儿童期虐待经历和中学生睡眠质量对抑郁情绪的影响

李奕曈; 梁亚男; 曹静; 杨光; 韦锦生; 朱敏惠; 张丽娜; 黄海; 张俊杰; 王佳; 张慧颖

doi:10.16835/j.cnki.1000-9817.2025029

儿童期虐待经历和中学生睡眠质量对抑郁情绪的影响

doi: 10.16835/j.cnki.1000-9817.2025029

1.
哈尔滨医科大学公共卫生学院，黑龙江 150081
2.
哈尔滨医科大学药学院
3.
黑龙江省伊春市嘉荫县第一小学
4.
哈尔滨市阿城区胜利小学

基金项目:

黑龙江省自然科学基金项目 LH2021H013

黑龙江省家庭教育学会“十四五”课题项目 HLJSJJ-2022003

详细信息

作者简介:
李奕曈(2000-)，女，甘肃天水人，在读硕士，主要研究方向为生命早期经历与儿童青少年健康

通讯作者:
张慧颖，E-mail: zhysxj@aliyun.com

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R179 B844.1 Q428
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- 被引次数: 0
出版历程
- 收稿日期: 2024-10-08
- 修回日期: 2024-11-15
- 网络出版日期: 2025-01-25
- 刊出日期: 2025-01-25

Impact of childhood maltreatment and sleep quality on depressive symptoms among middle school students

1.
School of Public Health, Harbin Medical University, Harbin (150081), Heilongjiang Province, China

摘要

摘要: 目的探讨中学生睡眠质量和儿童期虐待经历及其交互作用对抑郁情绪的影响，为中学生抑郁情绪的及早干预提供参考依据。方法 2023年9—12月，采用方便抽样方法在黑龙江省哈尔滨市2所中学选取1 231名学生进行问卷调查，内容包括一般人口学信息、儿童期虐待问卷(简版)、匹兹堡睡眠质量指数量表以及简版流调中心抑郁量表。使用χ²检验分析不同人口学特征中学生抑郁情绪、睡眠质量、儿童期虐待经历的差异，关联性分析采用Logistic回归，交互作用分析采用相加和相乘交互分析。结果中学生抑郁情绪检出率为22.7%，其中高中生检出率(35.2%)高于初中生(17.0%)，差异有统计学意义(χ²=50.35，P < 0.01)。存在儿童期虐待经历和睡眠质量差的中学生抑郁情绪检出率分别为45.8%和44.0%。多因素Logistic回归分析结果显示，相比不存在儿童期虐待经历的中学生，存在儿童期虐待经历的中学生发生抑郁情绪的风险更高(OR=4.49，95%CI=3.31~6.09)；睡眠质量差的中学生发生抑郁情绪的风险高于睡眠质量好的中学生(OR=5.99，95%CI=4.37~8.22)(P值均 < 0.01)。交互作用结果显示，存在儿童期虐待经历和睡眠质量差对中学生抑郁情绪的发生存在相加交互作用；与不存在儿童期虐待经历且睡眠质量好的中学生相比，同时存在儿童期虐待经历与存在睡眠质量差的中学生发生抑郁情绪的风险是前者的22.49倍(OR=22.49，95%CI=14.22~35.59，P < 0.01)。结论中学生的抑郁情绪与儿童期虐待经历及睡眠质量有关联，且儿童期虐待经历和睡眠质量差对抑郁情绪的影响有相加交互作用。
- 虐待儿童 /
- 睡眠 /
- 抑郁 /
- 精神卫生 /
- 回归分析 /
- 学生
Abstract: Objective To explore the impact of sleep quality, experience of childhood maltreatment, and their interaction on depressive symptoms among middle school students, so as to provide the reference for early intervention of depressive symptoms among middle school students. Methods From September to December 2023, a questionnaire survey was conducted among 1 231 students from two secondary schools in Harbin, Heilongjiang Province by a convenient sampling method. The survey included general demographic information, Childhood Trauma Questionnaire Short Form, Pittsburgh Sleep Quality Index and Short Version of Center for Epidemiological Studies Depression Scale. The Chi-square test was used to analyze the differences in depressive symptom, sleep quality and childhood maltreatment among students with different demographic characteristics. Correlation analysis was conducted using Logistic regression, and interaction analysis was performed by both additive and multiplicative interaction models. Results The detection rate of depressive symptoms among middle school students was 22.7%, and the rate for high school students (35.2%) was significantly higher than that for middle school students (17.0%) (χ²=50.35, P < 0.01). The detection rates of depressive symptoms among middle school students with a history of childhood maltreatment and poor sleep quality were 45.8% and 44.0%, respectively. Multivariate Logistic regression analysis showed that compared to students without a history of childhood maltreatment, students with a history of childhood maltreatment had a higher risk of depressive symptoms (OR=4.49, 95%CI=3.31~6.09, P < 0.01);students with poor sleep quality had a higher risk of depressive symptoms than students with good sleep quality (OR=5.99, 95%CI=4.37~8.22, P < 0.01).The interaction results showed that the presence of childhood maltreatment and poor sleep quality had an additive interaction on the occurrence of depression in middle school students. Compared with students without childhood maltreatment and having good sleep quality, students with childhood maltreatment and poor sleep quality had a 22.49 times higher risk of developing depression (OR=22.49, 95%CI=14.22~35.59, P < 0.01). Conclusion Depressive symptoms among middle school students are associated with childhood maltreatment and poor sleep quality, and there is an additive interaction between childhood maltreatment and poor sleep quality on the impact of depressive symptoms.
- Child abuse /
- Sleep /
- Depression /
- Mental health /
- Regression analysis /
- Students
注释:

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表 1 不同人口学特征中学生儿童虐待期经历、睡眠质量差及抑郁情绪检出率比较

Table 1. Comparison of detection rates of childhood maltreatment, poor sleep quality and depression among middle school students with different demographic characteristics

人口统计学指标	选项	人数	儿童期虐待经历		睡眠质量差		抑郁情绪
人口统计学指标	选项	人数	检出人数	χ²值	检出人数	χ²值	检出人数	χ²值
性别	男	606	153(25.2)	0.82	215(35.5)	4.38^*	117(19.3)	8.03^*
	女	625	144(23.0)		258(41.3)		163(26.1)
学段	初中	842	177(21.0)	14.04^**	263(31.2)	58.20^**	143(17.0)	50.35^**
	高中	389	120(30.8)		210(54.0)		137(35.2)
民族	汉族	1 013	246(24.3)	0.08	392(38.7)	0.18	228(22.5)	0.19
	其他民族	218	51(23.4)		81(37.2)		52(23.9)
是否独生子女	是	843	190(22.5)	3.64	316(37.5)	0.97	184(21.8)	1.30
	否	388	107(27.6)		157(40.5)		96(24.7)
父亲文化程度	小学及以上	99	28(28.3)	4.46	53(53.5)	12.08^*	39(39.4)	32.12^**
	中学	879	220(25.0)		335(38.1)		210(23.9)
	大专及以上	253	49(19.4)		85(33.6)		31(12.3)
母亲文化程度	小学及以上	112	37(33.0)	9.76^*	55(49.1)	7.70^*	34(30.4)	17.01^**
	中学	853	211(24.7)		326(38.2)		209(24.5)
	大专及以上	266	49(18.4)		92(34.6)		37(13.9)
与谁同住	父母双方	741	154(20.8)	15.27^**	242(32.7)	27.43^**	138(18.6)	18.05^**
	父母一方	386	105(27.2)		177(45.9)		111(28.8)
	其他	104	38(36.5)		54(51.9)		31(29.8)
父母婚姻状况	其他	212	64(30.2)	5.14^*	109(51.4)	18.27^**	60(28.3)	4.50^*
	初婚	1 019	233(22.9)		364(35.7)		220(21.6)
注： ()内数字为检出率/%；^* P < 0.05，^**P < 0.01。

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表 2 不同儿童期虐待经历和睡眠质量特征中学生抑郁情绪检出率比较

Table 2. Comparison of detection rates of depression symptoms among middle school students based on different childhood maltreatment and sleep quality characteristics

儿童期虐待经历和睡眠质量	选项	人数	抑郁情绪检出人数	χ²值
儿童期虐待经历	是	297	136(45.8)	118.31
	否	934	144(15.4)
身体忽视	是	208	90(43.3)	60.00
	否	1 023	190(18.6)
情感忽视	是	128	81(63.3)	133.58
	否	1 103	199(18.0)
性虐待	是	51	27(52.9)	27.61
	否	1 180	253(21.4)
身体虐待	是	42	31(73.8)	64.53
	否	1 189	249(20.9)
情感虐待	是	44	37(84.1)	97.72
	否	1 187	243(20.5)
睡眠质量	差	473	208(44.0)	197.01
	好	758	72(9.5)
注： ()内数字为检出率/%；P值均 < 0.05。

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表 3 中学生睡眠质量、儿童期虐待经历与抑郁情绪的Logistic回归分析(n=1 231)

Table 3. Logistic regression analysis of sleep quality, childhood maltreatment and depressive symptoms among middle school students(n=1 231)

