戒毒人员精神病理症状与药物成瘾的关系及心理痛苦的中介作用

doi:10.3969/j.issn.1674-8115.2025.01.006

上海交通大学学报（医学版） ›› 2025, Vol. 45 ›› Issue (1): 51-59.doi: 10.3969/j.issn.1674-8115.2025.01.006

戒毒人员精神病理症状与药物成瘾的关系及心理痛苦的中介作用

高雨燕¹^,²(), 李伟³, 王书婷⁴, 岸本鹏子⁵^,⁶, 张洳源¹^,⁴()

^1.上海交通大学心理学院，上海 200030
^2.温州医科大学慈溪生物医药研究院，慈溪 315302
^3.云南省第一强制隔离戒毒所，昆明 650212
^4.上海交通大学医学院附属精神卫生中心，上海 200030
^5.南开大学社会学院社会心理学系，天津 300110
^6.北京师范大学心理学部，北京 100875

收稿日期:2024-06-01 接受日期:2024-08-08 出版日期:2025-01-28 发布日期:2025-01-28
通讯作者: 张洳源，副研究员，博士；电子信箱：ruyuanzhang@gmail.com。
作者简介:高雨燕（2000—），女，硕士生；电子信箱：yuyangao110@gmail.com。
基金资助:
国家自然科学基金(32100901)

Relationship between psychopathological symptoms and drug addiction, and mediating role of psychological distress in drug addicts

GAO Yuyan¹^,²(), LI Wei³, WANG Shuting⁴, KISHIMOTO Tomoko⁵^,⁶, ZHANG Ruyuan¹^,⁴()

^1.School of Psychology, Shanghai Jiao Tong University, Shanghai 200030, China
^2.Cixi Biomedical Research Institute, Wenzhou Medical University, Cixi 315302, China
^3.Yunnan First Compulsory Isolation Drug Rehabilitation Center, Kunming 650212, China
^4.Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
^5.Department of Social Psychology, Nankai University School of Sociology, Tianjin 300110, China
^6.Faculty of Psychology, Beijing Normal University, Beijing 100875, China

Received:2024-06-01 Accepted:2024-08-08 Online:2025-01-28 Published:2025-01-28
Contact: ZHANG Ruyuan, E-mail: ruyuanzhang@gmail.com.
Supported by:
National Natural Science Foundation of China(32100901)

摘要/Abstract

摘要：

目的·识别男性戒毒人员群体中由精神病理症状自发关联而产生的不同共病类型，探究潜在类型与药物成瘾之间的关系，以及心理痛苦在其间的中介作用。方法·招募450名由云南第一强制隔离戒毒所根据2017年国家公安部修订的《吸毒成瘾认定办法》认定为吸毒成瘾的男性戒毒人员为受试。分别采用症状自评量表（Symptom Checklist 90，SCL-90）、成瘾物质渴求与自动化行为反应量表（Craving Automated Scale for Substances，CAS-S）、心理痛苦量表（Psychache Scale，PAS）评估受试的精神病理症状水平、药物成瘾程度和心理痛苦程度。采用潜在类别分析方法识别受试群体中可能存在的不同精神病理共病类型，并根据识别结果对类型进行命名。使用方差分析检验不同潜在类别在药物成瘾和心理痛苦程度上的差异，建立中介效应模型探究心理痛苦在不同潜在类别与药物成瘾之间的中介作用。结果·潜在类别分析将受试识别为高、中、低精神病理水平3个类型；根据SCL-90包含的10种精神病理症状结果，这3类受试的阳性率和共病数依次递减。3种类型受试在心理痛苦、药物成瘾严重程度上存在显著差异；精神病理症状正向预测受试心理痛苦和药物成瘾程度。心理痛苦在中度精神病理水平与药物成瘾之间起完全中介作用，在高度精神病理水平与药物成瘾之间起部分中介作用。结论·男性戒毒人员中存在高、中、低3种精神病理共病类型，心理痛苦在中、高精神病理水平与药物成瘾之间分别起完全和部分中介作用。

关键词: 药物成瘾, 精神病理症状, 心理痛苦, 共病, 潜在类别分析

Abstract:

