Association between sleep and depressive symptoms among primary and secondary school students
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摘要:
目的 了解中国中小学生睡眠状况及其与抑郁症状的关系，为改善中小学生睡眠和降低抑郁症状发生率提供科研证据。 方法 利用2018和2020年中国家庭追踪调查(CFPS)中4 232名在校中小学生数据，使用自报方式了解睡眠状况，使用简易流调中心抑郁量表(CES-D8)测量抑郁症状。采用方差分析、χ2检验、多元线性回归分析和限制性立方样条模型分析中小学生睡眠状况及其与抑郁症状的关联。 结果 2018—2020年中国中小学生平均学习日、休息日夜晚睡眠时长分别为(7.96±1.38)(9.30±1.51)h，睡眠不足报告率依次是42.75%，11.41%；1 921名(45.39%)中小学生报告有午睡习惯，567名(13.40%)中小学生午睡>1.0 h/d；2 997名(70.82%)中小学生报告周末补觉，595名(14.06%)中小学生补觉>2.0 h/d。多元线性回归分析结果显示，控制其他因素后，学习日夜晚睡眠不足、休息日夜晚睡眠不足、周末补觉>2.0 h/d均与中小学生抑郁症状呈正相关(β值分别为0.40，0.39，0.41，P值均 < 0.05)。限制性立方样条分析结果显示，调整性别、年龄、城乡、地区、自评健康和体质量指数等因素后，学习日夜晚睡眠时长、休息日夜晚睡眠时长和午睡时长与中小学生抑郁症状均呈非线性剂量反应关系(P总趋势值均 < 0.05，P非线性值均 < 0.05)，最佳时长分别约为9.0 h，10.0 h和40 min。 结论 中小学生夜晚睡眠不足、午休不科学和周末补觉过长均是抑郁症状的重要风险因素。应积极改变中小学生的不良睡眠行为，降低其抑郁症状发生风险。 Abstract:Objective To understand the sleep status of primary and secondary school students in China and its relationship with depressive symptoms, so as to provide scientific evidence for improving their sleep status and reducing the incidence of depressive symptoms. Methods Data of 4 232 primary and secondary school students come from China Family Panel Studies (CFPS) data of 2018 and 2020. Sleep status was measured by using self-reported questionnaire, and depressive symptoms was measured by using the Center for Epidemiologic Studies Depression Scale-8 Items (CES-D8). Variance analysis, χ2 test, multiple linear regression analysis (MLR) and restricted cubic spline models (RCS) were conducted to analysis the association of sleep status and depressive symptoms among primary and secondary school students. Results From 2018 to 2020, the average sleep duration on weekdays and on weekends among primary and secondary school students was (7.96±1.38) and (9.30±1.51)h, respectively. The prevalence of insufficient sleep was 42.75%, 11.41%. A total of 1 921 students (45.39%) had a nap, 567 (13.40%) students napped >1.0 h/d. A total of 2 997 students (70.82%) caught up sleep on weekends, 595 (14.06%) caught up sleep >2.0 h/d. MLR showed that insufficient sleep on weekdays, insufficient sleep on weekends, catching up >2.0 h/d on weekends were risk factors for depressive symptoms of primary and secondary school students (β=0.40, 0.39, 0.41, P < 0.05). RCS showed that sleep duration at night, and napping duration had nonlinear dose-response relationships with depressive symptoms (Ptrend < 