Advances in Psychology
Vol. 13  No. 01 ( 2023 ), Article ID: 60708 , 2611 pages
10.12677/AP.2023.131035

新型冠状病毒疫情背景下儿童期 不良经历对成人心理健康的影响: 正念和自我同情的链式中介作用

江红芳,蒋冬红*

深圳大学心理学院,广东 深圳

收稿日期:2022年12月9日;录用日期:2023年1月12日;发布日期:2023年1月29日

摘要

目的:1、探讨疫情下儿童不良经历对的成人心理健康的影响;2、探讨正念和自我同情在童年不良经历ACEs与成人心理健康关系中的链式中介作用。方法:采用方便取样法对在校大学生及社会人士发送网络问卷,共有1994名参与者提交了问卷,最终得到1987份有效问卷。被试年龄在17~46岁之间(19.7 ± 1.874)。其中男性1016人(51.13%),女性971人(48.87%)。该调查分别采用童年创伤问卷(CTQ-SF)、自我同情量表(SCS)、正念五因素问卷(FFMQ)和抑郁焦虑和压力量表(DASS-21)评估了童年不良经历、正念、自我同情、心理健康情况。结果:1、有无童年不良经历的参与者在心理健康上存在统计学意义(P < 0.001),是否隔离不存在统计学意义,童年不良经历和隔离无交互作用。2、童年不良经历与正念、自我同情均呈显著负相关,与心理健康(抑郁、焦虑、压力)成显著正相关;正念与自我同情成显著正相关,与心理健康(抑郁、焦虑、压力)呈显著负相关;自我同情与心理健康(抑郁、焦虑、压力)呈显著负相关。正念和自我同情在童年不良经历对心理健康(抑郁、焦虑、压力)的链式中介作用成立。结论:1. 新型冠状病毒疫情下是否隔离不影响人们心理健康(抑郁、焦虑、压力),童年不良经历导致心理健康水平下降;2. 可以通过正念和自我同情提高童年不良经历人群的心理健康水平。

关键词

童年不良经历,正念,自我同情,心理健康,抑郁,焦虑,压力

The Impact of Adverse Childhood Experiences on Adult Mental Health under the Covid-19 Pandemic: The Chain Mediating Role of Mindfulness and Self-Compassion

Hongfang Jiang, Donghong Jiang*

School of Psychology, Shenzhen University, Shenzhen Guangdong

Received: Dec. 9th, 2022; accepted: Jan. 12th, 2023; published: Jan. 29th, 2023

ABSTRACT

Objective: 1) To explore the impact of adverse childhood experiences (ACEs) on adult mental health under the Covid-19 pandemic. 2) The chain-mediating role of mindfulness and self-compassion in the relationship between childhood adverse experiences and adult mental health (depression, anxiety, stress). Methods: Participants were 1,994 college students and social personages (N = 1,987, Mage = 19.7 ± 1.874, 1016 males (51.13%), 971 females (48.87%)). The convenient sampling method was used to send network questionnaires to Participants. The childhood Trauma Questionnaire (CTQ-SF), Self-compassion Scale (SCS), Mindfulness Five-Factor Questionnaire (FFMQ) and Depression Anxiety and Stress Scale (DASS-21) were used to assess ACEs, mindfulness, self-compassion and mental health, respectively. Results: 1. There was statistical significance in mental health of participants with or without adverse childhood experience (P < 0.001), there was no statistical significance in quarantine, and there was no interaction between ACEs and quarantine. 2. ACEs were significantly negatively correlated with mindfulness and self-compassion, and significantly positively correlated with mental health (depression, anxiety and stress); mindfulness was significantly positively correlated with self-compassion and negatively correlated with mental health (depression, anxiety and stress); self-compassion was significantly negatively associated with mental health (depression, anxiety, stress). The chain mediating effect of mindfulness and self-compassion on mental health (depression, anxiety and stress) caused by ACEs was confirmed. Conclusions: 1. Quarantine does not affect the mental health (depression, anxiety and stress), ACEs affect mental health (depression, anxiety and stress); 2. The mental health of people with ACEs can be improved through mindfulness and self-compassion.

Keywords:Adverse Childhood Experiences, Mindfulness, Self-Compassion, Mental Health, Depression, Anxiety, Stress

Copyright © 2023 by author(s) and Hans Publishers Inc.

This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).

http://creativecommons.org/licenses/by/4.0/

1. 引言

心理健康是指心理的各个方面及活动过程处于一种良好或正常的状态。心理健康的理想状态是保持性格完好、智力正常、认知正确、情感适当、意志合理、态度积极、行为恰当、适应良好的状态(百度百科词条,2022)。素质–应激模型理论(diathesis stress theories)《变态心理学》指出,心理障碍的发生和发展需要兼具易患障碍的素质(素质包括生物因素、心理因素和社会因素)以及诱因或应激(苏珊•诺伦-霍克西玛,2017)。新型冠状病毒疫情是近年来全球共同面临的应激源,童年不良经历是素质中的社会因素。在2020年1月31日至2月2日,中国在COVID-19疫情爆发仅两周和世卫组织宣布国际关注的突发公共卫生事件后一天,公众的最初心理反应中,53.8%的受访者认为疫情的心理影响为中度或重度;16.5%的受访者报告有中度至重度抑郁症状;28.8%的受访者报告有中度至重度焦虑症状;8.1%的人表示自己处于中度到重度的压力水平。女性性别、学生身份和特定的身体症状与疫情爆发带来的更大的心理影响以及更高水平的压力、焦虑和抑郁有关(Wang et al., 2020b)。新型冠状病毒流行期间,中国大学生焦虑和抑郁的检出率明显上升(石小盼等,2021)和普遍感到焦虑、强迫、恐惧、抑郁等,并出现一些躯体不适、精神病性等症状(王剑峰,2020)。精神疾病数量增加与COVID-19风险增加相关(Yang et al., 2020),精神障碍在COVID-19期间死亡风险更大(Das-Munshi et al., 2021)。中国COVID-19患者自残或自杀风险显著高于普通人群(Wang et al., 2020a; Zhao et al., 2020)。68.57%新型冠状病毒患者在出院后2周隔离期间出现焦虑(孙洁等,2021)。

