Assocation of family environment and depressive symptoms among primary and secondary school students in Shanxi province
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摘要:
目的 探索家庭环境与中小学生抑郁症状的关联，为进一步实现家庭环境在中小学生成长中的效用最大化及中小学生抑郁症状预防和干预提供建议。 方法 2024年6—7月，采用多阶段整群随机抽样方法从山西省3个市(大同、吕梁、临汾)36所学校抽取8 800名10~18岁中小学生，采用自编问卷进行家庭环境调查，内容包括家庭社会经济地位、家庭结构、家庭养育行为、家庭成员健康行为等；采用9条目患者健康问卷调查中小学生抑郁症状。运用χ2检验、二元Logistic回归方法分析家庭环境与中小学生抑郁症状的相关性，并对其性别、城乡异质性进行分析。 结果 中小学生抑郁症状检出率为46.7%(4 111名)。其中，男生和女生、农村和城市中小学生抑郁症状检出率分别为45.7%和47.7%，48.0%和44.9%。二元Logistic回归模型结果显示，家庭环境中，父亲受教育程度(初中：OR=0.84)、自评家庭社会经济状况(一般：OR=0.78，好：OR=0.80)、父母支持与理解(是：OR=0.55)、家庭氛围(融洽：OR=0.66)、居住安排(仅与父亲或仅与母亲居住：OR=1.31，与父母和祖辈居住：OR=1.19)、家庭教育方式(惩罚与奖励都有：OR=1.42，惩罚：OR=1.25)与山西省中小学生抑郁症状均相关(P值均 < 0.05)。性别异质性视角下，居住安排(仅与父亲或仅与母亲居住：OR=1.67，其他：OR=1.67)与男生抑郁症状的相关性有统计学意义；城乡异质性视角下，居住安排(仅与父亲或仅与母亲居住：OR=1.38)仅与农村中小学生抑郁症状的相关性有统计学意义(P值均 < 0.05)。 结论 家庭环境与中小学生抑郁症状密切相关，应充分发挥家庭功能减少中小学生抑郁症状的发生。 Abstract:Objective To explore the assocation of the family environment and depressive symptoms among primary and middle school students, so as to provide suggestions for further maximizing the utility of family environment in the growth of primary and secondary school students, as well as prevention and intervention of depressive symptoms among children and adolescents. Methods From June to July 2024, through a multistage cluster random sampling method, 8 800 primary and middle school students aged 10 to 18 from 36 schools in 3 cities (Datong, Lvliang, Linfen) in Shanxi Province. A self-designed questionnaire was used to conduct a family environment survey, including family socioeconomic conditions, family structure, family parenting behavior, family member health behavior, etc; and the depression symptoms of primary and secondary school students were investigated by Patient Health Questionnaire-9. The χ2 test and binary Logistic regression to method were used to analyze the association of the family environment with depressive symptoms among primary and secondary school students, and to analyze gender and urban-rural heterogeneity in this association. Results The detection rate of depressive symptoms among primary and middle school students was 46.7% (n=4 111). Among them, the detection rates of depressive symptoms for male and female students were 45.7% and 47.7% respectively, and the detection rates for rural and urban students were 48.0% and 44.9% respectively. The results of binary Logistic regression model showed that in the family environment, factors such as the father's education level (junior high school: OR=0.84), self-assessed family socio-economic status (average: OR=0.78, good: OR=0.80), parental support and understanding (yes: OR=0.55), family atmosphere (harmonious: OR=0.66), living arrangement (living only with father or mother: OR=1.31, living with parents and grandparents: OR=1.19), and family rearing style (combining punishment and reward: OR=1.42, punishment only: OR=1.25) were related to depressive symptoms in primary and middle school students in Shanxi Province (P < 0.05). From the perspective of gender heterogeneity, the living arrangement (living only with father or mother: OR=1.67, others: OR=1.67) had a statistically significant association with depressive symptoms in male students (P < 0.05). From the perspective of urban-rural heterogeneity, the living arrangement (living only with father or mother: OR=1.38) had a statistically significant association with depressive symptoms in rural primary and middle school students (P < 0.05). Conclusions The family environment has an important impact on depressive symptoms in primary and middle school students. Family functioning should be fully exerted to prevent depressive symptoms in primary and middle school students. -
Key words:
- Family /
- Depression /
- Mental health /
- Regression analysis /
- Students
1) 利益冲突声明 所有作者声明无利益冲突。 -
表 1 山西省不同人口学特征中小学生抑郁症状检出率比较
Table 1. Comparison of depression detection rates of depressive symptoms among primary and secondary school students with different demographic characteristics in Shanxi Province
特征 选项 人数 抑郁症状人数 χ2值 P值 特征 选项 人数 抑郁症状人数 χ2值 P值 性别 男 4 515 2 065(45.7) 3.57 0.06 独生子女 是 1 285 551(42.9) 8.90 0.00 女 4 285 2 046(47.7) 否 7 515 3 560(47.4) 年龄/岁 10~12 3 033 1 213(40.0) 281.69 < 0.01 自评家庭经济状况 差 1 643 957(58.2) 110.51 < 0.01 13~15 3 013 1 248(41.4) 一般 6 327 2 810(44.4) 16~18 2 754 1 650(59.9) 好 830 344(41.4) 学段 小学 3 280 1 436(43.8) 37.98 < 0.01 父母支持与理解 否 1 680 1 185(70.5) 473.29 < 0.01 初中 1 889 837(44.3) 是 7 120 2 926(41.1) 高中 3 631 1 838(50.6) 家人关爱 否 626 469(74.9) 215.37 < 0.01 地区 城镇 3 568 1 602(44.9) 7.96 0.01 是 8 174 3 642(44.6) 农村 5 232 2 509(48.0) 家庭氛围 不融洽 765 589(77.0) 308.56 < 0.01 父亲受教育程度 小学及以下 1 412 793(56.2) 68.62 < 0.01 融洽 8 035 3 522(43.8) 初中 4 589 2 121(46.2) 家庭教育方式 鼓励 1 620 623(38.5) 57.92 < 0.01 高中 1 403 601(42.8) 惩罚 1 201 613(51.0) 大学及以上 1 396 596(42.7) 鼓励和惩罚都有 5 979 2 875(48.1) 母亲受教育程度 小学及以下 1 743 939(53.9) 51.33 < 0.01 家人酗酒 父母都酗酒 18 11(61.1) 117.87 < 0.01 初中 4 217 1 948(46.2) 父亲酗酒 625 410(65.6) 高中 1 407 610(43.4) 母亲酗酒 17 10(58.8) 大学及以上 1 433 614(42.8) 其他家人酗酒 156 97(62.2) 父母婚姻状况 在婚 8 068 3 725(46.2) 11.61 < 0.01 无 7 984 3 583(44.9) 非在婚 732 386(52.7) 身体锻炼 每月≤1次 529 331(62.6) 109.56 < 0.01 居住安排 与父母居住 6 653 3 013(45.3) 36.62 < 0.01 每月2~3次 1 293 657(50.8) 仅与父母之一居住 747 415(55.6) 每周1~2次 3 572 1 510(42.3) 与父母和祖辈居住 1 025 481(46.9) 每周3~5次 1 365 585(42.9) 其他 375 202(53.9) 大约每天1次 2 041 1 028(50.4) 注： ()内数字为检出率/%。 
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表 2 山西省中小学生家庭环境与抑郁症状的二元Logistic回归模型分析[OR值(95%CI)，n=8 800]
