童年期不良经历和积极经历与中学生抑郁焦虑症状的关联

高悦; 肖婉; 魏瑞虹; 王若惜; 江琳琳; 万宇辉; 宋律

doi:10.16835/j.cnki.1000-9817.2024238

童年期不良经历和积极经历与中学生抑郁焦虑症状的关联

doi: 10.16835/j.cnki.1000-9817.2024238

高悦¹,
肖婉²,
魏瑞虹²,
王若惜²,
江琳琳³,
万宇辉^{1, 2},
宋律^{1, 4, ,}

1.
安徽医科大学公共卫生学院健康促进与行为科学系, 合肥 230032
2.
安徽医科大学公共卫生学院儿少卫生与妇幼保健学系
3.
安徽医药高等专科学校公共基础学院心理教研室
4.
安徽省疾病预防控制中心科教科

基金项目:

国家自然科学基金项目 82073576

安徽省高校自然科学基金项目 2023AH052603

详细信息

作者简介:
高悦(2000-)，女，安徽合肥人，在读硕士，主要研究方向为儿童青少年健康促进

通讯作者:
宋律，E-mail：95213280@qq.com

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R179 G444 B845.67
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出版历程
- 收稿日期: 2024-05-13
- 修回日期: 2024-07-09
- 刊出日期: 2024-08-25

Correlation of adverse and positive childhood experiences and depression and anxiety symptoms among middle school students

GAO Yue¹,
XIAO Wan²,
WEI Ruihong²,
WANG Ruoxi²,
JIANG Linlin³,
WAN Yuhui^{1, 2},
SONG Lü^{1, 4
, ,}

1.
Department of Health Education and Behavioral Sciences, School of Public Health, Anhui Medical University, Hefei (230032), Anhui Province, China

摘要

摘要: 目的分析童年期不良经历(ACEs)与童年期积极经历(PCEs)和中学生抑郁、焦虑症状的关联及性别差异，为促进中学生心理健康提供参考依据。方法采用分层随机整群抽样方法，于2021年10月—2022年10月选取南昌市、沈阳市、太原市、郑州市共6 656名中学生为研究对象，采用童年期不良经历问卷(ACEs-IQ)、童年期积极经历量表(BCEs)、患者健康问卷(PHQ-9)和广泛性焦虑障碍量表(GAD-7)进行问卷调查。采用χ²检验比较不同组别中学生抑郁、焦虑症状的报告率，建立Logistic回归模型分析ACEs和PCEs对中学生抑郁、焦虑症状的影响及其性别差异。结果中学生抑郁症状报告率为20.1%，焦虑症状报告率为13.9%。ACEs与中学生抑郁和焦虑症状均呈正相关(抑郁症状：OR=1.20，95%CI=1.18~1.22；焦虑症状：OR=1.18，95%CI=1.16~1.20)，PCEs与中学生抑郁、焦虑症状均呈负相关(抑郁症状：OR=0.84，95%CI=0.83~0.86；焦虑症状：OR=0.85，95%CI=0.83~0.87)(P值均 < 0.05)；在总人群(抑郁症状：OR=0.99，95%CI=0.98~0.99；焦虑症状：OR=0.99，95%CI=0.99~1.00)与女生中(抑郁症状：OR=0.98，95%CI=0.97~0.99；焦虑症状：OR=0.99，95%CI=0.98~1.00)，ACEs与PCEs交互项与抑郁、焦虑症状均呈负相关(P值均 < 0.05)。结论 ACEs显著影响中学生的抑郁、焦虑症状，而PCEs有助于减轻ACEs对中学生抑郁、焦虑症状的影响；女生比男生更易受到早期经历的影响。应关注性别差异，制定全面的心理健康保护策略，促进中学生心理健康发展。
- 生活变动事件 /
- 抑郁 /
- 焦虑 /
- 精神卫生 /
- 回归分析 /
- 学生
Abstract: Objective To analyze the correlation and gender differences between adverse childhood experiences (ACEs) and positive childhood experiences (PCEs) and depression and anxiety symptoms among middle school students, so as to provide a reference for promoting the mental health of middle school students. Methods With a stratified random cluster sampling method, a total of 6 656 middle school students in 4 cities, including Nanchang, Shenyang, Taiyuan, and Zhengzhou, were selected as research subjects from October 2021 to October 2022. The Adverse Childhood Experiences International Questionnaire (ACEs-IQ), Benevolent Childhood Experiences Scale (BCEs), Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorders-7 (GAD-7) scale were used to conduct questionnaire surveys.The Chi-square test was used to compare the reporting rates of depression and anxiety symptoms among middle school students in different groups, and a Logistic regression model was established to analyze the effects of ACEs and PCEs on depression and anxiety symptoms among middle school students and their gender differences. Results The reporting rate of depressive symptoms among middle school students was 20.1%, and the reporting rate of anxiety symptoms was 13.9%. ACEs were positively correlated with depression and anxiety symptoms among middle school students (depression symptoms: OR=1.20, 95%CI=1.18-1.22, anxiety symptoms: OR=1.18, 95%CI=1.16-1.20), while PCEs were negatively correlated with depression and anxiety symptoms among middle school students(depression symptoms: OR=0.84, 95%CI=0.83-0.86, anxiety symptoms: OR=0.85, 95%CI=0.83-0.87) (P < 0.05). In the general population (depression symptoms : OR=0.99, 95%CI=0.98-0.99, anxiety symptoms: OR=0.99, 95%CI=0.99-1.00) and among girls (depression symptoms: OR=0.98, 95%CI=0.97-0.99, anxiety symptoms : OR=0.99, 95%CI=0.98-1.00), the interaction term between ACEs and PCEs were negatively correlated with depression and anxiety symptoms (P < 0.05). Conclusions ACEs significantly affect the depression and anxiety symptoms of middle school students, while PCEs can help reduce the impact of ACEs on the depression and anxiety symptoms of middle school students, girls are more susceptible to the impact of early experiences than boys. It should focus on gender differences, formulate comprehensive mental health protection strategies, to promote the mental health development of middle school students.
- Life change events /
- Depression /
- Anxiety /
- Mental health /
- Regression analysis /
- Students
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表 1 不同组别中学生抑郁和焦虑症状报告率比较