童年不良经历(Adverse Childhood Experiences, ACEs)被定义为发生在生命的前18年的创伤性经历。十种个人经历是公认的,可以分为三个不同的组:童年虐待(情感、身体和性)、童年忽视(情感和身体)和家庭功能障碍(家庭暴力、药物滥用、精神疾病、父母分离和家庭成员被监禁) (Chapman et al., 2004; Dong et al., 2004; Felitti et al., 1998)。世界卫生组织定义儿童虐待,是指发生在18岁以下儿童身上的虐待和忽视。它包括在责任、信任或权力关系中对儿童的健康、生存、发展或尊严造成实际或潜在伤害的所有类型的身体和/或情感虐待、性虐待、忽视、疏忽和商业或其他剥削。暴露于亲密伴侣的暴力有时也被列为虐待儿童的一种形式(World Health Organization, 2016)。相关研究表明,63%的参与者经历过至少一种儿童虐待或家庭功能障碍,超过20%的参与者经历过三种或三种以上的不良童年经历(Felitti et al., 1998)。这项研究还发现,更多的不良童年经历与酗酒、药物滥用、抑郁、自杀企图和其他高风险健康状况的风险增加有关(Felitti et al., 1998)。多达三分之二的成年人(67%)报告称至少经历过一次ACE (Dong et al., 2004)。以往研究证实,儿童不良经历使人群的心理健康水平(与无儿童不良经历史人群对比)相对较低,具体而言,童年不良经历(ACE)已被发现与一系列情绪和焦虑障碍以及包括抑郁、焦虑和创伤后应激障碍在内的心理困扰症状呈正相关(Anda et al., 2009; Chapman et al., 2004; Kroska et al., 2018; Liu, 2017; Sachs-Ericsson et al., 2017; Sheffler et al., 2020)。童年不良经历与焦虑症状呈正相关(Chi et al., 2022)。当前的压力事件使有儿童不良经历史的大学生的心理健康状况持续恶化,并导致抑郁症的发生和复发(Kelifa et al., 2020)。最近的压力事件使童年时期曾遭受虐待的新兵的重度抑郁发作和广泛性焦虑障碍的风险增加(Bandoli et al., 2017)。

由此,提出假设1:疫情下隔离使得有儿童不良经历的成人的心理健康水平下降。

正念被定义为以一种特定的方式集中注意力:有目的的、当下的、不加评判的、为自我理解和智慧服务的(Kabat-Zinn & Hanh, 1990)。一种通过将注意指向当下目标而产生的意识状态,不加评判地对待此时此刻所展开的各种经历或体验。正念训练起源于中国南禅佛教,卡巴金博士受佛教影响,1979年在麻省大学医学院开设减压诊所,并设计了“正念减压”课程(Mindfulness-Based Stress Reduction, MBSR),协助病人以正念禅修处理压力、疼痛和疾病(Kabat-Zinn, 1982, 1996; Kabat-Zinn & Hanh, 1990)。Jon Kabat-Zinn认为,正念来自于三种机制的同时培养:1) 意图和理解一个人为什么要进行正念练习(例如,自我调节,减轻压力),2) 对一个人时刻的观察和体验的关注,而不进行判断或分析,3) 接受、善良、同情、开放、耐心、不努力、平静、好奇和不评价的态度(Carmody et al., 2009; Kabat-Zinn, 1994, 1996; Shapiro et al., 2006)。有研究表明,对于童年不良经历较多的女性来说,增强的正念(对内在体验的非反应性的)与压力、抑郁症状和生活质量的改善显著相关(Janusek et al., 2020)。创伤经历,如性侵犯,可能导致个体正念水平下降,这可能反过来导致消极的心理结果(Kroska et al., 2018)。正念与较低水平的抑郁和焦虑症状严重程度相关。创伤是焦虑的一个显著预测因子,高水平的正念削弱了创伤暴露和更高的焦虑症状严重程度之间的联系(Tubbs et al., 2019)。童年期虐待与正念呈显著负相关,与网络成瘾呈显著正相关;正念与网络成瘾呈显著负相关;童年期虐待通过正念的中介效应作用于网络成瘾(岳鹏飞等,2020)。有童年期虐待经历的大学生表现出更高水平的特质抑郁,其特质抑郁受到正念的调节(胡玄一等,2021)。正念在儿童期不良经历对中国大学生心理健康的影响中起到部分中介作用(Huang et al., 2021)。童年累积创伤显著降低正念水平,进而导致更多抑郁症状。童年累积创伤与抑郁症状之间的联系完全由正念和解离调节(Bolduc et al., 2018)。正念的各个方面显著地调节了不良童年经历与抑郁之间的关系(McKeen et al., 2021)。