Objective ·To identify different comorbidity types resulting from the spontaneous association of psychopathological symptoms among male drug addicts, explore the relationship between latent types and drug addiction, and examine the mediating role of psychological distress. Methods ·Four hundred and fifty male drug addicts, recruited by Yunnan First Compulsory Isolation Drug Rehabilitation Center according to the 2017 revised Drug Addiction Identification Method by the Ministry of Public Security, were enrolled as participants. The Symptom Checklist-90 (SCL-90), Craving Automated Scale for Substances (CAS-S), and Psychache Scale (PAS) were used to assess the severity of psychopathological symptoms, drug addiction, and psychological distress, respectively. Latent class analysis was employed to identify different types of psychopathological comorbidity that may exist in the participants, and the types were named based on the analysis results. Variance analysis was used to test differences in the severity of drug addiction and psychological distress among different latent types, and a mediation model was established to explore the mediating role of psychological distress between different latent types and drug addiction. Results ·Latent class analysis identified three types of psychopathology: high, medium, and low levels, with decreasing positive rates and numbers of comorbidity in each type based on the ten psychopathological symptoms included in the SCL-90. There were significant differences in the severity of psychological distress and drug addiction among the three types of participants. Psychopathological symptoms positively predicted the severity of psychological distress and drug addiction. Psychological distress completely mediated the relationship between medium levels of psychopathology and drug addiction, while partially mediating the relationship between high levels of psychopathology and drug addiction. Conclusion ·There are three types of psychopathological comorbidity among male drug addicts: high, medium, and low. Psychological distress plays a complete mediating role between medium levels of psychopathology and drug addiction, and a partial mediating role between high levels of psychopathology and drug addiction.

Key words: drug addiction, psychopathological symptoms, psychological distress, comorbidity, latent class analysis

中图分类号:

R749

高雨燕, 李伟, 王书婷, 岸本鹏子, 张洳源. 戒毒人员精神病理症状与药物成瘾的关系及心理痛苦的中介作用[J]. 上海交通大学学报（医学版）, 2025, 45(1): 51-59.

GAO Yuyan, LI Wei, WANG Shuting, KISHIMOTO Tomoko, ZHANG Ruyuan. Relationship between psychopathological symptoms and drug addiction, and mediating role of psychological distress in drug addicts[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(1): 51-59.

图/表 7

参考文献 38

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Item	Full sample (n=402)	High SCL (n=21)	Middle SCL (n=74)	Low SCL (n=307)
Psychoticism	40 (9.95)	9 (42.86)	27 (36.49)	4 (1.30)
Paranoid ideation	49 (12.19)	18 (85.71)	31 (41.89)	0 (0)
Phobic-anxiety	40 (9.95)	14 (66.67)	26 (35.14)	0 (0)
Anger-hostility	61 (15.17)	18 (85.71)	38 (51.35)	5 (1.62)
Anxiety	38 (9.45)	17 (80.95)	20 (27.02)	1 (0.33)
Depression	41 (10.20)	17 (80.95)	24 (32.43)	0 (0)
Interpersonal sensitivity	47 (11.69)	18 (85.71)	26 (35.14)	3 (0.97)
Obsessive-compulsive	49 (12.19)	19 (90.48)	24 (32.43)	6 (1.95)
Somatization	40 (9.95)	20 (95.24)	17 (22.97)	3 (0.97)
Additional items	52 (12.94)	18 (85.71)	30 (40.54)	4 (1.30)
Number of symptoms
0	281 (69.90)	0 (0)	0 (0)	281 (91.53)
1	28 (6.70)	0 (0)	2 (2.70)	26 (8.47)
2	20 (4.98)	0 (0)	20 (27.03)	0 (0)
3	18 (4.48)	0 (0)	18 (24.32)	0 (0)
Item	Full sample (n=402)	High SCL (n=21)	Middle SCL (n=74)	Low SCL (n=307)
4	12 (2.99)	0 (0)	12 (16.22)	0 (0)
5	14 (3.48)	0 (0)	14 (18.92)	0 (0)
6	10 (2.49)	3 (14.29)	7 (9.45)	0 (0)
7	8 (1.99)	7 (33.33)	1 (1.35)	0 (0)
8	1 (0.25)	1 (4.76)	0 (0)	0 (0)
9	7 (1.74)	7 (33.33)	0 (0)	0 (0)
10	3 (0.75)	3 (14.29)	0 (0)	0 (0)