0.05, Pnon-linear < 0.05), with optimal durations of 9.0 h, 10.0 h, and 40 min. Conclusions Insufficient sleep at night, inappropriate napping duration and inappropriate weekend catch-up sleep duration are risk factors for depressive symptoms of primary and secondary school students. It is necessary to actively change bad sleep behaviors to reduce the risk of depressive symptoms. -
Key words:
- Sleep /
- Depression /
- Mental health /
- Regression analysis /
- Students
1) 利益冲突声明 所有作者声明无利益冲突。 -
图 1 中小学生睡眠状况与抑郁症状剂量反应关系的限制性立方样条分析
Figure 1. Restricted cubic spline plot of the dose-response relationship between sleep status and depressive symptoms among primary secondary school students
表 1 不同组别中小学生每日各类型睡眠时长比较(x ± s)
Table 1. Comparison of different types of sleep time every day among primary and secondary school students in different groups(x ± s)
组别 选项 人数 统计值 学习日夜晚睡眠时长/h 休息日夜晚睡眠时长/h 午睡时长/mina 周末补觉时长/ha 性别 女 2 055 7.90±1.41 9.26±1.54 60(30, 90) 2(1, 2) 男 2 177 8.01±1.34 9.35±1.49 60(40, 90) 2(1, 2) t/Z值 -2.72 -2.00 1.91 0.62 P值 < 0.01 0.05 0.17 0.43 学段 小学 1 674 8.60±1.33 9.69±1.45 60(60, 120) 1(1, 2) 初中 1 509 7.78±1.20 9.22±1.45 60(40, 90) 2(1, 2) 高中 1 049 7.18±1.20 8.81±1.54 60(30, 60) 2(1, 3) F/H值 842.06 286.47 57.18 87.89 P值 < 0.01 < 0.01 < 0.01 < 0.01 城乡 农村 2 361 8.04±1.39 9.35±1.50 60(40, 90) 2(1, 2) 城镇 1 871 7.85±1.35 9.24±1.53 60(30, 90) 2(1, 2) F/Z值 4.53 2.26 11.21 3.19 P值 < 0.01 0.02 < 0.01 0.07 地区 东部 1 189 7.96±1.27 9.26±1.41 60(50, 120) 2(1, 2) 中部 1 459 7.92±1.41 9.25±1.55 60(40, 120) 2(1, 2) 西部 1 584 7.99±1.42 9.38±1.55 60(30, 120) 2(1, 2) F/H值 0.78 4.99 46.92 2.27 P值 0.68 0.08 < 0.01 0.32 年份 2018 3 112 8.04±1.36 9.35±1.49 60(40, 120) 2(1, 2) 2020 1 120 7.74±1.40 9.18±1.58 60(30, 80) 2(1, 2) t/Z值 6.08 3.18 8.94 3.41 P值 < 0.01 < 0.01 < 0.01 0.07 自评健康 不健康 154 7.98±1.52 9.29±1.61 60(50, 120) 2(1, 3) 健康 4 078 7.96±1.37 9.30±1.51 60(40, 90) 2(1, 2) t/Z值 0.23 -0.09 3.57 0.04 P值 0.82 0.93 0.06 0.85 BMI 非超重肥胖 3 413 7.97±1.39 9.33±1.52 60(40, 90) 2(1, 2) 超重 506 7.70±1.17 8.95±1.37 60(40, 90) 2(1, 2) 肥胖 313 7.82±1.26 8.90±1.39 60(40, 60) 1(1, 2) F/H值 13.01 2.18 0.96 0.82 P值 < 0.01 0.34 0.62 0.66 注： a不符合正态分布，采用M(P25, P75)描述。 
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表 2 不同组别中小学生学习日和休息日夜晚睡眠时间分布比较
Table 2. Comparison of distribution of sleep duration at night on weekdays and on weekends among primary and secondary school students in different groups