自我同情指的是在面对自己的苦难时,持开放态度并为之感动,体验对自己的关心和善意,对自己的不足和失败采取理解和不评判的态度,并认识到自己的经历是人类共同经历的一部分(Neff, 2003b)。对自己富有同情心的态度可以说是一种被称为正念的平衡的心理观点(Kabat-Zinn, 1994)。为了让个人充分体验自我同情,他们必须采取一种正念的观点,他们不能避免或压抑他们的痛苦感觉,因为承认自己的感觉是必要的,以便对他们感到同情(Scheff, 1981)。有研究表明,童年不良经历(ACE)直接和间接地通过较低的自我同情与更高的广泛性焦虑症状显著相关(Hagan et al., 2021)。较高的童年情感虐待、情感忽视和身体虐待与较低的自我同情相关(Tanaka et al., 2011)。情感虐待和忽视与自我同情减少之间存在显著相关(Messman-Moore & Bhuptani, 2020)。情感虐待、情感忽视和身体忽视都通过降低自我同情与自杀意念呈正相关(Zhang et al., 2021)。心理虐待(情感虐待和情感忽视)通过降低自我同情与成人抑郁症状相关(Wu et al., 2018)。自我同情在儿童虐待严重程度与后期情绪失调之间起中介作用(Vettese et al., 2011)。自我同情对童年不良经历和焦虑有部分中介作用(Chi et al., 2022)。自我同情在儿童虐待与抑郁之间起部分中介作用(Tao et al., 2021)。自我同情在童年虐待和心理健康之间起到部分中介作用(Tarber et al., 2016)。

由此,提出假设2:儿童不良经历影响疫情下成人的心理健康状况,正念和自我同情可能起链式中介作用。

2. 对象与方法

2.1. 对象

采用方便取样法对在校大学生及社会人士发送网络问卷,其中在校大学生主要通过班级群发送问卷,社会人士主要通过微信群、朋友圈等网络手段发送问卷,共有1994名参与者提交了问卷,最终得到1987份有效问卷。被试年龄在17~46岁之间(19.7 ± 1.874)。其中男性1016人(51.13%),女性971人(48.87%)。

2.2. 工具

2.2.1. 抑郁焦虑和压力量表(DASS-21, Lovibond & Lovibond, 1995)

该量表共21个题项,描述个人近期(“过去一周内”)负性情绪体验或相应生理反应,如“我感到忧郁沮丧”、“我感到口干舌燥”等,受测者就各题项的描述与自身情况的符合程度做出判断,0不符合,1有时符合,2常常符合,3总是符合。全量表由抑郁、焦虑和压力三个分量表组成,每个分量表含7个题项。Henry & Crawford (2005)报告了DASS-21的区分效度和聚合效度良好,对抑郁(α = 0.88)、焦虑(α = 0.82)和压力(α = 0.90)的内部一致性较高。本研究中该问卷的Cronbach’s α系数为0.946。

2.2.2. 童年创伤问卷(CTQ-SF, Bernstein et al., 2003)

该量表共有28个条目,分为五个临床分量表:情感虐待、躯体虐待、性虐待、情感忽视和躯体忽视。每个条目采用李克特5分制计分,1分:从不;2分:偶尔;3分:有时;4分:经常;5分:总是;每个分量表在5~25分之间,总分在25~125分之间。另有3个条目作为效度评价。赵幸福等人(2005)翻译并修订了中文版的CTQ量表,并证实具有较好的信度、效度和内部一致性。本研究中该问卷的Cronbach’s α系数为0.711。

2.2.3. 自我同情量表(Self-Compassion Scale, SCS; Neff, 2003a)

该量表共26个项目组成,评估了自我同情的三个主要因素的积极和消极方面:自我友善和自我批评;共同人性和孤立;正念和过度认同,总共六个维度,项目的得分采用李克特LIKERT量表5分制(1非常不符合,2不符合,3一般,4符合,5非常符合),分别计算六个分量表的得分,然后计算总分,其中自我批评、孤立感、过度认同反向计分。总分代表一个人的自我同情的整体水平,得分越高,表明自我同情程度越高。SCS量表具有良好的信效度。Birnie报告了SCS亚量表具有较高的内部一致性(α = 0.77~0.81),整体具有较高的收敛和鉴别效度(Birnie et al., 2010)。本研究中该问卷的Cronbach’s α系数为0.917。

2.2.4. 正念五因素问卷(FFMQ; Baer et al., 2006)

该量表是一份有39个项目的问卷,采用李克特5分制来衡量正念的五个方面:观察身体状态(观察),描述一个人的经验(描述),有意识地行动(意识),不立即反应地接近世界(无反应),以及对一个人的思想或经验不作判断(无判断)。每个分量表的分数是平均的,每个分量表的分数越高,表明正念的水平越高。在原始调查中,每个子量表具有良好的内部信度:观察(α = 0.83)、描述(α = 0.91)、意识(α = 0.87)、无反应(α = 0.75)和无判断(α = 0.87)。本研究中该问卷的Cronbach’s α系数为0.942。

2.3. 统计处理

采用IBM SPSS Statistics 26对收集的数据进行共同方法偏差、描述统计、独立样本t检验、信度分析、相关分析;采用Hayes编制的SPSS宏程序Process v3.4插件进行中介效应检验,并以Bootstrap法检验回归系数的显著性。

3. 结果

3.1. 共同方法偏差分析

问卷由参与者自主填写,为了检验本研究中是否存在共同方法偏差,采用Harman单因子检测方法 (周浩,龙立荣,2004),对数据进行同源方差检验。结果显示,特征值大于1的因子共16个,共解释了59.55%的变异,最大解释变异率的因子解释变异量为18.23% (小于临界标准40%),没有解释力过大的因子,表明本研究不存在严重共同方法偏差。

