中学生自杀意念潜在类别及影响因素分析

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

doi:10.16835/j.cnki.1000-9817.2024034

中学生自杀意念潜在类别及影响因素分析

doi: 10.16835/j.cnki.1000-9817.2024034

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

基金项目:

江苏省重点研发计划(社会发展专项)项目 BE2021617

江苏省研究生科研与实践创新计划项目 SJCX21_0085

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:
苏立燕(1999-)，女，河北石家庄人，在读硕士，主要研究方向为伤害流行病学

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: R174 G444 C913.5
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出版历程
- 收稿日期: 2023-11-06
- 修回日期: 2023-12-22
- 网络出版日期: 2024-02-01
- 刊出日期: 2024-01-25

Latent classes and associated factors of suicidal ideation among high school students

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

摘要

摘要: 目的了解宜兴市中学生自杀意念现状并探讨其影响因素，为早期针对性地干预青少年自杀意念提供科学指导。方法 2019年3—5月，采用分层整群随机抽样法对江苏宜兴3所初中和4所高中的12 799名学生进行问卷调查。使用潜在剖面分析对中学生自杀意念进行分类，并采用χ²检验比较自杀意念潜在类别在不同特征中学生组间差异，采用多元Logistic回归进行影响因素分析，构建列线图预测模型并验证。结果中学生自杀意念程度分为无或轻、中、重3类，其中中度自杀意念3 034名(23.7%)、重度753名(5.9%)。多元Logistic回归分析结果显示，性别为女生、学习成绩中等偏下、吸烟、饮酒、受同学欢迎程度(较不受欢迎和不受欢迎)、家庭成员关系(一般/偶有矛盾/矛盾很大)、对周围人信任程度(比较信任/不太信任/根本不信任)、恋爱过或正在恋爱、身体欺凌、关系欺凌、言语欺凌和性欺凌的中学生重度自杀意念发生风险更高(OR值分别为3.27；2.18；1.63；1.72；2.66，6.05；3.00，3.29，6.38；1.71，6.04，12.48；2.50；1.59；2.16；1.45；1.63，P值均 < 0.05)。列线图模型显示区分度较好。结论中学生自杀意念受多种因素共同影响，家庭与同伴情况、遭受欺凌等均与自杀意念程度有关。建议从改善学生的家庭与人际关系、控制欺凌等方面入手，减少学生自杀意念。
- 自杀 /
- 精神卫生 /
- 回归分析 /
- 学生
Abstract: Objective To understand current situation epidemiology and associated factors of suicidal ideation among high school students in Yixing, so as to provide basis for targeted intervention. Methods From March to May 2019, a questionnaire survey was conducted on 12 799 students from 3 junior high schools and 4 senior high schools in Yixing City, Jiangsu Province, using a stratified cluster random sampling method. Latent profile analysis was used to classify suicidal ideation among high school students, the chi-square test was used to compare the differences in suicidal ideation among different characteristics of students, multiple Logistic regression was used to analyze influencing factors, a risk predictive nomogram model was constructed and then verified. Results Three latent classes of suicidal ideation among high school students was divided into three categories were observed: none or mild, moderate, and severe. Among them, 3 034 (23.7%) had moderate suicidal ideation and 753 (5.9%) had severe suicidal ideation. The Logistic regression results showed that gender was female, academic performance was lower mid-range, smoking, drinking, popularity with classmates(less popular and unpopularity), family member relationships(general/occasional contradictions/contradictions), trust in others(more trusted/less trusted/less trusted at all), past or current relationships, physical bullying, relationship bullying, verbal bullying, and sexual bullying were the influencing factors for severe suicidal ideation among students (OR=3.27;2.18;1.63;1.72;2.66, 6.05;3.00, 3.29, 6.38;1.71, 6.04, 12.48; 2.50; 1.59; 2.16; 1.45; 1.63, P < 0.05). The nomogram prediction model had good discrimination. Conclusions Suicide ideation is influenced by multiple factors. Family and peer situations, as well as being bullied, are all related to the degree the severity of suicidal ideation. Efforts can be made to improve students' family and interpersonal relationships, control bullying, then reduce their suicidal ideation which might help prevent suicide ideation among students.
- Suicide /
- 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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图 1 中学生自杀意念风险列线图预测模型

Figure 1. Nomogram prediction model for high school students' suicidal ideation

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表 1 中学生自杀意念潜在剖面分析

Table 1. Latent profile analysis of suicidal ideation among high school students

类别	AIC值	BIC值	aBIC值	Entropy	P_LMR值	P_BLRT值	类别概率
1	445 767.70	445 976.50	445 887.51				1.00
2	370 647.82	370 968.47	370 831.82	0.99	0.32	0.32	0.92/0.08
3	344 096.00	344 528.51	344 344.20	0.94	< 0.01	< 0.01	0.70/0.24/0.06
4	324 816.66	325 361.03	325 129.04	0.94	< 0.01	< 0.01	0.65/0.25/0.08/0.02
5	314 779.52	315 435.75	315 156.09	0.94	0.12	< 0.01	0.63/0.08/0.04/0.24/0.01

