1 引言

抑郁癥在世界范圍內(nèi)的流行率為4.4% (Friedrich, 2017), 在中國為3.6% (Huang et al., 2019)。抑郁癥導致患者的生活質(zhì)量嚴重下降, 15%的患者選擇自殺(Gold et al., 2015)。此外, 抑郁癥大大增加了全球疾病的總體負擔, 也給病患家屬帶來了極大的痛苦(Herrman et al., 2019; Ledford, 2014)。據(jù)估計, 抑郁癥將在2030年成為世界第一大疾病(Lancet, 2012)。由于抑郁癥發(fā)病早期篩查工具的缺乏以及現(xiàn)有診斷方法(如量表、訪談等)的局限性(如, 有時難以實施或耗時較長), 尋找新的視角評估抑郁情緒對于抑郁癥的及時干預和治療具有重要意義。最近, 研究者找到了一種評估抑郁情緒的新方式, 即觀察個體的語言使用模式。

觀察個體的語言使用模式可以幫助心理學家在研究和臨床實踐中評估患者的抑郁情緒。例如, 在心理治療過程中, 通過對錄音會話或文字使用進行語言分析, 臨床醫(yī)生或研究人員可以潛在地評估患者在一段事件中抑郁情緒的軌跡。在一些情況下, 觀察抑郁癥患者的語言使用模式也可能是檢測和評估抑郁情緒相對容易的方法。

美國國家心理健康研究所(National Institute of Mental Health, 2012)鼓勵研究人員和實踐者采用多種方式評估各種心理疾病, 并特別強調(diào)制定能夠測量特定心理狀態(tài)的行為評估。觀察個體的語言使用模式為評估和檢查心理健康狀況提供了一種創(chuàng)新、便捷的方法, 可用于抑郁癥的早期預測和輔助診斷。語言使用模式的研究開始于傳統(tǒng)的心理學研究, 近年來, 隨著基于社交媒體研究的興起得到了越來越多研究者的關注。但總體來說, 該領域的研究仍處于起步階段, 并且國內(nèi)少有該領域的研究。本文對現(xiàn)有文獻進行整理, 綜合傳統(tǒng)心理學研究和社交媒體研究中的結果, 對抑郁癥患者的語言使用模式進行綜述, 為今后國內(nèi)在該領域的研究提供借鑒。

2 抑郁癥患者的精神病理學特征及相應語言標志

抑郁癥患者的語言使用模式涉及一系列詞匯使用的傾向性。這些詞匯能作為抑郁癥患者的精神病理學特征的語言標志, 將內(nèi)部心理特征轉化為外在行為特征表現(xiàn)出來(Boyd & Pennebaker, 2016), 因此在傳統(tǒng)心理學研究中受到了重視。

自我關注是抑郁癥患者的一個顯著特征, 它是“一種基于自我參考的, 內(nèi)部生成的信息的意識, 并且與對感官接受到的外部生成的信息的意識形成對比” (Ingram, 1990), 發(fā)生于比較現(xiàn)實自我和理想自我差異的自我評估的過程(Duval & Wicklund, 1972)。當感知到現(xiàn)實自我和理想自我差異時, 人們會不斷地采取減少差異的行為并進行自我評估, 直到這種差異消失。經(jīng)歷消極生活事件或未能實現(xiàn)重要目標的個體, 容易將理想狀態(tài)判斷為難以達到并發(fā)展出一種適應不良的自我關注方式, 這種過度的和僵化的自我關注會造成精神病理學方面的問題(Pyszcynski & Greenberg, 1987)。以往的研究證實了自我關注和抑郁相關(Nejad et al., 2019), 而個體自我關注的程度反映在第一人稱單數(shù)代詞的使用中(Pyszcynski & Greenberg, 1987; Silvia & Abele, 2002)。因此, 第一人稱單數(shù)代詞可作為個體自我關注的語言標志, 其在書面或口頭語言中的相對使用頻率反映了個體的自我關注程度(Zimmermann et al., 2017)。

在社會關系方面, 抑郁癥患者表現(xiàn)出社會隔離的特點。社會關系是人類生活的重要組成部分, 對心理健康有著重要的影響。社會關系常通過社交活動、社會支持的傳遞與交換、提供獲取物質(zhì)資源的機會對心理健康產(chǎn)生影響(Kawachi & Berkman, 2001)。不良社會關系和抑郁相關 (Liu et al., 2020), 其常見的指標包括單身、獨居、社交網(wǎng)絡薄弱或規(guī)模小以及社會互動不頻繁(Chan et al., 2011)。與主、賓語形式的第一人稱單數(shù)代詞強調(diào)自我作為一個孤立的個體相反, 第一人稱復數(shù)代詞強調(diào)將自我作為社會關系的一部分, 其使用除與抑郁相關外, 還與人際關系質(zhì)量和婚姻關系質(zhì)量等多項社會關系指標相關(Abe, 2009; Rohrbaugh et al., 2012; Schoch-Ruppen et al., 2018)。因此, 第一人稱復數(shù)代詞使用可作為衡量社會關系質(zhì)量的語言標志。

此外, 抑郁癥患者的認知表現(xiàn)出消極偏向和積極缺陷的特點。具體而言, 他們更多地注意消極刺激, 更少地注意積極刺激; 容易對情緒模糊的事件或刺激材料作出消極解釋; 傾向于反芻消極材料, 以及抑制自身的積極情緒反應(Suslow et al., 2019; Vanderlind et al., 2020)。個體的內(nèi)心世界可通過語言表達反映出來。多數(shù)研究表明, 相比正常個體, 抑郁個體更多地使用消極情緒詞, 更少地使用積極情緒詞(e.g. Schoch-Ruppen et al., 2018)。

