青少年体象满意度与童年期不良经历的关联

左霞云; 张紫微; 廉启国; 余春艳; 涂晓雯; 房宇航; 楼超华

doi:10.16835/j.cnki.1000-9817.2023.03.014

青少年体象满意度与童年期不良经历的关联

doi: 10.16835/j.cnki.1000-9817.2023.03.014

1.
上海市生物医药技术研究院/国家卫生健康委员会计划生育药具重点实验室，200237
2.
苏州市吴中区卫生健康委员会

基金项目:

国家卫生健康委员会计划生育药具重点实验室科技创新导向项目 CX2017-05

世界卫生组织项目 ERC0003027

详细信息

作者简介:
左霞云(1980-)，女，江苏丹阳人，博士，副研究员，主要从事青少年健康行为方面工作

通讯作者:
楼超华，E-mail: louchaohua60@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 B844.2
计量
- 文章访问数: 701
- HTML全文浏览量: 298
- PDF下载量: 67
- 被引次数: 0
出版历程
- 收稿日期: 2022-08-14
- 修回日期: 2022-11-27
- 刊出日期: 2023-03-25

Relationship between body image satisfaction and adverse childhood experiences in adolescents

1.
Key Lab of Reproduction Regulation of the National Health Commission, Shanghai Institute for Biomedical and Pharmaceutical Technologies, Shanghai (200237), China

摘要

摘要: 目的研究青少年身体意象情况及与童年期不良经历(adverse childhood experiences, ACEs)间的关联，为有效应对青少年的体象问题提供依据。方法采用分层整群抽样的方法，对上海市3所初中六至八年级1 701名10~14岁学生进行计算机辅助的匿名问卷调查，问卷内容包括人口学特征、ACEs暴露、体象情况等。采用χ²检验和多因素Logistic回归分析青少年体象满意率和各种ACEs间的关联。结果 60.73%的青少年对自己的体象较为满意，男生的体象满意率(66.16%)高于女生(55.13%)，差异有统计学意义(χ²=21.70，P < 0.01)；79.19%的青少年至少经历过1种类型的ACE，分别有61.61%，65.14%和21.58%有过被虐待、忽视和家庭功能不良经历。多因素Logistic回归分析显示，女生中有过任一种ACE、虐待、忽视、家庭功能不良与体象满意率相关联(OR=0.33~0.57, P值均＜0.01)，男生中仅发现忽视、有过3或≥4种ACEs与体象满意率相关联(OR=0.54~0.64, P值均 < 0.05)；ACEs暴露对青少年体象评价的负面影响有累积效应。结论 ACEs与青少年的体象评价有关联，并呈现一定的累积效应，关联与累积效应存在性别差异，应注重在青少年(尤其是女生)中开展ACEs筛查和家庭养育环境建设。
- 体象 /
- 生活变动事件 /
- 精神卫生 /
- 回归分析 /
- 青少年
Abstract: Objective To explore the relationship between body image and adverse childhood experiences (ACEs) in adolescents. Methods A total of 1 701 adolescents in grade 6-8 in three middle schools in Shanghai were selected by stratified cluster sampling, and were investigated anonymously using computer assisted self-interview approach. Information including demographic characteristics, body image satisfaction, and ACEs were collected. The Chi-square test and multivariate Logistic regression were used to explore the relationship between adolescent body image satisfaction and types of ACEs. Results About 60.73% of the respondents were satisfied with their body image, with higher satisfaction among boys(66.16%) than among girls(55.13%)(χ²=21.70, P < 0.01). About 79.19% of the respondents had experienced at least one ACE, and respectively 61.61%, 65.14% and 21.58% of them had experienced abuse, neglect and family dysfunction. Multivariate Logistic regression analysis indicated that experiencing at least one ACE, abuse, neglect and family dysfunction were all related with low body image satisfaction among girls(OR=0.33-0.57, P < 0.01), while among boys neglect, having 3 or more than 4 ACEs were found to be associated with body image satisfaction (OR=0.54-0.64, P < 0.05). The cumulative effects of ACEs on adolescent body image were observed. Conclusion Different types of ACEs are associated with body image in adolescents, ACEs have cumulative effects on adolescent body image, which shows gender differences.Screen of ACEs and improvement of family nurturing environment should be highlighted among adolescents, especially among girls.
- Body image /
- Life change events /
- Mental health /
- Regression analysis /
- Adolescent
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

