本文關(guān)鍵詞： 兒童 軀體化癥狀 多層線性模型 生物—心理—社會(huì)模式　出處：《南開大學(xué)》2013年博士論文　論文類型：學(xué)位論文

【摘要】：兒童功能性軀體化癥狀(Functional Somatic Symptoms, FSS)又被稱為“無醫(yī)學(xué)解釋的軀體癥狀”,是兒科臨床上常見的主訴,常被診斷為功能性腹痛、慢性疲勞綜合癥等,嚴(yán)重的FSS有可能符合精神病學(xué)中軀體形式障礙的診斷。兒童FSS不僅高發(fā)于臨床樣本中,輕微的軀體化癥狀在非臨床社區(qū)樣本中也很常見。社區(qū)樣本中的兒童FSS較為輕微,未達(dá)到臨床診斷的標(biāo)準(zhǔn),但是表現(xiàn)形式多樣,對(duì)兒童的出勤率、學(xué)業(yè)成績(jī)、家庭關(guān)系等方面都有負(fù)面影響。兒童FSS通常沒有醫(yī)學(xué)設(shè)備可檢測(cè)出的生理病變,而是與心理、社會(huì)環(huán)境因素密切相關(guān)。 本研究以非臨床小學(xué)生和中學(xué)生為樣本,采用縱向追蹤和橫斷相結(jié)合的研究設(shè)計(jì),使用問卷法對(duì)兒童功能性軀體化癥狀的發(fā)生率、發(fā)展趨勢(shì)、心理發(fā)生機(jī)制和社會(huì)環(huán)境影響因素進(jìn)行了探討。研究共分為3個(gè)部分,由9個(gè)子研究組成。第一部分修訂了測(cè)量?jī)和疐SS的工具,并對(duì)本研究中使用到的研究工具的心理測(cè)量學(xué)屬性進(jìn)行了檢驗(yàn)；第二部分探討了兒童FSS的發(fā)展趨勢(shì),以及個(gè)體心理學(xué)屬性,包括情緒、認(rèn)知方式、行為等方面與兒童FSS之間的互動(dòng)關(guān)系；第三部分探討了家庭、班級(jí)以及負(fù)性生活事件等環(huán)境因素對(duì)兒童FSS的影響。 綜合本研究結(jié)果,得出了以下結(jié)論： 1.兒童FSS在非臨床兒童和青少年群體中很常見。 本研究中,僅有5.6%的被試兒童在過去3個(gè)月中沒有感覺到任何軀體不適,有36.5%的被試在過去3個(gè)月中體驗(yàn)到“輕微”至“非常多”的軀體化癥狀。29.4%的被試在過去3個(gè)月中頻繁體驗(yàn)到至少1種軀體化癥狀。本研究樣本中發(fā)生率較高的軀體化癥狀依次是感覺乏力(65.3%)、肌肉酸痛(55.9%)、四肢疼痛(52.2%)、頭疼(48.5%)。 2.兒童FSS隨著年齡增長(zhǎng)呈逐漸增多趨勢(shì)。 本研究發(fā)現(xiàn)兒童FSS隨著年齡增長(zhǎng)表現(xiàn)出逐漸增多的趨勢(shì),并且,增長(zhǎng)趨勢(shì)存在性別和焦慮水平上的個(gè)體差異。每隔九個(gè)月,女生的軀體化癥狀增長(zhǎng)速度比男生高0.41分。初始狀態(tài)焦慮得分較高的兒童,比低分組兒童的軀體化癥狀增長(zhǎng)速度更快。每隔9個(gè)月,初始狀態(tài)焦慮高分組比低分組增加值多0.44分。 3.兒童FSS與兒童的心理健康狀況之間存在密切關(guān)系。 兒童焦慮、抑郁、社交退縮、多動(dòng)、攻擊違紀(jì)行為、刻板行為等心理健康問題均可預(yù)測(cè)兒童FSS。軀體化癥狀中的“疼痛與乏力”因子與兒童心理健康之間的關(guān)系最為密切。 4.反芻思維是兒童FSS的認(rèn)知易感性因素。 癥狀反芻、沉思、反省維度以及反芻思維可正向預(yù)測(cè)兒童FSS水平。在控制了抑郁水平之后,反芻思維對(duì)兒童FSS的預(yù)測(cè)作用依然顯著。 兒童抑郁對(duì)反芻思維與兒童FSS之間的關(guān)系有調(diào)節(jié)作用,即兒童抑郁程度越高,反芻思維與兒童FSS之間的關(guān)系越密切。兒童抑郁在反芻思維與軀體化癥狀之間的部分中介作用亦顯著,說明反芻思維對(duì)兒童FSS的影響有一部分是通過抑郁實(shí)現(xiàn)的。 5.兒童FSS不會(huì)導(dǎo)致日常功能的嚴(yán)重?fù)p傷。 兒童FSS不能預(yù)測(cè)兒童的日常功能損傷,軀體化癥狀的出現(xiàn)對(duì)兒童和青少年正常生活的影響不大。 6.家庭環(huán)境對(duì)兒童FSS的發(fā)生發(fā)展有影響作用。 功能性軀體癥狀存在著母系代際傳遞性,高軀體化癥狀水平兒童母親不僅有較多的情緒問題,而且在敵對(duì)、偏執(zhí)、恐懼等各維度及心理健康總體水平都比低軀體化癥狀水平兒童的母親要差。 在家庭教養(yǎng)方式方面,父母的過度保護(hù)行為和父親的拒絕行為對(duì)兒童FSS有預(yù)測(cè)作用。母親的過度保護(hù)可以中介母親和子女之間FSS的傳遞,父親家庭教養(yǎng)方式對(duì)母系FSS傳遞無調(diào)節(jié)作用。 7.班級(jí)環(huán)境因素對(duì)兒童FSS影響較為輕微。 在諸多班級(jí)環(huán)境因素中,只有學(xué)業(yè)壓力可以預(yù)測(cè)兒童FSS。 8.負(fù)性生活事件以及不良的應(yīng)對(duì)方式可以預(yù)測(cè)兒童FSS。 人際關(guān)系、學(xué)業(yè)壓力以及受懲罰三類青少年負(fù)性生活事件中可以正向預(yù)測(cè)兒童FSS的發(fā)生；對(duì)應(yīng)激事件采取“積極的合理化解釋”的方式進(jìn)行應(yīng)對(duì),可以減少兒童FSS的發(fā)生發(fā)展,而“忍耐”、“發(fā)泄情緒”的方式應(yīng)對(duì)則會(huì)正向預(yù)測(cè)兒童FSS的發(fā)生
[Abstract]:Children with functional somatic symptoms (Functional Somatic, Symptoms, FSS) is also known as "no medical explanation of physical symptoms," is a common complaint in the pediatric clinic, often diagnosed with functional abdominal pain, chronic fatigue syndrome, the diagnosis of severe FSS has the potential to meet the mental illness of somatoform disorders in children. FSS is not only high in clinical samples, somatization symptoms are common in non clinical samples. The community in a community sample of children FSS are relatively minor, does not meet the clinical diagnosis standard, but the forms of children's academic achievement attendance, all have a negative impact on family relations. Physiological disease FSS children usually have no medical equipment can be detected, but with the psychological, social and environmental factors are closely related.
In this study, non clinical primary and secondary school students as samples, through the longitudinal and cross-sectional research design is combined with the use of questionnaire on incidence of children's functional somatic symptoms development trend, influencing factors of psychological mechanism and social environment are discussed. The research is divided into 3 parts, consisting of 9 sub the first part of the revision. To measure the children's FSS tool, and psychometric attributes of research tools used in this study were tested; the second part discusses the development trend of FSS in children, as well as individual psychological attributes, including emotional, cognitive, behavior and other aspects of interaction between children with FSS; the third part to investigate the influence of family, class and negative life events and other environmental factors of FSS in children.
