青少年体质量指数和体重污名化与抑郁症状纵向交叉滞后分析

董子奇; 宋欣俐; 袁雯; 李晶; 杨田; 张秀红; 宋逸; 董彦会

doi:10.16835/j.cnki.1000-9817.2025286

青少年体质量指数和体重污名化与抑郁症状纵向交叉滞后分析

doi: 10.16835/j.cnki.1000-9817.2025286

董子奇¹,
宋欣俐¹,
袁雯²,
李晶¹,
杨田³,
张秀红³,
宋逸¹,
董彦会^1, ,

1.
北京大学公共卫生学院/北京大学儿童青少年卫生研究所，北京 100191
2.
华中师范大学心理学院
3.
内蒙古自治区疾病预防控制中心学校卫生科

基金项目:

“十四五”国家重点研发计划项目 2024YFC3308300

详细信息

作者简介:
董子奇(2001-)，女，北京市人，在读硕士，主要研究方向为儿童青少年慢性病

通讯作者:
董彦会，E-mail：dongyanhui@bjmu.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 B844.2 Q983^+.23
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出版历程
- 收稿日期: 2025-04-29
- 修回日期: 2025-05-30
- 网络出版日期: 2025-10-10
- 刊出日期: 2025-09-25

Longitudinal cross-lagged analysis of body mass index and weight stigma with depressive symptom in adolescents

1.
School of Public Health/Institute of Child and Adolescent Health, Peking University, Beijing 100191, China

摘要

摘要: 目的探讨青少年体质量指数(BMI)Z评分、体重污名化与抑郁症状之间的双向作用机制，为制定针对性的干预措施提供依据。方法采用分层整群随机抽样方法，于2023年9月(T1)和2024年9月(T2)从内蒙古自治区全部12个盟市(103个旗县区)抽取18 301名12~18岁青少年开展2次纵向调查。通过自编问卷评估体重污名化，采用流调中心抑郁量表(CES-D)测量抑郁症状，并依据世界卫生组织标准计算BMI Z评分。采用Pearson相关分析变量的相关性，构建交叉滞后面板模型考察三变量之间的动态双向关系。结果青少年BMI Z评分、体重污名化与抑郁症状在两个时间点之间均表现出自相关性(自回归路径P值均 < 0.01)。交叉滞后模型结果显示，双向路径模型拟合最佳(χ²=12.65，RMSEA=0.017，CFI=1.000；△χ²=193.39，P < 0.01)，支持三变量之间的动态双向作用机制。调整性别、年龄、主观社会地位和是否为独生子女变量后，青少年T1 BMI Z评分正向预测T2体重污名化(β=0.061)、T1体重污名化正向预测T2抑郁症状(β=0.608)；反向路径分析显示，青少年T1抑郁症状可预测T2体重污名化(β=0.003)、T1体重污名化可预测T2 BMI Z评分(β=0.081)(P值均 < 0.01)。结论青少年BMI Z评分、体重污名化与抑郁症状之间存在双向交叉滞后关系，体重污名化可能是连接肥胖与抑郁症状的关键变量。应重视体重污名化对青少年心理健康的潜在威胁，推动干预策略从生理指标延伸至社会心理层面。
- 人体质量指数 /
- 抑郁 /
- 精神卫生 /
- 交叉滞后分析 /
- 青少年
Abstract: Objective To explore the bidirectional associations among body mass index Z-scores (BMI Z-scores) and weight stigma with depressive symptoms in adolescents, thereby providing evidence for targeted intervention strategies. Methods A stratified cluster random sampling method was employed to select 18 301 adolescents aged 12-18 years from all 12 prefectures (103 counties) in the Inner Mongolia Autonomous Region, and two waves of longitudinal surveys were conducted in September 2023 (T1) and September 2024 (T2) among the adolescents. Weight stigma was assessed by using a self-developed questionnaire, depressive symptom was measured with the Center for Epidemiologic Studies Depression Scale (CES-D), and BMI Z-scores were calculated according to the World Health Organization standards. Pearson correlation analysis was used to examine associations among variables, and cross-lagged panel models were constructed to investigate the dynamic bidirectional relationships among the three variables. Results Adolescents' BMI Z-scores and weight stigma with depressive symptoms all exhibited autoregressive stability across the two time points (autoregressive paths, all P < 0.01). Cross-lagged model comparisons indicated that the bidirectional path model achieved the best fit (χ²=12.65, RMSEA=0.017, CFI=1.000; △χ²=193.39, P < 0.01), supporting dynamic bidirectional associations among the three variables. After adjusting for gender, age, subjective social status and only-child status, T1 BMI Z-scores among adolescents positively predicted T2 weight stigma (β=0.061), and T1 weight stigma positively predicted T2 depressive symptoms (β=0.608); in the reverse direction, T1 depressive symptoms predicted T2 weight stigma (β=0.003), and T1 weight stigma predicted T2 BMI Z-scores (β=0.081) (all P < 0.01). Conclusions There is a bidirectional cross-lagged relationship among adolescents' BMI Z-scores and weight stigma with depressive symptoms, suggesting that weight stigma may serve as a key psychological variable linking obesity and depressive symptoms. Greater attention should be paid to the potential threat of weight stigma to adolescents' mental health, with intervention strategies expanded from a solely physiological focus to encompass psychosocial dimensions.
- Body mass index /
- Depression /
- Mental health /
- Cross-lagged analysis /
- Adolescent
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 青少年BMI Z评分、体重污名化、抑郁症状交叉滞后模型

注：图中数值为β值; ^*P < 0.05，^**P < 0.01。

Figure 1. Cross-lagged panel model of BMI Z-scores, weight stigma, and depressive symptoms among adolescents

下载: 全尺寸图片幻灯片

表 1 T1不同组别青少年BMI Z评分、体重污名化和抑郁症状评分比较(x ±s)

Table 1. Comparison of BMI Z, weight stigma and depressive sy- mptoms scores among adolescents with different groups at T1(x ±s)

组别	人数	统计值	BMI Z	体重污名化	抑郁症状
性别
男	7 461		0.69±1.44	0.15±0.47	10.88±9.90
女	10 840		0.42±1.19	0.19±0.53	11.84±10.27
		t值	13.40	-5.12	-6.31
		P值	< 0.01	< 0.01	< 0.01
年龄/岁
12~13	9 391		0.63±1.31	0.14±0.46	10.24±9.55
14~15	4 693		0.47±1.29	0.19±0.54	12.21±10.55
16~18	4 217		0.38±1.29	0.21±0.56	13.28±10.55
		F值	61.20	26.52	150.86
		P值	< 0.01	< 0.01	< 0.01
主观社会地位/分
0~3	2 579		0.51±1.31	0.22±0.57	14.75±12.03
4~6	12 622		0.52±1.31	0.16±0.50	11.05±9.63
7~10	3 100		0.58±1.29	0.17±0.52	10.33±9.84
		F值	2.77	13.69	169.03
		P值	0.06	< 0.01	< 0.01
是否独生子女
是	7 170		0.63±1.35	0.17±0.52	11.07±10.18
否	11 131		0.46±1.28	0.17±0.50	11.69±10.10
		t值	8.28	0.65	-4.03
		P值	< 0.01	0.51	< 0.01

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