A mediation model analysis of emotional abuse on adolescent insomnia
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摘要:
目的 本研究旨在评估情感虐待与青少年失眠之间的关系及作用机制,探讨羞耻倾向、反刍思维从中起到的中介作用。 方法 2021年5月,随机选取安徽省合肥市4所中学学生作为研究对象进行问卷调查。采用情感虐待量表,中学生羞耻感量表,反刍思维量表,失眠严重指数量表对6 916名中学生进行测查。进行描述统计、相关分析及序列中介效应分析。 结果 结果显示,情感虐待显著正向预测青少年失眠现状(β=0.291,P<0.001)。中介效应分析结果显示,情感虐待显著正向预测青少年羞耻倾向(β=0.365,P<0.001), 而羞耻倾向显著正向预测青少年失眠症状(β=0.245,P<0.001),羞耻倾向在情感虐待与青少年失眠症状之间起中介作用。情感虐待显著正向预测青少年反刍思维(β=0.183,P<0.001), 而反刍思维显著正向预测青少年失眠症状(β=0.981,P<0.001),反刍思维在情感虐待与青少年失眠症状之间起中介作用。同时,羞耻倾向可显著正向预测反刍思维(β=0.433,P<0.001),显示出羞耻倾向和反刍思维在情感虐待与青少年失眠之间的链式中介作用。 结论 (1) 情感虐待与青少年失眠症状呈正相关关系。(2)情感虐待可直接影响青少年失眠症状,也可以通过3种间接效应影响失眠症状,即羞耻倾向的中介作用、反刍思维的中介作用以及羞耻倾向和反刍思维的链式中介作用。 Abstract:Objective To assess the relationship between emotional abuse and insomnia in adolescents and to discuss the mechanism of action and the mediating role played by shame tendencies and ruminative thinking. Methods In May 2021, students from 4 secondary schools in Hefei, Anhui Province were randomly selected as the study population for questionnaire survey. The emotional abuse scale, the shame scale for secondary school students, the regurgitated thinking scale, and the index of insomnia severity scale were used to measure 6 916 secondary school students. Descriptive statistics, correlation analysis and serial mediated effects analysis were performed. Results The results showed that, overall, emotional abuse positively and significantly predicted the current insomnia status in adolescents (β=0.291, P < 0.001). The results of the mediation effect analysis showed that emotional abuse significantly and positively predicted adolescent shame tendencies (β=0.365, P < 0.001), while shame tendencies significantly and positively predicted adolescent insomnia symptoms (β=0.245, P < 0.001), indicating that shame tendencies mediated the relationship between emotional abuse and adolescent insomnia symptoms. Emotional abuse significantly and positively predicted ruminative thinking in adolescents (β=0.183, P < 0.001), while ruminative thinking significantly and positively predicted insomnia symptoms in adolescents (β=0.981, P < 0.001), showing that ruminative thinking mediates the relationship between emotional abuse and insomnia symptoms in adolescents. Meanwhile, shame tendencies significantly and positively predicted ruminative thinking (β=0.433, P < 0.001), demonstrating a chain mediating role of shame tendencies and ruminative thinking between emotional abuse and insomnia in adolescents. Conclusion (1) Emotional abuse is significantly and positively associated with insomnia symptoms in adolescents. (2) Emotional abuse can affect insomnia symptoms in adolescents directly and also through three indirect effects, namely the mediating role of shame tendencies, the mediating role of ruminative thinking, and the chain mediating role of shame tendencies and ruminative thinking. This study reveals the mechanism of emotional abuse on adolescent insomnia and provides a theoretical basis for adolescent insomnia intervention. -