模型	自变量	β值	Wald χ²值	OR值(95%CI)
1	儿童期虐待经历	153.00	108.00	4.63(3.47~6.19)^**
	睡眠质量	2.01	169.18	7.48(5.52~10.13)^**
	儿童期虐待经历×睡眠质量差	0.25	0.54	1.28(0.66~2.47)
2	儿童期虐待经历	1.50	93.68	4.49(3.31~6.09)^**
	睡眠质量	1.79	123.36	5.99(4.37~8.22)^**
	儿童期虐待经历×睡眠质量差	0.25	0.51	1.28(0.65~2.51)
注： ^**P < 0.01；模型1未调整变量，模型2调整学段、父/母文化程度、与谁同住、父母婚姻状况。

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参考文献(30)

[1]	孙梦圆, 刘堃. 孤独感在中学生社交焦虑与抑郁症状间的中介作用分析[J]. 中国卫生统计, 2018, 35(6): 926-928. SUN M Y, LIU K. Analysis of the mediating role of loneliness between social anxiety and depressive symptoms in middle school students[J]. Chin J Health Stat, 2018, 35(6): 926-928. (in Chinese)
[2]	刘福荣, 宋晓琴, 尚小平, 等. 中学生抑郁症状检出率的Meta分析[J]. 中国心理卫生杂志, 2020, 34(2): 123-128. LIU F R, SONG X Q, SHANG X P, et al. A Meta-analysis of detection rate of depression symptoms among middle school students[J]. Chin Ment Health J, 2020, 34(2): 123-128. (in Chinese)
[3]	马逸凡, 杨楹. 青少年抑郁症影响因素的研究进展[J]. 心理月刊, 2024, 19(8): 222-224, 228. MA Y F, YANG Y. The research progress on influencing factors of adolescents with depression[J]. Psychol Mon, 2024, 19(8): 222-224, 228. (in Chinese)
[4]	BERNSTEIN D P, FINK L, HANDELSMAN L, et al. Initial reliability and validity of a new retrospective measure of child abuse and neglect[J]. Am J Psychiatry, 1994, 151(8): 1132-1136. doi: 10.1176/ajp.151.8.1132
[5]	WANG S, XU H, ZHANG S, et al. Linking childhood maltreatment and psychological symptoms: the role of social support, coping styles, and self-esteem in adolescents[J]. J Interpers Violence, 2022, 37(1/2): Np620-Np650.
[6]	HE Y, CHEN S S, XIE G D, et al. Bidirectional associations among school bullying, depressive symptoms and sleep problems in adolescents: a cross-lagged longitudinal approach[J]. J Affect Disord, 2022, 298(Pt A): 590-598.
[7]	赵幸福, 张亚林, 李龙飞, 等. 中文版儿童期虐待问卷的信度和效度[J]. 中国临床康复, 2005, 9(20): 105-107. ZHAO X F, ZHANG Y L, LI L F, et al. Reliability and validity of the Chinese version of Childhood Trauma Questionnaire[J]. Chin J Clin Rehabil, 2005, 9(20): 105-107. (in Chinese)
[8]	BERNSTEIN D P, STEIN J A, NEWCOMB M D, et al. Development and validation of a brief screening version of the Childhood Trauma Questionnaire[J]. Child Abuse Negl, 2003, 27(2): 169-190. doi: 10.1016/S0145-2134(02)00541-0
[9]	WANG X, DOCKERY D W, WYPI D, et al. Pulmonary function growth velocity in children 6 to 18 years of age[J]. Am Rev Respir Dis, 1993, 148(6 Pt 1): 1502-1508.
[10]	TANG Q, ZOU X, GUI J, et al. Effects of childhood trauma on the symptom-level relation between depression, anxiety, stress, and problematic smartphone use: a network analysis[J]. J Affect Disord, 2024, 358: 1-11. doi: 10.1016/j.jad.2024.05.018
[11]	BUYSSE D J, REYNOLDS C F, MONK T H, et al. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research[J]. Psychiatry Res, 1989, 28(2): 193-213. doi: 10.1016/0165-1781(89)90047-4
[12]	ANDRESEN E M, MALMGREN J A, CARTER W B, et al. Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale)[J]. Am J Prev Med. 1994, 10(2): 77-84. doi: 10.1016/S0749-3797(18)30622-6
[13]	ANDERSSON T, ALFREDSSON L, KÄLLBERG H, et al. Calculating measures of biological interaction[J]. Eur J Epidemiol, 2005, 20(7): 575-579. doi: 10.1007/s10654-005-7835-x
[14]	袁悦, 李楠, 任爱国, 等. 流行病学研究中相加和相乘尺度交互作用的分析[J]. 现代预防医学, 2015, 42(6): 961-965, 975. YUAN Y, LI N, REN A G, et al. Analysis of the application of the additive model and the multiplicative statistical model in biologial interaction[J]. Mod Prev Med, 2015, 42(6): 961-965, 975. (in Chinese)
