中学生睡眠时型与自杀相关心理行为的纵向关联

汪雅丽; 车琬钰; 王萌; 陶舒曼; 陶芳标; 伍晓艳

doi:10.16835/j.cnki.1000-9817.2024355

中学生睡眠时型与自杀相关心理行为的纵向关联

doi: 10.16835/j.cnki.1000-9817.2024355

汪雅丽¹,
车琬钰²,
王萌²,
陶舒曼³,
陶芳标^{2, 3},
伍晓艳^{2, 3, ,}

1.
安徽医科大学公共卫生学院，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.
安徽医科大学出生人口健康教育部重点实验室/环境与人口健康安徽省重点实验室

基金项目:

国家自然科学基金项目 82373592

国家自然科学基金项目 82173542

安徽医科大学科研水平提升计划资助项目 2022xkjT004

详细信息

作者简介:
汪雅丽(2002-)，女，安徽宣城人，在读本科

通讯作者:
伍晓艳，E-mail：xywu@ahmu.edu.cn

利益冲突声明 所有作者声明无利益冲突。
中图分类号: B844.2 Q428 C913.5
计量
- 文章访问数: 156
- HTML全文浏览量: 78
- PDF下载量: 36
- 被引次数: 0
出版历程
- 收稿日期: 2024-09-26
- 修回日期: 2024-10-26
- 网络出版日期: 2025-01-07
- 刊出日期: 2024-12-25

Longitudinal associations between sleep chronotype with suicide-related psychological behaviors among middle school students

WANG Yali¹,
CHE Wanyu²,
WANG Meng²,
TAO Shuman³,
TAO Fangbiao^{2, 3},
WU Xiaoyan^{2, 3
, ,}

1.
School of Public Health, Anhui Medical University, Hefei (230032), Anhui Privince, China

摘要

摘要: 目的分析中学生睡眠时型与自杀心理行为的关联，为预防和控制中学生自杀提供科学依据。方法 2021年10月和2022年11月，采用多阶段整群抽样方法在中国沈阳市、郑州市、南昌市、太原市进行基线和随访调查，共纳入6 656名初、高中学生为研究对象。采用χ²检验进行组间差异分析，采用广义估计方程分析中学生睡眠时型与自杀意念、自杀计划、自杀未遂的关联，并进行年级分层。结果中学生基线自杀意念、自杀计划和自杀未遂的检出率分别为26.3%，12.6%，5.3%；随访各项检出率分别为21.0%，10.0%，4.8%。基线及随访中不同性别、学习负担，是否吸烟、饮酒，有无焦虑症状、抑郁症状的中学生自杀计划、自杀未遂、自杀意念检出率的差异均有统计学意义(χ²=11.93~880.20，P值均<0.05)。调整性别、学习负担、体力活动、吸烟、饮酒、焦虑症状和抑郁症状等因素后，广义估计方程结果显示，夜晚型相较清晨型睡眠时型的中学生自杀意念、自杀计划和自杀未遂的OR值(95%CI)分别为1.61(1.36~1.89)，1.66(1.35~2.05)和1.41(1.06~1.88)(P值均<0.05)。年级分层后结果与总体基本一致，初中生与高中生的夜晚型相较清晨型睡眠时型的自杀意念、自杀计划的风险更高[OR值(95%CI)分别为1.78(1.39~2.27)，2.00(1.48~2.69)；1.84(1.44~2.35)，1.67(1.20~2.33)，P值均<0.01]。结论夜晚型睡眠时型与中学生自杀心理行为存在正向关联，改善睡眠时型可能是预防中学生自杀的有效措施之一。
- 睡眠 /
- 自杀 /
- 行为 /
- 精神卫生 /
- 学生
Abstract: Objective To analyze the association between sleep chronotype and suicidal psychological behaviors among middle school students, so as to provide a scientific basis for the prevention and control of middle school students suicide. Methods In October 2021 and November 2022, a multi-stage cluster sampling method was used to conduct baseline and follow-up surveys in Shenyang, Zhengzhou, Nanchang, and Taiyuan cities in China, and a total of 6 656 middle and high school students were included as the research subjects. The Chi-square test was used to analyze the groups differences, and generalized estimating equation was used to analyze the associations between middle school students' sleep chronotype and suicide ideation, suicide plan and suicide attempt, and the grade stratification was carried out. Results Baseline detection of suicide ideation, suicide plan, and suicide attempt were 26.3%, 12.6%, and 5.3%, respectively, with follow-up rates of 21.0%, 10.0%, and 4.8% for each, and varied significantly by gender, academic stress, smoking or alcohol use, and anxiety or depressive symptoms among middle school students (χ²=11.93-880.20, P<0.05). After adjusting for gender, academic stress, physical activity, smoking, alcohol use, anxiety and depressive symptoms, generalized estimating equations showed that compared with the morning sleep chronotype, the OR(95%CI) for suicide ideation, suicide plan and suicide attempt were 1.61(1.36-1.89), 1.66(1.35-2.05) and 1.41(1.06-1.88) among evening chronotype students, and were higher among junior 1.78(1.39-2.27), 2.00(1.48-2.69) and senior middle school students 1.84(1.44-2.35), 1.67(1.20-2.33) (P<0.05). Conclusion There is a positive association between evening sleep chronotype and middle school students suicidal psychological behavior, and improving sleep chronotype may be one of the effective measures to prevent middle school students suicide.
- Sleep /
- Suicide /
- Behavior /
- Mental health /
- Students
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