Item	Full sample (n=402)	High SCL (n=21)	Middle SCL (n=74)	Low SCL (n=307)
Psychoticism	40 (9.95)	9 (42.86)	27 (36.49)	4 (1.30)
Paranoid ideation	49 (12.19)	18 (85.71)	31 (41.89)	0 (0)
Phobic-anxiety	40 (9.95)	14 (66.67)	26 (35.14)	0 (0)
Anger-hostility	61 (15.17)	18 (85.71)	38 (51.35)	5 (1.62)
Anxiety	38 (9.45)	17 (80.95)	20 (27.02)	1 (0.33)
Depression	41 (10.20)	17 (80.95)	24 (32.43)	0 (0)
Interpersonal sensitivity	47 (11.69)	18 (85.71)	26 (35.14)	3 (0.97)
Obsessive-compulsive	49 (12.19)	19 (90.48)	24 (32.43)	6 (1.95)
Somatization	40 (9.95)	20 (95.24)	17 (22.97)	3 (0.97)
Additional items	52 (12.94)	18 (85.71)	30 (40.54)	4 (1.30)
Number of symptoms
0	281 (69.90)	0 (0)	0 (0)	281 (91.53)
1	28 (6.70)	0 (0)	2 (2.70)	26 (8.47)
2	20 (4.98)	0 (0)	20 (27.03)	0 (0)
3	18 (4.48)	0 (0)	18 (24.32)	0 (0)
Item	Full sample (n=402)	High SCL (n=21)	Middle SCL (n=74)	Low SCL (n=307)
4	12 (2.99)	0 (0)	12 (16.22)	0 (0)
5	14 (3.48)	0 (0)	14 (18.92)	0 (0)
6	10 (2.49)	3 (14.29)	7 (9.45)	0 (0)
7	8 (1.99)	7 (33.33)	1 (1.35)	0 (0)
8	1 (0.25)	1 (4.76)	0 (0)	0 (0)
9	7 (1.74)	7 (33.33)	0 (0)	0 (0)
10	3 (0.75)	3 (14.29)	0 (0)	0 (0)

Category	Log likelihood	AIC	BIC	ssaBIC	Entropy	LMRT(P)	BLRT(P)
1	-1 419.600	2 858.319	2 898.308	2 866.577
2	-998.399	2 038.799	2 122.777	2 056.141	0.953	0.000	0.000
3	-963.266	1 990.532	2 118.498	2 016.958	0.924	0.153	0.000
4	-926.591	1 982.996	2 154.951	2 018.507	0.932	0.245	0.065

Category	Log likelihood	AIC	BIC	ssaBIC	Entropy	LMRT(P)	BLRT(P)
1	-1 419.600	2 858.319	2 898.308	2 866.577
2	-998.399	2 038.799	2 122.777	2 056.141	0.953	0.000	0.000
3	-963.266	1 990.532	2 118.498	2 016.958	0.924	0.153	0.000
4	-926.591	1 982.996	2 154.951	2 018.507	0.932	0.245	0.065

Item	High SCL (n=21)	Middle SCL (n=74)	Low SCL (n=307)	P value	Pairwise comparisons
Age/year	44.154±3.053	40.227±2.912	37.384±3.143	0.001	C1>C3
Education/n				0.212
Junior middle school and below	21.000±10.002	63.000±9.224	246.000±8.951
High school		9.000±3.492	51.000±4.075
Junior college		1.000±1.176	5.000±1.264
Bachelor′s degree and above		1.000±1.182	5.000±1.306
Marital status/n				0.589
Married	9.000±6.556	42.000±7.543	128.000±6.464
Divorce	5.000±4.882	13.000±4.206	69.000±4.742
Unmarried	7.000±5.775	19.000±5.056	110.000±5.976
Age of first drug use/year	29.482±3.303	25.487±2.732	24.532±2.821	0.022	C1>C3
Years of drug use/year	14.624±3.121	14.743±2.864	12.846±2.943	0.181
Number of relapses/n	4.055±3.431	2.092±2.005	1.598±1.483	0.006	C1>C3, C2>C3
Number of symptoms/n	8.006±1.174	3.553±1.202	0.082±0.532	<0.001	C1>C2>C3
SCL-90/score	198.523±4.557	150.802±6.121	82.172±6.781	<0.001	C1>C2>C3
CAS/score	41.003±2.402	36.946±2.443	32.703±6.887	<0.001	C1>C2>C3
PAS/score	37.102±2.523	36.383±2.582	25.964±2.942	<0.001	C1>C3, C2>C3

戒毒人员精神病理症状与药物成瘾的关系及心理痛苦的中介作用

Relationship between psychopathological symptoms and drug addiction, and mediating role of psychological distress in drug addicts

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Metrics

Variable	SCL Classe	CAS	Year of drug use	PAS	Age
SCL Classe	‒
CAS	0.327 (<0.001)	‒
Year of drug use	0.093 (0.181)	0.132 (0.001)	‒
PAS	0.462 (<0.001)	0.493 (<0.001)	0.163 (0.001)	‒
Age	0.177 (<0.001)	0.177 (<0.001)	0.615 (<0.001)	0.233 (<0.001)	‒

Item	F	P value	Effect	BootLLCI	BootULCI
Omnibus mediation effect
Omnibus total effect	20.510	<0.001
Omnibus direct effect	4.083	0.018
Relative mediation effect
Relative total effect
Middle SCL	4.570	<0.001	3.954	2.253	5.654
High SCL	5.013	<0.001	7.812
Relative direct effect
Middle SCL	0.761	0.447	0.669	-1.060	2.398
High SCL	2.855	0.005	4.228	1.317	7.139
Relative indirect effect
Middle SCL			3.284	2.271	4.370
High SCL			3.584	2.323	4.992

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