小学生情绪状态与焦虑障碍发生的剂量反应关系

薛城; 任俊; 殷小雅; 陈勃昊; 王书梅

doi:10.16835/j.cnki.1000-9817.2021.03.014

小学生情绪状态与焦虑障碍发生的剂量反应关系

doi: 10.16835/j.cnki.1000-9817.2021.03.014

复旦大学公共卫生学院/公共卫生安全教育部重点实验室，上海 200032

基金项目:

上海市第五轮公共卫生体系建设三年行动计划重点学科项目 GWV-10.1-XK08

详细信息

作者简介:
薛城(1994-)，男，山东济南人，在读硕士，主要研究方向为伤害预防

通讯作者:
王书梅，E-mail：smwang@fudan.edu.cn

中图分类号: G 444 B 844.1 G 627.8
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- 被引次数: 0
出版历程
- 收稿日期: 2020-10-28
- 修回日期: 2020-11-17
- 网络出版日期: 2021-04-20
- 刊出日期: 2021-03-25

Dose-response relationship between emotional state and anxiety disorder among primary students

Key Laboratory of Public Health Safety, Ministry of Education, Shanghai(200032), China

摘要

摘要: 目的探究小学生情绪体验持续时间与焦虑障碍发生关联强度的剂量-反应关系，为研究不同情绪状态水平对应的焦虑障碍发生风险提供参考。方法采用方便整群抽样方法，抽取上海市闵行区16所公办小学三至五年级的7 152名学生作为调查对象，采用儿童焦虑障碍自评量表及积极情感-消极情感量表进行问卷调查。结果小学生焦虑障碍总检出率为19.91%，其中男、女生焦虑障碍患病率分别为19.41%和20.43%。调整了性别、年级、户籍、是否为独生子女、父母婚姻状况、父母职业、父母文化程度、家庭经济水平、担任班干部、接受过体育和艺术专项培训或辅导情况及被欺凌情况后，积极情绪持续天数为7~16 d组、17~24 d组和>24 d组与焦虑障碍患病风险的发生呈负相关(OR值分别为0.53，0.36，0.37，P值均<0.05)；消极情绪持续天数为0.27~0.93 d组、0.94~2 d组和>2 d组与焦虑障碍患病风险的发生呈正相关(OR值分别为1.27，3.73，7.66，P值均<0.05)。限制性立方样条分析显示，情绪状态的持续天数与焦虑障碍患病关联强度呈明显的非线性剂量-反应关系(P<0.01)，即随着小学生积极情绪持续天数的增长，患焦虑障碍的风险持续降低；随着小学生消极情绪持续天数的增长，患焦虑障碍的风险持续增高。结论小学生情绪状态持续天数与焦虑障碍发生呈显著剂量-反应关系，促进小学生获得和维持积极情绪可作为改善小学生心理健康的重要切入点。
- 情绪 /
- 精神卫生 /
- 焦虑 /
- 回归分析 /
- 学生
Abstract: Objective To explore the dose-response relationship between duration of emotional experience of primary school students and the intensity of anxiety disorders, and to understand the risk of anxiety disorders corresponding to different emotional state levels. Methods A total of 7 152 primary students from grade 3 to 5 were investigated with questionnaire survey from 16 public primary schools, by using the Screen for Child Anxiety Related Emotional Disorder (SCARED) and Positive Affect and Negative Affect Scale. Results The prevalence of anxiety disorders was 19.91%, among which the prevalence rates of anxiety disorders in boys and girls were 19.41% and 20.43%, respectively. After adjusting for gender, grade, household register, the only child, parental marital status, parental occupation, parental educational level, family financial level, serving as a class leader, receiving special training or counseling in sports and art, and being bullied, the risk of anxiety disorder in children with positive emotions lasting for 7-16 days, 17-24 days and >24 days was lower compared to those with positive emotions lasting for less than 6 days(P<0.05); the risk of anxiety disorder in children with negative emotions lasting for 0.27-0.93 day, 0.94-2 days and >2 days was higher compared to those with negative emotions lasting less than 0.26 day(P<0.05). Restricted cubic spline analysis showed that the duration of emotional state and anxiety disorder showed a significant non-linear dose-response relationship (non-linear test, P<0.01), that is, as the number of days of positive emotions increases, the risk of anxiety disorder continues to decrease, and as the number of days of negative emotions increases, the risk of anxiety disorder continues to increase. Conclusion There is a significant dose-response relationship between the duration of the emotional state of primary school students and the prevalence of anxiety disorders. Acquirement and maintain positive emotions m be an important entry point for mental health promotion among primary school students.
- Emotions /
- Mental health /
- Anxiety /
- Regression analysis /
- Students

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图 1 基于限制性立方样条分析调整前后小学生积极情绪状态持续天数与焦虑障碍发生的剂量-反应关系

Figure 1. The dose-response relationship between the number of days of positive emotional state of pupils before and after adjustment and the occurrence of anxiety disorders based on restricted cubic spline analysis

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图 2 基于限制性立方样条分析调整前后小学生消极情绪状态持续天数与焦虑障碍发生的剂量-反应关系

Figure 2. The dose-response relationship between the number of days of negative emotional state of pupils before and after adjustment and the occurrence of anxiety disorders based on restricted cubic spline analysis

