云南省多民族初一年级学生抑郁症状决策树模型

杨家兴; 李霄霄; 杨继宗; 杨朝源; 张明; 付允; 杨婉娟; 王继学; 徐洪吕

doi:10.16835/j.cnki.1000-9817.2024048

云南省多民族初一年级学生抑郁症状决策树模型

doi: 10.16835/j.cnki.1000-9817.2024048

杨家兴^{1, 2},
李霄霄^{1, 2},
杨继宗³,
杨朝源⁴,
张明⁵,
付允⁵,
杨婉娟⁶,
王继学⁷,
徐洪吕^{1, 2, ,}

1.
昆明学院医学院，云南 650214
2.
昆明学院社区护理研究团队
3.
南涧县第二中学
4.
南涧县南涧镇中学
5.
镇沅县民族中学
6.
南涧县疾病预防控制中心免疫规划科
7.
双江自治县第一完全中学

基金项目:

国家自然科学基金项目 82160622

云南省“兴滇英才支持计划”青年人才专项项目 XDYC-QNRC-2022-0289

详细信息

作者简介:
杨家兴(1979-)，男，云南临沧人，大学本科，讲师，主要研究方向为青少年心理行为健康

通讯作者:
徐洪吕，E-mail: x___hl@126.com

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R179 G444 G478
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- PDF下载量: 49
- 被引次数: 0
出版历程
- 收稿日期: 2023-12-22
- 修回日期: 2024-01-17
- 网络出版日期: 2024-03-02
- 刊出日期: 2024-02-25

Decision tree model of depressive symptoms among first-grade students from multi-ethnic middle schools in Yunnan Province

YANG Jiaxing^{1, 2},
LI Xiaoxiao^{1, 2},
YANG Jizong³,
YANG Chaoyuan⁴,
ZHANG Ming⁵,
FU Yun⁵,
YANG Wanjuan⁶,
WANG Jixue⁷,
XU Honglü^{1, 2
, ,}

1.
School of Medicine, Kunming University, Kunming (650214), Yunnan Province, China

摘要

摘要: 目的了解云南省多民族初中学生抑郁症状发生情况及其预测因素，为学校有针对性地开展心理健康教育提供参考依据。方法于2022年10—12月，采用整群随机抽样方法在云南省11个少数民族地区选取23所中学的8 500名初一年级学生，使用问卷调查收集中学生人口统计学和生活行为方式数据，采用儿童抑郁量表(CDI)评估抑郁症状。单因素分析使用χ²检验比较不同人口学变量的初一年级学生抑郁症状检出率，采用卡方自动交互检测法(CHAID)建立中学生抑郁症状决策树模型。结果云南省多民族初一年级学生抑郁症状检出率为28.26%。抑郁症状决策树的第1层是自评学习压力(χ²=469.08)，第2层是早餐行为(中/轻度学习压力：χ²=155.49；重度学习压力：χ²=105.24)，第3层是亲密朋友数量(中/轻度学习压力，每周吃早餐0~2 d：χ²=23.15；中/轻度学习压力，每周吃早餐3~4 d：χ²=14.99；重度学习压力，每周吃早餐0~2 d：χ²=29.26；重度学习压力，每周吃早餐3~4 d：χ²=20.15)、民族(χ²=78.22)和饮酒(χ²=50.36)(P值均＜0.01)。结论学习压力、早餐行为、亲密朋友数量、饮酒和民族是云南省多民族中学生抑郁症状的预测因子。学校应有针对性地制定抑郁症状防控策略，减少中学生抑郁症状的发生。
- 抑郁 /
- 精神卫生 /
- 决策树 /
- 学生 /
- 少数民族
Abstract: Objective To understand the occurrence and predictive factors of depressive symptoms among multi-ethnic middle school students in Yunnan Province, so as to provide a referential framework for schools to carry out targeted mental health education. Methods From October to December 2022, 8 500 first-grade students from 23 middle schools were selected from 11 minority areas in Yunnan Province by cluster random sampling method. Demographic information and data relating to the students' lifestyles were collected by questionnaire, and the Children's Depression Inventory (CDI) was used to evaluate depressive symptoms. Chi-square test was performed to compare differences in the detection rate of depressive symptoms among first-grade middle school students for univariate analysis. A decision tree model of depressive symptoms in middle school students was established by using the Chi-squared automatic interaction detector (CHAID). Results The detection rate of depressive symptoms among first-grade students from multi-ethnic middle schools in Yunnan Province was 28.26%. The decision tree model of depressive symptoms was academic stress (χ²=469.08) at the first level, breakfast behaviors (low/moderate academic stress: χ²=155.49; severe academic stress: χ²=105.24) at the second level, and the number of close friends (low/moderate academic stress and consuming breakfast 0-2 days weekly: χ²=23.15; low/moderate academic stress and consuming breakfast 3-4 days weekly: χ²=14.99; severe academic stress and consuming breakfast 0-2 days weekly: χ²=29.26; severe academic stress and consuming breakfast 3-4 days weekly: χ²=20.15), ethnicity (χ²=78.22) and drinking (χ²=50.36) at the third level (P<0.01). Conclusions The study identifies academic stress, breakfast behaviors, number of close friends, drinking and ethnicity as predictive factors of depressive symptoms among multi-ethnic middle school students in Yunnan Province. Schools should develop targeted strategies for preventing and managing depressive symptoms in middle school students, so as to reduce their occurrence.
- Depression /
- Mental health /
- Decision trees /
- Students /
- Minority groups
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