3 抑郁癥患者語言使用模式：來自傳統(tǒng)心理學研究的結果

在傳統(tǒng)的心理學研究中, 研究者主要采用分析構建反應數(shù)據(jù)(Constructed-response data)的方法, 即, 要求被試在規(guī)定時間內(nèi)完成一個指定的開放式任務(如寫作任務或演講任務), 然后對其生成的文本內(nèi)容進行分析。任務指導語可以是“請談談你未來的職業(yè)生涯”或“請談談你對于自身人際關系最深刻的想法和感受”等(Newell et al., 2017; Tackman et al., 2018)。這種突破結構化測量限制的開放式的評估過程, 在增加被試表達自由的同時, 也提供了能洞察其主觀內(nèi)心世界的信息。

研究者大多采用語言查詢和單詞計數(shù)軟件(Linguistic Inquiry and Word Count, LIWC)分析被試文本內(nèi)容中的語言使用模式(Pennebaker et al., 2007)。LIWC可以將獲取的定性數(shù)據(jù), 如語音或文本, 快速、系統(tǒng)地轉化為定量數(shù)據(jù)。通過使用LIWC, 可以量化抑郁癥患者的語言使用模式。LIWC作為結構化訪談和問卷調(diào)查的替代方法, 能夠避免共同方法偏差和內(nèi)容重疊。LIWC量化后的文本內(nèi)容可通過統(tǒng)計學方法, 篩選出抑郁癥患者的語言標志, 了解其語言使用模式的特點。此外, 也可以通過縱向比較的方式來評估心理治療及應激后產(chǎn)生的心理變化?；谏鲜龇椒? 傳統(tǒng)心理學研究得到以下研究結果。

3.1 抑郁癥患者多使用第一人稱單數(shù)代詞

Rude等(2004)最早使用分析構建反應數(shù)據(jù)的方法研究抑郁癥患者的語言使用模式。Rude等(2004)以大學生為被試, 要求其完成寫作任務“請描述你上大學以來最深刻的想法與感受”。結果表明抑郁癥大學生在寫作中使用了更多的第一人稱單數(shù)代詞(如, “自從我上大學以來, 我感到很孤獨。這并不是說我過得不愉快, 而是…”)。有過抑郁經(jīng)歷且目前不抑郁的大學生在寫作過程中第一人稱代詞使用頻率逐漸增加, 這可能是由于他們具有抑郁易感性特質(zhì), 認知負荷或信息加工任務易導致他們產(chǎn)生和抑郁個體相似的思維模式。隨后多個研究也關注了第一人稱單數(shù)代詞使用與抑郁間的關系(e.g. Fast & Funder, 2010; Molendijk et al., 2010; Zimmermann et al., 2013)。盡管多數(shù)研究結果表明, 抑郁癥患者更多地使用第一人稱單數(shù)代詞, 但也有少量研究未能得出該結論(e.g. Zimmermann et al., 2017; Schoch-Ruppen et al., 2018)。Edwards和Holtzman (2017)對囊括3758名被試的21篇文獻進行元分析, 得出了第一人稱單數(shù)代詞使用和抑郁間微弱的相關性(r = 0.13, 95% CI [0.10, 0.16])。Tackman等(2018)提出, 以往研究不一致的結果可能是小樣本量帶來的不穩(wěn)定效應和未控制兩者相關的調(diào)節(jié)變量導致的。他們采用來自2個國家的6個實驗室的11個樣本(共4754名被試, 包括大學生、臨床抑郁癥患者和成年社區(qū)被試)在多種不同的控制條件下完成寫作或演講任務。結果表明, 第一人稱單數(shù)代詞使用和抑郁間存在微弱的相關性(r = 0.10, 95% CI [0.07, 0.13])。

一些研究關注了第一人稱單數(shù)代詞具體類型(即, 主語“I—我”, 賓語“me—我”和所有格形式“my—我的”)與抑郁的關系(e.g. Rude et al., 2004; Zimmermann, et al., 2017; Tackman et al., 2018)。Tackman等(2018)通過對4754名被試的研究結果表明, 抑郁個體更多使用主語(如, “我覺得自己是一個丑陋和愚蠢的人”)、賓語(如, “這世上沒有人會掛念我”)形式的第一人稱單數(shù)代詞(r = 0.12和r = 0.09), 而非所有格形式。這表明主、賓語形式和所有格形式使用背后的心理過程不同。所有格形式的第一人稱單數(shù)代詞反映了一種對于自我和某些人或物體關系的關注, 而主語和賓語形式的第一人稱單數(shù)代詞反映了一種孤立形式的自我關注(其中, 主語和賓語形式的第一人稱單數(shù)代詞分別反映了將自我作為主動方和目標方形式的自我關注, James, 1890)?？傮w而言, 這一結果表明, 抑郁與孤立的自我關注語言相關, 與關系中的自我關注語言無關。

還有一些研究關注了語言環(huán)境對抑郁個體第一人稱單數(shù)代詞使用的影響(e.g. Edwards & Holtzman, 2017; Tackman et al., 2018)。Edwards和Holtzman (2017)的元分析表明, 在隱私的交流環(huán)境下(如, 寫個人日記), 第一人稱單數(shù)代詞使用與抑郁的相關略高于公共交流環(huán)境(如, 寫網(wǎng)絡博客)下的相關(r = 0.138和r = 0.119), 但其差異未達到統(tǒng)計上的顯著水平。Tackman等(2018)關注了個人—非個人條件下, 第一人稱單數(shù)代詞使用與抑郁相關的差異。結果顯示, 其相關僅存在于個人相關的交流環(huán)境中(如, 談論自己的人際關系) (r = 0.10), 而不存在于非個人相關的交流環(huán)境中(如, 描述物品或圖片)。因此, 目前的研究結果表明自我關注語言的產(chǎn)生主要受到個人—非個人交流環(huán)境的影響。

