中小学生抑郁焦虑者亚型和风险特征分析

李敏辉; 杨亚明; 肖月; 杨馨惟; 蒋炫励; 王晓宇; 盛佳婷; 刘芳妒; 苏立燕; 马俊; 张徐军

doi:10.16835/j.cnki.1000-9817.2023.12.008

中小学生抑郁焦虑者亚型和风险特征分析

doi: 10.16835/j.cnki.1000-9817.2023.12.008

1.
东南大学公共卫生学院流行病与卫生统计学系，南京 210009
2.
江苏省宜兴市疾病预防控制中心科教科
3.
江苏省宜兴市中医医院口腔科

基金项目:

江苏省重点研发计划(社会发展)专项基金项目 BE2021617

江苏省研究生科研与实践创新计划项目 SJCX22_0074

详细信息

作者简介:
李敏辉(1998-)，男，安徽合肥人，硕士，主要研究方向为伤害流行病学与心理健康

通讯作者:
张徐军，E-mail: xjzhang@seu.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 R193
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- 被引次数: 0
出版历程
- 收稿日期: 2023-07-13
- 修回日期: 2023-09-17
- 网络出版日期: 2023-12-26
- 刊出日期: 2023-12-25

Analysis of subtypes and risk characteristics of depression and anxiety among primary and secondary school students

1.
Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing (210009), Jiangsu Province, China

摘要

摘要: 目的了解抑郁-焦虑中小学生不同抑郁-焦虑类型及其影响因素, 为中小学生抑郁及焦虑干预方案的制定提供依据。方法于2022年12月-2023年2月, 采用分层随机整群抽样方法选取宜兴市小学四至六年级及初中、高中全年级共4 180名学生为研究对象, 采用网络自填问卷系统, 用抑郁-焦虑-压力量表简版(DASS-21)、失眠严重程度量表(ISI)、家庭环境量表(FES)、耶鲁食物成瘾量表(mYFAS 2.0)、渥太华自我伤害调查表(OSI)对学生进行调查, 采用χ²检验、多因素Logistic回归分析学生抑郁焦虑的不同类型及其影响因素。结果中小学生抑郁总体检出率为16.6%, 焦虑为22.4%, 抑郁和焦虑共同患病率为14.0%。Logistic回归分析结果显示, 相比"轻抑郁-轻焦虑型"的学生, 父母经常争吵(OR=3.06)、吸烟(OR=3.16)、中度食物成瘾(OR=3.56)、非自杀性自伤(NSSI)(OR=2.26)的抑郁-焦虑学生更易成为"抑郁为主抑郁-焦虑型"; 饮酒(OR=2.00)、重度食物成瘾(OR=5.44)、中重度失眠(OR=3.25)、轻度失眠(OR=1.88)的抑郁-焦虑学生更易成为"焦虑为主抑郁-焦虑型"; 情绪变差(OR=10.87), 轻(OR=2.00)、中(OR=4.32)、重食物成瘾(OR=7.35), 轻度(OR=2.96)、中重度(OR=16.52)失眠, NSSI (OR=4.24)的抑郁-焦虑学生更易成为"重抑郁-重焦虑型"(P值均 < 0.05)。结论中小学生不同抑郁-焦虑亚型在食物成瘾、失眠、NSSI、吸烟、饮酒等方面存在明显差异。相关部门应联合学校、家庭对学生采取针对性的干预措施, 减少心理健康问题的发生。
- 抑郁 /
- 焦虑 /
- 精神卫生 /
- 回归分析 /
- 学生
Abstract: Objective To understand different types of depression and anxiety among primary and secondary school students, as well as their influencing factors, so as to provide a basis for the development of future intervention programs for adolescent mental health. Methods From December 2022 to February 2023, a self-administered questionnaire survey was administered among grades 4 to 6 students and junior school, senior school students in Yixing City using Depression Anxiety and Stress Scale-21(DASS-21), Insomnia Severity Index (ISI), Family Environment Scale (FES), and modified Yale Food Addiction Scale 2.0(mYFAS 2.0), Ottawa Self-injury Inventory (OSI).A total of 4 180 students were included in the analysis.Different types of depression and anxiety in students and their influencing factors were analyzed by the Chi-square-test and multivariate Logistic regression. Results The overall prevalence of depression and anxiety among primary and secondary school students were 16.6% and 22.4%, respectively, with 14.0% of depression and anxiety comorbidities.The Logistic regression results showed that, compared to students with low-depression-low-anxiety, students of depression and anxiety who had parents in conflicts (OR=3.06), smoked (OR=3.16), exhibited moderate food addiction (OR=3.56), and had non-suicidal self-injury (NSSI)(OR=2.26) were more likely to be classified as a depression-predominant-depression-anxiety type.Students of depression and anxiety who consumed alcohol (OR=2.00), had serious food addiction (OR=5.44), moderate-to-severe insomnia (OR=3.25), and mild insomnia (OR=1.88) were more likely to be classified as anxiety-predominant-depression-anxiety type.Students of depression and anxiety with low mood (OR=10.87), mild food addiction (OR=2.00), moderate food addiction (OR=4.32), and severe food addiction (OR=7.35), mild (OR=2.96) or moderate to severe (OR=16.52) insomnia, and NSSI (OR=4.24) were more likely to be classified as the severe-depression-anxiety type (P < 0.05). Conclusions There are significant differences between different depression-anxiety types among primary and secondary school students with respect to food addiction, insomnia, NSSI, smoking, and alcohol use.Relevant departments should engage with schools and families to adopt targeted interventions for students to reduce the occurrence of mental health problems.
- Depression /
- Anxiety /
- Mental health /
- Regression analysis /
- Students
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

