安徽某高校大学生睡眠行为和时型与情绪症状的随访研究

查晓丽; 朱卓妍; 伍晓艳; 陈冬冬; 张燕; 陶舒曼

doi:10.16835/j.cnki.1000-9817.2021.08.020

安徽某高校大学生睡眠行为和时型与情绪症状的随访研究

doi: 10.16835/j.cnki.1000-9817.2021.08.020

1.
安徽医科大学卫生管理学院, 合肥 230032
2.
安徽医科大学公共卫生学院儿少卫生与妇幼保健学系/出生人口健康教育部重点实验室
3.
安徽医科大学第二附属医院肾脏内科

基金项目:

安徽医科大学科研基金立项资助项目 2018xkj096

安徽医科大学博士科研资助资金项目 XJ201711

详细信息

作者简介:
查晓丽(1985-)，女，安徽安庆人，硕士，讲师，主要研究方向为思想政治教育理论与实践，大学生创新创业教育理论与实践

通讯作者:
伍晓艳，E-mail：xywu85@126.com

中图分类号: B844.2 G647.8 G444
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- 被引次数: 0
出版历程
- 收稿日期: 2021-03-05
- 修回日期: 2021-07-20
- 网络出版日期: 2021-08-20
- 刊出日期: 2021-08-25

Follow-up study on sleep behavior, chronotype and emotional symptoms of college students in Anhui Province

1.
School of Health Service Management, Anhui Medical University, Hefei(230032), China

摘要

摘要: 目的探究大学生睡眠行为、睡眠时型与抑郁、焦虑情绪症状的关联，为促进大学生心理健康提供依据。方法采用整群抽样方法，在安徽医科大学随机抽取一个学院大一和大二年级全体学生，于2020年11月进行基线调查，2个月后开展随访调查。采用《爱泼沃斯嗜睡量表》《失眠严重程度指数量表》调查大学生睡眠行为，采用《清晨型与夜晚型量表—5项》评价睡眠时型。采用《抑郁-焦虑-压力自评量表》评估抑郁与焦虑症状。比较不同人口统计学特征、不同睡眠时型和睡眠行为组间大学生抑郁和焦虑症状检出率的差异，并分析大学生睡眠行为、睡眠时型与抑郁、焦虑症状的关联。结果有日间嗜睡现象、存在失眠症状的大学生抑郁、焦虑症状检出率均高于无日间嗜睡和不存在失眠症状的大学生(χ²值分别为12.39，22.68；40.14，29.46，P值均<0.01)。多因素Logistic回归分析结果显示，在基线调查中日间嗜睡和失眠与抑郁症状(OR值分别为3.03，5.23)和焦虑症状(OR值分别为3.74，4.24)均呈正性关联(P值均＜0.05)，而睡眠时型与抑郁和焦虑症状之间关联无统计学意义(P值均＞0.05)，随访调查结果与基线一致。方法大学生日间嗜睡症状和失眠症状与焦虑、抑郁症状密切相关，应着力改善大学生健康睡眠行为进而促进心理健康。
- 睡眠 /
- 行为 /
- 情绪 /
- 精神卫生 /
- 回归分析 /
- 学生
Abstract: Objective To explore the relationships between sleep behaviors, chronotype and emotional symptoms including depression and anxiety symptoms among college students. Methods Freshmen and sophomore from one university in Anhui Province were recruited through cluster sampling method. The baseline survey was conducted in November 2020, and the follow-up survey was conducted 2 months later. The Morning and Evening Questionnaire-5 (MEQ-5) was used to assess chronotype. The Insomnia severity Index (ISI) and Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD) were used to evaluate sleep behaviors. Depression Anxiety Stress Scale (DASS-21) was used to assess depression and anxiety symptoms, respectively. The detection rate of depression and anxiety among college students with different demographic characteristics, different sleep chronotypes and sleep behavior were compared, and the association between sleep behavior, chronotypes and depression and anxiety symptoms was analyzed. Results The detection rates of depressive and anxiety symptoms were higher in the college students with daytime sleepiness and insomnia(χ²=12.39, 22.68;40.14, 29.46, P<0.01). Logistic regression results showed that at the baseline daytime sleepiness and insomnia were positively associated with depression (OR=3.03, 5.23) and anxiety symptoms (OR=3.74, 4.24), respectively (P < 0.05), however, no association was found between chronotype and symptoms of depression and anxiety (P > 0.05). Follow-up survey results were consistent with baseline. Conclusion Daytime sleepiness and insomnia are risk factors for depression and anxiety symptoms among college students. It is suggested that keeping healthy sleep behaviors play an important role in mental health promotion among college students in the future.
- Sleep /
- Behavior /
- Emotions /
- Mental health /
- Regression analysis /
- Students