反芻是指重復和持續(xù)不斷的、主要關于自我的消極思維, 是引起和維持抑郁的重要因素之一(楊營凱, 劉衍玲, 2016)。反芻被認為是一種特殊形式的自我關注, 其結構可分為兩個子成分, 即憂思(Brood)和沉思(Reflect)。沉思指“有目的地轉向內(nèi)部以解決認知問題來減輕抑郁癥狀”, 憂思指“當前狀態(tài)與期望但未達到的狀態(tài)的消極比較” (Treynor et al., 2003)。憂思代表了反芻結構中更適應不良的成分(Gooding et al., 2012)。Brockmeyer等(2015)發(fā)現(xiàn), 進行消極回憶任務時(如, 要求被試描述其人生中最悲傷的時刻), 第一人稱單數(shù)的使用與憂思呈正相關(r = 0.469), 而與沉思無關。故第一人稱單數(shù)代詞作為自我關注的語言標志, 更多地反映其中的適應不良成分。

女性比男性更有可能對抑郁情緒進行反芻式自我關注(Johnson & Whisman, 2013), 按照這一邏輯, 抑郁和第一人稱單數(shù)代詞使用的相關在女性中可能強于男性。但以往的研究都未發(fā)現(xiàn)這一性別差異(Fast & Funder, 2010; Edward & Holtzman, 2017; Tackman et al., 2018)。Tackman等(2018)對不同性別進行事后偏相關分析, 提供了男女心理過程差異的證據(jù)。其結果表明, 性別差異主要體現(xiàn)在形成情緒痛苦的過程中。女性的情緒痛苦主要由較低喚醒的消極情緒體驗(如抑郁)導致, 而男性的情緒痛苦主要由較高喚醒的消極情緒體驗(如焦慮, 情緒波動)所致。故第一人稱單數(shù)代詞似乎是一個更好的女性抑郁語言標志, 一個更好的男性焦慮或情緒波動語言標志。這一結果為今后給不同性別分別建立評估情緒的語言指標提供了依據(jù)。

3.2 抑郁癥患者少使用第一人稱復數(shù)代詞

第一人稱復數(shù)代詞(we, us, our)的較多使用反映了一種適應性的心理過程, 即, 將自己嵌入社會關系中(Zimmermann et al., 2013)。多項研究發(fā)現(xiàn), 抑郁和第一人稱復數(shù)代詞使用呈顯著負相關(e.g. Frost 2013; Zimmermann et al., 2013; Schoch-Ruppen et al., 2018), 但也有研究未得出兩者間的相關性(e.g. Rude et al., 2004)。這種不一致的結果可能是交流環(huán)境因素造成的。例如, 懷孕女性在描述本次懷孕期間的想法與感受時(Schoch-Ruppen et al., 2018); 處于長期關系中的個體在描述關系中發(fā)生的事件、決策經(jīng)歷和目標實現(xiàn)經(jīng)歷時(Frost, 2013), 第一人稱復數(shù)代詞使用和抑郁呈負相關。而大學生在描述自己上大學以來最深刻的想法與感受時(Rude et al., 2004), 第一人稱復數(shù)代詞使用和抑郁無關。因此, 社會隔離語言的產(chǎn)生可能主要受到人際—非人際交流環(huán)境的影響, 抑郁個體傾向于在人際交流場合較少地使用第一人稱復數(shù)代詞。

3.3 抑郁癥患者多使用消極情緒詞且少使用積極情緒詞

抑郁個體消極偏向和積極缺陷的認知特點導致他們會更多使用消極情緒詞(如, 難過、沮喪、壓抑和低落等), 更少使用積極情緒詞。一些研究得出了抑郁和消極情緒詞使用的顯著正相關、和積極情緒詞使用的顯著負相關(e.g. Rude et al., 2004; Molendijk et al., 2010; Schoch-Ruppen et al., 2018), 另一些卻沒有(e.g. van der Zanden et al., 2014; Bernard et al., 2015)。這種不一致的結果可能是交流對象因素造成的。Ireland和Mehl (2014)提出, 抑郁個體可能會隱藏情緒語言以避免消極的社交結果(如被非抑郁個體排斥)。Baddeley等(2012)使用設備追蹤社區(qū)中人群的行為發(fā)現(xiàn), 抑郁癥患者使用更多的消極情緒詞, 并且兩者間的相關受到交流對象的調(diào)節(jié), 即抑郁癥患者更多地向親密朋友或伴侶表達消極情緒。因此, 在寫作或演講任務的實驗條件下可能不易觀察到抑郁癥患者使用情緒詞的偏向。

由于被試樣本數(shù)量少、被試同質(zhì)性高、時間跨度小、特定詞匯使用與抑郁間本身的弱相關性等多個因素的影響, 采用傳統(tǒng)心理學方法得到的結果并不穩(wěn)定。而收集大量的、來自不同被試群體的、具有時間跨度的數(shù)據(jù)是非常困難的, 這也給抑郁癥患者語言使用模式的研究帶來了挑戰(zhàn)。最近興起的、基于社交媒體數(shù)據(jù)的研究可以在一定程度上克服這些問題, 進一步檢驗現(xiàn)有研究結果, 并帶來一些新發(fā)現(xiàn)。

