中学生抑郁症状预测模型的构建和验证

谭振昆; 张卓; 张影; 平军娇; 罗佳丽; 章杰; 刘新霞

doi:10.16835/j.cnki.1000-9817.2024219

中学生抑郁症状预测模型的构建和验证

doi: 10.16835/j.cnki.1000-9817.2024219

谭振昆¹,
张卓²,
张影¹,
平军娇³,
罗佳丽³,
章杰³,
刘新霞^{1, 3, ,}

1.
广东药科大学公共卫生学院，广州 510006
2.
合肥市疾病预防控制中心艾滋病性病防治科
3.
中山市第三人民医院科教部

基金项目:

中山市社会公益与基础研究项目(医疗卫生) 2022B3007

详细信息

作者简介:
谭振昆(1999-)，男，广东梅州人，在读硕士，主要研究方向为青少年抑郁情绪

通讯作者:
刘新霞，E-mail：syliuxinxia@163.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 N945.12
计量
- 文章访问数: 159
- HTML全文浏览量: 63
- PDF下载量: 28
- 被引次数: 0
出版历程
- 收稿日期: 2024-01-22
- 修回日期: 2024-04-07
- 网络出版日期: 2024-07-27
- 刊出日期: 2024-07-25

Establishment and validation of depressive symptom predictive model in middle school students

1.
College of Public Health, Guangdong Pharmaceutical University, Guangzhou (510006), Guangdong Province, China

摘要

摘要: 目的调查中学生抑郁症状的影响因素，并构建和验证预测模型，为提供风险评估工具，有效筛查中学生抑郁症状提供参考。方法分别于2021年9—10月和2022年9—10月，采用多阶段整群抽样方法从广东省某市抽取2 376和4 344名中学生进行体格检查和问卷调查，并构建中学生抑郁症状的列线图预测模型。问卷调查主要采用学生健康状况及影响因素调查表(中学版)、流调中心抑郁量表测定中学生的生活行为方式和抑郁症状。结果 2021年中学生的抑郁症状检出率为23.3%。多因素Logistic回归分析结果显示，早餐不规律(OR=2.64)，遭受校园欺凌(OR=4.28)，被家长打骂(OR=2.86)，移动电子设备使用时间长(OR=1.08)和静坐时间长(OR=1.05)与中学生抑郁症状的发生均呈正相关；睡眠时间长(OR=0.78)和户外活动时间1~ < 2，2~ < 3和≥3 h/d(与 < 1 h/d相比，OR值分别为0.63，0.61，0.49)与中学生抑郁症状的发生均呈负相关(P值均 < 0.05)。多因素Logistic回归分析有统计学意义的7个预测因子构建列线图，列线图AUC为0.77，经内外部验证，区分度和可靠性良好。结论列线图预测模型可以作为有效评估中学生抑郁症状风险的工具。中学生的生活行为、饮食行为和伤害行为在抑郁症状形成中具有重要作用，应当重视这些行为因素对中学生心理健康的影响。
- 抑郁 /
- 精神卫生 /
- 列线图 /
- 回归分析 /
- 学生
Abstract: Objective To investigate the influencing factors of depressive symptoms and to construct and verify the prediction model of depressive symptoms in middle school students, so as to provide risk assessment tools for effectively screening depressive symptom. Methods Physical examination and questionnaire survey were conducted among middle school students in one city in Guangdong Province from September to October in 2021 (n=2 376) and from September to October in 2022 (n=4 344) by a multistage cluster sampling method, and a nomographic prediction model of depressive symptoms in middle school student was constructed. The questionnaire survey was conducted using the student health status and influencing factors questionnaire (secondary school version) and the Center for Epidemiological Studies Depression Scale (CES-D) to measure the lifestyle and depressive symptom of middle school students. Results The detection rate of depressive symptoms in 2021 was 23.3%. Multivariate Logistic regression analysis showed that irregular breakfast (OR=2.64), school bullying (OR=4.28), being beaten by parents (OR=2.86), using mobile devices for a long time (OR=1.08) and sitting for a long time (OR=1.05) were positively related to depressive symptoms in middle school students (P < 0.05). Long sleep duration (OR=0.78) and outdoor activity durations of 1- < 2, 2- < 3 and ≥3 h/d (compared with < 1 h/d, OR=0.63, 0.61, 0.49) were negatively related to depressive symptoms in middle school students (P < 0.05). Multivariate Logistic regression analysis showed that 7 statistically signifucant predictive factors constructed a nomogram, and the AUC of the nomogram was 0.77, which had been verified internally and externally with good differentiation and reliability. Conclusions The nomogram prediction model of depressive symptoms provides a convenient and effective risk assessment tool for depressive symptoms among middle school students. The life behavior, diet behavior and injury behavior of middle school students play an important role in the formation of depressive symptoms. It should pay attention to the impact of the behavioral factors on the mental health of middle school students.
- Depression /
- Mental health /
- Nomograms /
- Regression analysis /
- Students
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

