【作者】 罗英姿；

【导师】 姚树桥；

【作者基本信息】 中南大学 ， 临床心理学， 2009， 博士

【摘要】 目的：运用多水平追踪设计,探讨冗思反应方式与应激水平在青少年抑郁症状发生过程中的协同作用,对青少年抑郁症状的认知易感性-应激假说进行检验,并考察反应方式理论在中国青少年群体当中的适用性。研究方法：对湖南省长沙市某中学(城市中学)与浏阳某乡中学(乡村中学)青少年进行了6次共半年的追踪研究,其中长沙市中学553人,浏阳乡中学577人。第一次次采样过程中,所有参与者均完成了流调中心用抑郁量表(CES-D),(2)儿童青少年多维度焦虑量表(MASC),(3)反应方式问卷-冗思分量表(RSQ-R),(4)大五人格问卷-神经质分量表(FFI-N)。随后采用CES-D、MASC和青少年生活事件量表-修订版(ALEQ-R),每个月追踪测量一次所有参与者的抑郁、焦虑症状及生活事件发生情况。进行了反应方式问卷冗思分量表的重测信度研究。采用多层线性模型(HLM)对城乡追踪数据结果进行分析,构建抑郁症状的冗思易感性-应激模型。模型中因变量为追踪过程中抑郁/焦虑症状得分的波动情况,自变量分别为冗思和追踪过程中的生活应激水平的波动情况以及冗思与应激水平波动情况的交互作用,控制变量为焦虑/抑郁症状得分的波动情况、神经质得分以及性别。结果：(1)首次测查后一个月进行重测,RSQ冗思分量表显示出了良好的重测信度(r=.70,p<.001)。(2)在城乡样本中,在控制了第一次抑郁症状得分、追踪过程中焦虑症状的变化及神经质后,冗思仍对追踪过程中的抑郁症状得分有显著的预测作用,但控制了第一次焦虑症状得分、追踪过程中抑郁症状的变化及神经质后,冗思对追踪过程中的焦虑症状得分不再有显著的预测作用。(3)多层线性模型统计结果显示：在控制了焦虑、神经质以及性别因素后对城乡青少年抑郁症状的预测中,冗思的主效应、冗思与应激水平的交互作用均显著。在控制了抑郁、神经质以及性别因素后对城乡青少年焦虑症状进行预测冗思的主效应不显著,其与应激水平的交互作用显著。结论：(1)在中国城乡青少年中,冗思反应方式是一种相对稳定的具有个体化差异的认知易感因素,较高水平的冗思反应方式均与抑郁症状的进行性加重有关。(2)冗思反应方式在负性生活事件及抑郁水平进行性升高的关系中起到调节作用,支持抑郁症状的冗思-应激模型的构建。(3)冗思反应方式对于中国青少年的抑郁症状具有独立预测作用,但不是焦虑症状的独立预测因素,可能仅仅预测了经由抑郁症状中介的焦虑水平的升高。(4)反应方式理论在中国城乡青少年群体当中均具有较好的适用性。目的：运用静息态fMRI对抑郁症患者的自发脑功能活动情况进行研究,探索其局部一致性异常的脑区以及异常脑区的自发活动与个体冗思水平之间的关系,进一步探讨冗思及抑郁发生与大脑自发活动异常之间的关系,为解析抑郁症的神经病理基础提供新的资料。研究方法：31例首发抑郁症患者(依据美国精神疾病诊断与统计手册第四版,DSM -Ⅳ)与43例健康对照者在静息状态下接受脑功能磁共振(fMRI)扫描。以DPARSF软件对影像数据进行局部一致性(ReHo)分析,然后用SPM软件对病例组一对照组的ReHo值进行t检验；对差异脑区ReHo值与患者的社交性应激反应方式问卷冗思因子分进行相关分析,并选取激活最强点为感兴趣区进行与冗思得分相关的功能连接分析。结果：(1)正常组在右侧额内侧回、双侧额中回、左侧额上回及额下回等处ReHo值高于抑郁组；而抑郁组在左侧梭状回、枕中回、楔叶、双侧颞中回及右侧楔前叶等处ReHo值高于正常组(p＜0.005,cluster>10 voxels, uncorrected).(2)抑郁患者与正常组ReHo值的差异脑区中,与冗思水平正相关的有右侧壳核、右侧颞中回及右侧楔前叶,均为抑郁患者ReHo值显著升高的脑区。未发现与冗思反应方式负相关的脑区。(3)以右额内侧回及左侧梭状回为感兴趣区的功能连接分析表明,左侧尾状核、右侧壳核及脑岛等与右额内侧回的功能连接和冗思水平呈正相关；而右侧颞上回、颞下回、以及右侧额上回等与左侧梭状回的功能连接和冗思水平呈正相关。未发现与冗思水平呈负相关的功能连接。结论：(1)静息态fMRI下首发重症抑郁患者的ReHo异常脑区符合默认网络(default mode)的分布,额叶内侧皮质局部一致性的减低及楔前叶与颞叶后部皮质局部一致性的升高为其主要异常。(2)首发重症抑郁患者的冗思水平与静息态下腹侧纹状体及楔前叶等脑区的自发活动一致性异常呈正相关。与首发重症抑郁患者冗思水平正相关的功能连接主要有：额内侧回-纹状体、额内侧回-脑岛、额内侧回-梭状回。(3)抑郁症患者皮层-边缘系统情绪调节环路异常与冗思反应方式有关,冗思产生的机制可能是皮层-边缘系统的功能连接异常所带来的情感反应调节功能下降。更多还原