4 抑郁癥患者語言使用模式：來自基于社交媒體研究的結果

4.1 個人帖子中的語言使用模式

現(xiàn)有的抑郁預測研究多采用機器學習方法。簡單來說, 其過程就是將用戶個人社交媒體上的人口學信息、個人帖子中的語言信息和用戶行為信息等特征作為輸入變量, 將用戶在抑郁癥的標準化測驗上的分數(shù)或被臨床醫(yī)師確診為抑郁癥的信息作為輸出變量, 構建抑郁的預測模型。這種抑郁癥的識別方法已被許多研究證明是可行的(e.g. Leis et al., 2019; Hussain et al., 2019), 并且能夠提供抑郁個體日常生活中的語言使用模式信息以補充和完善傳統(tǒng)心理學研究的結果。表1展示了一些抑郁癥患者發(fā)布的個人帖子。個人帖子中的語言使用模式結果主要通過兩種方法獲得(Guntuku et al., 2017)。一是使用LIWC軟件量化文本內(nèi)容中的語言使用模式, 再通過統(tǒng)計學方法或特征工程(Feature Engineering)橫向或縱向地比較語言使用模式的差異。二是通過主題模型推測文本的主題(Topic)分布。隱含狄利克雷分布(Latent Dirichlet Allocation, LDA)是常見的主題模型。主題模型可以自動以概率分布的形式生成各類別文本中的不同數(shù)量的主題, 并統(tǒng)計不同主題下各詞匯出現(xiàn)的頻率。通過主題模型抽取文本的主題分布, 也可實現(xiàn)文本的差異比較和分類, 從而獲得語言使用模式的結果(曹奔 等, 2018)。與LIWC軟件相比, 主題模型不受限于詞典所創(chuàng)建的詞匯類別, 能從語境、句子、段落等更高的意義單元理解文本(Imel et al., 2015)。

表1  抑郁癥用戶發(fā)布的個人帖子樣例

1. “Are you okay?” Yes…. I understand that I am upset and hopeless and nothing can help me… I’m okay… but I am not alright
“你沒事吧?”是的…。我知道我很沮喪, 沒有希望, 沒有什么能幫助我…我沒事…但我不太好2. “empty” feelings I WAS JUST TALKING ABOUT HOW I I HAVE EMOTION OH MY GOODNESS I FEEL AWFUL
“空虛”的感覺 我只是談談我的情緒如何 天吶 我感覺糟透了3. I want someone to hold me and be there for me when I’m sad.
當我悲傷的時候, 我希望有人抱緊我, 陪在我身邊。4. I actually made sure no one knew about my feelings or thoughts.
事實上, 我確定沒有人知道我的感受或想法。

資料來源：de Choudhury et al., 2013; de Choudhury et al., 2014

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抑郁預測模型中的語言使用模式結果與傳統(tǒng)的心理學研究中的結果基本一致(詳細的研究結果見表2), 此外還提供了一些新的、一致的發(fā)現(xiàn)：

表2  抑郁癥患者和對照組的語言使用模式差異

文獻信息及差異項目參考文獻[1][2][3][4][5][6][7][8]年份20142014201420152015201620192019平臺FacebookFacebookTwitterTwitterTwitterTwitterTwitterFacebook樣本量1652874921866402619579005404350工具LIWCLIWC
LDALIWCLIWCLIWC
LDA其他其他LIWC
LDA第一人稱單數(shù)代詞++/+++++第一人稱復數(shù)代詞-//-//-/消極情緒詞=++++/++積極情緒詞-/==//-/第二、三人稱代詞-//=//-/死亡詞///++//+臟話+++=++//憤怒詞/+++//++焦慮詞//++///+宗教詞///=///+健康詞///+///+因果詞///++//+否定詞++/=++/+

注：“+”表示抑郁癥患者使用更多該詞匯, “=”表示無差異, “-”表示使用更少, “/”表示未提供該結果。
參考文獻[1] de Choudhury et al., 2014; [2] Schwartz et al., 2014; [3] Coppersmith et al., 2014; [4] Coppersmith et al., 2015; [5] Preotiuc-Pietro et al., 2015; [6] Nadeem et al., 2016; [7] Leis et al., 2019; [8] Hussain et al., 2019

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(1)抑郁個體更少地使用第二、三人稱代詞, 這可能是社會隔離的另一方面表現(xiàn)。即較差的社會關系(如單身、獨居、社交網(wǎng)絡薄弱或規(guī)模小以及社會互動不頻繁等)使抑郁個體更少地在語言中提到他人; (2)更多地使用死亡詞(death)。以往的研究已證實了相當一部分的抑郁癥患者會出現(xiàn)自殺意念與行為, 并通過語言向外界表達(Li et al., 2019); (3)更多地使用焦慮詞(anxiety)、臟話(swear words)和憤怒詞(anger)。一方面, 除了焦慮癥和抑郁癥在臨床上表現(xiàn)出高共病率外, 以往研究表明未共病的抑郁與焦慮個體的憂慮程度不存在統(tǒng)計學上的差異, 這說明抑郁個體中也存在和焦慮相關的精神病理學特征并反映在其語言使用模式中(Merino et al., 2016)。另一方面, 導致抑郁的刺激或事件(如壓力事件)可能讓個體產(chǎn)生除抑郁外的其他情緒, 如焦慮、憤怒等(Newell et al., 2017); (4) 更多地使用宗教詞(religion)和健康詞(health), 這表明抑郁個體對自身狀況的察覺促使他們尋求擺脫困境的方法, 即他們可能尋求宗教支持或對自身健康狀況更加關注; (5)更多地使用因果詞(cause)和否定詞(negation), 這可能是由他們傾向于作出消極歸因和解釋的認知偏向導致。