HTML全文

图 1 中学生抑郁症状风险预测模型

Figure 1. Prediction model of depression risk of middle school students

下载: 全尺寸图片幻灯片

图 2 中学生抑郁症状风险预测模型校准曲线

Figure 2. Calibration curve of the prediction model for depression risk in middle school students

下载: 全尺寸图片幻灯片

图 3 中学生抑郁症状风险预测模型临床决策曲线

Figure 3. Decision curve of the prediction model for depression risk in middle school students

下载: 全尺寸图片幻灯片

表 1 中学生抑郁症状的单因素和多因素Logistic回归分析(n=1 663)

Table 1. Univariate and multivariate Logistic regression analysis of depression among middle school students(n=1 663)

自变量	单因素		多因素
自变量	OR值(95%CI)	P值	OR值(95%CI)	P值
性别
男	1.00		1.00
女	1.06(0.84~1.34)	0.60	1.22(0.93~1.60)	0.15
早餐习惯
规律	1.00		1.00
不规律	3.43(2.65~4.44)	< 0.01	2.64(1.97~3.53)	< 0.01
遭受校园欺凌
无	1.00		1.00
有	5.15(4.01~6.64)	< 0.01	4.28(3.25~5.64)	< 0.01
户外活动时间/(h·d^-1)
< 1	1.00		1.00
1~ < 2	0.48(0.37~0.64)	< 0.01	0.63(0.46~0.88)	< 0.01
2~ < 3	0.40(0.28~0.58)	< 0.01	0.61(0.40~0.92)	0.02
≥3	0.38(0.25~0.57)	< 0.01	0.49(0.30~0.78)	< 0.01
网络成瘾
否	1.00		1.00
是	2.67(1.38~5.16)	< 0.01	0.80(0.36~1.79)	0.59
被家长打骂
无	1.00		1.00
有	2.99(2.06~4.32)	< 0.01	2.86(1.87~4.35)	< 0.01
学段
初中	1.00		1.00
高中	1.37(1.07~1.76)	0.01	1.13(0.84~1.53)	0.43
职高	1.38(0.96~1.97)	0.08	1.41(0.92~2.11)	0.11
睡眠时间/(h·d^-1)	0.72(0.66~0.79)	< 0.01	0.78(0.70~0.85)	< 0.01
移动电子设备使用时间/(h·d^-1)	1.16(1.10~1.22)	< 0.01	1.08(1.02~1.14)	0.01
静坐时间/(h·d^-1)	1.05(1.02~1.08)	< 0.01	1.05(1.02~1.09)	< 0.01

下载: 导出CSV

参考文献(39)

