Association of tobacco/alcohol-excessive Internet usage and insufficient sleep with depressive symptoms among middle school students
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摘要:
目的 探究中学生烟酒-过度网络使用和睡眠不足与抑郁症状的关联，为改善中学生心理健康状况提供参考。 方法 采用整群随机抽样方法，于2022年9—11月抽取上海市18 484名初、高中学生作为研究对象，按照学生常见病和健康影响因素监测调查问卷中的相关条目判定烟酒-过度网络使用、睡眠不足和抑郁症状。采用χ2检验进行组间比较，采用Logistic回归分析和似然比检验分析烟酒-过度网络使用和睡眠不足与抑郁症状的独立和聚合关联。 结果 中学生烟酒-过度网络使用、睡眠不足和抑郁症状的自我报告率分别为14.7%，73.5%和16.3%。Logistic回归分析结果显示，烟酒-过度网络使用(OR=2.69，95%CI=2.44~2.97)和睡眠不足(OR=1.76，95%CI=1.58~1.95)与抑郁症状均呈正相关(P值均 < 0.05)；与“无烟酒-过度网络使用且睡眠充足”中学生相比，“有烟酒-过度网络使用且睡眠不足”中学生检出抑郁症状更高(OR=4.71，95%CI=4.08~5.44，P < 0.05)。进一步分层分析结果显示，相较于男生组和高中组，烟酒-过度网络使用和睡眠不足与抑郁症状的单独/联合关联在女生组和初中组中更加明显[烟酒-过度网络使用OR值(95%CI)分别为3.09(2.68~3.56)和4.74(3.86~5.83)；睡眠不足OR值(95%CI)分别为1.86(1.60~2.17)和2.00(1.58~2.53)；二者联合关联OR值(95%CI)分别为6.05(5.01~7.31)和9.15(6.98~11.99)，P值均 < 0.05]。 结论 烟酒-过度网络使用和睡眠不足与中学生抑郁症状有关。应关注性别和学校类型间差异，着眼于健康相关行为，制定中学生心理健康防控策略。 Abstract:Objective To explore the association of tobacco/alcohol-excessive Internet usage and insufficient sleep with depressive symptoms among middle school students, so as to provide a reference for improving mental health of middle school students. Methods In accordance with the cluster random sampling method, a total of 18 484 middle school students in Shanghai were surveyed from September to November 2022. Tobacco/alcohol-excessive Internet usage and sleep duration with depressive symptoms were assessed using the relevant scale items included in the questionnaire of Surveillance for Common Disease and Health Risk Factors among Students. The χ2 test was used for inter group comparison, Logistic regression analysis and likelihood ratio test were used to analyze the independent and aggregated associations of tobacco/alcohol-excessive Internet use and insufficient sleep wiht depressive symptoms. Results Self-reported rates of tobacco/alcohol-excessive Internet usage, insufficient sleep and depressive symptoms among adolescents were 14.7%, 73.5% and 16.3%, respectively. Tobacco/alcohol-excessive Internet usage (OR=2.69, 95%CI=2.44-2.97) and insufficient sleep (OR=1.76, 95%CI=1.58-1.95) were associated with depressive symptoms (P < 0.05). Compared to middle school students with no tobacco/alcohol-excessive Internet usage and sufficient sleep, those with both tobacco/alcohol-excessive Internet usage and insufficient sleep showed the higher rate of depressive symptoms (OR=4.71, 95%CI=4.08-5.44, P < 0.05). Further stratified analysis results showed that, compared to the boys and the high school students, the separate and joint association of tobacco/alcohol-excessive Internet usage and insufficient sleep with depressive symptoms were more pronounced in the girls and the middle-school students [OR(95%CI) for tobacco/alcohol-excessive Internet usage were 3.09 (2.68-3.56) and 4.74 (3.86-5.83), respectively; OR(95%CI) for insufficient sleep were 1.86 (1.60-2.17) and 2.00 (1.58-2.53), respectively; and the OR(95%CI) for the joint association were 6.05 (5.01-7.31) and 9.15 (6.98-11.99), respectively, P < 0.05]. Conclusions Tobacco/alcohol-excessive Internet usage and insufficient sleep are associated with depressive symptoms in middle school students. Prevention and control strategies for adolescent mental health should be developed with consideration of health-related behaviors, and also need to be tailored by focusing on gender and grade differences. -