Based on the results of this study, the following conclusions are drawn.
1. children, FSS, are common among non clinical and adolescent groups.
In this study, only 5.6% of the children were in the past 3 months did not feel any physical discomfort, there are 36.5% subjects in the past 3 months to experience the "minor" to "very much" somatic symptoms of.29.4% subjects in the past 3 months if traditional to experience at least 1 body the symptoms of somatization symptoms. The occurrence rate is higher in this study are the feeling of weakness (65.3%), (55.9%), muscle soreness and pain in the limbs (52.2%), headache (48.5%).
2. children's FSS increased with age.
The study found that children with age FSS showed a gradually increasing trend, and there are individual differences in gender and anxiety level on the growth trend. Every nine months, the growth rate of female somatic symptoms is higher than boys 0.41. Initial state anxiety scores higher than the growth of children, children's somatization symptoms group faster. Every 9 months, the initial state anxiety of high scoring groups to increase the value of more than 0.44 points.
There is a close relationship between 3. children's FSS and the mental health of children.
Children's mental health problems such as anxiety, depression, social withdrawal, hyperactivity, aggressive behavior and stereotyped behavior can all predict that the relationship between "FSS." and "mental fatigue" is most closely related to children's somatization symptoms.
4. ruminant thinking is a cognitive susceptibility factor for children's FSS.
Symptom ruminating, meditation, introspection and ruminating can positively predict children's FSS level. After controlling the level of depression, ruminant plays a significant role in predicting FSS in children.
The children's depression has moderating effect on the relationship between rumination in children with FSS, the degree of depression in children is higher, the relationship between rumination and child FSS more closely. The part of the intermediary role between rumination and depression in children's somatization symptoms significantly, explain the effect of rumination on children FSS partly by depression to achieve.
5. children with FSS do not cause serious injury to daily function.
Children's FSS can not predict children's daily functional impairment, and the presence of somatization symptoms has little effect on normal life in children and adolescents.
6. the family environment has an impact on the development of FSS in children.
There are maternal intergenerational transmission and high somatization symptoms in functional somatic symptoms. Mothers of children not only have more emotional problems, but also have dimensions of hostility, paranoia, fear and mental health.
In terms of family rearing styles, parental overprotective behavior and father's refusal behavior have a predictive effect on children's FSS. Mothers' excessive protection can mediate the transmission of FSS between mothers and children, and the way of family rearing has no moderating effect on maternal FSS transmission.
The influence of 7. class environmental factors on children's FSS was slight.
Among the many class environmental factors, only academic pressure can predict children's FSS.
8. negative life events and bad coping styles can predict children's FSS.
The interpersonal relationship, the occurrence of FSS in children can positively predict academic pressure and punished three teenagers in negative life events; take "reasonable positive interpretation" way to deal with the stress events, can reduce the occurrence and development of FSS in children, and "patience", "to vent emotions" approach will be positively predict children FSS

【學(xué)位授予單位】：南開大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2013
【分類號(hào)】：R749.94

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