睡眠昼夜节律紊乱与中小学生抑郁焦虑症状共存的相关性

叶盛; 杨月; 卢雪蕾; 靳和玥; 李俊同; 刘辉; 刘黎

doi:10.16835/j.cnki.1000-9817.2025287

睡眠昼夜节律紊乱与中小学生抑郁焦虑症状共存的相关性

doi: 10.16835/j.cnki.1000-9817.2025287

江苏省南京市疾病预防控制中心学校卫生科，210003

基金项目:

南京医科大学科技发展基金项目 NMUB20230279

南京市疾控中心青年人才科研培育团队项目 NPY2304

详细信息

作者简介:
叶盛(1993-)，男，安徽黄山人，硕士，主管医师，主要从事学生常见病防制工作

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出版历程
- 收稿日期: 2025-05-12
- 修回日期: 2025-07-23
- 刊出日期: 2025-10-25

Association of sleep and circadian rhythm disruption with co-occurring depressive and anxiety symptoms among primary and secondary school students

Section of School Health, Nanjing Municipal Center for Disease Control and Prevention, Nanjing 210003, Jiangsu Province, China

摘要

摘要: 目的探讨睡眠昼夜节律紊乱指标(睡眠时型、时长和社会时差)与中小学生抑郁焦虑症状共存的关系，为促进中小学生心理健康提供参考依据。方法 2023年10月，基于分层整群随机抽样方法选取南京市15 944名中小学生为研究对象，其睡眠时型、抑郁焦虑症状共存情况通过清晨与夜晚型问卷、流调中心抑郁量表和广泛性焦虑障碍量表进行调查。采用χ²检验进行率的组间比较，应用Logistic回归模型分析睡眠时型、时长和社会时差与中小学生抑郁焦虑症状共存的关联。结果南京市中小学生抑郁焦虑症状共存检出率为16.9%。调整协变量后，Logistic回归模型结果显示，夜晚型睡眠时型(OR=6.55，95%CI=5.59~7.68)、睡眠不足(OR=3.05，95%CI=2.60~3.59)和社会时差≥2 h(OR=2.09，95%CI=1.85~2.37)与中小学生抑郁焦虑症状共存独立相关(P值均 < 0.05)，独立相关性在性别、学段亚组中始终稳健。同时经历夜晚型睡眠时型和睡眠不足(OR=7.54，95%CI=3.55~16.01)、夜晚型睡眠时型和社会时差≥2 h(OR=4.18，95%CI=3.01~5.81)与抑郁焦虑症状共存风险增加相关(P值均 < 0.05)。女生组、高中生组的夜晚型睡眠时型且睡眠不足、社会时差≥2 h呈现出对抑郁焦虑症状共存更高的联合效应[OR值(95%CI)分别为8.46(3.25~22.04)，15.90(3.66~69.08)；7.87(4.90~12.65)，4.85(3.10~7.59)，P值均 < 0.05]。结论夜晚型睡眠时型、睡眠不足和社会时差≥2 h可能是抑郁焦虑症状共存的风险因素。关注多个睡眠风险因素的共存可能有助于减缓中小学生情绪障碍的发生。
- 睡眠 /
- 昼夜节律 /
- 焦虑 /
- 抑郁 /
- 回归分析 /
- 学生
Abstract: Objective To investigate the association of sleep and circadian rhythm disruption indicators (including chronotype, sleep duration, and social jetlag) with co-occurring depressive and anxiety symptoms among primary and secondary school students, so as to provide a reference for promoting their mental health. Methods In October 2023, a total of 15 944 primary and secondary school students were recruited from Nanjing, using a stratified cluster random sampling method. The Morning and Evening Questionnaire-5, Center for Epidemiological Studies Depression, and Generalized Anxiety Disorder-7 were used for the survey. Chi-square test was employed for intergroup comparisons, and Logistic regression model was applied to analyze the independent and joint effects of sleep-related factors on comorbid symptoms of depressive and anxiety among primary and middle school students. Results The prevalence of co-occurring depressive and anxiety symptoms among primary and secondary school students in Nanjing was 16.9%. After adjusting for covariates, Logistic regression analysis revealed significant independent associations between evening chronotype (OR=6.55, 95%CI=5.59-7.68), insufficient sleep duration (OR=3.05, 95%CI=2.60-3.59), and social jetlag ≥2 h (OR=2.09, 95%CI=1.85-2.37) with comorbid symptoms of depressive and anxiety among students (all P < 0.05). Concurrent of evening chronotype and insufficient sleep (OR=7.54, 95%CI=3.55-16.01), as well as evening chronotype and social jetlag ≥2 h (OR=4.18, 95%CI=3.01-5.81), were associated with an increased risk of co-occurring depressive and anxiety symptoms (both P < 0.05). In the female and high school student subgroups, the combination of evening chronotype and insufficient sleep or social jetlag ≥2 h showed stronger joint effects on co-occurring depressive and anxiety symptoms [OR(95%CI)=8.46(3.25-22.04) and 15.90(3.66-69.08); 7.87(4.90-12.65) and 4.85(3.10-7.59), respectively; all P < 0.05]. Conclusions Evening chronotype, insufficient sleep, and social jetlag≥2 h may serve as risk factors for comorbid symptoms of depressive and anxiety in school-aged populations. Paying attention to the coexistence of multiple sleep-related risk factors may help mitigate the occurrence of emotional disorders in this demographic.
- Sleep /
- Circadian rhythm /
- Anxiety /
- Depression /
- Regression analysis /
- Students
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表 1 不同组别中小学生抑郁焦虑症状共存检出率比较