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表 1 基线调查不同人口统计学特征大学生抑郁与焦虑症状检出率比较

Table 1. Comparison of detection rates of depression and anxiety symptoms among college students with different demographic characteristics in baseline survey

人口统计学指标	选项	人数	抑郁症状			焦虑症状
人口统计学指标	选项	人数	检出人数	χ²值	P值	检出人数	χ²值	P值
性别	男	210	54(25.7)	2.00	0.16	81(38.6)	1.57	0.21
	女	164	32(19.5)			53(32.3)
年级	大一	220	40(18.2)	3.84	0.01	76(34.5)	0.38	0.54
	大二	154	46(29.9)			58(37.7)
是否独生子女	是	137	27(19.7)	1.32	0.25	40(29.2)	4.17	0.06
	否	237	59(24.9)			94(39.7)
父亲文化程度	小学及以下	81	28(34.6)	7.83	0.02	35(43.2)	2.45	0.29
	初中	168	33(19.6)			57(33.9)
	高中及以上	125	25(20.0)			42(33.6)
母亲文化程度	小学及以下	163	50(30.7)	12.17	0.00	66(40.5)	4.31	0.12
	初中	122	16(13.1)			35(28.7)
	高中及以上	89	20(22.5)			33(37.1)
家庭经济情况	差	108	30(27.8)	2.02	0.37	42(38.9)	0.80	0.67
	中等	240	51(21.3)			84(35.0)
	好	26	5(19.2)			8(30.8)
朋友数量/个	≤2	73	28(38.4)	13.74	0.00	41(56.2)	19.94	0.01
	3~<5	87	29(30.2)			34(39.1)
	≥5	208	52(25.0)			57(27.4)
学习负担	重	96	29(30.2)	10.25	0.01	45(46.9)	11.71	0.00
	一般	269	52(19.3)			83(30.9)
	轻	9	5(55.6)			6(66.7)
学习成绩	差	63	26(41.3)	15.80	0.00	21(33.3)	8.36	0.02
	中等	245	51(20.8)			64(26.1)
	好	66	9(13.6)			8(12.1)
注： ()内数字为检出率/%。

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表 2 随访调查不同人口统计学特征大学生抑郁与焦虑症状检出率比较

Table 2. Comparison of detection rates of depression and anxiety symptoms among college students with different demographic characteristics in follow-up survey