4.2 抑郁社區(qū)中的語言使用模式

在線健康社區(qū)作為社交媒體的另一種形式, 給精神障礙患者提供了一個交換社會支持、與他人連接的平臺(Pendry & Salvatore, 2015)。用戶可以在平臺上自由表達, 這一定程度上克服了社會對精神障礙的污名化與歧視問題(Li et al., 2018)。平臺上用戶發(fā)布的文本內(nèi)容可作為語言使用模式的研究數(shù)據(jù), 例如, 可以對這些內(nèi)容進行情感分析, 橫向比較不同社區(qū)間的語言使用模式差異, 以及縱向分析個人加入社區(qū)后的語言使用模式變化等(Lyons et al., 2018; Park & Conway, 2017)。與上文中提到的研究結果一致, 抑郁社區(qū)中包含比對照社區(qū)更多的第一人稱單數(shù)代詞、消極情緒詞, 更少的第一人稱復數(shù)代詞、積極情緒詞等(Nguyen et al., 2014; Xu & Zhang, 2016; Lyons et al., 2018)。

雖然網(wǎng)絡上的同伴支持能夠增強個體的社會聯(lián)結和歸屬感(Uden-Kraan et al., 2009), 但也有研究者提出了情緒傳染理論, 即與抑郁個體的交流可能是導致抑郁的一個潛在因素(Bastiampillai et al., 2013)。因此, 抑郁社區(qū)如何對抑郁個體產(chǎn)生影響是一個有待澄清的問題。Park和Conway (2017)開展的一項縱向研究表明, 處于抑郁社區(qū)一段時間后, 用戶的抑郁相關語言標志均朝積極的方向變化(盡管這種變化有的并不顯著), 并且這種積極變化隨著交流數(shù)量的增加而增強, 這表明抑郁社區(qū)中的交流給抑郁個體帶來了正面的影響。然而, 由于抑郁社區(qū)是一種新興的社交媒體, 其中的抑郁個體如何互相影響的具體機制目前仍尚不清楚。故這方面的研究還有待完善, 以改進抑郁社區(qū)的運作機制來更好地幫助抑郁癥患者。

5 抑郁癥相關理論對抑郁癥患者語言使用模式的解釋

研究者從不同視角提出了關于抑郁癥的不同理論或理論模型。這些理論模型一定程度上能幫助我們理解抑郁癥患者的語言使用模式。抑郁癥的行為模型從個體與外部環(huán)境的關系角度理解抑郁, 認為抑郁本質(zhì)上是一系列無法獲得強化/獎勵的行為的結果(Leahy et al., 2012)。典型的抑郁行為包括孤立、抱怨、思維反芻等, 反映在語言使用模式上, 就表現(xiàn)為大量第一人稱單數(shù)代詞(尤其是主、賓語)、較少第一人稱復數(shù)代詞、較少第二/三人稱代詞、以及較多消極情緒詞, 甚至臟話和憤怒詞的使用。

抑郁癥的認知模型強調(diào)抑郁癥狀是由負性認知偏差所導致。認知內(nèi)容方面, 抑郁癥患者對自己、世界和未來均持有負性信念(Beck & Alford, 2009), 反映在語言使用上, 易表現(xiàn)為死亡詞、焦慮詞的大量使用。認知過程方面, 抑郁癥患者也存在一系列偏差, 例如, 過分聚焦、反芻負性想法、感受和問題, 幾乎不關注積極方面(Nolen-Hoeksenma et al., 2008; Wells, 2009), 反映在語言使用上, 表現(xiàn)為消極情緒詞的大量使用。此外, 抑郁癥患者還傾向于把錯誤和失敗歸因于自身內(nèi)部因素, 如能力不夠(Abramson et al., 1978; Abramson et al., 1989)。這些歸因方式體現(xiàn)在因果詞和否定詞的大量使用上。還有一些認知取向的模型認為抑郁癥是自我中心、自我專注的結果, 患者過分自我關注, 導致負性情感增加(Leahy et al., 2012)。反映在語言使用上, 易表現(xiàn)為大量第一人稱單數(shù)代詞和消極情緒詞的使用上。

人際和社會行為學取向的研究者認為抑郁是適應不良人際行為, 或者人際關系功能失調(diào)的結果。Coyne (1989)的人際獎賞模型認為, 抑郁癥患者通過抱怨引起他人的關注, 從而獲得正性強化, 然而持續(xù)的抱怨和執(zhí)著于自我易導致他人對其的拒絕, 進而加重患者的抑郁。抑郁癥患者引發(fā)他人關注、求助他人的行為體現(xiàn)在其語言使用上, 即表現(xiàn)為宗教詞、健康詞的大量使用。抑郁癥患者面臨的人際關系功能失調(diào)(Klerman et al., 1984), 包括人際沖突、人際關系困難等, 導致患者孤單、怨恨等消極認知和消極情緒增加, 體現(xiàn)在其語言上, 表現(xiàn)為大量第一人稱單數(shù)代詞、消極情緒詞、焦慮與憤怒詞的使用。Joiner與同事(2009)提出了自殺和抑郁的人際理論, 認為自殺意圖與患者對自身人際關系的認知(覺得自己是別人的負擔或者缺乏歸屬感)有關, 因而在描述自身狀況時, 患者會使用大量死亡詞。

6 現(xiàn)存問題及未來展望

6.1 語言標志的特異性不足

傳統(tǒng)心理學研究發(fā)現(xiàn)的語言標志不僅和抑郁相關, 還與更廣泛的精神障礙(如焦慮)存在聯(lián)系(e.g. Sweeny et al., 2015; Tackman et al., 2018; Schoch-Ruppen et al., 2018)?；谏缃幻襟w的研究中, 嘗試使用LIWC通過語言標志來區(qū)分抑郁癥與其他精神障礙的研究也得出了不一致的結果(Nguyen et al., 2014; Cheng et al., 2017)。因此, 目前的語言標志可能代表了一種并非特定于抑郁的情緒痛苦傾向。要想通過語言使用模式對具體不同情緒進行評估, 未來的研究需要探索更精細的特征或加上其他的特征來共同評估。例如, 研究發(fā)現(xiàn)抑郁癥患者的聲音特征有語速慢、音量小、音調(diào)缺乏變化、停頓時間長及次數(shù)多、語言持續(xù)時間短和啟動延時長等(Wang et al., 2018)。抑郁癥患者在肢體語言方面的特征有行走速度慢、感覺運動空間減少、站立與坐下時上半身直立時間減少等(Scheffers et al., 2018)。結合這些非言語行為特征有助于在研究和臨床實踐中更準確地評估抑郁情緒。