3.2. 描述性统计、差异分析、相关分析及中介分析

3.2.1. 描述性统计

有童年不良经历780人(39.3%),无童年不良经历1207人(60.7%);曾经隔离159人(8%),正在隔离75人(3.8%),未隔离1753人(88.2%)。

3.2.2. 差异分析

表1所示,以童年不良经历和隔离情况作为自变量,心理健康作为因变量,进行单因素和多因素方差分析。结果显示,有无童年不良经历的参与者在心理健康上存在统计学意义(p < 0.001),是否隔离不存在统计学意义。由此可见,童年不良经历能显著影响心理健康(抑郁、焦虑、压力);隔离不影响心理健康(抑郁、焦虑、压力);童年不良经历和隔离无交互作用。

Table 1. Mental health differences test for presence or absence of adverse childhood experiences and quarantine (multivariate analysis of variance)

表1. 有无童年不良经历、是否隔离的心理健康差异检验(多因素方差分析)

3.2.3. 相关分析

各变量的均值、标准差及相关系数见表2所示。由此可见,童年不良经历与正念、自我同情均呈显著负相关,与心理健康(抑郁、焦虑、压力)成显著正相关;正念与自我同情成显著正相关,与心理健康(抑郁、焦虑、压力)呈显著负相关;自我同情与心理健康(抑郁、焦虑、压力)呈显著负相关。

Table 2. Mean, standard deviation and correlation analysis of each variable

表2. 各变量的均值、标准差及相关分析

**在0.01级别(双尾),相关性显著。

3.2.4. 正念与自我同情的链式中介效应检验

使用Hayes (2013)提供的SPSS插件PROCESS v3.4 by Andrew F. Hayes的MODEL 6进行中介效应检验。以童年不良经历为自变量,以正念和自我同情为中介变量,以心理健康(抑郁、焦虑、压力)为因变量进行中介分析,得出结果见表3所示,童年不良经历负向预测正念和自我同情,正向预测心理健康(抑郁、焦虑、压力);正念正向预测自我同情,负向预测心理健康(抑郁、焦虑、压力);自我同情负向预测心理健康(抑郁、焦虑、压力)。路径系数结果见图1所示,整个回归方程显著,R2 = 0.13,F(1, 1985) = 284.53,p < 0.00001。

同时采用Hayes提供的偏差校正的非参数百分位Bootstrap (5000个抽样)方法进行中介效应检验,结果见表4所示,以正念为中介变量的路径间接效应为0.03 (95% CI = [0.02, 0.04]),以自我同情为中介变量的路径间接效应为0.07 (95% CI = [0.05, 0.08]),以正念与自我同情为中介变量的路径间接效应为0.04 (95% CI = [0.03, 0.05]),所有间接效应合计0.13 (95% CI = [0.11, 0.15]),所有路径的95%置信区间都不包含0,说明正念和自我同情的中介效应显著,并且正念和自我同情的链式中介效应也显著。这一结果支持了假设2,正念和自我同情在童年不良经历对心理健康(抑郁、焦虑、压力)的链式中介作用成立。

Table 3. Results of regression analysis of variables

表3. 变量的回归分析结果

*p < 0.05, **p < 0.01.

Table 4. Results of mediating effect test

表4. 中介效应检验结果

备注:LLCI指估计值95%区间下限,ULCI指估计值95%区间上限。

注:X = 童年不良经历;M1 = 正念;M2 = 自我同情;Y = 心理健康(抑郁、焦虑、压力)。

Figure 1. Relationship model between variables (standardized regression coefficient) (*p < 0.05, **p < 0.01)

图1. 变量间关系模型(标准化回归系数) (*p < 0.05, **p < 0.01)

4. 讨论

4.1. 研究1:疫情下有儿童不良经历史的成人的心理健康水平下降。

研究1初步部分验证了假设1,结果表明,疫情下有儿童不良经历史的成人的心理健康水平下降;疫情隔离不影响成人的心理健康(抑郁、焦虑、压力)水平;童年不良经历和隔离无交互作用。过往研究只测量评估了疫情下受访者的心理健康状况,如:68.57%新型冠状病毒患者在出院后2周隔离期间出现焦虑(孙洁等,2021)。但未比较疫情中是否隔离带来的心理健康差异。本研究结果表明,童年不良经历能显著影响心理健康(抑郁、焦虑、压力)。这与多位心理学家研究结论一致,儿童不良经历(ACEs)被发现与各种情绪和焦虑障碍以及包括抑郁、焦虑和创伤后应激障碍在内的心理困扰症状呈正相关(Anda et al., 2009; Chapman et al., 2004; Kroska et al., 2018; Liu, 2017; Sachs-Ericsson et al., 2017; Sheffler et al., 2020)。