HTML全文

表 1 不同组别青少年体象满意率比较

Table 1. Comparison of body image satisfaction among adolescents with different groups

组别	选项	人数	体象满意人数	χ²值	P值
性别	男	863	571(66.16)	21.70	< 0.01
	女	838	462(55.13)
年龄/岁	10~12	850	504(59.29)	1.46	0.23
	13~14	851	529(62.16)
是否独生子女	是	1 098	676(61.57)	0.91	0.34
	否	603	357(59.20)
是否上海户籍^*	是	1 350	836(61.93)	1.06	0.30
	否	213	124(58.22)
是否租房^*	是	312	170(54.49)	6.63	0.01
	否	1 366	852(62.37)
父母文化程度^*	初中及以下	206	123(59.71)	2.93	0.23
	高中/技校/中专	501	296(59.08)
	大学及以上	849	539(63.49)
自我感知体重^*	偏瘦	357	224(62.75)	52.24	< 0.01
	正好	533	384(72.05)
	偏胖	806	423(52.48)
自我感知身高^*	偏高	252	167(66.27)	25.56	< 0.01
	正好	732	481(65.71)
	偏矮	713	383(53.72)
注：()内数字为满意率/%；*表示该组数据有缺失值。

下载: 导出CSV

表 2 不同ACEs暴露的青少年体象满意率比较

Table 2. Comparison of body image satisfaction among adolescents with different ACEs exposure

组别	选项	男生				女生				合计
组别	选项	人数	满意人数	χ²值	P值	人数	满意人数	χ²值	P值	人数	满意人数	χ²值	P值
有过任一种ACE	是	692	450(65.03)	2.01	0.16	655	326(49.77)	34.83	< 0.01	1 347	776(57.61)	26.40	< 0.01
	否	171	121(70.76)			183	136(74.32)			354	257(72.60)
虐待	是	546	350(64.10)	2.82	0.09	502	235(46.81)	35.02	< 0.01	1 048	585(55.82)	27.57	< 0.01
	否	317	221(69.72)			336	227(67.56)			653	448(68.61)
忽视	是	569	357(62.74)	8.74	< 0.01	539	255(47.31)	37.35	< 0.01	1 108	612(55.23)	40.23	< 0.01
	否	294	214(72.79)			299	207(69.23)			593	421(70.99)
家庭功能不良	是	187	114(60.96)	2.88	0.09	180	80(44.44)	10.58	< 0.01	367	194(52.86)	12.14	< 0.01
	否	676	457(67.60)			658	382(58.05)			1 334	839(62.89)
ACEs暴露种类	0	171	121(70.76)	25.32	< 0.01	183	136(74.32)	65.38	< 0.01	354	257(72.60)	80.17	< 0.01
累计	1	186	139(74.73)			157	95(60.51)			343	234(68.22)
	2	182	130(71.43)			174	103(59.20)			356	233(65.45)
	3	201	112(55.72)	198			86(43.43)	399			198(49.62)
	≥4	123	69(56.10)			126	42(33.33)			249	111(44.58)
注：()内数字为满意率/%。

下载: 导出CSV

表 3 不同ACEs与青少年体象满意率的Logistic回归分析

Table 3. Logistic regression analysis on the correlation between ACEs and adolescent body image satisfaction

自变量	男生(n=863)			女生(n=838)			合计(n=1 701)
自变量	OR值(OR值95%CI)	Z值	P值	OR值(OR值95%CI)	Z值	P值	OR值(OR值95%CI)	Z值	P值
有过任一种ACE	0.81(0.52~1.26)	-0.91	0.36	0.33(0.22~0.51)	-5.03	< 0.01	0.50(0.37~0.68)	-4.45	< 0.01
虐待	0.84(0.59~1.19)	-0.94	0.35	0.39(0.28~0.54)	-5.49	< 0.01	0.56(0.44~0.72)	-4.69	< 0.01
忽视	0.64(0.45~0.92)	-2.39	0.02	0.42(0.30~0.60)	-4.86	< 0.01	0.52(0.40~0.66)	-5.21	< 0.01
家庭功能不良	0.72(0.48~1.06)	-1.64	0.10	0.57(0.39~0.83)	-2.88	< 0.01	0.64(0.49~0.84)	-3.19	< 0.01
ACEs暴露种类累计
1	1.29(0.75~2.24)	0.93	0.35	0.50(0.29~0.86)	-2.50	0.01	0.76(0.52~1.12)	-1.36	0.18
2	1.03(0.60~1.77)	0.14	0.89	0.52(0.31~0.86)	-2.51	0.01	0.70(0.48~1.01)	-1.86	0.06
3	0.57(0.34~0.94)	-2.16	0.03	0.25(0.15~0.41)	-5.33	< 0.01	0.36(0.25~0.52)	-5.55	< 0.01
≥4	0.54(0.30~0.96)	-2.07	0.04	0.16(0.09~0.29)	-6.27	< 0.01	0.28(0.19~0.42)	-6.10	< 0.01