此外, 雖然使用LIWC量化語言使用模式在過去的研究中已被證明是一種有效的方法, 但整體上來看現(xiàn)有的研究結果仍受限于LIWC限定的詞匯類別。一方面, 未來研究應繼續(xù)探索現(xiàn)有詞匯類別下更精細的抑郁特異性語言標志。另一方面, 隨著時代的發(fā)展, 一些不包含于LIWC詞匯類別中的、新興的、拼寫不規(guī)范的詞匯和俚語在日常生活或網(wǎng)絡中的交流中是非常常見的。因此, 研究者應持續(xù)更新語言分析方法和工具, 以探索其他可能的抑郁特異性語言標志外, 臨床工作者也應更開放地、謹慎地理解患者使用的語言背后的心理意義。

6.2 影響語言使用模式的因素有待確認

雖然通過語言標志評估抑郁情緒是一個可行的方法, 但語言使用模式和抑郁情緒間的聯(lián)系可能受到很多內(nèi)部和外部因素的影響。傳統(tǒng)心理學研究主要關注外部因素對抑郁癥患者語言使用模式的影響(如交流環(huán)境對第一人稱單數(shù)及復數(shù)代詞使用的影響、交流對象對情緒詞使用的影響等), 并且得出了初步的結果。未來的研究可根據(jù)基于社交媒體的研究新發(fā)現(xiàn), 進一步探索外部因素對語言使用模式的影響。例如, 焦慮詞、臟話和憤怒詞的使用可能受到刺激類型的調(diào)節(jié), 某種喪失事件(如親人或伴侶的離去)可能僅致使個體產(chǎn)生抑郁情緒, 而一些壓力事件(如遭受責罵或歧視)則可能使個體同時產(chǎn)生抑郁、焦慮和憤怒等情緒。死亡詞、宗教詞和健康詞的使用可能受到交流環(huán)境的調(diào)節(jié), 抑郁個體在尋求擺脫當前困境(如自殺、尋求宗教支持和關注自身健康等)時更容易涉及這方面的話題, 因而這些詞匯較容易被使用。同樣地, 因果詞和否定詞更可能在對一些消極事件進行歸因時使用。

從個人內(nèi)部因素來看, 一方面, 為了滿足社會贊許, 個體可能傾向于在自我報告量表中報告較低的精神病理水平(Hampson et al., 1987)。另一方面, 抑郁個體的認知偏向可能使他們的自我察覺能力減弱, 在臨床上表現(xiàn)出更嚴重的病理水平。例如, Fast和Funder (2010)在研究中發(fā)現(xiàn), 第一人稱單數(shù)代詞僅和臨床醫(yī)師評定的抑郁水平相關, 而和自我報告的抑郁水平無關。因此, 相對量表等自我報告, 語言使用模式可成為相關研究和臨床評定的一個客觀行為指標。此外, 已有研究表明, 具有高神經(jīng)質(zhì)人格、低自尊和自我效能感等個人特質(zhì)的個體患抑郁癥的風險較高, 這些個人特質(zhì)本身也可能對語言使用模式產(chǎn)生影響(Merino et al., 2016; Orth et al., 2016; Zhang & Jin, 2014)。然而, 目前鮮有研究關注個人內(nèi)部因素對語言使用模式的影響, 確認這些影響因素能夠更好的控制有關變量和提高評估的準確性。

6.3 語言標志對中國人的適用性有待驗證

過去相關研究的被試群體大多為西方人, 這些結果能否適用于中國人群體尚未得到驗證。跨文化研究表明, 受到社會污名化和文化價值觀等因素的影響, 中國抑郁癥患者傾向于表達自己的軀體癥狀而不是心理癥狀(即, 更少表達情緒癥狀和認知癥狀), 這也造成了許多誤診的情況(Zhou et al., 2016; Zhao et al., 2018)。此外還有一些未意識到自身心理健康問題的人也可能主要報告軀體癥狀(如失眠、頭痛等)從而造成誤診。因此, 軀體癥狀相關詞(如生理歷程詞、身體詞等)可能是一種在中國抑郁群體的特異性語言標志。未來的研究除了需要檢驗以往研究的語言標志在中國人中的適用性以外, 還可將語言使用模式和癥狀學的研究結合起來, 以提高識別的準確率。

6.4 對抑郁癥患者語言使用模式的理論研究有待加強

基于社交媒體的研究揭示了很多新的、關于抑郁癥患者語言使用模式的發(fā)現(xiàn), 其中一部分發(fā)現(xiàn)可以為抑郁癥相關理論所解釋(見第5部分), 但還有一些研究結果無法很好地為現(xiàn)有理論解釋, 例如, 新興的在線抑郁社區(qū)如何對抑郁個體產(chǎn)生影響。此外, 抑郁癥患者不同于普通人群的語言使用模式的確反映了其心理病理特征, 那么, 抑郁癥患者的語言使用模式反過來是否也會影響其心理病理水平?其影響機制是什么?現(xiàn)有認知行為取向的心理治療重視幫助抑郁癥患者增加積極的自我(言語)陳述, 語言使用模式對抑郁情緒的影響研究有助于幫助臨床研究者與實踐者進一步從語言使用角度開發(fā)新的抑郁干預方法。