Key words:
- Emotional abuse /
- Insomnia /
- Shame tendency /
- Ruminative thinking
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表 1 各变量之间的相关分析
Table 1. Correlation analysis among variables
变量 性别 年龄 情感虐待 羞耻倾向 反刍思维 失眠 性别 1 年龄 -0.035 1 情感虐待 0.071 -0.106 1 羞耻倾向 0.093 0.050 0.352 1 反刍思维 0.070 0.044 0.328 0.498 1 失眠 0.016 -0.081 0.302 0.359 0.280 1 注:均P<0.01。 表 2 中介模型拟合分析
Table 2. Mediation model fitting analysis
因变量 自变量 R R2 F值 β t值 P值 羞耻倾向 性别 0.370 0.137 365.129a 0.141 6.340 <0.001 年龄 0.090 8.033 <0.001 情感虐待 0.360 31.673 <0.001 反刍倾向 性别 0.526 0.276 659.866a 0.036 1.761 0.078 年龄 0.042 4.055 <0.001 情感虐待 0.182 16.307 <0.001 羞耻倾向 0.432 39.080 <0.001 失眠 性别 0.422 0.178 299.352a -0.057 -2.697 0.007 年龄 -0.078 -7.307 <0.001 情感虐待 0.169 14.379 <0.001 羞耻倾向 0.247 19.613 <0.001 反刍倾向 0.099 7.966 <0.001 注:R,R2为拟合指数。 表 3 中介效应路径的Bootstrap 95% CI
Table 3. Bootstrap of mediation effect path 95% CI
效应 路径 效应值 效果量(%) 95% CI 直接效应 情感虐待→失眠 0.169 58.08 0.146~0.192 间接效应 情感虐待→羞耻倾向→失眠 0.090 30.93 0.078~0.101 情感虐待→反刍思维→失眠 0.018 6.19 0.013~0.024 情感虐待→羞耻思维→反刍倾向→失眠 0.015 5.15 0.011~0.020 总中介效应 0.122 41.92 0.110~0.135 总效应 0.291 100.00 0.269~0.314 -
[1] CHRIST C, DE WAAL M M, DEKKER J J M, et al. Linking childhood emotional abuse and depressive symptoms: the role of emotion dysregulation and interpersonal problems[J]. PLoS One, 2019, 14(2): e0211882. DOI: 10.1371/journal.pone.0211882. [2] YU H J, LIU X, YANG H G, et al. The association of adverse childhood experiences and its subtypes with adulthood sleep problems: a systematic review and meta-analysis of cohort studies[J]. Sleep Med, 2022, 98: 26-33. doi: 10.1016/j.sleep.2022.06.006 [3] BROWN S M, RODRIGUEZ K E, SMITH A D, et al. Associations between childhood maltreatment and behavioral sleep disturbances across the lifespan: a systematic review[J]. Sleep Med Rev, 2022, 64: 101621. DOI: 10.1016/j.smrv.2022.101621. [4] ZHANG L H, CUI Z H, SASSER J, et al. Family stress during the pandemic worsens the effect of adverse parenting on adolescent sleep quality[J]. Child Abuse Negl, 2022, 123: 105390. DOI: 10.1016/j.chiabu.2021.105390. [5] XIAO D, WANG T, HUANG Y, et al. Gender differences in the associations between types of childhood maltreatment and sleep disturbance among Chinese adolescents[J]. J Affect Disord, 2020, 265: 595-602. doi: 10.1016/j.jad.2019.11.099 [6] SUTTON E L. Insomnia[J]. Ann Intern Med, 2021, 174(3): ITC33-ITC48. DOI: 10.7326/AITC202103160. [7] YAKELEY J. Shame, culture and mental health[J]. Nord J Psychiatry, 2018, 72(sup1): S20-S22. doi: 10.1080/08039488.2018.1525641 [8] BABCOCK FENERCI R L, DEPRINCE A P. Shame and alienation related to child maltreatment: links to symptoms across generations[J]. Psychol Trauma, 2018, 10(4): 419-426. doi: 10.1037/tra0000332 [9] ROSS N D, KAMINSKI P L, HERRINGTON R. From childhood emotional maltreatment to depressive symptoms in adulthood: the roles of self-compassion and shame[J]. Child Abuse Negl, 2019, 92: 32-42. doi: 10.1016/j.chiabu.2019.03.016 [10] LI H, ZHENG L, LE H, et al. The mediating rrole of internalized stigma and shame on the relationship between COVID-19 related discrimination and mental health outcomes among back-to-school students in Wuhan[J]. Int J Environ Res Public Health, 2020, 17(24): 9237-9251. doi: 10.3390/ijerph17249237 [11] 邓金艳, 姜淑梅. 