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表 1 不同组别抑郁-焦虑中小学生抑郁-焦虑亚组分布比较

Table 1. Comparison of depression-anxiety subgroup distribution among different groups of primary and secondary school students of depression and anxiety

组别	选项	抑郁-焦虑人数	重抑郁-重焦虑型	焦虑为主抑郁-焦虑型	抑郁为主抑郁-焦虑型	轻抑郁-轻焦虑型	χ²值	P值
性别	男	277	45(16.2)	67(24.2)	22(7.9)	143(51.6)	1.56	0.67
	女	310	61(19.7)	67(21.6)	27(8.7)	155(50.0)
学段	小学	25	1(4.0)	4(16.0)	2(8.0)	18(72.0)	17.08	< 0.01
	初中	212	37(17.5)	64(30.2)	20(9.4)	91(42.9)
	高中	350	68(19.4)	66(18.9)	27(7.7)	189(54.0)
是否住校	是	129	25(19.4)	34(26.4)	13(10.1)	57(44.2)	3.07	0.38
	否	458	81(17.7)	100(21.8)	36(7.9)	241(52.6)
是否独生子女	是	233	40(17.2)	51(21.9)	17(7.3)	125(53.6)	1.46	0.69
	否	354	66(18.6)	83(23.4)	32(9.0)	173(48.9)
父母争吵频率	从未	89	13(14.6)	13(14.6)	8(9.0)	55(61.8)	34.5	< 0.01
	经常	72	23(31.9)	14(19.4)	14(19.4)	21(29.2)
	有时	426	70(16.4)	107(25.1)	27(6.4)	222(52.1)
学习成绩变动情况	进步	114	19(16.7)	25(21.9)	6(5.3)	64(56.1)	6.62	0.36
	退步	302	61(20.2)	63(20.9)	30(9.9)	148(49.0)
	稳定	171	26(15.2)	46(26.9)	13(7.6)	86(50.3)
情绪变动情况	变好	79	2(2.5)	21(26.6)	4(5.1)	52(65.8)	44.12	< 0.01
	变差	357	88(24.6)	87(24.4)	34(9.5)	148(41.5)
	不变	151	16(10.6)	26(17.2)	11(7.3)	98(64.9)
担任过学生干部	是	278	46(16.6)	64(23.0)	20(7.2)	148(53.2)	2.15	0.54
	否	309	60(19.4)	70(22.7)	29(9.4)	150(48.5)
吸烟	是	90	22(24.4)	22(24.4)	14(15.6)	32(35.6)	13.98	< 0.01
	否	497	84(16.9)	112(22.5)	35(7.1)	266(53.5)
饮酒	是	218	52(23.9)	67(30.7)	17(7.8)	82(37.6)	27.89	< 0.01
	否	369	54(14.6)	67(18.2)	32(8.7)	216(58.5)
注： ()内数字为构成比/%。