HTML全文

表 1 不同组别中学生基线与随访自杀心理行为检出率比较

Table 1. Comparison of detection rates of suicidal psychological behaviors between baseline and follow-up among midddle school students with different groups

组别	选项	人数	统计值	自杀意念		自杀计划		自杀未遂
组别	选项	人数	统计值	T1	T2	T1	T2	T1	T2
性别	男	3 197		668(20.9)	541(16.9)	286(8.9)	241(7.5)	92(2.9)	107(3.3)
	女	3 459		1 085(31.4)	857(24.8)	550(15.9)	424(12.3)	259(7.5)	210(6.1)
			χ²值	93.93^**	61.77^**	73.17^**	41.15^**	70.68^**	27.18^**
学段	初中	3 026		788(26.0)	703(23.2)	407(13.5)	352(11.6)	189(6.2)	201(6.6)
	高中	3 630		965(26.6)	695(19.1)	429(11.8)	313(8.6)	162(4.5)	116(3.2)
			χ²值	0.25	16.61^**	4.00^*	16.63^**	10.50^**	43.23^**
学习负担	轻	395		90(22.8)	84(21.3)	45(11.4)	34(8.6)	21(5.3)	22(5.6)
	中等	5 833		1 465(25.1)	1 163(19.9)	684(11.7)	558(9.6)	285(4.9)	258(4.4)
	重	428		198(46.3)	151(35.3)	107(25.0)	73(17.1)	45(10.5)	37(8.6)
			χ²值	94.63^**	56.58^**	64.49^**	25.77^**	25.29^**	16.27^**
体力活动	小运动量	4 560		1 243(27.3)	1 004(22.0)	587(12.9)	467(10.2)	260(5.7)	226(5.0)
	中等运动量	1 344		352(26.2)	251(18.7)	162(12.1)	133(9.9)	60(4.5)	61(4.5)
	大运动量	752		158(21.0)	143(19.0)	87(11.6)	65(8.6)	31(4.1)	30(4.0)
			χ²值	13.01^**	9.01^*	1.39	1.85	5.43	1.52
是否吸烟	是	133		70(52.6)	44(33.1)	46(34.6)	31(23.3)	31(23.3)	16(12.0)
	否	6 523		1 683(25.8)	1 354(20.8)	790(12.1)	634(9.7)	320(4.9)	301(4.6)
			χ²值	48.37^**	11.93^**	59.95^**	26.76^**	88.36^**	15.80^**
是否饮酒	是	623		269(43.2)	187(30.0)	165(26.5)	104(16.7)	78(12.5)	62(10.0)
	否	6 033		1 484(24.6)	1 211(20.1)	671(11.1)	561(9.3)	273(4.5)	255(4.2)
			χ²值	100.48^**	33.65^**	121.35^**	34.34^**	72.26^**	40.81^**
焦虑症状	有	2 353		1 094(46.5)	758(32.2)	575(24.4)	393(16.7)	238(10.1)	187(7.9)
	无	4 303		659(15.3)	640(14.9)	261(6.1)	272(6.3)	113(2.6)	130(3.0)
			χ²值	762.23^**	275.69^**	467.48^**	182.29^**	170.78^**	81.39^**
抑郁症状	有	2 853		1 279(44.8)	864(30.3)	653(22.9)	431(15.1)	274(9.6)	211(7.4)
	无	3 803		474(12.5)	534(14.0)	183(4.8)	234(6.2)	77(2.0)	106(2.8)
			χ²值	880.20^**	259.19^**	484.98^**	145.33^**	187.46^**	76.33^**
睡眠时型	清晨型	1 580		263(16.6)	246(15.6)	113(7.2)	115(7.3)	54(3.4)	58(3.7)
	中间型	4 157		1 083(26.1)	866(20.8)	493(11.9)	393(9.5)	195(4.7)	178(4.3)
	夜晚型	919		407(44.3)	286(31.1)	230(25.0)	157(17.1)	102(11.1)	81(8.8)
			χ²值	229.30^**	84.89^**	174.00^**	65.67^**	76.15^**	39.52^**
注： ()内数字为检出率/%；^P<0.05，^*P<0.01。