组别 选项 人数 学习日夜晚睡眠 休息日夜晚睡眠 不足 合适 过多 χ2值 P值 不足 合适 过多 χ2值 P值 性别 女 2 055 904(43.99) 1 055(51.34) 96(4.67) 4.48 0.11 231(11.24) 1 237(60.19) 587(28.56) 6.86 0.03 男 2 177 905(41.57) 1 145(52.60) 127(5.83) 252(11.58) 1 228(56.41) 697(32.02) 学段 小学 1 674 714(42.65) 890(53.17) 70(4.18) 38.59 < 0.01 276(16.49) 1 107(66.13) 291(17.38) 249.30 < 0.01 初中 1 509 577(38.24) 838(55.53) 94(6.23) 107(7.09) 818(54.21) 584(38.70) 高中 1 049 518(49.38) 472(45.00) 59(5.62) 100(9.53) 540(51.48) 409(38.99) 城乡 农村 2 361 941(39.86) 1 276(54.04) 144(6.10) 21.77 < 0.01 258(10.93) 1 368(57.94) 735(31.13) 2.29 0.32 城镇 1 871 868(46.39) 924(49.39) 79(4.22) 225(12.03) 1 097(58.63) 549(29.34) 地区 东部 1 189 497(41.80) 635(53.41) 57(4.79) 24.14 < 0.01 138(11.61) 712(59.88) 339(28.51) 17.86 < 0.01 中部 1 459 662(45.37) 745(51.06) 52(3.56) 181(12.41) 873(59.84) 405(27.76) 西部 1 584 650(41.04) 820(51.77) 114(7.20) 164(10.35) 880(55.56) 540(34.09) 年份 2018 3 112 1 250(40.17) 1 673(53.76) 189(6.07) 39.84 < 0.01 346(11.12) 1 795(57.68) 971(31.20) 4.42 0.11 2020 1 120 559(49.91) 527(47.05) 34(3.04) 137(12.23) 670(59.82) 313(27.95) 自评健康 不健康 154 67(43.51) 75(48.70) 12(7.79) 2.28 0.32 18(11.69) 92(59.74) 44(28.57) 0.24 0.89 健康 4 078 1 742(42.72) 2 125(52.11) 211(5.17) 465(11.41) 2 373(58.19) 1 240(30.41) BMI 非超重肥胖 3 413 1 434(42.02) 1 795(52.59) 184(5.39) 15.66 < 0.01 380(11.13) 1 980(58.02) 1 053(30.85) 7.99 0.09 超重 506 242(47.83) 239(47.23) 25(4.94) 73(14.43) 308(60.87) 125(24.70) 肥胖 313 145(46.33) 158(50.48) 10(3.19) 48(15.34) 194(61.98) 71(22.68) 注： ()内数字为构成比/%。
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表 3 不同组别中小学生每日午睡和周末补觉时间分布比较
Table 3. Comparison of distribution of napping duration and weekend catch-up duration among primary and secondary school students in different groups
组别 选项 人数 午睡 周末补觉 不午睡 ≤0.5 h >0.5~1.0 h >1.0 h χ2值 P值 不补觉 < 1.0 h 1.0~2.0 h >2.0 h χ2值 P值 性别 女 2 055 1 054(51.29) 257(12.51) 449(21.85) 295(14.36) 22.64 < 0.01 574(27.93) 626(30.46) 573(27.88) 282(13.72) 4.32 0.23 男 2 177 1 257(57.74) 199(9.14) 449(20.62) 272(12.49) 661(30.36) 635(29.17) 568(26.09) 313(14.38) 学段 小学 1 674 1 141(68.16) 94(5.62) 244(14.58) 195(11.65) 352.31 < 0.01 602(35.96) 558(33.33) 359(21.45) 155(9.26) 154.86 < 0.01 初中 1 509 810(53.68) 154(10.21) 322(21.34) 223(14.78) 370(24.52) 462(30.62) 446(29.56) 231(15.31) 高中 1 049 360(34.32) 208(19.83) 332(31.65) 149(14.20) 263(25.07) 241(22.97) 336(32.03) 209(19.92) 城乡 农村 2 361 1 276(54.04) 224(9.49) 521(22.07) 340(14.40) 14.34 < 0.01 720(30.50) 723(30.62) 605(25.62) 313(13.26) 10.36 0.02 城镇 