[1]	GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the global burden of disease study 2015[J]. Lancet, 2016, 388(10053): 1545-1602. doi: 10.1016/S0140-6736(16)31678-6
[2]	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. Meta-analysis of depressive symptoms in middle school students[J]. Chin Ment Health J, 2020, 34(2): 123-128. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZXWS202002009.htm
[3]	THAPAR A, EYRE O, PATEL V, et al. Depression in young people[J]. Lancet, 2022, 400(10352): 617-631. doi: 10.1016/S0140-6736(22)01012-1
[4]	CLAYBORNE Z M, VARIN M, COLMAN I. Systematic review and Meta-analysis: adolescent depression and long-term psychosocial outcomes[J]. J Am Acad Child Adolesc Psychiatry, 2019, 58(1): 72-79. doi: 10.1016/j.jaac.2018.07.896
[5]	RAO U, RYAN N D, BIRMAHER B, et al. Unipolar depression in adolescents: clinical outcome in adulthood[J]. J Am Acad Child Adolesc Psychiatry 1995, 34(5): 566-578. doi: 10.1097/00004583-199505000-00009
[6]	SURIS J C, MICHAUD P A, VINER R. The adolescent with a chronic condition Part I: developmental issues[J]. Arch Dis Child, 2004, 89(10): 938-942. doi: 10.1136/adc.2003.045369
[7]	SANDBERG-THOMA S E, KAMP DUSH C M. Indicators of adolescent depression and relationship progression in emerging adulthood[J]. J Marital Fam, 2014, 76(1): 191-206.
[8]	BHAVSAR V, HATCH S L, DEAN K, et al. Association of prior depressive symptoms and suicide attempts with subsequent victimization: analysis of population-based data from the adult psychiatric morbidity survey[J]. Eur Psychiatry, 2020, 63(1): e51. doi: 10.1192/j.eurpsy.2020.50
[9]	JOHNSON D, DUPUIS G, PICHE J, et al. Adult mental health outcomes of adolescent depression: a systematic review[J]. Depress Anx, 2018, 35(8): 700-716. doi: 10.1002/da.22777
[10]	高青, 刘懿卿, 叶茜雯, 等. 辽宁省中学生网瘾情况及其影响因素分析[J]. 现代预防医学, 2020, 47(18): 3378-3381. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF202018031.htm GAO Q, LIU Y Q, YE Q W, et al. Analysis of Internet addiction and its influencing factors in middle school students in Liaoning Province[J]. Mod Prev Med, 2020, 47(18): 3378-3381. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF202018031.htm
[11]	孙志颖, 刘忠慧, 徐渴, 等. 2019—2020年天津市中学生抑郁现况及影响因素分析[J]. 公共卫生与预防医学, 2022, 33(4): 152-155. https://www.cnki.com.cn/Article/CJFDTOTAL-FBYF202204036.htm SUN Z Y, LIU Z H, XU K, et al. Current situation and influencing factors of depression among middle school students in Tianjin, 2019-2020[J]. Public Health Prev Med, 2022, 33(4): 152-155. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-FBYF202204036.htm
[12]	奉琪, 陈艳, 吴鑫. 长沙市中学生抑郁症状流行状况及其影响因素分析[J]. 实用预防医学, 2023, 30(8): 949-954. doi: 10.3969/j.issn.1006-3110.2023.08.012 FENG Q, CHEN Y, WU X. Analysis on the prevalence and influencing factors of depressive symptoms in middle school students in Changsha[J]. Pract Prev Med, 2023, 30(8): 949-954. (in Chinese) doi: 10.3969/j.issn.1006-3110.2023.08.012
[13]	章婕, 吴振云, 方格, 等. 流调中心抑郁量表全国城市常模的建立[J]. 中国心理卫生杂志, 2010, 24(2): 139-143. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXWS201002019.htm ZHANG J, WU Z Y, FANG G, et al. Establishment of national urban norm of Center for Epidemiological Studies Depression Scale[J]. Chin Ment Health J, 2010, 24(2): 139-143. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZXWS201002019.htm