Table 2. Binary Logistic regression model analysis of family environment and depressive symptoms among primary and secondary school students in Shanxi Province[OR(95%CI), n=8 800]
自变量 选项 模型1 模型2 模型3 父亲受教育程度 初中 0.81(0.70~0.93)** 0.80(0.69~0.93)** 0.84(0.72~0.98)* 高中 0.79(0.66~0.96)* 0.80(0.66~0.97)** 0.84(0.69~1.03) 大学及以上 0.84(0.67~1.05) 0.84(0.67~1.06) 0.94(0.74~1.20) 自评家庭经济状况 一般 0.71(0.63~0.80)** 0.74(0.65~0.83)** 0.78(0.69~0.89)** 好 0.68(0.57~0.82)** 0.73(0.61~0.88)** 0.80(0.66~0.97)* 独生子女 否 1.20(1.05~1.36)** 1.16(1.01~1.32)* 1.12(0.98~1.28) 居住安排 仅与父母之一居住 1.30(1.09~1.53)** 1.30(1.09~1.55)** 1.31(1.10~1.57)** 与父母和祖辈居住 1.11(0.96~1.28) 1.22(1.05~1.41)** 1.19(1.03~1.39)* 其他 1.14(0.90~1.44) 1.12(0.88~1.42) 1.16(0.90~1.48) 父母支持与理解 是 0.42(0.37~0.48)** 0.46(0.40~0.53)** 0.55(0.48~0.64)** 家庭氛围 融洽 0.52(0.42~0.65)** 0.58(0.46~0.73)** 0.66(0.52~0.84)** 家庭教育方式 奖励和惩罚都有 1.43(1.27~1.61)** 1.44(1.28~1.63)** 1.42(1.25~1.61)** 惩罚 1.29(1.09~1.52)** 1.33(1.13~1.56)** 1.25(1.05~1.49)* 家人酗酒 父亲酗酒 1.64(0.57~4.73) 1.25(0.40~3.94) 1.40(0.43~4.57) 母亲酗酒 0.70(0.16~3.07) 0.68(0.14~3.34) 0.77(0.15~3.83) 家庭其他成员酗酒 1.44(0.48~4.30) 1.15(0.35~3.73) 1.31(0.39~4.44) 无 0.85(0.30~2.41) 0.66(0.21~2.05) 0.79(0.25~2.55) 注：自变量分别以父亲小学及以下文化程度、自评家庭经济状况差、是独生子女、与父母居住、未能得到父母支持与理解、家庭氛围不融洽、家庭教育方式以鼓励为主为参照；*P < 0.05，**P < 0.01。
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表 3 山西省中小学生家庭环境与抑郁症状关联的分层分析[OR值(95%CI)]
Table 3. Stratified analysis of the association between family environment and depressive symptoms among primary and secondary school students in Shanxi Province[OR(95%CI)]
自变量 选项 性别 地区 男生(n=2 065) 女生(n=2 046) 城市(n=1 602) 农村(n=2 509) 自评家庭经济状况 一般 0.75(0.63~0.89)** 0.82(0.68~0.99)* 0.76(0.59~0.99)* 0.78(0.67~0.90)** 好 0.76(0.58~0.99)* 0.87(0.65~1.16) 0.68(0.49~0.94)* 0.94(0.72~1.22) 居住安排 仅与父母之一居住 1.67(1.30~2.14)** 0.99(0.76~1.28) 1.16(0.84~1.60) 1.38(1.11~1.71)** 与父母和祖辈居住 1.20(0.97~1.49) 1.17(0.94~1.45) 1.25(0.95~1.63) 1.17(0.97~1.41) 其他 1.67(1.19~2.35)** 0.73(0.50~1.06) 0.88(0.52~1.48) 1.25(0.94~1.66) 父母支持与理解 是 0.61(0.50~0.74)** 0.50(0.40~0.61)** 0.52(0.41~0.65)** 0.57(0.47~0.68)** 家庭氛围 融洽 0.71(0.51~0.99)* 0.59(0.42~0.83)** 0.65(0.44~0.96)* 0.66(0.49~0.89)** 家庭教育方式 奖励和惩罚都有 1.36(1.14~1.62)** 1.47(1.23~1.76)** 1.46(1.20~1.78)** 1.39(1.18~1.64)** 惩罚 1.32(1.04~1.67)* 1.15(0.89~1.48) 1.33(0.98~1.76) 1.21(0.97~1.50) 家人酗酒 父亲酗酒 1.35(0.31~5.99) 1.63(0.24~11.30) 1.18(0.17~8.07) 1.82(0.38~8.61) 母亲酗酒 2.11(0.22~20.15) 0.24(0.02~3.08) 1.40(0.07~29.27) 0.74(0.10~5.58) 家庭其他成员酗酒 1.67(0.35~7.87) 1.14(0.16~8.29) 1.07(0.15~7.86) 1.74(0.35~8.61) 无 0.75(0.17~3.26) 0.95(0.14~6.45) 0.58(0.09~3.87) 1.14(0.25~5.33) 注：自变量分别以自评家庭经济状况差、与父母居住、未能得到父母支持与理解、家庭氛围不融洽、家庭教育方式以鼓励为主为参照；*P < 0.05，**P < 0.01。
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