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图 1 云南省多民族初一年级学生抑郁症状决策树模型

Figure 1. Depressive symptoms decision tree for first-grade students from multi-ethnic middle school in Yunnan Province

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表 1 云南省不同人口学特征多民族初一年级学生抑郁症状检出率比较

Table 1. Comparison of detection rates of depressive symptoms among first-grade students from multi-ethnic middle schools with different demographic characteristics in Yunnan Province

组别	选项	人数	抑郁症状	χ²值	P值	组别	选项	人数	抑郁症状	χ²值	P值
年龄/岁	12	3 698	987(26.69)	36.45	＜0.01	父亲文化程度	小学未毕业或没上过学	1 084	368(33.95)	24.70	＜0.01
	13	4 259	1 204(28.27)				小学	1 956	558(28.53)
	14	461	174(37.74)				初中	3 931	1 067(27.14)
	15	82	37(45.12)				高中/中专	1 056	297(28.13)
性别	男	4 184	1 069(25.55)	29.83	＜0.01		大专及以上	473	112(23.68)
	女	4 316	1 333(30.89)			母亲文化程度	小学未毕业或没上过学	1 700	559(32.88)	30.44	＜0.01
民族	汉族	3 856	947(24.56)	113.47	＜0.01		小学	2 045	588(28.75)
	哈尼族	1 585	465(29.34)				初中	3 472	902(25.98)
	彝族	1 379	369(26.76)				高中/中专	872	253(29.01)
	傈僳族	601	256(42.60)				大专及以上	411	100(24.33)
	拉祜族	254	101(39.76)			父亲职业	公职人员^b	4 173	1 174(28.13)	14.46	0.01
	傣族	235	83(35.32)				工人	502	128(25.50)
	其他民族	590	181(30.68)				公司职员	1 798	520(28.92)
家庭居住地	农村	6 358	1 824(28.69)	2.30	0.13		商人	659	156(23.67)
	城镇	2 142	578(26.98)				农民	269	80(29.74)
独生子女	是	1 256	395(31.45)	7.40	0.01		其他	1 099	344(31.30)
	否	7 244	2 007(27.71)			母亲职业	公职人员^b	4 660	1 328(28.50)	14.59	0.01
家庭类型	双亲	6 878	1 825(26.53)	54.91	＜0.01		工人	409	94(22.98)
	单亲	862	300(34.80)				公司职员	1 047	299(28.56)
	组合^a	617	219(35.49)				商人	758	192(25.33)
	其他	143	58(40.56)				农民	324	85(26.23)
自评家庭经济状况	差	1 127	498(44.19)	169.88	＜0.01		其他	1 302	404(31.03)
	中	6 000	1 590(26.50)
	好	1 373	314(22.87)
注：()内数字为检出率/%；a有继父或继母，b为公务员及事业单位人员。

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表 2 云南省多民族初一年级学生抑郁症状单因素分析

Table 2. Univariate analysis of depressive symptoms among first-grade students from multi-ethnic middle schools in Yunnan Province