[14]	中华人民共和国国家卫生和计划生育委员会. 学生健康检查技术规范: GB/T 26343—2010[S]. 北京: 中国标准出版社, 2011. National Health and Family Planning Commission of the PRC. Technical standard for physical examination for students: GB/T 26343-2010[S]. Beijing: Standards Press of China, 2011. (in Chinese)
[15]	中华人民共和国国家卫生和计划生育委员会. 学龄儿童青少年超重与肥胖筛查: WS/T 586—2018[S]. 2018-08-01. National Health and Family Planning Commission of the PRC. Screening for overweight and obesity among schoolage children and adolescents: WS/T 586-2018[S]. 2018-08-01(in Chinese)
[16]	中华人民共和国国家卫生健康委员会办公厅, 中华人民共和国教育部办公厅, 中华人民共和国财政部办公厅, 等. 关于印发《儿童青少年近视防控技术指南》的通知[EB/OL]. (2019-10-15)[2024-05-24]. http://www.nhc.gov.cn/jkj/s5898bm/201910/c475e0bd2de444379402f157523f03fe.shtml. Notice of the General Office of the National Health Commission of the PRC, General Office of the Ministry of Education of the PRC, General Office of the Ministry of Finance of the PRC, et al. Printing and distributing Appropriate Technical Guidelines for the Prevention and Control of Myopia in Children and Adolescents[EB/OL]. (2019-10-15)[2024-05-24]. http://www.nhc.gov.cn/jkj/s5898bm/201910/c475e0bd2de444379402f157523f03fe.shtml. (in Chinese)
[17]	中华人民共和国国家卫生和计划生育委员会. 儿童青少年脊柱弯曲异常的筛查: GB/T 16133—2014[S]. 北京: 中国标准出版社, 2014. National Health and Family Planning Commission of the PRC. Screening of spinal curvature abnormality of children and adolescents: GB/T 16133-2014[S]. Beijing: Standards Press of China, 2014. (in Chinese)
[18]	中华人民共和国国家卫生健康委员会. 7~18岁儿童青少年体检、性别、身高及血压测量标准操作指南: WS/T 610—2018[S]. 2018-06-13. National Health Commission of the PRC. Reference of screening for elevated blood pressure among children and adolescents aged 7-18 years: WS/T 610-2018[S]. 2018-06-13. (in Chinese)
[19]	柳键, 荣文苼. 口腔健康调查基本方法: 翻译版[M]. 5版. 北京: 人民卫生出版社, 2017. LIU J, RONG W S. Basic methods of oral health survey: translated edition[M]. 5 ed. Beijing: People's Medical Publishing House, 2017. (in Chinese)
[20]	陈祉妍, 杨小冬, 李新影. 流调中心抑郁量表在我国青少年中的试用[J]. 中国临床心理学杂志, 2009, 17(4): 443-445, 448. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLCY200904019.htm CHEN Z Y, YANG X D, LI X Y. A trial study of Center for Epidemiological Studies Depression Scale in Chinese adolescents[J]. Chin J Clin Psychol, 2009, 17(4): 443-445, 448. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZLCY200904019.htm
[21]	中华人民共和国国家卫生健康委办公厅关于印发2019年全国学生常见疾病和健康影响因素监测工作方案的通知[EB/OL]. (2019-03-26)[2024-05-24]. http://www.nhc.gov.cn/jkj/s5898bm/201903/1bcbac21e1864377ad24984fac014c7d.shtml. Notice of the General Office of the National Health Commission of the PRC on issuing the work program of monitoring and intervention of common diseases and health influencing factors among students in 2019[EB/OL]. (2019-03-26)[2024-05-24]. http://www.nhc.gov.cn/jkj/s5898bm/201903/1bcbac21e1864377ad24984fac014c7d.shtml. (in Chinese)
[22]	季成叶. 中国青少年健康相关/危险行为调查综合报告2005[M]. 北京: 北京大学医学出版社, 2007. JI C Y. Summary report of Chinese adolescent health related/risk behavior survey 2005[M]. Beijing: Peking University Medical Press 2007. (in Chinese)
[23]	WU W T, LI Y J, FENG A Z, et al. Data mining in clinical big data: the frequently used databases, steps, and methodological models[J]. Mil Med Res, 2021, 8: 44.
[24]	HWANG S, NAM J Y. Do lifestyle risk behaviors affect anxiety, depressive symptoms, and suicidal ideation among adolescents?[J]. Psychiatry Res, 2022, 318: 114942.