下载: 导出CSV

表 2 中学生睡眠时型与自杀心理行为的广义估计方程分析[OR值(95%CI)]

Table 2. Analysis of generalized estimated equation of sleep chronotype and suicidal psychological behavior among midddle school students[OR(95%CI)]

学段	自变量	模型1			模型2
学段	自变量	自杀意念	自杀计划	自杀未遂	自杀意念	自杀计划	自杀未遂
总体 (n=6 656)	清晨型	1.00	1.00	1.00	1.00	1.00	1.00
总体 (n=6 656)	中间型	1.60(1.41~1.80)^**	1.53(1.30~1.82)^**	1.28(1.01~1.62)^*	1.18(1.04~1.34)^*	1.10(0.93~1.31)	0.92(0.72~1.17)
	夜晚型	3.15(2.70~3.68)^**	3.43(2.82~4.17)^**	3.01(2.30~3.94)^**	1.61(1.36~1.89)^**	1.66(1.35~2.05)^**	1.41(1.06~1.88)^*
初中 (n=3 026)	清晨型	1.00	1.00	1.00	1.00	1.00	1.00
初中 (n=3 026)	中间型	1.63(1.39~1.91)^**	1.80(1.45~2.22)^**	1.62(1.21~2.17)^**	1.21(1.03~1.43)^*	1.29(1.04~1.61)^*	1.13(0.83~1.52)
	夜晚型	4.06(3.25~5.08)^**	4.80(3.68~6.25)^**	4.39(3.09~6.25)^**	1.78(1.39~2.27)^**	2.00(1.a48~2.69)^**	1.67(1.13~2.46)^**
高中 (n=3 630)	清晨型	1.00	1.00	1.00	1.00	1.00	1.00
高中 (n=3 630)	中间型	1.74(1.41~2.14)^**	1.43(1.07~1.91)^*	1.20(0.79~1.82)	1.38(1.12~1.70)^**	1.10(0.82~1.58)	0.95(0.63~1.44)
	夜晚型	3.10(2.45~3.92)^**	2.99(2.18~4.11)^**	2.77(1.76~4.36)^**	1.84(1.44~2.35)^**	1.67(1.20~2.33)^**	1.54(0.97~2.45)
注： ^P<0.05，^*P<0.01。