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表 1 不同组别小学生焦虑障碍检出率比较

Table 1. Comparison of detection rates of anxiety disorders among pupils in different groups

变量	人数	焦虑人数	χ²值	P值	变量	人数	焦虑人数	χ²值	P值
性别					大专	1 627	321(19.73)
男	3 648	708(19.41)	1.18	0.28	大学本科	2 928	585(19.98)
女	3 504	716(20.43)			硕士或以上学历	951	167(17.56)
年级					母亲文化程度
三	2 487	474(19.06)	1.99	0.37	小学及以下	90	29(32.22)	17.55	< 0.01
四	2 376	477(20.08)			初中	646	154(23.84)
五	2 289	473(20.66)			高中(或中专)	1 044	209(20.02)
户籍					大专	1 784	357(20.01)
上海	4 867	966(19.85)	0.04	0.85	大学本科	3 002	564(18.79)
非上海	2 285	458(20.04)			硕士或以上学历	586	111(18.94)
独生子女					家庭经济水平
是	4 473	852(19.05)	5.58	0.02	低	712	212(29.78)	66.29	< 0.01
否	2 679	572(21.35)			中等	2 929	619(21.13)
父母婚姻状况					高	3 511	593(16.89)
在婚	6 535	1 279(19.57)	8.97	0.06	担任班干部
离婚或分居	312	67(21.47)			是	2 752	456(16.57)	31.31	< 0.01
寡居/鳏居	11	3(27.27)			否	4 400	968(22.00)
再婚	89	27(30.34)			接受过体育专项培训或辅导
不知道	205	48(23.41)			是	3 414	620(18.16)	12.55	0.02
父亲职业					否	2 565	804(21.51)
机关或企事业单位管理人员	1 444	289(20.01)	10.76	0.96	接受过艺术专项培训或辅导
有专业职称的技术人员	1 823	339(18.60)			是	4 587	850(18.53)	15.27	< 0.01
商业或服务业人员	1 409	306(21.72)			否	2 565	574(22.38)
办事或一般业务人员	769	135(17.56)			被欺凌情况
制造/生产/运输或有关人员	1 083	223(20.59)			从没有过	5 521	923(16.72)	174.17	< 0.01
未就业	136	35(25.74)			很少	1 157	328(28.35)
其他	488	97(19.88)			有时	378	130(34.39)
母亲职业					经常	65	30(46.15)
机关或企事业单位管理人员	1 238	234(18.90)	16.98	< 0.01	总是	31	13(41.94)
有专业职称的技术人员	1 156	214(18.51)			积极情绪持续天数/d
商业或服务业人员	1 489	330(22.16)			0~6	1 807	545(30.16)	222.20	< 0.01
办事或一般业务人员	1 176	220(18.71)			7~16	1 950	429(22.00)
制造/生产/运输或有关人员	722	144(19.94)			17~24	1 683	248(14.53)
未就业	939	173(18.42)			>24	1 712	202(11.97)
其他	432	109(25.23)			消极情绪持续天数/d
父亲文化程度					0~0.26	1 917	143(7.46)	727.05	< 0.01
小学及以下	57	20(35.09)	16.94	< 0.01	0.27~0.93	1 710	157(9.18)
初中	519	124(23.89)			0.94~2	1 752	440(25.11)
高中(或中专)	1 070	207(19.35)			>2	1 773	684(38.58)
注： ()内数字为检出率/%。

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表 2 小学生情绪状态持续天数与焦虑障碍发生的Logistic回归分析(n=7 152)

Table 2. Logistic regression analysis of the duration of the emotional state and the occurrence of anxiety disorder of pupils(n=7 152)

情绪状态持续天数/d	单因素			模型a			模型b
情绪状态持续天数/d	标准误	Wald χ²值	OR值(OR值95%CI)	标准误	Wald χ²值	OR值(OR值95%CI)	标准误	Wald χ²值	OR值(OR值95%CI)
积极情绪
0~6		206.22	1.00		209.06	1.00		161.31	1.00
7~16	0.08	74.76	0.50(0.42~0.58)	0.08	76.35	0.49(0.42~0.58)	0.08	59.46	0.53(0.45~0.62)
17~24	0.09	145.31	0.33(0.28~0.40)	0.09	147.90	0.33(0.27~0.39)	0.09	118.26	0.36(0.30~0.43)
>24	0.10	130.86	0.33(0.27~0.40)	0.10	132.11	0.33(0.27~0.40)	0.10	100.15	0.37(0.30~0.45)
消极情绪
0~0.26		627.52	1.00		632.16	1.00		538.42	1.00
0.27~0.93	0.23	3.66	1.26(0.99~1.61)	0.24	3.93	1.28(1.00~1.62)	0.12	3.76	1.27(1.00~1.62)
0.94~2	1.34	163.06	3.82(3.11~4.69)	1.35	165.73	3.87(3.15~4.76)	0.11	152.31	3.73(3.03~4.60)
>2	2.12	426.56	8.36(6.83~10.22)	2.15	431.52	8.54(6.98~10.46)	0.11	371.55	7.66(6.23~9.42)
注： P值均<0.01。

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