心理援助热线青少年来电者自伤行为特征及自伤后就医的影响因素

目的 分析心理援助热线 11～18 岁青少年来电者的自伤行为特征及自伤后就医的影响因素。方法 选取 2020 年 1 月 1 日至 2022 年 12 月 31 日北京市心理援助热线接听中既往有自伤行为的青少年来电者为研究对象。接线员询问来电者来电前最后一次自伤行为发生时采用的自伤方式、自伤原因、自伤目的以及是否就医等情况，并比较不同性别及不同年龄段青少年来电者的自伤行为特征。采用多因素 Logistic 回归分析影响青少年来电者自伤后就医的相关因素。结果 共纳入 6 022 例青少年来电者，其中 77.9%（4 690/6 022）的来电者为女性，53.8%（3 241/6 022）的来电者为 11～15 岁。自伤行为最常用的方式是用刀割伤，占 55.3%（3 328/6 022）；自伤原因排名前 2 位的是情绪低落和家庭矛盾，分别占 32.2%（1 940/6 022）、31.7%（1 908/6 022）。85.0%（5 116/6 022）的来电者自伤时有强自杀意念，仅 25.2%（1 519/6 022）的来电者自伤后去就医。与男性青少年来电者相比，女性青少年来电者自伤时用刀割伤的比例更高，自杀意念更强，但自伤就医率较低，差异均有统计学意义（χ2=71.534、9.311、14.882；均P＜0.05）；16～18岁来电者服用治疗药的比例高于11～15岁来电者，差异有统计学意义（χ2=67.485，P＜ 0.001）。多因素 Logistic 回归分析结果显示，男性（OR=1.199，95%CI：1.022～1.406）、16～18 岁（OR=1.261，95%CI：1.058～1.504）、受教育程度为初中（OR=1.388，95%CI：1.131～1.705）或高中（OR=1.371，95%CI：1.056～1.780）、服用治疗药（OR=3.341，95%CI：2.861～3.900）或其他有毒物（OR=3.669，95%CI：2.674～5.034）以及有强自杀意念（OR=3.913，95%CI：1.969～7.776）均是青少年来电者自伤后就医的危险因素（均P＜ 0.05）；自伤次数≥ 2 次（OR=0.749，95%CI：0.648～0.865）、自伤原因为学习问题（OR=0.584，95%CI：0.404～0.844）均是青少年来电者自伤后就医的保护因素（均P＜ 0.01）。结论 心理援助热线青少年来电者较多采用刀割伤的方式自伤，且行为发生时自杀意念较强烈，但较少去就医；不同性别和年龄段青少年来电者的自伤特征存在差异。性别、年龄、自伤方式、自伤原因、自伤次数、自伤时自杀意念强度均是青少年来电者自伤后就医的影响因素。

Characteristics of self-harm behavior among adolescent callers on psychological support hotlines and factors influencing medical treatment after self-harm

Objective To analyze the characteristics of self-harm behavior among adolescents aged 11 to 18 on the psychological support hotline and factors influencing medical treatment after self-harm. Methods From January 1， 2020 to December 31， 2022， adolescents reporting history of self-harm who called the Beijing Psychological Support Hotline were selected as the research subject. The operator asked the caller about the method， cause， purpose of self-harm， and whether to seek medical advice during the last self-harm behavior before the call， and compared the self-harm behavior characteristics of adolescent callers of different genders and age groups. Logistic regression was used to analyze the factors related to seeking medical advice after self-harm. Results A total of 6 022 adolescent callers were included， of which 77.9% （4 690/6 022） were female and 53.8% （3 241/6 022） were aged 11 to 15. The most common way of self-harm was to cut with a knife， accounting for 55.3% （3 328/6 022）. The top two causes of self-harm were depression and family conflicts， accounting for 32.2% （1 940/6 022） and 31.7% （1 908/6 022）， respectively. Eighty-five percent （5 116/6 022） of callers had severe suicidal ideation when self-injuring， and only 25.2% （1 519/6 022） of callers sought medical advice after self-injuring. Compared with male adolescent caller， female caller had a higher proportion of self-harm caused by cutting with a knife， stronger suicidal ideation， but a lower rate of seeking medical advice after self-harm， and the differences were statistically significant （χ2=71.534， 9.311， 14.882； P ＜ 0.05）. The proportion of caller aged 16 to 18 taking therapeutic drugs was higher than that of caller aged 11 to 15， and the difference was statistically significant （χ2=67.485， P＜0.001）. Multivariate Logistic regression analysis showed that males ［OR=1.199， 95%CI （1.022， 1.406）］， 16 to 18 years old ［OR=1.261， 95%CI（1.058， 1.504）］， middle ［OR=1.388，95%CI (1.131，1.705）］ or high school ［OR=1.371，95%CI（1.056，1.780）］ education， taking therapeutic drugs ［OR=3.341， 95%CI （2.861， 3.900）］ or other toxic substances ［OR=3.669， 95%CI （2.674， 5.034）］， and severe suicidal ideation ［OR=3.913， 95%CI （1.969， 7.776）］ were risk factors for adolescent caller seeking medical advice after self-harm， and the differences were statistically significant （P＜0.05）. self-harm frequency ≥ 2 times ［OR=0.749， 95%CI （0.648， 0.865）］ and self-harm caused by learning problems ［OR=0.584， 95%CI （0.404， 0.844）］ were protective factors for adolescent caller seeking medical advice after self-harm， and the differences were statistically significant （P＜ 0.01）. Conclusions Adolescent hotline callers often engage in self-harm behavior through knife cuts， and the suicidal ideation is severe when the behavior occurs， but they rarely seek medical advice. There are differences in self-harm characteristics among adolescent callers of different genders and age groups. Gender， age， mode of self-harm， reason for self-harm， number of self-harm， and intensity of suicidal ideation at the time of self-harm were all influential factors in adolescent callers seeking medical care after self-harm.