【Abstract】 Objective:(1) To investigate the roles of rumination, as well as stress, in the development of adolescents’depression symptoms, and construct the adolescents’rumination vulnerability-stress model. (2) To test the cross-cultural applicability of the response styles theory of depression in urban and rural samples of adolescents in China.Methods:553 high school students of Changsha in urban areas and 577 high school students of Liuyang in rural areas participated in the longitudinal study for half a year, with an interval of 1 months. All participants finished the Center for Epidemiological Studies Depression Scale, Multidimensional Anxiety Scale for Children, Response Styles Questionnaire-Rumination Subscale, NEO Five Factor Inventory-Neuroticism Subscale, and Adolescent Life Events Questionnaire at Time 1, and questionnaires assessing depression and anxiety symptoms as well as life events at each follow-up. Hierarchical Lineal Modeling (HLM) was used in data analysis.Results:(1) The test-retest reliability was 0.70(p<.001). (2) In both our urban and rural samples, after controlling for initial depressive symptoms, residual change in anxious symptoms, and neuroticism, rumination remained a significant predictor of depressive symptoms at all six follow-ups. However, after controlling for initial anxious symptoms, residual change in depressive symptoms, and neuroticism, rumination was no longer a significant predictor of anxious symptoms at any of the six follow-ups. (3) In both our urban and rural samples, both the main effect of Rumination and the Ruminationxstress interaction on adolescents’ depression symptoms were significant. Only the Ruminationx stress interaction, but not the main effect of Rumination on adolescents’depression symptoms were significant.Conclusions:(1) A ruminative response style represents a relatively stable individual difference variable in Chinese adolescents. Higher rumination was associated with greater increases in depressive symptoms over time。(2)In line with a vulnerability-stress framework, in both samples, the association between the occurrence of negative events and increases in depressive symptoms over time was moderated by rumination. (3) Rumination represents a vulnerability factor that confers independent risk for depression, but not for anxiety symptoms in Chinese adolescents. rumination may only predict increases in anxious symptoms through the mediating role of depressive symptoms. (4) The results of the current study provide support for the cross-cultural applicability of the response styles theory of depression to two independent samples of adolescents in Hunan, China. Objective:Using the functional magnetic resonance imaging (fMRI), we examined the differences of regional brain spontaneous activity in resting state in depressed vs healthy participants, and explored the relationship between rumination and regional homogeneity (ReHo) or the functional connectivity in depression patients, to provide new clues and evidences for the understanding of the neuropathological mechanism in major depressive disorder.Methods:31 patients with major depressive disorder (according to DSM-IV) and 43 healthy subjects participated in the resting state-fMRI scans. The DPARSF was used to detect the homodynamic responses across the whole brain on fMRI data, and SPM was used to examine the t-test differences of ReHo between depression and control, the correlation between the rumination factor score of RSQ-SSV and the ReHo in the abnormal brain area or the functional connectivity of ROI in depression patients.Results:(1) Compared with healthy controls, decreased ReHo right medial frontal gyrus, the bilateral middle frontal gyrus, the left superior frontal gyrus and the left inferior frontal gyrus, and increased ReHo were found in depressed patients in the left fusiform gyrus, the left middle occipital gyrus, the left cuneus, the bilateral middle temporal gyrus, and the right precuneus (p<0.005, cluster> 10voxels, uncorrected). (2) Rumination was positively correlated with the ReHo in the right putamen, the right middle temporal gyrus and the right precuneus, which showed abnormally increased ReHo in the depression patient. (3) Significant positive correlations were found between the rumination and the functional connectivities between the right medial frontal gyrus and the left caudate, the right putamen and the right insula in depression patients. Significant positive correlations were also found between the rumination and the functional connectivities between the the left fusiform gyrus and the right superior temporal gyrus, the right middle temporal gyrus and the right insula in depression patients.Conclusions:(1) The distribution of brain areas with abnormal ReHo in depressed patients are is consistent with the Default Mode Network. Depression patients involved the ReHo reduction in medial frontal cortex and the ReHo elevation in the precuneus and posterior temporal cortex. (2) Rumination was correlated with the abnormal spontaneous activity in the ventral striatum and putamen in depression patients, and correlated with the functional connectivities between the medial frontal cortex and striatum, insula, and the fusiform gyrus in the depression patient. (3) Rumination was associated with the abnormality in cortex-limbic system of mood regulating circuit in depression patients, and that provide neural evidence for the production of rumination.更多还原