反刍思维述评[J]. 心理月刊, 2022, 17(5): 235-237. https://www.cnki.com.cn/Article/CJFDTOTAL-XLYK202205079.htmDENG J Y, JIANG S M. A review of ruminant thinking[J]. Psychological Monthly, 2022, 17(5): 235-237. https://www.cnki.com.cn/Article/CJFDTOTAL-XLYK202205079.htm [12] 甘明星, 王蒙, 林丽华, 等. 青少年儿童期心理虐待与忽视对非自杀性自伤行为: 反刍思维和认知融合的链式中介作用[J]. 中国健康心理学杂志, 2021, 29(5): 787-791. https://www.cnki.com.cn/Article/CJFDTOTAL-JKXL202105030.htmGAN M X, WANG M, LING L H, et al. Psychological Abuse and neglect in adolescents and children on non suicidal self injuring behaviors: the chain mediation of ruminant thinking and cognitive fusion[J]. Chinese Journal of Health Psychology, 2021, 29(5): 787-791. https://www.cnki.com.cn/Article/CJFDTOTAL-JKXL202105030.htm [13] CANDEA D M, SZENTAGOTAI-TATAR A. Shame as a predictor of post-event rumination in social anxiety[J]. Cogn Emot, 2017, 31(8): 1684-1691. doi: 10.1080/02699931.2016.1243518 [14] 赵幸福, 张亚林, 李龙飞, 等. 中文版儿童期虐待问卷的信度和效度[J]. 中国临床康复, 2005, 9(20): 105-107. https://www.cnki.com.cn/Article/CJFDTOTAL-XDKF200520049.htmZHAO X F, ZHANG Y L, LI L F, et al. The reliability and validity of the chinese childhood abuse questionnaire[J]. Clinical Rehabilitation in China, 2005, (20): 105-107. https://www.cnki.com.cn/Article/CJFDTOTAL-XDKF200520049.htm [15] 亓圣华, 张彤, 李繁荣, 等. 中学生羞耻感量表的编制[J]. 中国临床心理学杂志, 2008, 16(6): 599-601, 604. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLCY200806016.htmQI S H, ZHANG T, LI F R, et al. Development of shame scale for middle school students[J]. Chinese Journal of Clinical Psychology, 2008, 16(6): 599-601, 604. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLCY200806016.htm [16] NOLEN-HOEKSEMA S. The role of rumination in depressive disorders and mixed anxiety/depressive symptoms[J]. J Abnorm Psychol, 2000, 109(3): 504-511. doi: 10.1037/0021-843X.109.3.504 [17] BASTIEN C H, VALLIÈRES A, MORIN C M. Validation of the Insomnia Severity Index as an outcome measure for insomnia research[J]. Sleep Medicine, 2001, 2(4): 297-307. doi: 10.1016/S1389-9457(00)00065-4 [18] 李恩泽, 李伟霞, 谢植涛. 等. 失眠严重指数量表应用于工商学校学生的心理测量学特征[J]. 神经疾病与精神卫生, 2019, 19(3): 268-272.LI E Z. Psychometric characteristics of insomnia severity index scale applied to business school students[J]. Neuropathy and Mental Health, 2019(19): 268-272. [19] 周琪, 刘亚鹏, 李丽. 徐州市中学生失眠现状及影响因素分析[J]. 中国校医, 2017, 31(12): 890-891, 893. https://www.cnki.com.cn/Article/CJFDTOTAL-XIYI201712006.htmZhou Q, Liu Y P, Li L. Analysis on the current situation and influencing factors of insomnia among middle school students in Xuzhou City[J]. Chinese School Physician, 2017, 31(12): 890-891, 893. https://www.cnki.com.cn/Article/CJFDTOTAL-XIYI201712006.htm [20] 马晓蒙, 郝凤仪, 蒋晓江. 儿童及青少年失眠的临床特征及治疗研究概况[J]. 