组别	选项	人数	抑郁症状	χ²值	P值	组别	选项	人数	抑郁症状	χ²值	P值
家庭变故	是	1 061	389(36.66)	42.24	＜0.01	每周吃夜宵天数/d	0	2 217	572(25.80)	25.78	＜0.01
	否	7 439	2 013(27.06)				1~2	2 976	800(26.88)
住院经历	是	1 377	488(35.44)	41.79	＜0.01		3~4	1 640	494(30.12)
	否	7 123	1 914(26.87)				5~6	667	205(30.73)
新型冠状病毒感染疫情影响学习	是	3 362	1 092(32.48)	48.90	＜0.01		7	1 000	331(33.10)
	否	5 138	1 310(25.50)			每周吃西式快餐频率/d	0	6 122	1 708(27.90)	21.98	＜0.01
抑郁症家族史	是	192	94(48.96)	41.52	＜0.01		1~2	2 027	560(27.63)
	否	8 308	2 308(27.78)				3~4	243	85(34.98)
学习日视屏时间/h	＜1	4 862	1 255(25.81)	95.10	＜0.01		5~6	44	19(43.18)
	1~＜2	1 765	503(28.50)				≥7	64	30(46.88)
	2~＜3	982	308(31.36)			每周吃中式快餐频率/d	0	5 594	1 493(26.69)	41.44	＜0.01
	3~＜4	433	123(28.41)				1~2	2 128	619(29.09)
	4~＜5	168	74(44.05)				3~4	479	181(37.79)
	≥5	290	139(47.93)				5~6	146	47(32.19)
休息日视屏时间/h	＜1	1 790	467(26.09)	140.86	＜0.01		≥7	153	62(40.52)
	1~＜2	2 334	584(25.02)			每周吃外卖快餐频率/d	0	6 835	1 829(26.76)	68.94	＜0.01
	2~＜3	1 968	499(25.36)				1~2	1 151	360(31.28)
	3~＜4	1 085	319(29.40)				3~4	317	117(36.91)
	4~＜5	480	157(32.71)				5~6	113	49(43.36)
	≥5	843	376(44.60)				≥7	84	47(55.95)
留守经历	是	2 334	856(36.68)	112.42	＜0.01	每周喝含糖饮料频率/d	0	2 085	548(26.28)	104.50	＜0.01
	否	6 166	1 546(25.07)				1~2	3 837	983(25.62)
每天吸烟/支	0	8 239	2 243(27.22)	168.13	＜0.01		3~4	1 412	402(28.47)
	1~2	135	64(47.41)				5~6	577	215(37.26)
	3~4	46	33(71.74)				≥7	589	254(43.12)
	5~6	28	20(71.43)			每周吃零食频率/d	0	1 195	349(29.21)	62.84	＜0.01
	≥7	52	42(80.77)				1~2	3 734	948(25.39)
自评学习压力	重	3 040	1 290(42.43)	469.39	＜0.01		3~4	2 011	546(27.15)
	中	5 190	1 053(20.29)				5~6	845	291(34.44)
	轻	270	59(21.85)				≥7	715	268(37.48)
亲密朋友数量/个	0~2	945	437(46.24)	193.19	＜0.01	每月饮酒/杯	0	8 079	2 169(26.85)	165.24	＜0.01
	3~4	1 361	427(31.37)				1~2	231	119(51.52)
	≥5	6 194	1 538(24.83)				3~4	73	46(63.01)
每周吃早餐天数/d	0~2	1 329	613(46.12)	318.98	＜0.01		5~6	43	23(53.49)
	3~4	1 458	493(33.81)				≥7	74	45(60.81)
	5~7	5 713	1 296(22.69)
注：()内数字为检出率/%。

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参考文献(31)