人口统计学指标	选项	人数	抑郁症状			焦虑症状
人口统计学指标	选项	人数	检出人数	χ²值	P值	检出人数	χ²值	P值
性别	男	210	49(23.3)	5.13	0.02	58(27.6)	1.94	0.16
	女	164	23(14.0)			53(32.3)
年级	大一	220	35(15.9)	3.84	0.05	50(22.7)	1.31	0.25
	大二	154	37(24.0)			43(27.9)
是否独生子女	是	137	27(19.7)	0.03	0.87	30(21.9)	1.02	0.31
	否	237	45(19.0)			63(26.6)
父亲文化程度	小学及以下	78	19(24.4)	2.64	0.27	20(25.6)	0.50	0.78
	初中	160	32(20.0)			42(26.3)
	高中及以上	136	21(15.4)			31(22.8)
母亲文化程度	小学及以下	146	34(23.3)	3.55	0.17	41(28.1)	4.67	0.10
	初中	132	25(18.9)			36(27.3)
	高中及以上	96	13(13.5)			16(16.7)
家庭经济情况	差	78	15(19.2)	2.04	0.36	15(19.2)	3.61	0.16
	中等	265	54(20.4)			73(27.5)
	好	31	3(9.7)			5(16.1)
朋友数量/个	≤2	76	20(26.3)	4.41	0.11	27(35.5)	6.57	0.04
	3~<5	99	18(20.1)			25(25.3)
	≥5	199	29(13.9)			41(20.6)
学习负担	重	84	24(28.6)	6.07	0.05	32(38.1)	10.20	0.01
	一般	279	46(16.5)			59(21.1)
	轻	11	2(18.2)			2(18.1)
学习成绩	差	63	20(31.7)	9.62	0.01	21(33.3)	8.36	0.02
	中等	245	45(18.4)			64(26.1)
	好	66	7(10.6)			8(12.1)
注： ()内数字为检出率/%。

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表 3 基线调查不同睡眠时型和睡眠行为大学生情绪症状检出率比较

Table 3. Comparison of detection rates of mood symptoms among college students with different sleep chronotypes and sleep behaviors in baseline survey

睡眠情况	选项	人数	抑郁症状			焦虑症状
睡眠情况	选项	人数	检出人数	χ²值	P值	检出人数	χ²值	P值
日间嗜睡	有	76	29(38.2)	12.39	<0.01	45(59.2)	22.68	<0.01
	无	298	57(19.1)			89(29.9)
失眠情况	有	58	32(55.2)	40.14	<0.01	39(67.2)	29.46	<0.01
	无	316	54(17.1)			95(30.1)
睡眠时型	清晨	50	12(24.0)	0.23	0.89	18(36.0)	2.07	0.36
	中间	285	64(22.5)			98(34.4)
	夜晚	39	10(25.6)			18(46.2)
注：()内数字为检出率/%。

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表 4 随访调查不同睡眠时型和睡眠行为大学生情绪症状检出率比较

Table 4. Comparison of detection rates of mood symptoms among college students with different sleep chronotypes and sleep behaviors in follow-up survey

睡眠情况	选项	人数	抑郁症状			焦虑症状
睡眠情况	选项	人数	检出人数	χ²值	P值	检出人数	χ²值	P值
日间嗜睡	有	44	17(38.6)	12.05	<0.01	23(52.3)	20.05	<0.01
	无	330	55(16.7)			70(21.2)
失眠情况	有	39	18(46.2)	20.27	<0.01	26(66.7)	40.72	<0.01
	无	335	54(16.1)			67(20.1)
睡眠时型	清晨	59	11(18.6)	2.16	0.34	14(23.7)	11.68	<0.01
	中间	280	51(18.2)			62(22.1)
	夜晚	35	10(28.6)			17(48.6)
注： ()内数字为检出率/%。

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表 5 基线调查睡眠情况与大学生情绪症状关联的多因素Logistic回归分析[OR值(OR值95%CI)，n=374]

Table 5. Multivariate Logistic regression analysis of the association between baseline sleep and mood disorders of college students [OR(OR 95%CI), n=374]

睡眠情况	选项	未调整		调整
睡眠情况	选项	抑郁	焦虑	抑郁	焦虑
日间嗜睡	无	1.00	1.00	1.00	1.00
	有	2.72(1.57~4.70)^*	3.42(2.03~5.76)^*	3.03(1.68~5.47)^*	3.74(2.16~6.51)^*
失眠情况	无	1.00	1.00	1.00	1.00
	有	5.94(3.26~10.82)^*	4.62(2.52~8.43)^*	5.23(2.80~9.77)^*	4.24(2.27~7.93)^*
睡眠时型	清晨	1.00	1.00	1.00	1.00
	中间	0.98(0.37~2.65)	1.44(0.61~3.41)	0.90(0.31~2.64)	1.39(0.56~3.48)
	夜晚	0.90(0.44~1.83)	0.94(0.50~1.77)	0.94(0.45~1.99)	0.94(0.49~1.82)
注：*P<0.05。