4.2. 研究2:儿童不良经历影响疫情下成人的心理健康状况, 正念和自我同情可能起链式中介作用

4.2.1. 相关

本研究结果表明,童年不良经历与正念、自我同情均呈显著负相关,与心理健康(抑郁、焦虑、压力)呈显著正相关;正念与自我同情呈显著正相关,与心理健康(抑郁、焦虑、压力)呈显著负相关;自我同情与心理健康(抑郁、焦虑、压力)呈显著负相关。这与过往研究一致,有研究表明,儿童虐待与低自我同情有关(Vettese et al., 2011; Tanaka et al., 2011),童年期虐待与正念呈显著负相关(岳鹏飞等,2020)。报告有严重虐待史的人,如果他们报告的特质正念水平也很低,那么他们尤其容易患复发性抑郁症(Beshai & Parmar, 2019)。不良童年经历(ACEs)与心理健康之间存在显著的负相关,而正念与心理健康之间存在显著的正相关(Huang et al., 2021)。另有研究表明,创伤经历,如性侵犯,可能导致个体正念水平下降,这可能反过来导致消极的心理结果(Kroska et al., 2018)。较高的童年情感虐待、情感忽视和身体虐待与较低的自我同情相关(Tanaka et al., 2011)。抑郁症与儿童虐待及其子量表(包括情绪虐待、身体虐待、性虐待、情绪忽视和身体忽视)显著正相关(Tao et al., 2021)。正念与较低水平的抑郁和焦虑症状严重程度相关。高水平的正念削弱了创伤暴露和更高的焦虑症状严重程度之间的联系(Tubbs et al., 2019)。童年不良经历(ACEs)的直接和间接地通过较低的自我同情与更高的广泛性焦虑症状显著相关(Hagan et al., 2021)。情感虐待和忽视与自我同情减少之间存在显著相关(Messman-Moore & Bhuptani, 2020)。情感虐待、情感忽视和身体忽视都通过降低自我同情与自杀意念呈正相关(Zhang et al., 2021)。心理虐待(情感虐待和情感忽视)通过降低自我同情与成人抑郁症状相关(Wu et al., 2018)。正念的增加促进了自我同情的增加,自我同情和正念都与焦虑的减少有关(Bergen-Cico & Cheon, 2014)。

4.2.2. 正念与自我同情在童年不良经历与心理健康间的链式中介作用

本研究结果支持了假设2,童年不良经历通过正念和自我同情链式中介了心理健康(抑郁、焦虑、压力)。过往研究虽然没有关于正念和自我同情在童年不良经历与心理健康方面的链式中介的研究,但有研究表明,童年期虐待通过正念的中介效应作用于网络成瘾(岳鹏飞等,2020)。正念在儿童期不良经历对中国大学生心理健康的影响中起到部分中介作用(Huang et al., 2021)。正念的培养对特质焦虑的减少具有最强大的中介作用(Bergen-Cico & Cheon, 2014)。自我同情在儿童虐待严重程度与后期情绪失调之间起中介作用(Vettese et al., 2011)。自我同情对童年不良经历和焦虑有部分中介作用(Chi et al., 2022)。自我同情在儿童虐待与抑郁之间起部分中介作用(Tao et al., 2021)。自我同情在童年虐待和心理健康之间起到部分中介作用(Tarber et al., 2016)。

5. 局限性和发展

目前的研究有几个局限性。第一,数据收集可能覆盖范围不够广,为了推广研究结果,还需要更多不同年龄、群体和文化背景等,更有代表性的样本。第二,本研究具有横断面设计研究的缺点。由于所有变量都是同时测量的,所以这项研究不能检验随时间变化的影响和中介效应。因此,需要利用纵向方法进行进一步研究。第三,数据收集由自我报告问卷组成的数据有众所周知的局限性。未来的研究可以考虑采用三角法收集数据,数据来源还可以包括来自教师、朋友和父母等,以使数据更有效,另外,也可以使用实验或治疗方式来检验结果。第四,心理健康(抑郁、焦虑和压力)是一个多层面的概念,我们只测量了受试者的主观感受报告,而更全面的生物反馈测量,可以揭示更多的信息。第五,正念和自我同情的部分效应意味着,还有其他解释因素,这表明有必要对当前研究中的变量进行更多的研究。最后,不足之处,对于39.3%的有童年不良经历的780名参与人员,未能进一步跟踪提供心理辅导等支持。

尽管有这些局限性,但目前的研究扩展了之前的研究,提示了童年不良经历对心理健康的作用机制,有利于深入了解有童年不良经历史的个体的心理困扰形成过程。研究结果提示,改善正念和自我同情可能有助于缓解童年不良经历对心理健康的影响,有利于维护该群体的身心健康,有关基于正念的行为干预可以帮助有童年虐待史的年轻人缓解压力、抑郁和焦虑。自我同情的增加在干预的治疗效果中起着重要的作用(Joss et al., 2019)。在今后的干预方案制定中,可以结合正念训练和自我同情干预共同进行,临床可以使用正念慈悲生活(MBCL)、正念认知疗法(MBCT)和同情聚焦疗法(CFT)等进行治疗,达到显著增加正念和自我同情,减少沉思、抑郁、焦虑和压力,减轻重度、长期、反复出现抑郁症状的人群的抑郁症状的目的(Schuling et al., 2020; Frostadottir & Dorjee, 2019; Williams et al., 2014; Kuyken et al., 2015; Michalak et al., 2016)。

文章引用

江红芳,蒋冬红. 新型冠状病毒疫情背景下儿童期不良经历对成人心理健康的影响:正念和自我同情的链式中介作用
The Impact of Adverse Childhood Experiences on Adult Mental Health under the Covid-19 Pandemic: The Chain Mediating Role of Mindfulness and Self-Compassion[J]. 心理学进展, 2023, 13(01): 283-2893. https://doi.org/10.12677/AP.2023.131035

参考文献

  1. 1. 百度百科词条(2022). 心理学. https://baike.baidu.com/item/%E5%BF%83%E7%90%86%E5%81%A5%E5%BA%B7/5593?fr=aladdin

  2. 2. 胡玄一, 刘爱书, 石婷玉, 等(2021). 大学生童年期虐待与特质抑郁和正念的关系. 中国心理卫生杂志, 35(5), 410-416.