下载: 导出CSV

参考文献(37)

[1]	CHEN R, AN J, OU J. Suicidal behaviour among children and adolescents in China[J]. Lancet Child Adolesc Health, 2018, 2(8): 551-553. doi: 10.1016/S2352-4642(18)30170-6
[2]	XU H, LIU D, XU X, et al. Suicide attempts and non-suicidal self-injury in Chinese adolescents: predictive models using a neural network model[J]. Asian J Psychiatr, 2024, 97: 104088. doi: 10.1016/j.ajp.2024.104088
[3]	BOROWSKY I W, IRELAND M, RESNICK M D. Adolescent suicide attempts: risks and protectors[J]. Pediatrics, 2001, 107(3): 485-493. doi: 10.1542/peds.107.3.485
[4]	BRAUSCH A M, GUTIERREZ P M. Differences in non-suicidal self-injury and suicide attempts in adolescents[J]. J Youth Adolesc, 2010, 39(3): 233-242. doi: 10.1007/s10964-009-9482-0
[5]	叶娟, 张郁林, 王少杰, 等. 青少年遭受传统同伴欺凌与自杀相关心理行为的关联及睡眠质量的调节作用[J]. 中华疾病控制杂志, 2024, 28(5): 510-515. YE J, ZHANG Y L, WANG S J, et al. Association between traditional bullying victimization and suicide-related psychological behaviors among adolescents and the moderating role of sleep quality[J]. Chin J Dis Control Prev, 2024, 28(5): 510-515. (in Chinese)
[6]	孙英, 王伟国. 高海拔地区塔吉克族中学生睡眠与非自杀性自伤行为的关联[J]. 中国学校卫生, 2021, 42(8): 1189-1192, 1197. doi: 10.16835/j.cnki.1000-9817.2021.08.016 SUN Y, WANG W G. Relationship between sleep and non-suicidal self-injury behaviors of Tajik middle school students in high altitude areas[J]. Chin J Sch Health, 2021, 42(8): 1189-1192, 1197. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2021.08.016
[7]	CARSKADON M A. Sleep in adolescents: the perfect storm[J]. Pediatr Clin North Am, 2011, 58(3): 637-647. doi: 10.1016/j.pcl.2011.03.003
[8]	CROWLEY S J, WOLFSON A R, TAROKH L, et al. An update on adolescent sleep: new evidence informing the perfect storm model[J]. J Adolesc, 2018, 67: 55-65. doi: 10.1016/j.adolescence.2018.06.001
[9]	罗媛, 任鹏宇, 马臣萃, 等. "双减"政策下中学生学习倦怠、睡眠质量对非自杀性自伤行为的影响[J]. 中国健康教育, 2024, 40(1): 51-55. LUO Y, REN P Y, MA C C, et al. Influence of learning burnout and sleep quality on non-suicidal self-injurious behaviors among middle school students under Double Reduction policy context[J]. Chin J Health Educ, 2024, 40(1): 51-55. (in Chinese)
[10]	GEOFFROY M C, ORRI M, GIRARD A, et al. Trajectories of suicide attempts from early adolescence to emerging adulthood: prospective 11-year follow-up of a Canadian cohort[J]. Psychol Med, 2021, 51(11): 1933-1943. doi: 10.1017/S0033291720000732
[11]	ADAN A, ALMIRALL H. Horne & Stberg Morningness-Eveningness Questionnaire: a reduced scale[J]. Person Individ Differ, 1991, 12(3): 241-253. doi: 10.1016/0191-8869(91)90110-W
[12]	DANIELSSON K, SAKARYA A, JANSSON-FRÖJMARK M. The reduced Morningness-Eveningness Questionnaire: psychometric properties and related factors in a young Swedish population[J]. Chronobiol Int, 2019, 36(4): 530-540. doi: 10.1080/07420528.2018.1564322