[15]	刘小群, 杨孟思, 彭畅, 等. 校园欺凌中不同角色中学生的焦虑抑郁情绪[J]. 中国心理卫生杂志, 2021, 35(6): 475-481. LIU X Q, YANG M S, PENG C, et al. Anxiety emotion and depressive mood of middle school students with different roles in school bullying[J]. Chin Ment Health J, 2021, 35(6): 475-481. (in Chinese)
[16]	DEMIR T, KARACETIN G, DEMIR D E, et al. Epidemiology of depression in an urban population of Turkish children and adolescents[J]. J Affect Disord, 2011, 134(1-3): 168-176. doi: 10.1016/j.jad.2011.05.041
[17]	SUN W, MEI J, WANG Y, et al. Psychosocial factors associated with high depressive symptomatology in female adolescents and gender difference in adolescent depression: an epidemiological survey in China's Hubei Province[J]. BMC Psychiatry, 2021, 21(1): 168. doi: 10.1186/s12888-021-03165-7
[18]	胥寒梅, 张航, 陶圆美, 等. 儿童青少年抑郁症的重要社会心理因素[J]. 精神医学杂志, 2021, 34(6): 499-502. XU H M, ZHANG H, TAO Y M, et al. Social psychological factors in children and adolescents with depression[J] J Psychiatry, 2021, 34(6): 499-502. (in Chinese)
[19]	HANKIN B L, ABRAMSON L Y. Development of gender differences in depression: description and possible explanations[J]. Ann Med, 1999, 31(6): 372-379. doi: 10.3109/07853899908998794
[20]	石绪亮, 李子涵, 朱亚. 初中生睡眠问题与抑郁和多动注意问题关系的纵向研究[J]. 中国心理卫生杂志, 2023, 37(11): 958-964. SHI X L, LI Z H, ZHU Y. A longitudinal study on sleep problems and relationship with depression and hyperactivity/inattention in junior middle school students[J]. Chin Ment Health J, 2023, 37(11): 958-964. (in Chinese)
[21]	裴亚兴, 王雪纯, 孔令敏, 等. 山东省中小学生睡眠与心理健康的相关性[J]. 中国学校卫生, 2023, 44(11): 1674-1678. PEI Y X, WANG X C, KONG L M, et al. Analysis of the correlation between sleep and mental health among primary and secondary school students in Shandong Province[J]. Chin J Sch Health, 2023, 44(11): 1674-1678. (in Chinese)
[22]	PALMER C A, ALFANO C A. Sleep and emotion regulation: an organizing, integrative review[J]. Sleep Med Rev, 2017, 31: 6-16. doi: 10.1016/j.smrv.2015.12.006
[23]	WICKLOW A, ESPIE C A. Intrusive thoughts and their relationship to actigraphic measurement of sleep: towards a cognitive model of insomnia[J]. Behav Res Ther, 2000, 38(7): 679-693.
[24]	ANDA R F, FELITTI V J, BREMNER J D, et al. The enduring effects of abuse and related adverse experiences in childhood. A convergence of evidence from neurobiology and epidemiology[J]. Eur Arch Psychiatry Clin Neurosci, 2006, 256(3): 174-186.
[25]	TEICHER M H, ANDERSEN S L, POLCARI A, et al. Developmental neurobiology of childhood stress and trauma[J]. Psychiatr Clin North Am, 2002, 25: 397-426.
[26]	刘文, 刘方, 邵姝姮. 国外儿童心理虐待的神经机制研究综述[J]. 中国特殊教育, 2015(12): 66-71. LIU W, LIU F, SHAO S H. On the neural mechanism for the psychological maltreatment of children outside China[J]. Chin J Spec Educ, 2015(12): 66-71. (in Chinese)
[27]	胡梓悦, 李鹏声, 郭蓝, 等. 深圳市中学生儿童期虐待与抑郁症状关系[J]. 中国公共卫生, 2019, 35(6): 703-707. HU Z Y, LI P S, GUO L, et al. Correlation between childhood maltreatment and depressive symptoms among middle school students in Shenzhen City[J]. Chin J Public Health, 2019, 35(6): 703-707. (in Chinese)
[28]	MASUYA J, MORISHITA C, ONO M, et al. Moderation by better sleep of the association among childhood maltreatment, neuroticism, and depressive symptoms in the adult volunteers: a moderated mediation model[J]. PLoS One, 202419(7): e0305033.
[29]	PARK E J, KIM S Y, KIM Y, et al. The relationship between adverse childhood experiences and sleep problems among adolescent students: mediation by depression or anxiety[J]. Int J Environ Res Public Health, 2020, 18(1): 236.
[30]	JAVAKHISHVILI M, SPATZ WIDOM C. Childhood maltreatment, sleep disturbances, and anxiety and depression: a prospective longitudinal investigation[J]. J Appl Dev Psychol, 2021, 77: 101351.