綜上所述, 來自傳統(tǒng)的心理學研究和基于社交媒體的研究相輔相成, 在一定程度上彌補了各自的缺陷, 增加了研究者對抑郁癥患者語言使用模式的理解。但總的來說, 該領域的研究目前仍面臨著語言標志的特異性不足、相關影響因素研究不足、在中國人群中的適用性不明確、以及相關理論研究不足等問題。未來研究者需要探索更具特異性的抑郁語言標志、確認影響語言使用模式的因素、開展以中國人為被試的語言使用模式研究, 以及加強相關理論研究, 不斷優(yōu)化該領域的研究結果, 并應用于臨床實踐。

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OBJECTIVE: Guided by the uncertainty navigation model, this study examined experiences of uncertainty associated with trying to conceive and identified predictors of this experience using a multi-method approach. METHOD: 429 American adults from Amazon's Mechanical Turk who had a child under age three completed online questionnaires regarding their experiences trying to conceive, including recollections of psychological adjustment, use of coping strategies, and individual and situational variability. Then they provided open-ended reflections of their experience trying to conceive. Participants' descriptions were analyzed for word use using LIWC, a text-analysis software program, to obtain an unobtrusive and pseudo-observational measure of coping resources. RESULTS: Consistent with the uncertainty navigation model, recollections of distress as individuals tried to conceive were associated with lower levels of dispositional optimism; intolerance of uncertainty; fewer social, emotional, and cognitive resources (reflected in word use); placing greater importance on conception; lower risk for infertility; and less searching for meaning in life. CONCLUSIONS: This study revealed many novel insights regarding the experience of trying to conceive, including protective factors and vulnerabilities that may buffer or heighten the distress associated with this experience.

[72]

Tackman, A. M., Sbarra, D. A., Carey, A. L., Donnellan, M. B., Horn, A. B., Holtzman, N. S.,… Mehl, M. R. (2019).

Depression, negative emotionality, and self-referential language: A multi-lab, multi-measure, and multi-language-task research synthesis

Journal of Personality and Social Psychology, 116(5),817-834. doi: 10.1037/pspp0000187.

URL    PMID:29504797    

[73]

Treynor, W., Gonzalez, R., & Nolen-Hoeksema, S. (2003).

Rumination reconsidered: A psychometric analysis

Cognitive Therapy and Research. 27,247-259. doi: 10.1023/ A:1023910315561.

[本文引用: 1]

[74]

Trotzek, M., Koitka, S., & Friedrich, C. M. (2018).

Utilizing neural networks and linguistic metadata for early detection of depression indications in text sequences

IEEE Transactions on Knowledge and Data Engineering, 32(3),588-601.

[本文引用: 1]

[75]

Uden-Kraan, C. F. V., Drossaert, C. H. C., Taal, E., Seydel, E. R., & van de Laar, M. A. F. J. (2009).

Participation in online patient support groups endorses patients' empowerment

Patient Education and Counseling, 74(1),61-69.

DOI:10.1016/j.pec.2008.07.044    URL    PMID:18778909     [本文引用: 1]

OBJECTIVE: Although much has been expected of the empowering effect of taking part in online patient support groups, there is no direct evidence thus far for the effects of participation on patient empowerment. Hence our exploring to what extent patients feel empowered by their participation in online support groups, and which processes that occur in these groups are related to the empowering outcomes. METHODS: An online questionnaire was completed by 528 individuals who were active in online groups for patients with breast cancer, fibromyalgia and arthritis. RESULTS: The respondents felt empowered in several ways by their participation. The empowering outcomes that were experienced to the strongest degree were 'being better informed' and 'enhanced social well-being'. No significant differences in empowering outcomes between diagnostic groups were found. The empowering outcomes could only be predicted in a modest way by the processes that took place in the online support groups. CONCLUSION: This study indicates that participation in online support groups can make a valuable contribution to the empowerment of patients. PRACTICE IMPLICATIONS: Health care providers should acquaint their patients with the existence of online support groups and with the benefits that participation in these groups can offer.

[76]

Vanderlind, W. M., Millgram, Y., Baskin-Sommers, A. R., Clark, M. S., & Joormann, J. (2020).

Understanding positive emotion deficits in depression: From emotion preferences to emotion regulation

Clinical Psychology Review, 76,101826. doi: 10.1016/j.cpr.2020.101826.

URL    PMID:32058881     [本文引用: 1]

[77]

van der Zanden, R., Curie, K., van Londen, M., Kramer, J., Steen, G., & Cuijpers, P. (2014).

Web-based depression treatment: Associations of clients? word use with adherence and outcome

Journal of Affective Disorders, 160,10-13. doi: 10.1016/j.jad.2014.01.005.

URL    PMID:24709016     [本文引用: 1]

BACKGROUND: The growing number of web-based psychological treatments, based on textual communication, generates a wealth of data that can contribute to knowledge of online and face-to-face treatments. We investigated whether clients' language use predicted treatment outcomes and adherence in Master Your Mood (MYM), an online group course for young adults with depressive symptoms. METHODS: Among 234 participants from a randomised controlled trial of MYM, we tested whether their word use on course application forms predicted baseline levels of depression, anxiety and mastery, or subsequent treatment adherence. We then analysed chat session transcripts of course completers (n=67) to investigate whether word use changes predicted changes in treatment outcomes. RESULTS: Depression improvement was predicted by increasing use of 'discrepancy words' during treatment (e.g. should). At baseline, more discrepancy words predicted higher mastery level. Adherence was predicted by more words used at application, more social words and fewer discrepancy words. LIMITATIONS: Many variables were included, increasing the chance of coincidental results. This risk was constrained by examining only those word categories that have been investigated in relation to depression or adherence. CONCLUSIONS: This is the first study to link word use during treatment to outcomes of treatment that has proven to be effective in an RCT. The results suggest that paying attention to the length of problem articulation at application and to 'discrepancy words' may be wise, as these seem to be psychological markers. To expand knowledge of word use as psychological marker, research on web-based treatment should include text analysis.

