重庆市中学生抑郁焦虑症状共存现状及影响因素分析

李霞; 熊鹰; 杨思维; 张敬; 彭畅; 李梦芬; 王宏

doi:10.16835/j.cnki.1000-9817.2025266

重庆市中学生抑郁焦虑症状共存现状及影响因素分析

doi: 10.16835/j.cnki.1000-9817.2025266

李霞¹,
熊鹰²,
杨思维¹,
张敬²,
彭畅¹,
李梦芬³,
王宏^1, ,

1.
重庆医科大学公共卫生学院/医学与社会发展研究中心，重庆 401331
2.
重庆市疾病预防控制中心学校卫生所
3.
重庆市合川区疾病预防控制中心地方病与寄生虫病防制科

基金项目:

教育部人文社会科学研究规划基金项目 22YJA840010

国家自然科学基金青年项目 82404288

重庆市学校卫生协会2024健康学校研究项目 WXA2024003

重庆市学校卫生协会2024健康学校研究项目 WXA2024004

详细信息

作者简介:
李霞(1995-)，女，重庆合川人，在读硕士，主要研究方向为公共卫生

通讯作者:
王宏，E-mail: 100113@cqmu.edu.cn

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R179 G444 G479
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出版历程
- 收稿日期: 2025-05-28
- 修回日期: 2025-07-26
- 刊出日期: 2025-10-25

Analysis of the current situation and influencing factors of comorbidity of depressive and anxiety symptoms among middle school students in Chongqing

1.
College of Public Health/Center for Medical and Social Development Research, Chongqing Medical University, Chongqing 401331, China

摘要

摘要: 目的了解重庆市中学生抑郁焦虑症状共存现状及影响因素，为制定中学生多病共防综合策略提供科学依据。方法 2024年9—12月，采用分层整群抽样与方便抽样相结合的方法从重庆市6个区县共抽取12 327名中学生，采用流调中心抑郁量表(CES-D)、广泛性焦虑量表(GAD-7)调查抑郁、焦虑症状。采用χ²检验比较抑郁焦虑症状共存组间差异，运用多因素Logistic回归分析其相关因素，并绘制列线图预测模型。结果重庆市中学生抑郁症状、焦虑症状、二者共存检出率分别为26.34%，34.55%，21.16%，其中女生3类症状检出率(29.80%，40.99%，25.15%)均高于男生(23.22%，28.73%，17.55%)(χ²值分别为68.61，204.23，106.51，P值均 < 0.01)。不同性别、学段、片区、家庭类型，是否缺乏体育锻炼、家长打骂、吸烟、饮酒、睡眠不足、电子屏幕使用时间过长、网络成瘾、校园欺凌中学生抑郁焦虑症状类型分布差异均有统计学意义(χ²=14.49~991.46，P值均 < 0.01)。多因素Logistic回归分析结果显示，与初中生相比，普通高中生发生抑郁焦虑症状共存风险更高(OR=2.71，95%CI=2.41~3.05)；性别为女(OR=2.17，95%CI=1.95~2.40)、非核心家庭(OR=1.20，95%CI=1.08~1.32)、好片区(OR=1.16，95%CI=1.02~1.30)、受到校园欺凌(OR=4.88，95%CI=4.32~5.50)、有网络成瘾(OR=4.77，95%CI=3.41~6.68)、被家长打骂(OR=3.18，95%CI=2.72~3.71)、饮酒(OR=2.10，95%CI=1.86~2.37)、睡眠不足(OR=1.73，95%CI=1.54~1.95)的中学生抑郁焦虑症状共存风险较高(P值均 < 0.05)。基于显著变量构建列线图预测模型显示，C-index=0.75(AUC=0.75，95%CI=0.74~0.76，P < 0.05)，模型预测效能良好。结论重庆市中学生抑郁焦虑症状共存现状不容乐观，可以利用列线图有效预测中学生抑郁焦虑症状共存的发生风险。
- 抑郁 /
- 焦虑 /
- 共病现象 /
- 精神卫生 /
- 回归分析 /
- 学生
Abstract: Objective To understand the current situation and influencing factors of comorbidity of depressive and anxiety symptoms among middle school students in Chongqing, so as to provide a scientific basis for formulating a comprehensive strategy for the co-prevention of multiple diseases among middle school students. Methods From September to December 2024, 12 327 middle school students were selected from 6 districts and counties in Chongqing by the combination of stratified cluster sampling and convenience sampling method. The current status of depressive and anxiety symptoms was investigated by using the Center for Epidemiological Survey-Depression Scale (CES-D) and the Generalized Anxiety Disorder-7 (GAD-7). The Chi-squared test was used to compare the differences between groups with comorbidity of depressive and anxiety symptoms, multivariate Logistic regression analysis was used to analyze its related factors, and a nomogram prediction model was drawn. Results The detection rates of depressive symptoms, anxiety symptoms and comorbidity among middle school students in Chongqing were 26.34%, 34.55% and 21.16%, respectively. Among them, the detection rates of the three types of symptoms in girls (29.80%, 40.99%, 25.15%) were all higher than those in boys (23.22%, 28.73%, 17.55%) (χ²=68.61, 204.23, 106.51, all P < 0.01). Statistical significance was observed in the distribution of depressive and anxious symptoms among middle school students across different gender, academic stage, school district, family type, physical activity levels, parental discipline, smoking, alcohol consumption, sleep deprivation, excessive screen time, Internet addiction, and bullying (χ²=14.49-991.46, all P < 0.01). Multivariate Logistic regression analysis showed that compared with junior high school students, ordinary high school students had a higher risk of comorbidity (OR=2.71, 95%CI=2.41-3.05); girls (OR=2.17, 95%CI=1.95-2.40), non-core family (OR=1.20, 95%CI=1.08-1.32), and good neighborhood (OR=1.16, 95%CI=1.02-1.30), campus bullying (OR=4.88, 95%CI=4.32-5.50), Internet addiction (OR=4.77, 95%CI=3.41-6.68), parental beating and scolding (OR=3.18, 95%CI=2.72-3.71), alcohol consumption (OR=2.10, 95%CI=1.86-2.37), and insufficient sleep (OR=1.73, 95%CI=1.54-1.95) had higher risks with comorbidity of depression and anxiety symptoms (all P < 0.05). A nomogram prediction model was constructed based on significant variables shows that C-index=0.75 (AUC=0.75, 95%CI=0.74-0.76, P < 0.05), and the model had good predictive performance. Conclusions The current situation of comorbidity of depressive and anxiety symptoms among middle school students in Chongqing is not optimistic. The nomograms can be used to effectively predict the risk of comorbidity of depressive and anxiety symptoms in middle school students.
- Depression /
- Anxiety /
- Comorbidity /
- Mental health /
- Regression analysis /
- Students
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图 1 中学生抑郁焦虑症状共存风险预测模型