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表 2 不同自杀意念潜在类别中学生PANSI量表得分比较(x±s)

Table 2. Comparison of PANSI scale scores among high school students with different latent categories of suicidal ideation(x±s)

类型	人数	条目1	条目2	条目3	条目4	条目5	条目6	条目7	条目8
Ⅰ类	9 012	2.30±0.92	2.29±0.97	1.23±0.57	1.03±0.20	1.03±0.21	1.73±0.80	1.03±0.20	1.06±0.31
Ⅱ类	3 034	3.54±0.87	3.56±0.95	1.96±0.89	1.27±0.56	1.33±0.63	3.36±0.88	1.31±0.58	1.35±0.65
Ⅲ类	753	3.63±1.09	3.71±1.11	3.56±0.93	2.79±1.25	3.06±1.18	3.63±1.07	3.16±1.10	2.92±1.24

类型	人数	条目9	条目10	条目11	条目12	条目13	条目14	总得分
Ⅰ类	9 012	1.83±0.81	1.01±0.16	1.03±0.21	1.02±0.17	1.24±0.52	1.42±0.61	19.27±3.29
Ⅱ类	3 034	3.29±0.99	1.18±0.44	1.38±0.65	1.37±0.60	2.65±1.15	3.12±0.94	30.68±4.47
Ⅲ类	753	3.50±1.13	3.02±1.19	3.39±1.10	3.44±1.02	3.25±1.09	3.50±1.13	46.55±7.85
注：条目1——学习上很顺利，感觉很愉快；条目2——感觉生活中大部分情况在自己的掌控中；条目3——觉得未来没有希望，产生轻生念头；条目4——感觉和某人的关系很不愉快，想要自杀；条目5——无法完成生命中重要的事情，想要自杀；条目6——对生活很满意，觉得未来有希望；条目7——对于自己的问题束手无策，想要自杀；条目8——感觉无法达到他人的要求，产生轻生念头；条目9——相信自己能有效处理生活中的问题；条目10——问题如此难以解决，自杀似乎是唯一的选择；条目11——觉得很寂寞忧伤，为了结束痛苦想要自杀；条目12——生活中感觉很失败，想要自杀；条目13——感觉生命是值得活下去的；条目14——对于未来，感觉有信心。

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表 3 不同特征中学生自杀意念程度构成比较

Table 3. Comparison of the composition of suicidal ideation degree among hgih school students with different characteristics

特征	选项	人数	无或轻度	中度	重度	χ²值	P值
性别^*	男	6 524	4 903(75.2)	1 345(20.6)	276(4.2)	157.12	< 0.01
	女	6 260	4 100(65.5)	1 685(26.9)	475(7.6)
民族^*	汉族	12 663	8 931(70.5)	2 989(23.6)	743(5.9)	5.27	0.072
	少数民族	115	70(60.9)	37(32.2)	8(6.9)
独生子女^*	是	7 648	5 498(71.9)	1 722(22.5)	428(5.6)	18.95	< 0.01
	否	5 117	3 495(68.3)	1 301(25.4)	321(6.3)
学段	初中	7 995	5 728(71.6)	1 797(22.5)	470(5.9)	18.16	< 0.01
	高中	4 804	3 284(68.4)	1 237(25.7)	283(5.9)
学习成绩^*	优等	1 651	1 392(84.3)	191(11.6)	68(4.1)	619.83	< 0.01
	中等偏上	4 099	3 131(76.4)	766(18.7)	202(4.9)
	中等	4 193	2 954(70.4)	1 021(24.4)	218(5.2)
	中等偏下	2 799	1 495(53.4)	1 040(37.2)	264(9.4)
吸烟	是	387	178(46.0)	138(35.7)	71(18.3)	163.20	< 0.01
	否	12 412	8 834(71.2)	2 896(23.3)	682(5.5)
饮酒	是	3 148	1 836(58.3)	973(30.9)	339(10.8)	347.41	< 0.01
	否	9 651	7 176(74.4)	2 061(21.3)	414(4.3)
受同学欢迎程度^*	很受欢迎	1 936	1 666(86.0)	199(10.3)	71(3.7)	1 012.60	< 0.01
	较受欢迎	9 015	6 520(72.3)	2 057(22.8)	438(4.9)
	较不受欢迎	1 385	621(44.8)	605(43.7)	159(11.5)
	不受欢迎	263	74(28.1)	117(44.5)	72(27.4)
父母均在外地工作^*	是	1 303	855(65.6)	376(28.9)	72(5.5)	21.45	< 0.01
	否	11 459	8 131(71.0)	2 647(23.1)	681(5.9)
家庭成员关系^*	和睦	8 866	7 045(79.4)	1 558(17.6)	263(3.0)	1 362.80	< 0.01
	一般	1 849	1 004(54.3)	652(35.3)	193(10.4)
	偶有矛盾	1 686	825(48.9)	656(38.9)	205(12.2)
	矛盾很大	342	106(31.0)	147(43.0)	89(26.0)
对周围人信任程度^*	非常信任	4 011	3 502(87.3)	420(10.5)	89(2.2)	1 658.15	< 0.01
	比较信任	7 629	5 116(67.1)	2 110(27.6)	403(5.3)
	不太信任	959	307(32.0)	445(46.4)	207(21.6)
	根本不信任	139	51(36.7)	39(28.1)	49(35.2)
恋爱过或正在恋爱^*	否	10 190	7 486(73.5)	2 278(22.3)	426(4.2)	358.87	< 0.01
	是	2 508	1 455(58.0)	734(29.3)	319(12.7)
身体欺凌	否	11 871	8 584(72.3)	2 697(22.7)	590(5.0)	383.02	< 0.01
	是	928	428(46.1)	337(36.3)	163(17.6)
关系欺凌	否	11 031	8 195(74.3)	2 409(21.8)	427(3.9)	837.67	< 0.01
	是	1 768	817(46.2)	625(35.4)	326(18.4)
言语欺凌	否	10 173	7 600(74.7)	2 164(21.3)	409(4.0)	546.22	< 0.01
	是	2 626	1 412(53.8)	870(33.1)	344(13.1)
财物欺凌	否	10 599	7 822(73.8)	2 315(21.8)	462(4.4)	434.36	< 0.01
	是	2 200	1 190(54.1)	719(32.7)	291(13.2)
性欺凌	否	10 935	8 017(73.3)	2 442(22.3)	476(4.4)	448.46	< 0.01
	是	1 864	995(53.4)	592(31.7)	277(14.9)
网络欺凌	否	12 057	8 660(71.8)	2 796(23.2)	601(5.0)	367.77	< 0.01
	是	742	352(47.4)	238(32.1)	152(20.5)
注： ()内数字为报告率/%；*表示数据存在缺失值。