下载: 导出CSV

参考文献(28)

[1]	CASH T, FLEMING E, ALINDOGAN J, et al. Beyond body image as a trait: the development and validation of the Body Image States Scale[J]. Eat Disord, 2002, 10(2): 103-113. doi: 10.1080/10640260290081678
[2]	DION J, BLACKBURN M E, AUCLAIR J, et al. Development and aetiology of body dissatisfaction in adolescent boys and girls[J]. Int J Adolesc Youth, 2015, 20(2): 151-166. doi: 10.1080/02673843.2014.985320
[3]	BROWN T A, FORNEY K J, KLEIN K M, et al. A 30-year longitudinal study of body weight, dieting, and eating pathology across women and men from late adolescence to later midlife[J]. J Abn Psychol, 2020, 129(4): 376-386. doi: 10.1037/abn0000519
[4]	LINARDON J, GREENWOOD C J, FULLER-TYSZKIEWICZ M, et al. Young adult mental health sequelae of eating and body image disturbances in adolescence[J]. Int J Eat Disord, 2021, 54(9): 1680-1688. doi: 10.1002/eat.23575
[5]	MITCHISON D, HAY P, GRIFFITHS S, et al. Disentangling body image: the relative associations of overvaluation, dissatisfaction, and preoccupation with psychological distress and eating disorder behaviors in male and female adolescents[J]. Int J Eat Disord, 2016, 50(2): 118-126.
[6]	MURRAY K M, BYRNE D G, RIEGER E. Investigating adolescent stress and body image[J]. J Adolesc, 2011, 34(2): 269-278. doi: 10.1016/j.adolescence.2010.05.004
[7]	张雷, 严双琴, 汪素美, 等. 童年期不良经历与青春期发育的前瞻性研究[J]. 中国学校卫生, 2019, 40(5): 662-665, 668. doi: 10.16835/j.cnki.1000-9817.2019.05.007 ZHANG L, YAN S Q, WANG S M, et al. Prospective association between adverse childhood experiences and pubertal development[J]. Chin J Sch Health, 2019, 40(5): 662-665, 668. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2019.05.007
[8]	EASTERLIN M C, CHUNG P J, MEI L, et al. Association of team sports participation with long-term mental health outcomes among individuals exposed to adverse childhood experiences[J]. JAMA Pediatr, 2019, 173 (7): 681-688. doi: 10.1001/jamapediatrics.2019.1212
[9]	马双双, 万宇辉, 郝加虎. 童年期不良经历与终身健康[J]. 卫生研究, 2016, 45(5): 857-861. https://www.cnki.com.cn/Article/CJFDTOTAL-WSYJ201605032.htm MA S S, WAN Y H, HAO J H. Adverse childhood experiences and life-long health[J]. J Hyg Res, 2016, 45(5): 857-861. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-WSYJ201605032.htm
[10]	ZUO X Y, ZHANG Z W, YAN L, et al. Childhood adversity subtypes and violence victimization and perpetration among early adolescents in Shanghai, China[J]. BMC Pediatr, 2021, 21(1): 381. doi: 10.1186/s12887-021-02853-3
[11]	ROBERT W B, LI M M, CHOIRIYYAH I, et al. Body satisfaction in early adolescence: a multisite comparison[J]. J Adolesc Health, 2021, 69(1S): S39-S46.
[12]	PRESNELL K, BEARMAN S K, STICE E. Risk factors for body dissatisfaction in adolescent boys and girls: a prospective study[J]. Int J Eat Disord, 2004, 36(4): 389-401. doi: 10.1002/eat.20045
[13]	FELITTI V J, ANDA R F, NORDENBERG D, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults[J]. Am J Prev Med, 1998, 14(4): 245-258. doi: 10.1016/S0749-3797(98)00017-8