Figure 1. A prediction model for middle school students at risk for comorbidity of depressive and anxiety symptoms

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表 1 不同组别中学生抑郁焦虑症状类型分布比较

Table 1. Comparison of distribution of depressive and anxiety symptoms types among middle school students with different groups

组别	选项	人数	无任何症状	仅有抑郁症状	仅有焦虑症状	抑郁焦虑症状共存	χ²值	P值
性别	男	6 474	4 247(65.60)	367(5.67)	724(11.18)	1 136(17.55)	204.28	< 0.01
	女	5 853	3 182(54.37)	272(4.65)	927(15.84)	1 472(25.15)
学段	初中	4 921	3 402(69.13)	235(4.78)	516(10.49)	768(15.61)	380.92	< 0.01
	普高	5 036	2 617(51.97)	224(4.45)	852(16.92)	1 343(26.67)
	职高	2 370	1 410(59.49)	180(7.59)	283(11.94)	497(20.97)
片区	好	4 055	2 390(58.94)	216(5.33)	492(12.13)	957(23.60)	64.15	< 0.01
	中	4 102	2 627(64.04)	177(4.31)	556(13.55)	742(18.09)
	差	4 170	2 412(57.84)	246(5.90)	603(14.46)	909(21.80)
家庭类型^*	核心家庭	7 240	4 450(61.46)	349(4.82)	970(13.40)	1 471(20.32)	14.49	< 0.01
	非核心家庭	5 087	2 979(58.56)	290(5.70)	681(13.39)	1 137(22.35)
缺乏体育锻炼	是	6 975	3 890(55.77)	398(5.71)	1 003(14.38)	1 684(24.14)	141.73	< 0.01
	否	5 352	3 539(66.12)	241(4.50)	648(12.11)	924(17.26)
家长打骂	是	1 238	441(35.62)	93(7.51)	169(13.65)	535(43.21)	469.65	< 0.01
	否	11 089	6 988(63.02)	546(4.92)	1 482(13.36)	2 073(18.69)
吸烟	是	774	368(47.55)	74(9.56)	78(10.08)	254(32.82)	112.54	< 0.01
	否	11 553	7 061(61.12)	565(4.89)	1 573(13.62)	2 354(20.38)
饮酒	是	2 499	1 123(44.94)	157(6.28)	372(14.89)	847(33.89)	375.05	< 0.01
	否	9 828	6 306(64.16)	482(4.90)	1 279(13.01)	1 761(17.92)
睡眠不足	是	8 546	4 916(57.52)	413(4.83)	1 214(14.21)	2 003(23.44)	123.63	< 0.01
	否	3 781	2 513(66.46)	226(5.98)	437(11.56)	605(16.00)
电子屏幕使用时间过长	是	6 641	3 697(55.67)	371(5.59)	974(14.67)	1 599(24.08)	130.47	< 0.01
	否	5 686	3 732(65.63)	268(4.71)	677(11.91)	1 009(17.75)
网络成瘾	是	276	59(21.38)	17(6.16)	52(18.84)	148(53.62)	218.28	< 0.01
	否	12 051	7 370(61.16)	622(5.16)	1 599(13.27)	2 460(20.41)
校园欺凌	是	2 200	773(35.14)	196(8.91)	272(12.36)	959(43.59)	991.46	< 0.01
	否	10 127	6 656(65.73)	443(4.37)	1 379(13.62)	1 649(16.28)
注： ()内数字为构成比/%；^*核心家庭指亲生父母与未婚子女共同组成的家庭，非核心家庭指单亲、隔代、重组家庭等。

