摘要目的:探讨中国青少年抑郁患者自伤行为的心理特征及情绪行为困难的链式中介作用机制。方法:2022年3月至2024年1月，纳入214例住院青少年抑郁患者(自伤组158例，非自伤组56例)，通过Rosenberg自尊量表(SES)、Barratt冲动量表(BIS-11)、抑郁自评量表(SDS)和长处和困难问卷(SDQ)评估心理特征。使用R 4.4.1软件进行置换检验、岭回归及Bootstrap链式中介模型分析。结果:自伤组自尊[(21.6±4.9)分比(24.8±6.4)分]评分低于非自伤组( F＝14.9， P<0.01)，冲动性[(68.1±8.9)分比(63.2±10.6)分]、抑郁[(33.0±6.2)分比(27.5±7.6)分]及情绪行为困难[(21.5±5.8)分比(17.4±7.5)分]评分均高于非自伤组，均差异有统计学意义( F＝11.5、29.0、17.9，均 P<0.01)。岭回归显示，抑郁为青少年自伤行为的核心预测因子( β＝0.137， P<0.001)。中介分析表明，情绪行为困难对自伤行为的直接效应不显著( β＝0.004，95% CI＝－0.011~0.018)；情绪行为困难通过困难影响因子、抑郁的中介作用及二者的链式中介作用影响自伤行为，总间接效应为0.015(95% CI＝0.006~0.026)。 结论:青少年自伤行为由情绪行为困难、困难影响因子与抑郁的链式机制驱动，需靶向干预情绪调节与降低困难影响因子以阻断恶性循环。

abstractsObjective:To investigate the psychological characteristics of self-injurious behavior (SIB) among Chinese adolescents with depression and the chain mediation mechanism of emotional-behavioral difficulties.Methods:A total of 214 hospitalized adolescents with depression (158 SIB, 56 non-SIB) were assessed using the Rosenberg self-esteem scale (SES), Barratt impulsiveness scale-11 (BIS-11), self-rating depression scale (SDS), and strength and difficulty questionnaire (SDQ) from March 2022 to January 2024. Permutation test, ridge regression, and Bootstrap chain mediation models were applied to identify predictors and pathways by R 4.4.1 software.Results:The SIB group exhibited significantly lower self-esteem (21.6±4.9 vs 24.8±6.4, F=14.9, P<0.01) compared with the non-SIB group.The scores of impulsivity (68.1±8.9 vs 63.2±10.6), depression (33.0±6.2 vs 27.5±7.6), and emotional-behavioral difficulties (21.5±5.8 vs 17.4±7.5) in the SIB group were significantly higher than those in the non-SIB group( F=11.5, 29.0, 17.9, all P<0.01). Ridge regression identified depression ( β=0.137, P<0.001) as the core predictor. Chain mediation analysis revealed that the direct effect of emotional-behavioral difficulties on SIB was not significant ( β=0.004, 95% CI=-0.011-0.018).Emotional-behavioral difficulties affected self-injurions behavior indirectly through the mediating effects of functional impairment and depression, as well as their chain mediating effect, with a total indirect effect of 0.015 (95% CI=0.006-0.026). Conclusion:SIB is driven by the chain mechanism linking emotional-behavioral difficulties, functional impairment, and depression, necessitating integrated interventions targeting emotional regulation and functional recovery.