[14]	马金凤, 戴江红, 茹建国, 等. 医学生心理健康状况与儿童期不良经历的关系探讨[J]. 中华疾病控制杂志, 2013, 17(3): 218-221. https://www.cnki.com.cn/Article/CJFDTOTAL-JBKZ201303008.htm MA J F, DAI J H, RU J G, et al. Study on the relationship between adult mental health status and adverse childhood experiences among medical college students[J]. Chin J Dis Control Prev, 2013, 17(3): 218-221. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-JBKZ201303008.htm
[15]	肖琴. 安徽省医学生儿童期不良经历与相关风险行为的关联研究[D]. 合肥: 安徽医科大学, 2008. XIAO Q. Study on related factors of adverse childhood experiences of medical college students in Anhui Province[D]. Hefei: Anhui Medical University, 2008. (in Chinese)
[16]	REN L L, XU Y Y, GUO X, et al. Body image as risk factor for emotional and behavioral problems among Chinese adolescents[J]. BMC Public Health, 2018, 18(1): 1179. doi: 10.1186/s12889-018-6079-0
[17]	NIU J J, SEO D C, LOHRMANN D K. Weight perception and dietary intake among Chinese youth, 2004-2009[J]. Int J Behav Med, 2014, 21(4): 691-699. doi: 10.1007/s12529-013-9332-z
[18]	FORSTER M, GOWER A L, MCMORRIS B J, et al. Adverse childhood experiences and school-based victimization and perpetration[J]. J Inter Viol, 2020, 35(3/4): 662-681.
[19]	张紫微, 余春艳, 袁萍, 等. 儿童期不良经历与青春早期抑郁的关联性[J]. 中国学校卫生, 2019, 40(6): 874-877. doi: 10.16835/j.cnki.1000-9817.2019.06.023 ZHANG Z W, YU C Y, YUAN P, et al. Relationship between adverse childhood experiences and deperssion in early adolescence[J]. Chin J Sch Health, 2019, 40 (6): 874-877. doi: 10.16835/j.cnki.1000-9817.2019.06.023
[20]	HAYES S D, CROCKER P, KOWALSKI K C. Gender differences in physical self-perceptions, global self-esteem and physical activity: evaluation of the physical self-perception profile model[J]. J Sport Behav, 1999, 22: 1-14.
[21]	WU Q L, CAO H J, LIN X Y, et al. Child maltreatment and subjective well-being in Chinese emerging adults: a process model involving self-esteem and self-compassion[J]. J Inter Viol, 2022, 37(15-16): NP13685-NP13706.
[22]	YU C W, GUEROLA M M, YI C L, et al. Effects of childhood adversity and resilience on Taiwanese youth health behaviors[J]. Pediatr Neonatol, 2019, 60: 368-376. http://www.ncbi.nlm.nih.gov/pubmed/30201445
[23]	CRANDALL A A, BROADBENT E, STANFILL M, et al. The influence of adverse and advantageous childhood experiences during adolescence on young adult health[J]. Child Abuse Negl, 2020, 108: 104644.
[24]	VARTANIAN L R, SMYTH J M, ZAWADZKI M J, et al. Early adversity, personal resources, body dissatisfaction, and disordered eating[J]. Int J Eat Disord, 2014, 47(6): 620-629.
[25]	DOOM J R, CICCHETTI D, ROGOSCH F A, et al. Child maltreatment and gender interactions as predictors of differential neuroendocrine profiles[J]. Psychoneuroendocrinology, 2013, 38(8): 1442-1454.
[26]	Van DAMMEN L, De ROOIJ S R, BEHNSEN P M, et al. Sex-specific associations between person and environment-related childhood adverse events and levels of cortisol and DHEA in adolescence[J]. PLoS One, 2020, 15 (6): e0233718.
[27]	BARENDSE M, SIMMONS JG, BYRNE ML, et al. Associations between adrenarcheal hormones, amygdala functional connectivity and anxiety symptoms in children[J]. Psychoneuroendocrinology, 2018, 97(2): 156-163.
[28]	NEGRIFF S, GORDIS E B, SUSMAN E J. Associations between HPA axis reactivity and PTSD and depressive symptoms: importance of maltreatment type and puberty[J]. Dev Psychopathol, 2021, 7: 1-12.