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表 2 中学生抑郁焦虑症状共存的多因素Logistic回归分析(n=12 327)

Table 2. Multivariate Logistic regression analysis of comorbidity of depressive and anxiety symptoms among middle school students(n=12 327)

自变量	选项	仅有抑郁症状		仅有焦虑症状		抑郁焦虑症状共存
自变量	选项	OR值(95%CI)	P值	OR值(95%CI)	P值	OR值(95%CI)	P值
性别	男	1.00		1.00		1.00
	女	1.15(0.97~1.37)	0.10	1.78(1.59~1.99)	< 0.01	2.17(1.95~2.40)	< 0.01
学段	初中	1.00		1.00		1.00
	职高	1.76(1.40~2.22)	< 0.01	1.37(1.15~1.63)	< 0.01	1.70(1.45~1.98)	< 0.01
	普高	1.38(1.13~1.69)	< 0.01	2.22(1.95~2.52)	< 0.01	2.71(2.41~3.05)	< 0.01
家庭类型	核心家庭	1.00		1.00		1.00
	非核心家庭	1.23(1.04~1.45)	0.02	1.05(0.93~1.17)	0.43	1.20(1.08~1.32)	< 0.01
片区	差	1.00		1.00		1.00
	好	0.96(0.79~1.17)	0.70	0.83(0.72~0.95)	< 0.01	1.16(1.02~1.30)	0.02
	中	0.71(0.58~0.88)	< 0.01	0.86(0.75~0.98)	0.02	0.81(0.72~0.92)	< 0.01
缺乏体育锻炼	否	1.00		1.00		1.00
	是	1.37(1.16~1.63)	< 0.01	1.16(1.03~1.30)	0.01	1.31(1.18~1.46)	< 0.01
家长打骂	否	1.00		1.00		1.00
	是	2.26(1.76~2.91)	< 0.01	1.79(1.48~2.18)	< 0.01	3.18(2.72~3.71)	< 0.01
吸烟	否	1.00		1.00		1.00
	是	1.86(1.41~2.46)	< 0.01	0.89(0.69~1.16)	0.39	1.64(1.36~1.99)	< 0.01
饮酒	否	1.00		1.00		1.00
	是	1.36(1.11~1.67)	< 0.01	1.49(1.30~1.72)	< 0.01	2.10(1.86~2.37)	< 0.01
睡眠不足	否	1.00		1.00		1.00
	是	1.11(0.92~1.33)	0.27	1.42(1.25~1.62)	< 0.01	1.73(1.54~1.95)	< 0.01
电子屏幕使用时间过长	否	1.00		1.00		1.00
	是	1.20(1.01~1.42)	0.04	1.49(1.33~1.67)	< 0.01	1.46(1.32~1.62)	< 0.01
网络成瘾	否	1.00		1.00		1.00
	是	2.35(1.34~4.12)	< 0.01	3.31(2.25~4.88)	< 0.01	4.77(3.41~6.68)	< 0.01
校园欺凌	否	1.00		1.00		1.00
	是	3.40(2.81~4.12)	< 0.01	1.79(1.53~2.10)	< 0.01	4.88(4.32~5.50)	< 0.01

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