Table 1. Comparison of the detection rates of co-occurring depressive and anxiety symptoms among primary and secondary school students by different groups

组别	选项	人数	抑郁焦虑症状共存人数	χ²值	P值
学段	小学	5 766	592(10.3)	418.44	< 0.01
	初中	5 832	983(16.9)
	高中	4 346	1 115(25.7)
性别	男	8 226	1 159(14.1)	93.78	< 0.01
	女	7 718	1 531(19.8)
地区	城区	8 598	1 416(16.5)	2.16	0.14
	郊县	7 346	1 274(17.3)
超重肥胖	未检出	9 788	1 689(17.3)	3.06	0.22
	超重	3 037	503(16.6)
	肥胖	3 119	498(16.0)
吸烟史	无	15 424	2 454(15.9)	312.85	< 0.01
	有	519	236(45.5)
饮酒史	无	13 447	1 802(13.4)	735.71	< 0.01
	有	2 496	887(35.5)
每周中高强度活动天数/d	< 7	13 338	2 332(17.5)	21.75	< 0.01
	7	2 605	358(13.7)
注： ()内数字为检出率/%。吸烟史、饮酒史、每周中高强度活动天数变量各有1人缺失数据。

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表 2 不同SCRD指标不同性别中小学生抑郁焦虑症状共存检出率比较

Table 2. Comparison of co-occurrence rates of depressive and anxiety symptoms among primary and secondary school students by gender based on different SCRD indicators

SCRD指标	选项	男生			女生			总体
SCRD指标	选项	人数	共存人数	χ²值	人数	共存人数	χ²值	人数	共存人数	χ²值
睡眠时型	清晨型	4 393	296(6.7)	547.15^**	3 549	297(8.4)	724.59^**	7 942	593(7.5)	1 324.07^**
	中间型	3 367	679(20.2)		3 522	917(26.0)		6 889	1 596(23.2)
	夜晚型	466	184(39.5)		647	317(49.0)		1 113	501(45.0)
睡眠时长	充足	1 800	87(4.8)	163.09^**	1 334	92(6.9)	169.83^**	3 134	179(5.7)	346.39^**
	不足	6 426	1 072(16.7)		6 384	1 439(22.5)		12 810	2 511(19.6)
社会时差/h	< 1	3 949	499(12.6)	36.47^**	3 543	490(13.8)	354.45^**	7 492	989(13.2)	325.94^**
	1~ < 2	3 175	442(13.9)		3 129	620(19.8)		6 304	1 062(16.8)
	≥2	1 102	218(19.8)		1 046	421(40.2)		2 148	639(29.7)
注： ()内数字为检出率/%；^**P < 0.01。