[1]	SHOREY S, NG E D, WONG C H J. Global prevalence of depression and elevated depressive symptoms among adolescents: a systematic review and Meta-analysis[J]. Br J Clin Psychol, 2022, 61(2): 287-305. doi: 10.1111/bjc.12333
[2]	MALHI G S, MANN J J. Depression[J]. Lancet, 2018, 392(10161): 2299-2312. doi: 10.1016/S0140-6736(18)31948-2
[3]	刘福荣, 宋晓琴, 尚小平, 等. 中学生抑郁症状检出率的Meta分析[J]. 中国心理卫生杂志, 2020, 34(2): 123-128. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXWS202002009.htm LIU F R, SONG X Q, SHANG X P, et al. A Meta-analysis of detection rate of depression symptoms among middle school students[J]. Chin Mental Health J, 2020, 34(2): 123-128. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZXWS202002009.htm
[4]	ZHANG X, YAN Y, YE Z, et al. Descriptive analysis of depression among adolescents in Huangshi, China[J]. BMC Psychiatry, 2023, 23(1): 176. doi: 10.1186/s12888-023-04682-3
[5]	徐涛, 周县委, 张天成, 等. 中国中学生抑郁症状危险因素的Meta分析[J]. 现代预防医学, 2022, 49(5): 814-818, 844. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF202205010.htm XU T, ZHOU X W, ZHANG T C, et al. Risk factors of depression symptom among Chinese middle school students: a Meta-analysis[J]. Mod Prev Med, 2022, 49(5): 814-818, 844. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF202205010.htm
[6]	张桂杰, 王小灿, 邢维康, 等. 基于决策树分类算法的心理测评模型研究[J]. 吉林师范大学学报, 2023, 44(4): 123-130. https://www.cnki.com.cn/Article/CJFDTOTAL-SLXK202304018.htm ZHANG G J, WANG X C, XING W K, et al. Research on psychological assessment model based on decision tree classification algorithm[J]. J Jilin Normal Univ, 2023, 44(4): 123-130. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-SLXK202304018.htm
[7]	徐洪吕, 万宇辉, 张诗晨, 等. 青少年抑郁症状与外卖快餐碳酸饮料消费相关性分析[J]. 中国学校卫生, 2019, 40(4): 538-541, 545. doi: 10.16835/j.cnki.1000-9817.2019.04.017 XU H L, WAN Y H, ZHANG S C, et al. Interaction effects of co-consumption of takeaway fast foods and sodas on depressive symptom in Chinese adolescents[J]. Chin J Sch Health, 2019, 40(4): 538-541, 545. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2019.04.017
[8]	柳之啸, 李京, 王玉, 等. 中文版儿童抑郁量表的结构验证及测量等值[J]. 中国临床心理学杂志, 2019, 27(6): 1172-1176. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLCY201906020.htm LIU Z X, LI J, WANG Y, et al. Structural verification and measurement invariance of Chinese version of Children's Depression Inventory[J]. Chin J Clin Psychol, 2019, 27(6): 1172-1176. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZLCY201906020.htm
[9]	洪忻, 李解权, 梁亚琼, 等. 儿童抑郁量表中文版在中学生中的信效度分析[J]. 中国学校卫生, 2012, 33(10): 1182-1185. https://www.cnki.com.cn/Article/CJFDTOTAL-XIWS201210010.htm HONG X, LI J Q, LIANG Y Q, et al. Reliability and validity of the Chinese version of Children' s Depression Inventory[J]. Chin J Sch Health, 2012, 33(10): 1182-1185. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-XIWS201210010.htm
[10]	ZHANG X, GAO F, KANG Z, et al. Perceived academic stress and depression: the mediation role of mobile phone addiction and sleep quality[J]. Front Public Health, 2022, 10: 760387. doi: 10.3389/fpubh.2022.760387
[11]	REN Z, ZHOU G, WANG Q, et al. Associations of family relationships and negative life events with depressive symptoms among Chinese adolescents: a cross-sectional study[J]. PLoS One, 2019, 14(7): e0219939. doi: 10.1371/journal.pone.0219939
[12]	ZENG X, CHEN Y, ZHANG Q, et al. Multidimensional self-rating biological rhythm disorder and its association with depression and anxiety symptoms among adolescents aged 11-23 years: a school-based cross-sectional study from China[J]. BMC Psychiatry, 2022, 22(1): 700. doi: 10.1186/s12888-022-04354-8
[13]	JAYANTHI P, THIRUNAVUKARASU M, RAJKUMAR R. Academic stress and depression among adolescents: a cross-sectional study[J]. Indian Pediat, 2015, 52(3): 217-219. doi: 10.1007/s13312-015-0609-y