[25]	KUNUGI H. Depression and lifestyle: focusing on nutrition, exercise, and their possible relevance to molecular mechanisms[J]. Psychiatry Clin Neurosci, 2023, 77(8): 420-433.
[26]	WILSON J E, BLIZZARD L, GALL S L, et al. An eating pattern characterised by skipped or delayed breakfast is associated with mood disorders among an Australian adult cohort[J]. Psychol Med, 2020, 50(16): 2711-2721.
[27]	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.
[28]	LIU B P, FANG H J, JIA C X. The serial mediation of the association between breakfast skipping and suicidality by weight status and depressive symptoms: findings from the national youth risk behavior surveys of the United States[J]. Nutrients, 2022, 14(5): 956.
[29]	XIAN X, WANG C, YU R, et al. Breakfast frequency and sleep quality in college students: the multiple mediating effects of sleep chronotypes and depressive symptoms[J]. Nutrients, 2023, 15(12): 2678.
[30]	CHUNNAN L, SHAOMEI S, WANNIAN L. The association between sleep and depressive symptoms in US adults: data from the NHANES (2007-2014)[J]. Epidemiol Psychiatr Sci, 2022, 31: 63.
[31]	UM Y J, KIM Y, CHANG Y, et al. Association of changes in sleep duration and quality with incidence of depression: a cohort study[J]. J Affect Disord, 2023, 328: 64-71.
[32]	GUPTA P, SAGAR R, MEHTA M. Subjective sleep problems and sleep hygiene among adolescents having depression: a case-control study[J]. Asian J Psychiatr, 2019, 44: 150-155.
[33]	WANG W, DU X, GUO Y, et al. Associations among screen time, sleep duration and depressive symptoms among Chinese adolescents[J]. J Affect Disord, 2021, 284: 69-74.
[34]	SAMPASA-KANYINGA H, COLMAN I, GOLDFIELD G S, et al. Combinations of physical activity, sedentary time, and sleep duration and their associations with depressive symptoms and other mental health problems in children and adolescents: a systematic review[J]. Int J Behav Nutr Phys Act, 2020, 17: 72.
[35]	PEARCE M, GARCIA L, ABBAS A, et al. Association between physical activity and risk of depression[J]. JAMA Psychiatry, 2022, 79(6): 550-559.
[36]	彭艾平, 兰玉坤, 贾英男. 上海市中学生问题性智能手机使用与心理健康的相关性: 学业压力的中介效应[J]. 复旦学报(医学版), 2022, 49(1): 16-22. https://www.cnki.com.cn/Article/CJFDTOTAL-SHYK202201003.htm PENG A P, LAN Y K, JIA Y N. The correlation between problematic smartphone use and mental health of middle school students in Shanghai: the mediating effect of academic stress[J]. Fudan Univ J (Med Sci), 2022, 49(1): 16-22. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-SHYK202201003.htm
[37]	王琳, 郝燕, 陈立, 等. 长期居家学习期间儿童和青少年心理行为问题的研究[J]. 中华预防医学杂志, 2021, 55(9): 1059-1066. https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO202302024.htm WANG L, HAO Y, CHEN L, et al. Study on psychological and behavioral problems in children and adolescents during long-term home learning[J]. Chin J Prev Med, 2021, 55(9): 1059-1066. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO202302024.htm
[38]	郑利锋, 杨开仁, 谭素仙, 等. 青少年抑郁症状现况调查[J]. 预防医学, 2018, 30(4): 338-340, 344. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYFX201804004.htm ZHENG L F, YANG K R, TAN S X, et al. Adolescent depression inventory survey[J]. Prev Med, 2018, 30(4): 338-340, 344. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZYFX201804004.htm
[39]	ANDERSON J R, MAYES T L, FULLER A, et al. Experiencing bullying's impact on adolescent depression and anxiety: mediating role of adolescent resilience[J]. J Affect Disord, 2022, 310: 477-483.