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表 3 不同SCRD指标不同学段中小学生抑郁焦虑症状共存检出率比较

Table 3. Comparison of co-occurrence rates of depressive and anxiety symptoms among primary and secondary school students by educational stage based on different SCRD indicators

SCRD指标	选项	小学生			初中生			高中生
SCRD指标	选项	人数	共存人数	χ²值	人数	共存人数	χ²值	人数	共存人数	χ²值
睡眠时型	清晨型	4 255	273(6.4)	341.33^**	2 807	212(7.6)	472.13^**	880	108(12.3)	190.70^**
	中间型	1 415	273(19.3)		2 645	594(22.5)		2 829	729(25.8)
	夜晚型	96	46(47.9)		380	177(46.6)		637	278(43.6)
睡眠时长	充足	1 472	56(3.8)	89.61^**	1 273	88(6.9)	114.87^**	389	35(9.0)	346.39^**
	不足	4 294	536(12.5)		4 559	895(19.6)		3 957	1 080(27.3)
社会时差/h	< 1	4 345	389(9.0)	34.53^**	1 691	281(16.6)	51.83^**	1 456	319(21.9)	325.94^**
	1~ < 2	1 091	150(13.7)		3 165	463(14.6)		2 048	449(21.9)
	≥2	330	53(16.1)		976	239(24.5)		842	347(41.2)
注： ()内数字为检出率/%；^**P < 0.01。

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表 4 不同SCRD指标不同学段中小学生抑郁焦虑症状共存检出率比较[OR值(95%CI)]

Table 4. Comparison of co-occurrence rates of depressive and anxiety symptoms among primary and secondary school students by educational stage based on different SCRD indicators[OR(95%CI)]

SCRD指标	选项	性别		学段			总体(n=15 944)
SCRD指标	选项	男生(n=8 226)	女生(n=7 718)	小学(n=5 766)	初中(n=5 832)	高中(n=4 346)	总体(n=15 944)
睡眠时型	清晨型	1.00	1.00	1.00	1.00	1.00	1.00
	中间型	2.84(2.42~3.32)^**	3.13(2.68~3.65)^**	3.31(2.75~3.99)^**	2.94(2.47~3.49)^**	2.40(1.92~3.00)^**	2.98(2.67~3.32)^**
	夜晚型	6.02(4.73~7.65)^**	6.99(5.64~8.68)^**	10.51(6.75~16.36)^**	7.45(5.76~9.64)^**	4.70(3.62~6.12)^**	6.55(5.59~7.68)^**
睡眠时长	充足	1.00	1.00	1.00	1.00	1.00	1.00
	不足	3.00(2.38~3.78)^**	3.17(2.53~3.99)^**	3.45(2.60~4.61)^**	2.66(2.09~3.37)^**	3.42(2.39~4.90)^**	3.05(2.60~3.59)^**
社会时差/h	< 1	1.00	1.00	1.00	1.00	1.00	1.00
	1~ < 2	0.93(0.81~1.08)	1.22(1.06~1.41)^**	1.55(1.26~1.91)^**	0.96(0.81~1.13)	1.01(0.85~1.20)	1.07(0.97~1.18)
	≥2	1.34(1.11~1.61)^**	3.07(2.59~3.64)^**	1.63(1.18~2.27)^**	1.80(1.47~2.22)^**	2.49(2.05~3.01)^**	2.09(1.85~2.37)^**
注：全样本模型调整了年龄、性别、学段、吸烟史、饮酒史和中高强度活动；分性别、学段亚组分析时，协变量调整不包含该亚组变量，其余协变量与全样本模型相同。^**P < 0.01。

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表 5 中小学生睡眠时型、时长与抑郁焦虑症状共存相关性的Logistic回归分层分析[OR值(95%CI)]