[14]	ALI N M, NOWSHAD N A, MANSOOR K M, et al. Perceived academic and psychological stress among adolescents in United Arab Emirates: role of gender, age, depression, and high expectation of parents[J]. Psychiatr Danub, 2019, 31(Suppl 3): 331-337.
[15]	SCHMIDT H D, DUMAN R S. The role of neurotrophic factors in adult hippocampal neurogenesis, antidepressant treatments and animal models of depressive-like behavior[J]. Behav Pharmacol, 2007, 18(5-6): 391-418. doi: 10.1097/FBP.0b013e3282ee2aa8
[16]	YANG L, ZHAO Y, WANG Y, et al. The effects of psychological stress on depression[J]. Curr Neuropharmacol, 2015, 13(4): 494-504. doi: 10.2174/1570159X1304150831150507
[17]	ZAHEDI H, DJALALINIA S, SADEGHI O, et al. Breakfast consumption and mental health: a systematic review and Meta-analysis of observational studies[J]. Nutr Neurosci, 2022, 25(6): 1250-1264. doi: 10.1080/1028415X.2020.1853411
[18]	PENGPID S, PELTZER K. Skipping breakfast and its association with health risk behaviour and mental health among university students in 28 countries[J]. Diabetes Metab Syndr Obes, 2020, 13: 2889-2897. doi: 10.2147/DMSO.S241670
[19]	ZURAIKAT F M, WOOD R A, BARRAGÁN R, et al. Sleep and diet: mounting evidence of a cyclical relationship[J]. Annu Rev Nutr, 2021, 41: 309-332. doi: 10.1146/annurev-nutr-120420-021719
[20]	JENKINS T A, NGUYEN J C, POLGLAZE K E, et al. Influence of tryptophan and serotonin on mood and cognition with a possible role of the gut-brain axis[J]. Nutrients, 2016, 8(1): 56. doi: 10.3390/nu8010056
[21]	GIMÉNEZ-LEGARRE N, MIGUEL-BERGES M L, FLORES-BARRANTES P, et al. Breakfast characteristics and its association with daily micronutrients intake in children and adolescents: a systematic review and Meta-analysis[J]. Nutrients, 2020, 12(10): 3201. doi: 10.3390/nu12103201
[22]	WANG J, UM P, DICKERMAN B A, et al. Zinc, magnesium, selenium and depression: a review of the evidence, potential mechanisms and implications[J]. Nutrients, 2018, 10(5): 584. doi: 10.3390/nu10050584
[23]	BOKSZCZANIN A, PALACE M, BROWN W, et al. Depression, perceived risk of COVID-19, loneliness, and perceived social support from friends among university students in Poland, UK, and India[J]. Psychol Res Behav Manage, 2023, 16: 651-663. doi: 10.2147/PRBM.S380318
[24]	KANG M, MIN A, MIN H. Predicting multicultural adolescents' depression in South Korea: roles of ego-resilience and social support[J]. J Pediatr Nurs, 2022, 65: e93-e98. doi: 10.1016/j.pedn.2022.03.012
[25]	ACHTERBERGH L, PITMAN A, BIRKEN M, et al. The experience of loneliness among young people with depression: a qualitative Meta-synthesis of the literature[J]. BMC Psychiatry, 2020, 20(1): 415. doi: 10.1186/s12888-020-02818-3
[26]	GRIFFITHS K M, CRISP D A, BARNEY L, et al. Seeking help for depression from family and friends: a qualitative analysis of perceived advantages and disadvantages[J]. BMC Psychiatry, 2011, 11: 196. doi: 10.1186/1471-244X-11-196
[27]	CHOW M S C, POON S H L, LUI K L, et al. Alcohol consumption and depression among university students and their perception of alcohol use[J]. East Asian Arch Psychiatry, 2021, 31(4): 87-96. doi: 10.12809/eaap20108
[28]	LINA-JOLIEN P, ROCÍO G J, MIQUEL R, et al. Moderate alcohol consumption and depression prevention: a critical review[J]. Actas Esp Psiquiatr, 2022, 50(3): 126-133.
[29]	RICHARDSON H N, LEE S Y, O'DELL L E, et al. Alcohol self-administration acutely stimulates the hypothalamic-pituitary-adrenal axis, but alcohol dependence leads to a dampened neuroendocrine state[J]. Eur J Neurosci, 2008, 28(8): 1641-1653. doi: 10.1111/j.1460-9568.2008.06455.x
[30]	FLORES-BONILLA A, RICHARDSON H N. Sex differences in the neurobiology of alcohol use disorder[J]. Alcohol Res, 2020, 40(2): 4.
[31]	ZHANG X, HUANG R, HO S Y, et al. Alcohol drinking, especially light drinking, and depressive symptoms in adolescents[J]. Drug Alcohol Depend, 2021, 227: 108932. doi: 10.1016/j.drugalcdep.2021.108932