  3. 3. 石小盼, 罗红, 房茹, 等(2021). 新冠肺炎疫情下湖北省大学生焦虑抑郁现状及影响因素. 河南预防医学杂志, 32(9), 657-661.

  4. 4. 苏珊•诺伦-霍克西玛(2017). 变态心理学(p. 26, 邹丹 译). 人民邮电出版社有限公司.

  5. 5. 孙洁, 邱文娟, 李海燕, 等(2021). 新型肺炎患者出院隔离期焦虑心理调查. 解放军医院管理杂志, (8), 758-760.

  6. 6. 王剑峰(2020). 新冠肺炎疫情下坚持临床实践的在校医学生心理健康状况及职业认同调查. 中国高等医学教育, (9), 7-8.

  7. 7. 岳鹏飞, 张敏, 魏华(2020). 童年虐待经历对网络成瘾的影响: 正念和心理弹性的作用. 中国临床心理学杂志, 28(6), 1144-1147+1151.

  8. 8. 赵幸福, 张亚林, 李龙飞, 等(2005). 中文版儿童期虐待问卷的信度和效度. 中国临床康复, 9(20), 105-107.

  9. 9. 周浩, 龙立荣(2004). 共同方法偏差的统计检验与控制方法. 心理科学进展, 12(6), 942-950.

  10. 10. Anda, R. F., Dong, M., Brown, D. W. et al. (2009). The Relationship of Adverse Childhood Experiences to a History of Premature Death of Family Members. BMC Public Health, 9, Article No. 106. https://doi.org/10.1186/1471-2458-9-106

  11. 11. Baer, R. A., Smith, G. T., Hopkins, J. et al. (2006). Using Self-Report Assessment Methods to Explore Facets of Mindfulness. Assessment, 13, 27-45. https://doi.org/10.1177/1073191105283504

  12. 12. Bandoli, G., Campbell-Sills, L., Kessler, R. C. et al. (2017). Childhood Adversity, Adult Stress, and the Risk of Major Depression or Generalized Anxiety Disorder in US Soldiers: A Test of the Stress Sensitization Hypothesis. Psychological Medicine, 47, 2379-2392. https://doi.org/10.1017/S0033291717001064

  13. 13. Bergen-Cico, D., & Cheon, S. (2014). The Mediating Effects of Mindfulness and Self-Compassion on Trait Anxiety. Mindfulness, 5, 505-519. https://doi.org/10.1007/s12671-013-0205-y

  14. 14. Bernstein, D. P., Stein, J. A., Newcomb, M. D., Walker, E., Pogge, D., Ahluvalia, T. et al. (2003). Development and Validation of a Brief Screening Version of the Childhood Trauma Questionnaire. Child Abuse & Neglect, 27, 169-190. https://doi.org/10.1016/S0145-2134(02)00541-0

  15. 15. Beshai, S., & Parmar, P. (2019). Trait Mindfulness May Buffer against the Deleterious Effects of Childhood Abuse in Recurrent Depression: A Retrospective Exploratory Study. Clinical Psychologist, 23, 26-36. https://doi.org/10.1111/cp.12147

  16. 16. Birnie, K., Speca, M., & Carlson, L. E. (2010). Exploring Self-Compassion and Empathy in the Context of Mindfulness-Based Stress Reduction (MBSR). Stress and Health, 26, 359-371. https://doi.org/10.1002/smi.1305

  17. 17. Bolduc, R., Bigras, N., Daspe, M. È. et al. (2018). Childhood Cumulative Trauma and Depressive Symptoms in Adulthood: The Role of Mindfulness and Dissociation. Mindfulness, 9, 1594-1603. https://doi.org/10.1007/s12671-018-0906-3

  18. 18. Carmody, J., Baer, R. A., Lykins, E. L. B. et al. (2009). An Empirical Study of the Mechanisms of Mindfulness in a Mindfulness-Based Stress Reduction Program. Journal of Clinical Psychology, 65, 613-626. https://doi.org/10.1002/jclp.20579

  19. 19. Chapman, D. P., Whitfield, C. L., Felitti, V. J. et al. (2004). Adverse Childhood Experiences and the Risk of Depressive Disorders in Adulthood. Journal of Affective Disorders, 82, 217-225. https://doi.org/10.1016/j.jad.2003.12.013

  20. 20. Chi, X., Jiang, W., Guo, T. et al. (2022). Relationship between Adverse Childhood Experiences and Anxiety Symptoms among Chinese Adolescents: The Role of Self-Compassion and Social Support. Current Psychology, 1-13. https://doi.org/10.1007/s12144-021-02534-5

  21. 21. Das-Munshi, J., Chang, C. K., Bakolis, I. et al. (2021). All-Cause and Cause-Specific Mortality in People with Mental Disorders and Intellectual Disabilities, before and during the COVID-19 Pandemic: Cohort Study. The Lancet Regional Health-Europe, 11, Article ID: 100228. https://doi.org/10.1016/j.lanepe.2021.100228

  22. 22. Dong, M., Anda, R. F., Felitti, V. J. et al. (2004). The Interrelatedness of Multiple Forms of Childhood Abuse, Neglect, and Household Dysfunction. Child Abuse & Neglect, 28, 771-784. https://doi.org/10.1016/j.chiabu.2004.01.008

  23. 23. Felitti, V. J., Anda, R. F., Nordenberg, D. et al. (1998). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14, 245-258. https://doi.org/10.1016/S0749-3797(98)00017-8

  24. 24. Frostadottir, A. D., & Dorjee, D. (2019). Effects of Mindfulness Based Cognitive Therapy (MBCT) and Compassion Focused Therapy (CFT) on Symptom Change, Mindfulness, Self-Compassion, and Rumination in Clients with Depression, Anxiety, and Stress. Frontiers in Psychology, 10, Article 1099. https://doi.org/10.3389/fpsyg.2019.01099

  25. 25. Hagan, M., Lara, J., & Montanes, M. C. (2021). Childhood Adversity, Socioemotional Functioning and Generalized Anxiety in Young Adults from Mixed Immigration Status Families. Child Abuse & Neglect, 118, Article ID: 105128. https://doi.org/10.1016/j.chiabu.2021.105128

  26. 26. Hayes, A. F. (2013). Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach. The Guilford Press.