Table 5. Stratified Logistic regression analysis of chronotype, sleep duration and co-occurring depressive and anxiety symptoms among primary and secondary students[OR(95%CI)]

SCRD指标	睡眠时长	性别		学段			总体(n=15 944)
SCRD指标	睡眠时长	男生(n=8 226)	女生(n=7 718)	小学(n=5 766)	初中(n=5 832)	高中(n=4 346)	总体(n=15 944)
清晨型时型	充足	1.00	1.00	1.00	1.00	1.00	1.00
	不足	2.20(1.58~3.06)^**	1.80(1.28~2.52)^**	2.79(1.94~4.01)^**	1.24(0.88~1.76)	2.38(1.01~5.62)^*	1.97(1.55~2.49)^**
中间型时型	充足	1.00	1.00	1.00	1.00	1.00	1.00
	不足	2.62(1.85~3.70)^**	3.41(2.44~4.77)^**	3.26(1.96~5.43)^**	3.23(2.34~4.67)^**	2.72(1.80~4.11)^**	3.00(2.36~3.82)^**
夜晚型时型	充足	1.00	1.00	1.00	1.00	1.00	1.00
	不足	5.75(1.68~19.73)^**	8.46(3.25~22.04)^**	9.74(1.98~47.86)^**	4.73(1.54~14.59)^**	15.90(3.66~69.08)^**	7.54(3.55~16.01)^**
注：全样本模型调整了年龄、性别、学段、吸烟史、饮酒史和中高强度活动；分性别、学段亚组分析时，协变量调整不包含亚组变量，其余协变量与全样本模型相同。^P < 0.05，^*P < 0.01。

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表 6 中小学生睡眠时型、社会时差与抑郁焦虑症状共存相关性的Logistic回归分层分析[OR值(95%CI)]

Table 6. Stratified Logistic regression analysis of chronotype, social jetlag and co-occurring depressive and anxiety symptoms among primary and secondary students[OR(95%CI)]

SCRD指标	社会时差/h	性别		学段			总体(n=15 944)
SCRD指标	社会时差/h	男生(n=8 226)	女生(n=7 718)	小学(n=5 766)	初中(n=5 832)	高中(n=4 346)	总体(n=15 944)
清晨型时型	< 1	1.00	1.00	1.00	1.00	1.00	1.00
	1~ < 2	0.84(0.60~1.18)	1.28(0.91~1.79)	1.57(1.17~2.11)^**	1.31(0.75~2.30)	0.37(0.04~3.35)	1.05(0.82~1.33)
	≥2	0.64(0.41~1.00)	1.66(1.08~2.57)^*	1.12(0.66~1.90)	0.55(0.27~1.10)	1.91(0.21~17.10)	1.02(0.75~1.39)
中间型时型	< 1	1.00	1.00	1.00	1.00	1.00	1.00
	1~ < 2	1.35(1.11~1.64)^**	1.38(1.15~1.64)^**	1.17(0.85~1.62)	1.34(1.08~1.65)^**	1.50(1.23~1.84)^**	1.35(1.18~1.54)^**
	≥2	2.18(1.68~2.82)^**	3.71(2.95~4.67)^**	0.60(0.29~1.27)	3.21(2.43~4.23)^**	3.79(2.97~4.83)^**	2.94(2.48~3.48)^**
夜晚型时型	< 1	1.00	1.00	1.00	1.00	1.00	1.00
	1~ < 2	1.20(0.76~1.88)	3.44(2.21~5.35)^**	1.61(0.50~5.19)	2.34(1.35~4.06)^**	2.18(1.45~3.28)^**	2.01(1.48~2.73)^**
	≥2	2.23(1.36~3.63)^**	7.87(4.90~12.65)^**	3.37(1.07~10.60)^*	4.36(2.41~7.89)^**	4.85(3.10~7.59)^**	4.18(3.01~5.81)^**
注：全样本模型调整了年龄、性别、学段、吸烟史、饮酒史和中高强度活动；分性别、学段亚组分析时，协变量调整不包含亚组变量，其余协变量与全样本模型相同。^P < 0.05，^*P < 0.01。

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