[13]	NING K, YAN C, ZHANG Y, et al. Regular exercise with suicide ideation, suicide plan and suicide attempt in university students: data from the health minds survey 2018-2019[J]. Int J Environ Res Public Health, 2022, 19(14): 8856. doi: 10.3390/ijerph19148856
[14]	万宇辉, 陶芳标, 胡传来, 等. 青少年亚健康对自杀心理行为的预测作用[J]. 中国学校卫生, 2009, 30(4): 295-297. https://d.wanfangdata.com.cn/periodical/ChpNaW5lclBlcmlvZGljYWxDSEkyMDIzMTIwNBIPemd4eHdzMjAwOTA0MDA0GghpeTl0dzkxNw%3D%3D WAN Y H, TAO F B, HU C L, et al. Predictive value of adolescent sub-health for suicidal psychology and behaviors[J]. Chin J Sch Health, 2009, 30(4): 295-297. (in Chinese) https://d.wanfangdata.com.cn/periodical/ChpNaW5lclBlcmlvZGljYWxDSEkyMDIzMTIwNBIPemd4eHdzMjAwOTA0MDA0GghpeTl0dzkxNw%3D%3D
[15]	梁德清. 高校学生应激水平及其与体育锻炼的关系[J]. 中国心理卫生杂志, 1994, 15(1): 5-6. LIANG D Q. The stress level of college students and its relationship with physical exercise[J]. Chin J Men Health, 1994, 15(1): 5-6. (in Chinese)
[16]	MOSSMAN S A, LUFT M J, SCHROEDER H K, et al. The Generalized Anxiety Disorder 7-Item Scale in adolescents with generalized anxiety disorder: signal detection and validation[J]. Ann Clin Psychiatry, 2017, 29(4): 227A-234A.
[17]	KROENKE K, SPITZER R L, WILLIAMS J B. The PHQ-9: validity of a brief depression severity measure[J]. J Gen Intern Med, 2001, 16(9): 606-613. doi: 10.1046/j.1525-1497.2001.016009606.x
[18]	张至贤, 黄雪雪, 胡婕, 等. 中学生心理健康素养和非自杀性自伤行为交互作用与自杀相关行为关联[J]. 中国公共卫生, 2022, 38(12): 1517-1522. ZHANG Z X, HUANG X X, HU J, et al. Association of interaction between mental health literacy and non-suicidal self-injury with suicidal behaviors among middle school students[J]. Chin J Public Health, 2022, 38(12): 1517-1522. (in Chinese)
[19]	LIM K S, WONG C H, MCINTYRE R S, et al. Global lifetime and 12-month prevalence of suicidal behavior, deliberate self-harm and non-suicidal self-injury in children and adolescents between 1989 and 2018: a Meta-analysis[J]. Int J Environ Res Public Health, 2019, 16(22): 4581. doi: 10.3390/ijerph16224581
[20]	周烈, 周丽芳, 张新风, 等. 青少年学生非自杀性自伤行为的相关因素[J]. 中国心理卫生杂志, 2023, 37(10): 860-865. ZHOU L, ZHOU L F, ZHANG X F, et al. Related factors of non-suicidal self-injury in adolescent students[J]. Chin Ment Health J, 2023, 37(10): 860-865. (in Chinese)
[21]	KANN L, MCMANUS T, HARRIS W A, et al. Youth risk behavior surveillance-United States, 2017[J]. MMWR Surveill Summ, 2018, 67(8): 1-114. doi: 10.15585/mmwr.ss6708a1
[22]	BRESIN K, SCHOENLEBER M. Gender differences in the prevalence of nonsuicidal self-injury: a Meta-analysis[J]. Clin Psychol Rev, 2015, 38: 55-64. doi: 10.1016/j.cpr.2015.02.009
[23]	汪妍, 彭畅, 程君菡, 等. 中国5省在校中学生自杀行为流行状况及其与抑郁、焦虑关联[J]. 中国公共卫生, 2023, 39(10): 1225-1231. WANG Y, PENG C, CHENG J H, et al. Prevalence of and impact of depression and anxiety on suicidal behaviors among high school students: a cross-sectional survey in five provinces, China[J]. Chin J Public Health, 2023, 39(10): 1225-1231. (in Chinese)
[24]	DÁVILA CERVANTES C A, LUNA CONTRERAS M. Suicide attempt in teenagers: associated factors[J]. Rev Chil Pediatr, 2019, 90(6): 606-616.