  27. 27. Henry, J. D., & Crawford, J. R. (2005). The Short-Form Version of the Depression Anxiety Stress Scales (DASS-21): Construct Validity and Normative Data in a Large Non-Clinical Sample. British Journal of Clinical Psychology, 44, 227-239. https://doi.org/10.1348/014466505X29657

  28. 28. Huang, C. C., Tan, Y., Cheung, S. P. et al. (2021). Adverse Childhood Experiences and Psychological Well-Being in Chinese College Students: Mediation Effect of Mindfulness. International Journal of Environmental Research and Public Health, 18, Article 1636. https://doi.org/10.3390/ijerph18041636

  29. 29. Janusek, L. W., Tell, D., & Mathews, H. L. (2020). Mindfulness Predicts Psycho-Behavioral Improvement after Breast Cancer Diagnosis: Influence of Childhood Adversity. Western Journal of Nursing Research, 43, 239-249. https://doi.org/10.1177/0193945920932290

  30. 30. Joss, D., Khan, A., Lazar, S. W. et al. (2019). Effects of a Mindfulness-Based Intervention on Self-Compassion and Psychological Health among Young Adults with a History of Childhood Maltreatment. Frontiers in Psychology, 10, Article 2373. https://doi.org/10.3389/fpsyg.2019.02373

  31. 31. Kabat-Zinn, J. (1982). An Outpatient Program in Behavioral Medicine for Chronic Pain Patients Based on the Practice of Mindfulness Meditation: Theoretical Considerations and Preliminary Results. General Hospital Psychiatry, 4, 33-47. https://doi.org/10.1016/0163-8343(82)90026-3

  32. 32. Kabat-Zinn, J. (1994). Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life. Hachette Books.

  33. 33. Kabat-Zinn, J. (1996). Mindfulness Meditation: What It Is, What It Isn’t, and Its Role in Health Care and Medicine. In Y. Haruki, Y. Ishii, & M. Suzuki (Eds.), Comparative and Psychological Study on Meditation (pp. 161-170). Eburon Publishers.

  34. 34. Kabat-Zinn, J., & Hanh, T. N. (1990). Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. Delacorte Press.

  35. 35. Kelifa, M. O., Yang, Y., Herbert, C. et al. (2020). Psychological Resilience and Current Stressful Events as Potential Mediators between Adverse Childhood Experiences and Depression among College Students in Eritrea. Child Abuse & Neglect, 106, Article ID: 104480. https://doi.org/10.1016/j.chiabu.2020.104480

  36. 36. Kroska, E. B., Miller, M. L., Roche, A. I. et al. (2018). Effects of Traumatic Experiences on Obsessive-Compulsive and Internalizing Symptoms: The Role of Avoidance and Mindfulness. Journal of Affective Disorders, 225, 326-336. https://doi.org/10.1016/j.jad.2017.08.039

  37. 37. Kuyken, W., Hayes, R., Barrett, B. et al. (2015). Effectiveness and Cost-Effectiveness of Mindfulness-Based Cognitive Therapy Compared with Maintenance Antidepressant Treatment in the Prevention of Depressive Relapse or Recurrence (PREVENT): A Randomised Controlled Trial. The Lancet, 386, 63-73. https://doi.org/10.1016/S0140-6736(14)62222-4

  38. 38. Liu, R. T. (2017). Childhood Adversities and Depression in Adulthood: Current Findings and Future Directions. Clinical Psychology: Science and Practice, 24, 140-153. https://doi.org/10.1111/cpsp.12190

  39. 39. Lovibond, P. F., & Lovibond, S. H. (1995). The Structure of Negative Emotional States: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33, 335-343. https://doi.org/10.1016/0005-7967(94)00075-U

  40. 40. McKeen, H., Hook, M., Podduturi, P. et al. (2021). Mindfulness as a Mediator and Moderator in the Relationship between Adverse Childhood Experiences and Depression. Current Psychology, 1-11. https://doi.org/10.1007/s12144-021-02003-z

  41. 41. Messman-Moore, T. L., & Bhuptani, P. H. (2020). Self-Compassion and Fear of Self-Compassion: Mechanisms Underlying the Link between Child Maltreatment Severity and Psychological Distress in College Women. Mindfulness, 11, 1446-1459. https://doi.org/10.1007/s12671-020-01361-2

  42. 42. Michalak, J., Probst, T., Heidenreich, T. et al. (2016). Mindfulness-Based Cognitive Therapy and a Group Version of the Cognitive Behavioral Analysis System of Psychotherapy for Chronic Depression: follow-Up Data of a Randomized Controlled Trial and the Moderating Role of Childhood Adversities. Psychotherapy and Psychosomatics, 85, 378-380. https://doi.org/10.1159/000447014