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表 6 随访调查睡眠情况与大学生情绪症状关联的多因素Logistic回归分析[OR值(OR值95%CI)，n=374]

Table 6. Multivariate Logistic regression analysis of the association between sleep and mood disorder of college students in follow-up survey[OR(OR 95%CI), n=374]

睡眠情况	选项	未调整		调整
睡眠情况	选项	抑郁	焦虑	抑郁	焦虑
日间嗜睡	无	1.00	1.00	1.00	1.00
	有	3.15(1.61~6.17)^*	4.07(2.13~7.78)^*	2.99(1.48~6.05)^*	3.97(2.03~7.79)^*
失眠情况	无	1.00	1.00	1.00	1.00
	有	4.46(2.23~8.93)^*	8.00(3.90~16.40)^*	3.58(1.72~7.46)^*	7.05(3.34~14.86)^*
睡眠时型	清晨	1.00	1.00	1.00	1.00
	中间	1.75(0.65~4.67)	3.04(1.24~7.42)^*	1.50(0.54~4.22)	2.80(1.11~7.08)^*
	夜晚	0.97(0.47~2.00)	0.91(0.47~1.77)	0.93(0.44~1.96)	0.91(0.46~1.81)
注： *P<0.05。

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参考文献(36)

[1]	VANKIM N A, NELSON T F. Vigorous physical activity, mental health, perceived stress, and socializing among college students[J]. Am J Health Promot, 2013, 28(1): 7-15. doi: 10.4278/ajhp.111101-QUAN-395
[2]	ZIVIN K, EISENBERG D, GOLLUST S E. Persistence of mental health problems and needs in a college student population[J]. J Affect Disord, 2009, 117(3): 180-185. doi: 10.1016/j.jad.2009.01.001
[3]	BEITER R, NASH R, MCCRADY M, et al. The prevalence and correlates of depression, anxiety, and stress in a sample of college students[J]. J Affect Disord, 2015, 173: 90-96. doi: 10.1016/j.jad.2014.10.054
[4]	SAROKHANI D, DELPISHEH A, VEISANI Y, et al. Prevalence of depression among university students: a systematic review and meta-analysis study[J]. Depress Res Treat, 2013, 2013: 373857. http://www.ncbi.nlm.nih.gov/pubmed/24187615
[5]	REAVLEY N, JORM A F. Prevention and early intervention to improve mental health in higher education students[J]. Early Interv Psychiatry, 2010, 4(2): 132-142. doi: 10.1111/j.1751-7893.2010.00167.x
[6]	LEMMA S, GELAYE B, BERHANE Y, et al. Sleep quality and its psychological correlates among university students in Ethiopia: a cross-sectional study[J]. BMC Psychiatry, 2012, 12(1): 237. doi: 10.1186/1471-244X-12-237
[7]	ORZECH K M, SALAFSKY D B, HAMILTON L A. The state of sleep among college students at a large public university[J]. J Am Coll Health, 2011, 59(7): 612-619. doi: 10.1080/07448481.2010.520051
[8]	KENNEY S R, LABRIE J W, HUMMER J F, et al. Global sleep quality as a moderator of alcohol consumption and consequences in college students[J]. Addict Behav, 2012, 37(4): 507-512. doi: 10.1016/j.addbeh.2012.01.006
[9]	MARKARIAN S A, GILDNER D J, PICKETT S M, et al. Morningness-eveningness and social anxiety symptoms: the influence of depression symptoms on the indirect effect through punishment sensitivity and experiential avoidance[J]. Chronobiol Int, 2019, 36(2): 214-224. doi: 10.1080/07420528.2018.1529679
[10]	林延敏, 卢金逵. 山西省大学生睡眠与身体形态及活动量的关系[J]. 中国学校卫生, 2019, 40(6): 921-923. doi: 10.16835/j.cnki.1000-9817.2019.06.037 LIN Y M, LU J K. The relationship between sleep and body shape and activity level of college students in Shanxi Province[J]. Chin J Sch Health, 2019, 40(6): 921-923. doi: 10.16835/j.cnki.1000-9817.2019.06.037