[78]

Wang, J., Sui, X., Hu, B., Flint, J., & Zhu, T. (2018).

Detecting postpartum depression in depressed people by speech features

Human Centered Computing, 10745,433-442.

[本文引用: 1]

[79]

Wells, A. (2009). Metacognitive therapy for depression. Acceptance and mindfulness in cognitive behavior therapy.

New York, NY:

Guilford Press.

[本文引用: 1]

[80]

Xu, R., & Zhang, Q. (2016).

Understanding online health groups for depression: Social network and linguistic perspectives

Journal of Medical Internet Research, 18(3),e63.

DOI:10.2196/jmir.5042    URL    PMID:26966078     [本文引用: 1]

BACKGROUND: Mental health problems have become increasingly prevalent in the past decade. With the advance of Web 2.0 technologies, social media present a novel platform for Web users to form online health groups. Members of online health groups discuss health-related issues and mutually help one another by anonymously revealing their mental conditions, sharing personal experiences, exchanging health information, and providing suggestions and support. The conversations in online health groups contain valuable information to facilitate the understanding of their mutual help behaviors and their mental health problems. OBJECTIVE: We aimed to characterize the conversations in a major online health group for major depressive disorder (MDD) patients in a popular Chinese social media platform. In particular, we intended to explain how Web users discuss depression-related issues from the perspective of the social networks and linguistic patterns revealed by the members' conversations. METHODS: Social network analysis and linguistic analysis were employed to characterize the social structure and linguistic patterns, respectively. Furthermore, we integrated both perspectives to exploit the hidden relations between them. RESULTS: We found an intensive use of self-focus words and negative affect words. In general, group members used a higher proportion of negative affect words than positive affect words. The social network of the MDD group for depression possessed small-world and scale-free properties, with a much higher reciprocity ratio and clustering coefficient value as compared to the networks of other social media platforms and classic network models. We observed a number of interesting relationships, either strong correlations or convergent trends, between the topological properties and linguistic properties of the MDD group members. CONCLUSIONS: (1) The MDD group members have the characteristics of self-preoccupation and negative thought content, according to Beck's cognitive theory of depression; (2) the social structure of the MDD group is much stickier than those of other social media groups, indicating the tendency of mutual communications and efficient spread of information in the MDD group; and (3) the linguistic patterns of MDD members are associated with their topological positions in the social network.

[81]

Zhang, Y. J., & Jin, S. H. (2014).

The impact of social support on postpartum depression: The mediator role of self-efficacy

Journal of Health Psychology, 21(5),720-726. https://doi.org/10.1177/1359105314536454.

URL    PMID:24925546     [本文引用: 1]

[82]

Zhao, D., Wu, Z., Zhang, H., Mellor, D., Ding, L., Wu, H.,… Fang, Y. (2018).

Somatic symptoms vary in major depressive disorder in China

Comprehensive Psychiatry, 87,32-37. doi: 10.1016/j.comppsych.2018.08.013.

URL    PMID:30195098     [本文引用: 2]

[83]

Zhou, X. L., Peng, Y. S., Zhu, X. Z., Yao, S. Q., Dere, J., Chentsova-Dutton, Y. E., & Ryder, A. G. (2016).

From culture to symptom: Testing a structural model of “Chinese somatization”

Transcultural Psychiatry, 53(1),3-23.

URL    PMID:26076689     [本文引用: 1]

[84]

Zimmermann, J., Brockmeyer, T., Hunn, M., Schauenburg, H., & Wolf, M. (2017).

First-person pronoun use in spoken language as a predictor of future depressive symptoms: Preliminary evidence from a clinical sample of depressed patients

Clinical Psychology and Psychotherapy, 24(2),384-391. doi: 10.1002/cpp.2006.

URL    PMID:26818665     [本文引用: 3]

Several theories suggest that self-focused attention plays an important role in the maintenance of depression. However, previous studies have predominantly relied on self-report and laboratory-based measures such as sentence completion tasks to assess individual differences in self-focus. We present a prospective, longitudinal study based on a sample of 29 inpatients with clinical depression, investigating whether an implicit, behavioural measure of self-focused attention, i.e., the relative frequency of first-person singular pronouns in naturally spoken language, predicts depressive symptoms at follow-up over and above initial depression. We did not find a significant cross-sectional association between depressive symptoms and first-person singular pronoun use. However, first-person singular pronoun use significantly predicted depressive symptoms approximately 8 months later, even after controlling for depressive symptoms at baseline or discharge. Exploratory analyses revealed that this effect was mainly driven by the use of objective and possessive self-references such as 'me' or 'my'. Our findings are in line with theories that highlight individual differences in self-focused attention as a predictor of the course of depression. Moreover, our findings extend previous work in this field by adopting an unobtrusive approach of non-reactive assessment, capturing naturally occurring differences in self-focused attention. We discuss possible clinical applications of language-based assessments and interventions with regard to self-focus. Copyright (c) 2016 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE: Naturally occurring individual differences in first-person singular pronoun use provide an unobtrusive way to assess patients' automatic self-focused attention. Frequent use of first-person singular pronouns predicts an unfavourable course of depression. Self-focused language might offer innovative ways of tracking and targeting therapeutic change.

[85]

Zimmermann, J., Wolf, M., Bock, A., Peham, D., & Benecke, C. (2013).

The way we refer to ourselves reflects how we relate to others: Associations between first-person pronoun use and interpersonal problems

Journal of Research in Personality, 47(3),218-225. doi: 10.1016/j.jrp.2013.01.008.

[本文引用: 4]

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