Key words:
- Smoking /
- Alcohol drinking /
- Internet /
- Behavior, addictive /
- Regression analysis /
- Students
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表 1 不同人口学特征中学生抑郁症状检出率比较
Table 1. Comparison of detection rates of depressive symptoms among middle school students with different demographic characteristics
人口学指标 选项 人数 抑郁症状 χ2值 P值 人口学指标 选项 人数 抑郁症状 χ2值 P值 性别 男 9 323 1 368(14.7) 35.58 < 0.01 父亲学历 小学及以下 418 92(22.0) 18.48 < 0.01 女 9 161 1 641(17.9) 初中或高中 6 961 1 193(173.1) 学校类型 初中 7 021 808(11.5) 189.30 < 0.01 专科及以上 11 105 1 724(15.5) 普通高中 7 751 1 479(19.1) 家庭经济状况 很好 873 114(13.1) 353.99 < 0.01 职业高中 3 712 722(19.5) 较好 5 060 643(12.7) 居住地 城区 8 402 1 347(16.0) 0.69 0.42 一般 11 449 1 865(16.3) 郊县 10 082 1 662(16.5) 较差 685 262(38.2) 家庭类型 核心家庭a 9 410 1 417(15.1) 20.95 < 0.01 很差 417 125(30.0) 其他 9 074 1 592(17.5) 烟酒-过度网络使用 是 2 708 885(32.7) 626.30 < 0.01 母亲学历 小学及以下 749 172(23.0) 33.72 < 0.01 否 15 776 2 124(13.5) 初中或高中 6 745 1 147(17.0) 过度网络使用 是 231 135(58.4) 305.12 < 0.01 专科及以上 10 990 1 690(15.4) 否 18 253 2 874(15.7) 学业成绩 优异 1 567 184(11.7) 486.60 < 0.01 吸烟/饮酒行为 是 2 567 812(31.6) 515.59 < 0.01 中等偏上 5 437 639(11.8) 否 15 917 2 197(13.8) 中等 7 091 1 058(14.9) 睡眠不足 是 13 582 2 463(18.1) 129.35 < 0.01 中等偏下 3 243 734(22.6) 否 4 902 546(11.1) 差 1 146 394(34.4) 注： a指只与父母同住的家庭；()内数字为检出率/%。 
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表 2 上海市中学生烟酒-过度网络使用和睡眠不足与抑郁症状的单独关联(n=18 484)
Table 2. Separate associations of tobacco/alcohol-excessive Internet usage and insufficient sleep with depressive symptoms among middle school students in Shanghai(n=18 484)
自变量 选项 模型1 模型2 模型3 模型4 OR值(95%CI) P值 OR值(95%CI) P值 OR值(95%CI) P值 OR值(95%CI) P值 烟酒-过度网络使用 否 1.00 1.00 1.00 1.00 是 3.12(2.85~3.42) < 0.01 2.87(2.60~3.15) < 0.01 2.75(2.49~3.03) < 0.01 2.69(2.44~2.97) < 0.01 过度网络使用 否 1.00 1.00 1.00 1.00 是 7.53(5.78~9.81) < 0.01 6.82(5.21~8.91) < 0.01 5.95(4.51~7.84) < 0.01 5.85(4.43~7.73) < 0.01 吸烟/饮酒行为 否 1.00 1.00 1.00 1.00 是 2.89(2.63~3.18) < 0.01 2.65(2.40~2.92) < 0.01 2.56(2.31~2.82) < 0.01 2.50(2.26~2.76) < 0.01 睡眠不足 否 1.00 1.00 1.00 1.00 是 1.77(1.60~1.95) < 0.01 1.76(1.59~1.95) < 0.01 1.82(1.64~2.02) < 0.01 1.76(1.58~1.95) < 0.01 注：模型1未调整任何变量；模型2调整年龄、性别；模型3调整年龄、性别、年级、居住地、家庭类型、母亲学历、父亲学历、学业成绩、家庭经济状况；模型4在模型3基础上调整烟酒-过度网络使用(当分析变量是睡眠时)或睡眠不足(当分析变量是烟酒-过度网络使用时)。
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表 3 上海市中学生烟酒-过度网络使用和睡眠不足与抑郁症状的联合关联[OR值(95%CI)，n=18 484]
Table 3. Joint associations of tobacco/alcohol-excessive Internet usage and insufficient sleep with depressive symptoms among middle school students in Shanghai[OR(95%CI), n=18 484]
自变量 模型1 模型2 模型3 无烟酒-过度网络使用+睡眠充足 1.00 1.00 1.00 无烟酒-过度网络使用+睡眠不足 1.74(1.55~1.95) 1.72(1.53~1.92) 1.74(1.54~1.96) 有烟酒-过度网络使用+睡眠充足 3.04(2.46~3.74) 2.74(2.28~3.38) 2.60(2.10~3.22) 有烟酒-过度网络使用+睡眠不足 5.42(4.72~6.21) 4.92(4.28~5.66) 4.71(4.08~5.44) 注：模型1未调整任何变量；模型2调整年龄、性别；模型3调整年龄、性别、年级、居住地、家庭类型、母亲学历、父亲学历、学业成绩、家庭经济状况。P值均 < 0.05。