[25]	BERLIN I, HAKES J K, HU M C, et al. Tobacco use and suicide attempt: longitudinal analysis with retrospective reports[J]. PLoS One, 2015, 10(4): e0122607. doi: 10.1371/journal.pone.0122607
[26]	KHAZAIE H, NAJAFI F, CHEHRI A, et al. Physical activity patterns, circadian rhythms, and aggressive and suicidal behavior among a larger sample of the general population aged 15 to 34 years[J]. J Clin Med, 2023, 12(8): 2821. doi: 10.3390/jcm12082821
[27]	GAU S S, SHANG C Y, MERIKANGAS K R, et al. Association between morningness-eveningness and behavioral/emotional problems among adolescents[J]. J Biol Rhythms, 2007, 22(3): 268-274. doi: 10.1177/0748730406298447
[28]	PARK H, LEE H K, LEE K. Chronotype and suicide: the mediating effect of depressive symptoms[J]. Psychiatry Res, 2018, 269: 316-320. doi: 10.1016/j.psychres.2018.08.046
[29]	RUMBLE M E, DICKSON D, MCCALL W V, et al. The relationship of person-specific eveningness chronotype, greater seasonality, and less rhythmicity to suicidal behavior: a literature review[J]. J Affect Disord, 2018, 227: 721-730. doi: 10.1016/j.jad.2017.11.078
[30]	KEARNS J C, KITTEL J A, SCHLAGBAUM P, et al. Worry-related sleep problems and suicidal thoughts and behaviors among adolescents in 88 low-, middle-, and high-income countries: an examination of individual- and country-level factors[J]. Eur Child Adolesc Psychiatry, 2022, 31(12): 1995-2011. doi: 10.1007/s00787-021-01838-y
[31]	TZISCHINSKY O, SHOCHAT T. Eveningness, sleep patterns, daytime functioning, and quality of life in Israeli adolescents[J]. Chronobiol Int, 2011, 28(4): 338-343. doi: 10.3109/07420528.2011.560698
[32]	MAGNANI L, AGUGLIA A, ALEXANDER J, et al. Evening chronotype and suicide: exploring neuroinflammation and psychopathological dimensions as possible bridging factors: a narrative review[J]. Brain Sci, 2023, 14(1): 30. doi: 10.3390/brainsci14010030
[33]	ORSOLINI L, RICCI L, POMPILI S, et al. Eveningness chronotype and depressive affective temperament associated with higher high-sensitivity C-reactive protein in unipolar and bipolar depression[J]. J Affect Disord, 2023, 332: 210-220. doi: 10.1016/j.jad.2023.04.004
[34]	NEUPANE S P, DARAY F M, BALLARD E D, et al. Immune-related biomarkers and suicidal behaviors: a Meta-analysis[J]. Eur Neuropsychopharmacol, 2023, 75: 15-30. doi: 10.1016/j.euroneuro.2023.05.009
[35]	WRIGHT K P J R, DRAKE A L, FREY D J, et al. Influence of sleep deprivation and circadian misalignment on cortisol, inflammatory markers, and cytokine balance[J]. Brain Behav Immun, 2015, 47: 24-34. doi: 10.1016/j.bbi.2015.01.004
[36]	DONEGAN J J, NEMEROFF C B. Suicide and inflammation[J]. Adv Exp Med Biol, 2023, 1411: 379-404.
[37]	BRUNDIN L, BRYLEVA E Y, THIRTAMARA RAJAMANI K. Role of inflammation in suicide: from mechanisms to treatment[J]. Neuropsychopharmacology, 2017, 42(1): 271-283. doi: 10.1038/npp.2016.116