中华诊断学电子杂志, 2019, 7(3): 164-167. https://www.cnki.com.cn/Article/CJFDTOTAL-ZDDZ201903007.htmMa X M, HAO F Y, JIANG X J. Clinical characteristics and treatment of insomnia in children and adolescents[J]. Chinese Journal of Diagnostics, 2019, 7(3): 164-167. https://www.cnki.com.cn/Article/CJFDTOTAL-ZDDZ201903007.htm [21] BLAKE M J, TRINDER J A, ALLEN N B. Mechanisms underlying the association between insomnia, anxiety, and depression in adolescence: implications for behavioral sleep interventions[J]. Clin Psychol Rev, 2018, 63: 25-40. [22] 何文知, 温健, 王瑶, 等. 失眠在中学生童年创伤与非自杀性自伤间的中介作用[J]. 现代预防医学, 2022, 49(13): 2371-2376. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF202213012.htmHE W Z, WEN J, WANG Y, et al. Mediation of insomnia between childhood trauma and non suicidal self injury in middle school students[J]. Modern Preventive Medicine, 2022, 49(13): 2371-2376. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF202213012.htm [23] 倪喆, 刘露. 低频重复经颅刺激对原发性失眠患者的临床效果及神经内分泌的影响[J]. 中华全科医学, 2022, 20(1): 62-64. doi: 10.16766/j.cnki.issn.1674-4152.002277NI Z, LIU L. Clinical effect and neuroendocrine effect of low-frequency repetitive transcranial stimulation on patients with primary insomnia[J]. Chinese Journal of General Practice, 2022, 20(1): 62-64. doi: 10.16766/j.cnki.issn.1674-4152.002277 [24] PFAFF A, SCHLARB A A. Child maltreatment and sleep: two pathways explaining the link[J]. J Sleep Res, 2022, 31(2): e13455. DOI: 10.1111/jsr.13455. [25] SAYA A, DI CIACCIA G, NIOLU C, et al. Positive and psycho-pathological aspects between shame and shamelessness[J]. Front Psychol, 2022, 13: 941576. DOI: 10.3389/fpsyg.2022.941576. [26] LUIK A I, IYADURAI L, GEBHARDT I, et al. Sleep disturbance and intrusive memories after presenting to the emergency department following a traumatic motor vehicle accident: an exploratory analysis[J]. Eur J Psychotraumatol, 2019, 10(1): 1556550. DOI: 10.1080/20008198.2018.1556550. [27] 韩娟, 陈东莉, 王敏娜, 等. 三甲医院ICU护士社会阻抑与离职意愿间的相关性: 反刍思维的中介作用[J]. 中华全科医学, 2019, 17(3): 508-510, 514. doi: 10.16766/j.cnki.issn.1674-4152.000720HAN J, CHEN D L, WANG M N, et al. Social undermining and turnover intention in ICU nurses of tertiary hospital: the mediating effect of rumination[J]. Chinese Journal of General Practice, 2019, 17(3): 508-510, 514. doi: 10.16766/j.cnki.issn.1674-4152.000720 [28] JOHN-HENDERSON N A, WILLIAMS S E, BRINDLE R C, et al. Changes in sleep quality and levels of psychological distress during the adaptation to university: the role of childhood adversity[J]. Br J Psychol, 2018, 109(4): 694-707. [29] 邱小英, 张琳娜, 褚成静. 特质正念对新冠肺炎疫情引发的应激反应及负面情绪的缓冲作用[J]. 中华全科医学, 2021, 19(8): 1390-1394. doi: 10.16766/j.cnki.issn.1674-4152.002068QiU X Y, ZHANG L N, CHU C J. Buffering effect of trait mindfulness on the stress response and negative emotion caused by the new coronary pneumonia epidemic[J]. Chinese Journal of General Practice, 2021, 19(8): 1390-1394. doi: 10.16766/j.cnki.issn.1674-4152.002068 [30] PROEVE M, ANTON R, KENNY M. Effects of mindfulness-based cognitive therapy on shame, self-compassion and psychological distress in anxious and depressed patients: a pilot study[J]. Psychol Psychother, 2018, 91(4): 434-449.