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表 4 上海市中学生烟酒-过度网络使用和睡眠不足与抑郁症状单独关联的性别及学校类型分层分析[OR值(95%CI)，n=18 484]
Table 4. Stratified analysis by gender and school type of separate associations of tobacco/alcohol-excessive Internet usage and insufficient sleep duration with depressive symptoms among middle school students in Shanghai[OR(95%CI), n=18 484]
自变量 模型 性别 学校类型 男生 女生 P交互值 初中 普通高中 职业高中 P交互值 烟酒-过度网络使用 1 2.94(2.58~3.34)** 3.62(3.17~4.15)** < 0.01 5.34(4.41~6.48)** 2.78(2.43~3.18)** 1.93(1.62~2.30)** < 0.01 2 2.49(2.18~2.84)** 3.32(2.89~3.81)** < 0.01 5.44(4.48~6.62)** 2.73(2.38~3.13)** 1.93(1.61~2.31)** < 0.01 3 2.39(2.09~2.74)** 3.15(2.74~3.63)** < 0.01 4.86(3.96~5.97)** 2.62(2.28~3.01)** 1.91(1.59~2.28)** < 0.01 4 2.34(2.04~2.68)** 3.09(2.68~3.56)** < 0.01 4.74(3.86~5.83)** 2.58(2.24~2.97)** 1.82(1.52~2.19)** < 0.01 过度网络使用 1 8.28(5.78~11.87)** 6.94(4.69~10.27)** 0.78 8.78(4.54~16.96)** 8.51(5.50~13.18)** 5.15(3.47~7.65)** 0.61 2 7.46(5.18~10.75)** 6.16(4.16~9.14)** 0.89 9.77(5.02~18.99)** 8.36(5.39~12.97)** 5.15(3.47~7.65)** 0.66 3 6.65(4.56~9.69)** 5.18(3.45~7.79)** 0.95 6.00(2.96~12.20)** 6.92(4.41~10.87)** 5.11(3.41~7.65)** 0.41 4 6.43(4.40~9.40)** 5.23(3.47~7.89)** 0.98 5.79(2.85~11.75)** 7.21(4.57~11.38)** 4.80(3.20~7.21)** 0.58 吸烟/饮酒行为 1 2.71(2.38~3.09)** 3.38(2.94~3.89)** < 0.01 5.04(4.14~6.13)** 2.62(2.28~3.00)** 1.70(1.42~2.03)** < 0.01 2 2.28(2.00~2.61)** 3.09(2.68~3.56)** < 0.01 5.10(4.17~6.22)** 2.57(2.23~2.95)** 1.69(1.41~2.04)** < 0.01 3 2.21(1.92~2.54)** 2.97(2.57~3.44)** < 0.01 4.69(3.80~5.78)** 2.48(2.16~2.86)** 1.67(1.39~2.02)** < 0.01 4 2.16(1.88~2.48)** 2.91(2.52~3.37)** < 0.01 4.57(3.70~5.64)** 2.44(2.12~2.82)** 1.60(1.33~1.93)** < 0.01 睡眠不足 1 1.67(1.45~1.92)** 1.83(1.58~2.10)** < 0.01 2.39(1.91~2.99)** 1.85(1.57~2.18)** 1.90(1.60~2.24)** < 0.01 2 1.69(1.47~1.95)** 1.84(1.59~2.12)** < 0.01 2.20(1.75~2.76)** 1.72(1.46~2.03)** 1.86(1.57~2.20)** 0.04 3 1.74(1.50~2.02)** 1.93(1.66~2.24)** < 0.01 2.10(1.66~2.65)** 1.69(1.43~2.00)** 1.85(1.56~2.19)** 0.03 4 1.68(1.44~1.95)** 1.86(1.60~2.17)** < 0.01 2.00(1.58~2.53)** 1.64(1.38~1.94)** 1.79(1.50~2.12)** 0.20 注：模型1未调整任何变量；模型2调整年龄、性别；模型3调整年龄、性别、年级、居住地、家庭类型、母亲学历、父亲学历、学业成绩、家庭经济状况；模型4在模型3基础上调整烟酒-过度网络使用(当分析变量是睡眠时)或睡眠不足(当分析变量是烟酒-过度网络使用时)。**P < 0.01，各自变量均以否为参照组。
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表 5 上海市中学生烟酒-过度网络使用和睡眠不足与抑郁症状联合关联的性别及学校类型分层分析[OR值(95%CI)，n=18 484)]
Table 5. Joint associations of tobacco/alcohol-excessive Internet usage and insufficient sleep with depressive symptoms stratified by gender and school type among middle school students in Shanghai [OR(95%CI), n=18 484)]
自变量 性别 学校类型 男 女 初中 普通高中 职业高中 无烟酒-过度网络使用+睡眠充足 1.00 1.00 1.00 1.00 1.00 无烟酒-过度网络使用+睡眠不足 1.71(1.47~1.99) 1.93(1.67~2.24) 1.88(1.52~2.33) 2.02(1.71~2.40) 1.75(1.46~2.10) 有烟酒-过度网络使用+睡眠充足 2.14(1.66~2.75) 3.35(2.50~4.50) 3.81(2.26~6.43) 3.52(2.53~4.89) 1.94(1.50~2.52) 有烟酒-过度网络使用+睡眠不足 4.07(3.41~4.85) 6.05(5.01~7.31) 9.15(6.98~11.99) 5.12(4.19~6.26) 3.02(2.41~3.78) 注： P值均 < 0.01。
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