  43. 43. Neff, K. D. (2003a). The Development and Validation of a Scale to Measure Self-Compassion. Self and Identity, 2, 223-250. https://doi.org/10.1080/15298860309027

  44. 44. Neff, K. D. (2003b). Self-Compassion: An Alternative Conceptualization of a Healthy Attitude toward Oneself. Self and Identity, 2, 85-101. https://doi.org/10.1080/15298860309032

  45. 45. Sachs-Ericsson, N. J., Sheffler, J. L., Stanley, I. H. et al. (2017). When Emotional Pain Becomes Physical: Adverse Childhood Experiences, pain, and the Role of Mood and Anxiety Disorders. Journal of Clinical Psychology, 73, 1403-1428. https://doi.org/10.1002/jclp.22444

  46. 46. Scheff, T. J. (1981). The Distancing of Emotion in Psychotherapy. Psychotherapy, 18, 46-53. https://doi.org/10.1037/h0085960

  47. 47. Schuling, R., Huijbers, M. J., van Ravesteijn, H. et al. (2020). Recovery from Recurrent Depression: Randomized Controlled Trial of the Efficacy of Mindfulness-Based Compassionate Living Compared with Treatment-as-Usual on Depressive Symptoms and Its Consolidation at Longer Term Follow-Up. Journal of Affective Disorders, 273, 265-273. https://doi.org/10.1016/j.jad.2020.03.182

  48. 48. Shapiro, S. L., Carlson, L. E., Astin, J. A. et al. (2006). Mechanisms of Mindfulness. Journal of Clinical Psychology, 62, 373-386. https://doi.org/10.1002/jclp.20237

  49. 49. Sheffler, J. L., Stanley, I., & Sachs-Ericsson, N. (2020). ACEs and Mental Health Outcomes. In G. J. G. Asmundson, & T. O. Afifi (Eds.), Adverse Childhood Experiences (pp. 47-69). Academic Press. https://doi.org/10.1016/B978-0-12-816065-7.00004-5

  50. 50. Tanaka, M., Wekerle, C., Schmuck, M. L. et al. (2011). The Linkages among Childhood Maltreatment, Adolescent Mental Health, and Self-Compassion in Child Welfare Adolescents. Child Abuse & Neglect, 35, 887-898. https://doi.org/10.1016/j.chiabu.2011.07.003

  51. 51. Tao, J., He, K., & Xu, J. (2021). The Mediating Effect of Self-Compassion on the Relationship between Childhood Maltreatment and Depression. Journal of Affective Disorders, 291, 288-293. https://doi.org/10.1016/j.jad.2021.05.019

  52. 52. Tarber, D. N., Cohn, T. J., Casazza, S. et al. (2016). The Role of Self-Compassion in Psychological Well-Being for Male Survivors of Childhood Maltreatment. Mindfulness, 7, 1193-1202. https://doi.org/10.1007/s12671-016-0562-4

  53. 53. Tubbs, J. D., Savage, J. E., Adkins, A. E. et al. (2019). Mindfulness Moderates the Relation between Trauma and Anxiety Symptoms in College Students. Journal of American College Health, 67, 235-245. https://doi.org/10.1080/07448481.2018.1477782

  54. 54. Vettese, L. C., Dyer, C. E., Li, W. L. et al. (2011). Does Self-Compassion Mitigate the Association between Childhood Maltreatment and Later Emotion Regulation Difficulties? A Preliminary Investigation. International Journal of Mental Health and Addiction, 9, 480-491. https://doi.org/10.1007/s11469-011-9340-7

  55. 55. Wang, C., Pan, R., Wan, X. et al. (2020a). Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China. International Journal of Environmental Research and Public Health, 17, Article 1729. https://doi.org/10.3390/ijerph17051729

  56. 56. Wang, R., Li, J., Mei, J. et al. (2020b). Research on the Suicide Risk, Sleep, Psychological Status and Influencing Factors of Coronavirus Disease 2019 Patients. Acta Academiae Medicinae Militaris Tertiae, 14, 1462-1468.

  57. 57. Williams, J. M. G., Crane, C., Barnhofer, T. et al. (2014). Mindfulness-Based Cognitive Therapy for Preventing Relapse in Recurrent Depression: A Randomized Dismantling Trial. Journal of Consulting and Clinical Psychology, 82, 275-286. https://doi.org/10.1037/a0035036

  58. 58. World Health Organization (2016). Child Maltreatment. https://www.who.int/news-room/fact-sheets/detail/child-maltreatment

  59. 59. Wu, Q., Chi, P., Lin, X. et al. (2018). Child Maltreatment and Adult Depressive Symptoms: Roles of Self-Compassion and Gratitude. Child Abuse & Neglect, 80, 62-69. https://doi.org/10.1016/j.chiabu.2018.03.013

  60. 60. Yang, H., Chen, W., Hu, Y. et al. (2020). Pre-Pandemic Psychiatric Disorders and Risk of COVID-19: A UK Biobank Cohort Analysis. The Lancet Healthy Longevity, 1, E69-E79. https://doi.org/10.1016/S2666-7568(20)30013-1

  61. 61. Zhang, H., Liu, M., & Long, H. (2021). Child Maltreatment and Suicide Ideation in Rural China: The Roles of Self-Compassion and School Belonging. Child and Adolescent Social Work Journal, 38, 325-335. https://doi.org/10.1007/s10560-020-00679-z

  62. 62. Zhao, Q., Hu, C., Feng, R. et al. (2020). Investigation of the Mental Health of Patients with Novel Coronavirus Pneumonia. Chinese Journal of Neurology, No. 12, E003.

期刊菜单