[11]	LI L, WU C, GAN Y, et al. Insomnia and the risk of depression: a meta-analysis of prospective cohort studies[J]. BMC Psychiatry, 2016, 16(1): 375. doi: 10.1186/s12888-016-1075-3
[12]	REBECCA C C, BUNMI O O. A systematic review of sleep disturbance in anxiety and related disorders[J]. J Anxiety Disord, 2016, 37: 104-129. doi: 10.1016/j.janxdis.2015.12.001
[13]	CRAWFORD J R, HENRY J D. The Depression Anxiety Stress Scales (DASS): normative data and latent structure in a large non-clinical sample[J]. Br J Clin Psychol, 2003, 42(2): 111-131. doi: 10.1348/014466503321903544
[14]	JOHNS M W. A new method for measuring daytime sleepiness: the Epworth sleepiness scale[J]. Sleep, 1991, 14(6): 540-545. doi: 10.1093/sleep/14.6.540
[15]	MORIN C M, BELLEVILLE G, BLANGER L, et al. The Insomnia severity index: psychometric indicators to detect insomnia cases and evaluate treatment response[J]. Sleep, 2011, 34(5): 601-608. doi: 10.1093/sleep/34.5.601
[16]	ADAN A, ALMIRALL H. Horne & stberg morningness-eveningness questionnaire: a reduced scale[J]. Pers Individ Dif, 1991, 12(3): 241-253. doi: 10.1016/0191-8869(91)90110-W
[17]	李伟霞, 穆叶色·艾则孜, 谢植涛, 等. 清晨型与夜晚型量表-5项测评技工学校学生的效度和信度[J]. 中国心理卫生杂志, 2016, 30(6): 406-412. doi: 10.3969/j.issn.1000-6729.2016.06.002 LI W X, MUYESE A Z Z, XIE Z T, et al. Validity and reliability of the Chinese version of Morningness/Eveningness Questionnaire-5 items (MEQ-5) in students of technical schools[J]. Chin Ment Health J, 2016, 30(6): 406-412. doi: 10.3969/j.issn.1000-6729.2016.06.002
[18]	陈明, 耿庆山, 陈瑞华, 等. 广州某医学院校学生心理健康状况调查[J]. 广东医学, 2016, 37(20): 3113-3115. doi: 10.3969/j.issn.1001-9448.2016.20.038 CHEN M, GENG Q S, CHEN R H, et al. Investigation on the mental health of students in a medical college in Guangzhou[J]. Guangdong Med J, 2016, 37(20): 3113-3115. doi: 10.3969/j.issn.1001-9448.2016.20.038
[19]	AL-KHANI A M, SARHANDI M I, ZAGHLOU M S, et al. A cross-sectional survey on sleep quality, mental health, and academic performance among medical students in Saudi Arabia[J]. BMC Res Notes, 2019, 12(1): 665. doi: 10.1186/s13104-019-4713-2
[20]	MOELLER R W, SEEHUUS M. Loneliness as a mediator for college students' social skills and experiences of depression and anxiety[J]. J Adolesc, 2019, 73: 1-13. doi: 10.1016/j.adolescence.2019.03.006
[21]	AUERBACH R P, ALONSO J, AXINN W G, et al. Mental disorders among college students in the World Health Organization World Mental Health Surveys[J]. Psychol Med, 2016, 46(14): 2955-2970.
[22]	WOLF T, KISSLING G. Changes in life-style characteristics, health, and mood of freshman medical students[J]. J Med Educ, 1984, 59(10): 806-814. http://europepmc.org/abstract/MED/6481777
[23]	DEMENECH LM, OLIVEIRA AT, NEIVA-SILVA L, et al. Prevalence of anxiety, depression and suicidal behaviors among Brazilian undergraduate students: a systematic review and meta-analysis[J]. J Affect Disord, 2021, 282: 147-159. doi: 10.1016/j.jad.2020.12.108
