for the South‐West Peninsula (or PenCLAHRC) – a joint health service and university partnership and reflect on implications for the wider context of priority setting in health‐care research.

Method

PenCLAHRC''s process establishes the priorities of Stakeholders including service users across a regional health system for locally relevant health services research and implementation. Health research questions are collected from clinicians, academics and service users in Devon and Cornwall (UK) using a web‐based question formulation tool. There is a two‐stage prioritization process which uses explicit criteria and a wide Stakeholder group, including service users to identify important research questions relevant to the south‐west peninsula locality.

Results

To date, a wide variety of health research topics have been prioritized by the PenCLAHRC Stakeholders. The research agenda reflects the interests of academics, clinicians and service users in the local area. Potential challenges to implementation of the process include time constraints, variable quality of questions (including the language of research) and initiating and maintaining engagement in the process. Shared prioritization of local health research needs can be achieved between Stakeholders from a wide range of perspectives.

Conclusions

The processes developed have been successful and, with minor changes, will continue to be used during subsequent rounds of prioritization. Engagement of Stakeholders in establishing a research agenda encourages the most relevant health questions to be asked and may improve implementation of research findings and take up by service users.     

Racial and ethnic diversity and organizational behavior: a focused research agenda for health services management

Initiatives to reduce racial and ethnic disparities are conceptualized as a three-legged stool. Public policy: to ensure a legal and regulatory environment designed to eliminate disparities in access and health status; clinical practice: to ensure patient satisfaction and loyalty and improve treatment outcomes through the cultural competence of clinicians; and organizational behavior: to ensure that leadership, staff, and the culture of the health services organization represents and values the communities they serve. Our review of the health services and general management literature published since 1990 reveals a paucity of research on organizational behavior. Based on our review of health services and general management organizational behavior and racial/ethnic diversity literature, we offer an agenda for future research in this area. Factors that will facilitate or inhibit the pursuit of the proposed research agenda are also identified and discussed. The literature reviewed is mainly from the United States and the proposed research agenda results from that review, which presents a potential limitation to its applicability internationally.     

Setting priorities for a research agenda to combat drug-resistant tuberculosis in children

Setting: Numerous knowledge gaps hamper the prevention and treatment of childhood drug-resistant tuberculosis (TB). Identifying research priorities is vital to inform and develop strategies to address this neglected problem.Objective: To systematically identify and rank research priorities in childhood drug-resistant TB.Design: Adapting the Child Health and Nutrition Research Initiative (CHNRI) methodology, we compiled 53 research questions in four research areas, then classified the questions into three research types. We invited experts in childhood drug-resistant TB to score these questions through an online survey.Results: A total of 81 respondents participated in the survey. The top-ranked research question was to identify the best combination of existing diagnostic tools for early diagnosis. Highly ranked treatment-related questions centred on the reasons for and interventions to improve treatment outcomes, adverse effects of drugs and optimal treatment duration. The prevalence of drug-resistant TB was the highest-ranked question in the epidemiology area. The development type questions that ranked highest focused on interventions for optimal diagnosis, treatment and modalities for treatment delivery.Conclusion: This is the first effort to identify and rank research priorities for childhood drug-resistant TB. The result is a resource to guide research to improve prevention and treatment of drug-resistant TB in children.