1 871 1 035(55.32) 232(12.40) 377(20.15) 227(12.13) 515(27.53) 538(28.75) 536(28.65) 282(15.07) 地区 东部 1 189 670(56.35) 94(7.91) 237(19.93) 188(15.81) 50.55 < 0.01 351(29.52) 363(30.53) 318(26.75) 157(13.20) 11.26 0.08 中部 1 459 799(54.76) 149(10.21) 289(19.81) 222(15.22) 458(31.39) 410(28.10) 373(25.57) 218(14.94) 西部 1 584 842(53.16) 213(13.45) 372(23.48) 157(9.91) 426(26.89) 488(30.81) 450(28.41) 220(13.89) 年份 2018 3 112 1827(58.71) 296(9.51) 583(18.73) 406(13.05) 88.94 < 0.01 973(31.27) 877(28.18) 826(26.54) 436(14.01) 28.58 < 0.01 2020 1 120 484(43.21) 160(14.29) 315(28.13) 161(14.37) 262(23.39) 384(34.29) 315(28.13) 159(14.20) 自评健康 不健康 154 87(56.49) 13(8.44) 27(17.53) 27(17.53) 3.97 0.26 52(33.77) 44(31.17) 23(14.94) 31(20.13) 14.01 < 0.01 健康 4 078 2 224(54.54) 443(10.86) 871(21.36) 540(13.24) 1 183(29.01) 1 213(29.74) 1 118(27.42) 564(13.83) BMI 非超重肥胖 3 413 1 875(54.94) 371(10.87) 712(20.86) 455(13.33) 10.75 0.10 983(28.80) 1 022(29.94) 920(26.96) 488(14.30) 8.77 0.19 超重 506 288(56.92) 46(9.09) 105(20.75) 67(13.24) 161(31.82) 139(27.47) 145(28.66) 61(12.06) 肥胖 313 186(59.42) 30(9.58) 64(20.45) 33(10.54) 127(40.58) 93(29.71) 67(21.41) 26(8.31) 注：()内数字为构成比/%。
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表 4 不同睡眠类型中小学生的抑郁症状得分比较[M(P25，P75)]
Table 4. Comparison of depressive symptoms in primary and secondary school students with different sleep types[M(P25, P75)]
睡眠类型 选项 人数 抑郁得分 Z值 P值 学习日夜晚睡眠 合适 2 200 4(3, 7) 16.54 < 0.01 不足 1 809 5(3, 7) 过多 223 5(3, 7) 休息日夜晚睡眠 合适 2 465 4(3, 7) 4.07 0.13 不足 483 5(3, 7) 过多 1 284 5(3, 7) 午睡/(h·d-1) 0 2 311 4(3, 7) 12.64 < 0.01 ≤0.5 456 5(3, 7) >0.5~1.0 898 5(3, 7) >1.0 567 5(3, 7) 周末补觉/(h·d-1) 0 1 235 4(3, 7) 11.41 < 0.01 < 1.0 1 261 4(3, 7) 1.0~2.0 1 141 4(3, 7) >2.0 595 5(3, 8)
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表 5 中小学生睡眠状况与抑郁症状关系的多元线性回归分析(n=4 232)
Table 5. Multiple linear regression of association between sleep status and depressive symptoms among primary and secondary school students (n=4 232)
自变量 选项 β值(95%CI) 标准误 P值 学习日睡眠 合适 1.00 不足 0.40(0.20~0.59) 0.10 < 0.01 过多 -0.01(-0.44~0.42) 0.22 0.96 休息日睡眠 合适 1.00 不足 0.39(0.09~0.69) 0.15 0.01 过多 0.09(-0.12~0.31) 0.11 0.39 午睡/(h·d-1) 0 1.00 ≤0.5 0.17(-0.15~0.49) 0.16 0.30 >0.5~1.0 -0.07(-0.31~0.18) 0.13 0.59 >1.0 0.16(-0.13~0.45) 0.15 0.27 周末补觉/(h·d-1) 0 1.00 < 1.0 -0.10(-0.34~0.14) 0.12 0.42 1.0~2.0 -0.04(-0.29~0.21) 0.13 0.77 >2.0 0.41(0.10~0.71) 0.16 < 0.01
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