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表 4 中学生自杀意念影响因素的多元Logistic回归分析(n=12 374)

Table 4. Multiple Logistic regression analysis of related factors for suicidal ideation among high school students(n=12 374)

变量	选项	中度			重度
变量	选项	β值	P值	OR值(95%CI)	β值	P值	OR值(95%CI)
截距		-3.91	< 0.01		-5.69	< 0.01
性别	女	0.59	< 0.01	1.81(1.64~1.99)	1.19	< 0.01	3.27(2.72~3.94)
学段	高中	0	0.95	1.00(0.90~1.10)	-0.30	< 0.01	0.74(0.62~0.89)
学习成绩	中等偏上	0.37	< 0.01	1.45(1.21~1.75)	0.14	0.38	1.15(0.84~1.59)
	中等	0.64	< 0.01	1.90(1.58~2.28)	0.23	0.16	1.26(0.91~1.73)
	中等偏下	1.20	< 0.01	3.31(2.73~4.00)	0.78	< 0.01	2.18(1.58~3.02)
吸烟	是	0.24	0.09	1.27(0.97~1.68)	0.49	0.01	1.63(1.12~2.37)
饮酒	是	0.32	< 0.01	1.38(1.24~1.55)	0.54	< 0.01	1.72(1.42~2.09)
受同学欢迎程度	较受欢迎	0.58	< 0.01	1.78(1.50~2.11)	0.28	0.07	1.32(0.98~1.78)
	较不受欢迎	1.25	< 0.01	3.48(2.82~4.28)	0.98	< 0.01	2.66(1.87~3.78)
	不受欢迎	1.58	< 0.01	4.86(3.36~7.02)	1.80	< 0.01	6.05(3.68~9.92)
家庭成员关系	一般	0.66	< 0.01	1.93(1.70~2.18)	1.10	< 0.01	3.00(2.40~3.74)
	偶有矛盾	0.85	< 0.01	2.34(2.05~2.66)	1.19	< 0.01	3.29(2.64~4.12)
	矛盾很大	1.16	< 0.01	3.20(2.40~4.26)	1.85	< 0.01	6.38(4.43~9.19)
对周围人信任程度	比较信任	0.89	< 0.01	2.43(2.14~2.75)	0.54	< 0.01	1.71(1.33~2.22)
	不太信任	1.63	< 0.01	5.10(4.17~6.22)	1.80	< 0.01	6.04(4.39~8.31)
	根本不信任	1.47	< 0.01	4.34(2.67~7.08)	2.52	< 0.01	12.48(7.07~22.04)
恋爱过或正在恋爱	是	0.24	< 0.01	1.28(1.13~1.44)	0.92	< 0.01	2.50(2.06~3.05)
身体欺凌	是	0.34	< 0.01	1.40(1.17~1.69)	0.46	< 0.01	1.59(1.22~2.07)
关系欺凌	是	0.22	< 0.01	1.25(1.09~1.44)	0.77	< 0.01	2.16(1.75~2.66)
言语欺凌	是	0.23	< 0.01	1.26(1.11~1.44)	0.37	< 0.01	1.45(1.17~1.80)
性欺凌	是	0.12	0.10	1.13(0.98~1.30)	0.49	< 0.01	1.63(1.31~2.03)

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