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表 2 不同抑郁-焦虑类型中小学生食物成瘾、失眠、家庭亲密度和NSSI构成比较

Table 2. Comparison of food addiction, insomnia, family intimacy, and NSSI composition among primary and secondary school students from different depression-anxiety subgroups

组别	人数	食物成瘾				失眠			家庭亲密度			NSSI
组别	人数	无	轻度	中度	重度	无	轻度	中重度	欠佳	适中	良好	无	有
重抑郁-重焦虑型	106	53(50.0)	28(26.4)	17(16.0)	8(7.5)	18(17.0)	43(40.6)	45(42.4)	52(49.1)	39(36.8)	15(14.1)	62(58.5)	44(41.5)
焦虑为主抑郁-焦虑型	134	89(66.4)	26(19.4)	11(8.2)	8(6.0)	48(35.8)	65(48.5)	21(15.7)	56(41.8)	60(44.8)	18(13.4)	110(82.0)	24(17.9)
抑郁为主抑郁-焦虑型	49	33(67.3)	8(16.3)	7(14.3)	1(2.0)	21(42.9)	23(46.9)	5(10.2)	29(59.2)	16(32.7)	4(8.2)	36(73.5)	13(26.5)
轻抑郁-轻焦虑型	298	234(78.5)	49(16.4)	12(4.0)	3(1.0)	183(61.4)	98(32.9)	17(5.7)	82(27.5)	141(47.3)	75(25.2)	270(90.6)	28(9.4)
χ²值		43.86				115.99			34.48			55.57
P值		< 0.01				< 0.01			< 0.01			< 0.01
注： ()内数字为构成比/%。

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表 3 中小学生抑郁-焦虑类型多因素Logistic回归分析[OR值(95%CI), n=587]

Table 3. Multinomial Logistic regression analysis of different depression-anxiety types among primary and secondary school students [OR(95%CI), n=587]

自变量	选项	抑郁为主抑郁-焦虑型	焦虑为主抑郁-焦虑型	重抑郁-重焦虑型
父母争吵频率	经常	3.06(1.05~8.91)^*	2.00(0.76~5.26)	2.33(0.84~6.49)
	有时	0.75(0.31~1.81)	1.79(0.91~3.54)	1.23(0.55~2.75)
	从未	1.00	1.00	1.00
情绪变动情况	变差	2.82(0.91~8.77)	1.37(0.74~2.54)	10.87(2.40~49.25)^**
	不变	1.62(0.47~5.60)	0.72(0.35~1.48)	4.22(0.85~20.86)
	变好	1.00	1.00	1.00
吸烟	是	3.16(1.40~7.15)^*	1.19(0.63~2.28)	1.93(0.92~4.06)
	否	1.00	1.00	1.00
饮酒	是	0.83(0.40~1.73)	2.00(1.25~3.19)^**	1.48(0.83~2.63)
	否	1.00	1.00	1.00
食物成瘾	重度	2.95(0.28~30.79)	5.44(1.27~23.40)^*	7.35(1.55~34.92)^*
	中度	3.56(1.21~10.51)^*	2.36(0.94~5.90)	4.32(1.65~11.32)^**
	轻度	0.99(0.41~2.38)	1.31(0.74~2.31)	2.00(1.04~3.88)^*
	无	1.00	1.00	1.00
失眠	中重度	1.54(0.48~4.93)	3.25(1.52~6.97)^**	16.52(7.29~37.44)^**
	轻度	1.60(0.81~3.19)	1.88(1.18~3.02)^*	2.96(1.54~5.69)^**
	无	1.00	1.00	1.00
NSSI	有	2.26(1.01~5.08)^*	1.34(0.71~2.52)	4.24(2.20~8.16)^**
	无	1.00	1.00	1.00
注： P < 0.05，*P < 0.01。

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