[24]	ASELTON P. Sources of stress and coping in American college students who have been diagnosed with depression[J]. J Child Adolesc Psychiatr Nurs, 2012, 25(3): 119-123. doi: 10.1111/j.1744-6171.2012.00341.x
[25]	ZUNHAMMER M, EICHGAMMER P, BUCH V. Sleep quality during exam stress: the role of alcohol, caffeine and nicotine[J]. PLoS One, 2014, 9(10): e109490. doi: 10.1371/journal.pone.0109490
[26]	TSOU M T, CHANG B C C. Association of depression and excessive daytime sleepiness among sleep-deprived college freshmen in northern Taiwan[J]. Int J Environ Res Public Health, 2019, 16(17): 3148. doi: 10.3390/ijerph16173148
[27]	DOHNT H, GRADISAR M, SHORT M A. Insomnia and its symptoms in adolescents: comparing DSM-Ⅳ and ICSD-Ⅱ diagnostic criteria[J]. J Clin Sleep Med, 2012, 8(3): 295-299. doi: 10.5664/jcsm.1918
[28]	DRUIVEN S J M, HOVENKAMP-HERMELINK J H M, Knapen S E. Stability of chronotype over a 7-year follow-up period and its association with severity of depressive and anxiety symptoms[J]. Depress Anx, 2020, 37(5): 466-474. doi: 10.1002/da.22995
[29]	MATSUSHITA M, KOYAMA A, USHIJIMA H, et al. Sleep duration and its association with sleepiness and depression in "ronin-sei" preparatory school students[J]. Asian J Psychiatr, 2014, 9: 61-66. doi: 10.1016/j.ajp.2014.01.006
[30]	BLAKE M J, TRINDER J A, ALLEN N B. Mechanisms underlying the association between insomnia, anxiety, and depression in adolescence: implications for behavioral sleep interventions[J]. Clin Psychol Rev, 2018, 63: 25-40. http://europepmc.org/abstract/MED/29879564
[31]	HARVEY A G. A cognitive model of insomnia[J]. Behav Res Ther, 2002, 40(8): 869-893.
[32]	GARCÍA J A N, VERGEL M F B, LABRADOR J A O, et al. Factors associated with excessive daytime sleepiness in medical students of a higher education institution of bucaramanga[J]. Rev Colomb Psiquiatr, 2019, 48(4): 222-231. doi: 10.1016/j.rcp.2017.12.002
[33]	SHIM E J, NOH H L, YOON J, et al. A longitudinal analysis of the relationships among daytime dysfunction, fatigue, and depression in college students[J]. J Am Coll Health, 2019, 67(1): 51-58. doi: 10.1080/07448481.2018.1462819
[34]	CHAN N Y, ZHANG J, TSANG C C, et al. The associations of insomnia symptoms and chronotype with daytime sleepiness, mood symptoms and suicide risk in adolescents[J]. Sleep Med, 2020, 74: 124-131. http://www.sciencedirect.com/science/article/pii/S1389945720302458
[35]	丛皓, 郭菲, 陈祉妍. 青少年昼夜偏好类型及其与睡眠质量关系[J]. 中国公共卫生, 2019, 35(10): 1400-1403. doi: 10.11847/zgggws1122257 CONG H, GUO F, CHEN Z Y. Relationship between morningness-eveningness and sleep quality among Chinese adolescents[J]. Chin J Public Health, 2019, 35(10): 1400-1403. doi: 10.11847/zgggws1122257
[36]	PARK C I, AN S K, KIM H W. Relationships between chronotypes and affective temperaments in healthy young adults[J]. J Affect Disord, 2015, 175: 256-259.