Table 1. Comparison of the reporting rates of depressive and anxiety symptoms among middle school students in different groups

组别	选项	人数	抑郁症状			焦虑症状
组别	选项	人数	报告人数	χ²值	P值	报告人数	χ²值	P值
性别	男	3 197	663(20.7)	1.55	0.21	450(14.1)	0.09	0.76
	女	3 459	675(19.5)			478(13.8)
居住地	农村	1 135	260(22.9)	8.04	0.02	116(14.6)	0.53	0.77
	乡镇	1 318	272(20.6)			182(13.8)
	城市	4 203	806(19.2)			580(13.8)
独生子女	是	1 772	352(19.9)	0.09	0.77	230(13.0)	1.87	0.17
	否	4 884	986(20.2)			698(14.3)
父亲文化程度	初中及以下	3 499	792(20.8)	4.73	0.09	481(13.7)	0.26	0.88
	高中或中专	1 952	393(20.1)			275(14.1)
	大专及以上	1 205	216(17.9)			172(14.3)
母亲文化程度	初中及以下	3821	800(20.9)	5.92	0.05	537(14.1)	0.13	0.94
	高中或中专	1 724	342(19.8)			236(13.7)
	大专及以上	1 111	196(17.6)			155(14.0)
家庭经济情况	较差	784	224(28.6)	39.73	＜0.01	152(19.4)	23.05	＜0.01
	中等	4 898	927(18.9)			637(13.0)
	较好	974	187(19.2)			139(14.3)
朋友数量/个	0	207	61(29.5)	42.47	＜0.01	48(23.2)	40.11	＜0.01
	1~2	1 629	399(24.5)			281(17.2)
	3~5	2 959	552(18.7)			381(12.9)
	≥6	1 861	326(17.5)			218(11.7)
学习负担	较轻	386	63(16.3)	48.16	＜0.01	49(12.7)	48.81	＜0.01
	一般	1719	444(25.8)			326(19.0)
	较重	4 551	831(18.3)			553(12.2)
注：( )内数字为报告率/%。

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表 2 中学生ACEs和PCEs与抑郁症状的关联

Table 2. Association between ACEs, PCEs and depressive symptoms among middle school students

组别	自变量	模型1		模型2
组别	自变量	OR值(95%CI)	P值	OR值(95%CI)	P值
总人群	ACEs	1.20(1.18~1.24)	＜0.01	1.20(1.18~1.22)	＜0.01
(n=6 656)	PCEs	0.84(0.83~0.86)	＜0.01	0.84(0.83~0.86)	＜0.01
	PCEs×ACEs	0.99(0.98~0.99)	＜0.01	0.99(0.98~0.99)	＜0.01
男	ACEs	1.19(1.16~1.22)	＜0.01	1.19(1.16~1.22)	＜0.01
(n=3 197)	PCEs	0.85(0.83~0.87)	＜0.01	0.85(0.83~0.85)	＜0.01
	PCEs×ACEs	0.99(0.99~1.00)	0.05	0.99(0.99~1.00)	0.09
女	ACEs	1.22(1.18~1.25)	＜0.01	1.21(1.18~1.25)	＜0.01
(n=3 459)	PCEs	0.83(0.81~0.85)	＜0.01	0.83(0.81~0.85)	＜0.01
	PCEs×ACEs	0.98(0.97~0.99)	＜0.01	0.98(0.97~0.99)	＜0.01
注：模型1未调整变量；模型2调整居住地、家庭经济情况、朋友数量、学习负担；PCEs×ACEs为PCEs和ACEs中心化后的相乘交互项。

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表 3 中学生ACEs和PCEs与焦虑症状的关联

Table 3. Association between ACEs, PCEs and anxiety symptoms among middle school students

组别	自变量	模型1		模型2
组别	自变量	OR值(95%CI)	P值	OR值(95%CI)	P值
总人群	ACEs	1.18(1.16~1.21)	＜0.01	1.18(1.16~1.20)	＜0.01
(n=6 656)	PCEs	0.85(0.83~0.86)	＜0.01	0.85(0.83~0.87)	＜0.01
	PCEs×ACEs	0.99(0.99~1.00)	＜0.01	0.99(0.99~1.00)	＜0.01
男	ACEs	1.17(1.14~1.20)	＜0.01	1.17(1.13~1.20)	＜0.01
(n=3 197)	PCEs	0.86(0.84~0.89)	＜0.01	0.86(0.84~0.89)	＜0.01
	PCEs×ACEs	0.99(0.99~1.00)	0.13	1.00(0.99~1.00)	0.17
女	ACEs	1.20(1.17~1.24)	＜0.01	1.20(1.16~1.23)	＜0.01
(n=3 459)	PCEs	0.83(0.81~0.86)	＜0.01	0.83(0.81~0.86)	＜0.01
	PCEs×ACEs	0.99(0.98~0.99)	＜0.01	0.99(0.98~1.00)	＜0.01
注：模型1未调整变量；模型2调整家庭经济状况、朋友数量、学习负担；PCEs×ACEs为PCEs和ACEs中心化后的相乘交互项。

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