Association between adverse experience and subsequent incidence of depressive symptoms among middle school students in Liangshan
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摘要:
目的 探明凉山州中学生不良经历与抑郁症状发生的关系，为预防中学生抑郁症状的发生提供依据。 方法 2021年10月采取方便结合整群随机抽样选取凉山州3所中学888名初一、初二和高一学生进行问卷调查，2023年3月开展随访。分别通过问卷和中文版流调中心抑郁量表(CES-D)收集其不良经历(校园欺凌、家庭暴力、缺乏父母理解)及抑郁症状情况。使用Logistic回归模型分析基线时不良经历的数量和随访时抑郁症状发生的关系。 结果 随访时，中学生抑郁症状检出率为9.4%。基线时中学生校园欺凌、家庭暴力、缺乏父母理解与随访时抑郁症状发生有关[OR值(95%CI)分别为2.26(1.37~3.73)，2.56(1.55~4.21)，1.91(1.15~3.16)，P值均 < 0.05]。无论何种不良经历，相对于基线和随访时均无不良经历的参与者，基线和随访时均有不良经历的参与者在随访时更易出现抑郁症状(P值均 < 0.01)。抑郁症状发生率随着基线不良经历数量的增加而上升(P < 0.01)。相对于基线和随访均无不良经历的参与者，基线时有不良经历但随访时无不良经历的参与者在随访时出现抑郁症状的风险未上升[OR值(95%CI)=0.78(0.13~4.80)，P>0.05]。 结论 中学生不良经历增加其抑郁症状发生的风险；相对于一直没有不良经历的中学生，逆转不良经历的中学生抑郁症状的发生风险未见增加。应针对中学时期不良经历采取措施，以预防中学生抑郁症状的发生。 Abstract:Objective To assess the association of adverse experiences and subsequent incidence of depressive symptoms among middle school students in Liangshan, so as to provide a basis for preventing the occurrence of depression symptoms among middle school students. Methods In October 2021, a convenient sampling combined with cluster random sampling method was employed to select 888 students from three high schools (junior first year and second year, senior first year) in Liangshan for a questionnaire survey. In March 2023, a follow-up survey was conducted to collect data on adverse experiences (such as school bullying, domestic violence, and lack of parental understanding). Depressive symptoms were assessed using the Chinese version of the Center for Epidemiologic Studies Depression Scale (CES-D). Logistic regression model analysis was used to examine the relationship between the number of adverse experiences at baseline and the incidence of depressive symptoms during the follow-up period. Results The detection rate of depressive symptoms among middle school students was 9.4% at follow-up. School bullying (OR=2.26, 95%CI=1.37-3.73), domestic violence (OR=2.56, 95%CI=1.55-4.21), and lack of parental understanding (OR=1.91, 95%CI=1.15-3.16) at baseline were positively associated with the incidence of depressive symptoms at follow-up (P < 0.05). Compared with participants with no adverse experiences at both baseline and follow-up, those with adverse experiences at both baseline and follow-up were more likely to exhibit depressive symptoms at follow-up, regardless of the type of adverse experiences (P < 0.01). The incidence of depressive symptoms increased with the increase of baseline adverse experiences (P < 0.01). Compared to the participants with no adverse experiences at both baseline and follow-up, those with adverse experiences at baseline but not at follow-up did not show a statistically significant difference in the likelihood of developing depressive symptoms at follow-up (OR=0.78, 95%CI=0.13-4.80, P>0.05). Conclusions Adverse experiences increase the risk of developing depressive symptoms among middle school students. Participants who have reversed adverse experiences show no increased risk of depressive symptoms compared to those with no adverse experiences. Measures should be taken to prevent the occurrence of depression symptoms among middle school students based on their adverse experiences during their middle school years. -
Key words:
- Life change events /
- Depression /
- Mental health /
- Regression analysis /
- Students
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表 1 随访时不同组别中学生抑郁症状检出率比较
Table 1. Comparison of student reporting rates of depressive symptoms at follow-up
组别 选项 人数 抑郁症状人数 χ2值 P值 性别 女 487 52(10.7) 2.25 0.13 男 401 31(7.7) 民族 汉族 339 30(8.8) 0.78 0.68 彝族 528 52(9.8) 其他 21 1(4.8) 学校 A 268 22(8.2) 4.30 0.12 B 335 26(7.8) C 285 35(12.3) 视屏时间/(h·d-1) ≥2 196 19(9.7) 0.04 0.85 < 2 692 64(9.2) 水产品摄入不足 是 778 70(9.0) 0.91 0.34 否 110 13(11.8) 超重肥胖 是 190 14(7.4) 1.12 0.29 否 698 69(9.9) 校园欺凌 是 180 28(15.6) 10.27 < 0.01 否 708 55(7.8) 家庭暴力 是 182 30(16.5) 13.76 < 0.01 否 706 53(7.5) 缺乏父母理解 是 505 59(11.7) 7.54 < 0.01 否 383 24(6.3) 注： ()内数据为检出率/%。 
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表 2 中学生不良经历的变化与随访时抑郁症状的关系
Table 2. Change of adverse experiences from baseline to follow-up and depressive symptoms at follow-up
自变量 人数 检出人数 检出率/% OR值(95%CI) P值 校园欺凌 持续正常组 625 45 7.2 1.00 恢复正常组 99 10 10.1 1.51(0.73~3.12) 0.27 发生组 83 10 12.0 1.80(0.86~3.80) 0.12 持续组 81 18 22.2 4.00(2.11~7.58) < 0.01 家庭暴力 持续正常组 607 39 6.4 1.00 恢复正常组 119 16 13.4 2.44(1.29~4.60) 0.01 发生组 99 14 14.1 2.63(1.34~5.15) 0.01 持续组 63 14 22.2 4.71(2.30~9.63) < 0.01 缺乏父母理解 持续正常组 234 6 2.6 1.00 恢复正常组 134 5 3.7 1.42(0.42~4.80) 0.57 发生组 149 18 12.1 5.07(1.94~13.22) < 0.01 持续组 371 54 14.6 6.27(2.62~14.99) < 0.01
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表 3 基线时不良经历数量和从基线到随访时不良经历数量的变化对随访时抑郁症状检出的影响
Table 3. Number of adverse experiences at baseline, their change and depressive symptoms at follow-up
自变量 人数 检出人数 检出率/% OR值(95%CI) P值 基线时不良经历数量 无 282 15 5.3 1.00 1 387 31 8.0 1.56(0.82~2.98) 0.18 2 177 25 14.1 2.93(1.47~5.83) < 0.01 3 42 12 28.6 7.82(3.25~18.84) < 0.01 不良经历数量的变化 持续正常组 153 3 2.0 1.00 恢复到无不良经历组 133 2 1.5 0.78(0.13~4.80) 0.79 随访时1个不良经历组 399 37 9.3 5.31(1.60~17.69) 0.01 随访时2个不良经历组 162 32 19.8 13.80(4.01~47.49) < 0.01 随访时3个不良经历组 41 9 22.0 17.26(4.27~69.70) < 0.01
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