生态系统理论下医学生心理健康状况影响因素分析

许晨晨; 吴若脩; 王瓅珠; 李墨萱; 张志豪

doi:10.16835/j.cnki.1000-9817.2025093

生态系统理论下医学生心理健康状况影响因素分析

doi: 10.16835/j.cnki.1000-9817.2025093

许晨晨¹,
吴若脩²,
王瓅珠²,
李墨萱²,
张志豪^{1, 3, 4, ,}

1.
南京医科大学第四临床医学院，江苏 211166
2.
南京医科大学医政学院
3.
南京医科大学药学院
4.
中国科学院生物物理研究所

基金项目:

江苏省高校哲学社会科学专题研究项目思想政治工作专项项目 2023SJSZ0132

江苏省大学生创新创业训练计划重点项目 202410312007Z

南京医科大学2023年度教育研究课题 2023LX002

详细信息

作者简介:
许晨晨(1994-)，男，安徽阜阳人，硕士，讲师，主要研究方向为大学生心理健康及创新创业教育

通讯作者:
张志豪，E-mail: zhangzhihaochem@163.com

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R179 G444 R193
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出版历程
- 收稿日期: 2024-10-12
- 修回日期: 2025-01-31
- 网络出版日期: 2025-04-03
- 刊出日期: 2025-03-25

Factors influencing mental health of medical students based on an ecological systems theory perspective

XU Chenchen¹,
WU Ruoxiu²,
WANG Lizhu²,
LI Moxuan²,
ZHANG Zhihao^{1, 3, 4
, ,}

1.
The Fourth School of Clinical Medicine, Nanjing Medical University, Nanjing (211166), Jiangsu Province, China

摘要

摘要: 目的基于生态系统理论分析医学院校学生心理健康状况的影响因素，为构建医学生心理健康保障体系提供参考。方法 2024年6月，采用问卷调查和专家访谈法，对中国东部地区19所不同类型医科院校采用分层整群随机抽取方法抽取1 760名学生进行调查，通过描述性统计、交叉分析、分层线性回归分析、构建结构方程模型等方法进行统计学分析。结果医学院校学生对学校满意度较高(65.85%)、社会领悟支持较强(57.16%)，有较高的抑郁水平(44.89%)，但人际交往正常(91.14%)。分层线性回归分析显示，社会领悟支持得分高(β=-11.40)、对学校满意(β=-4.85)以及污名化求助得分低(β=9.31)均对医学生心理健康状态产生积极作用(P值均 < 0.05)。结构方程模型分析显示，社会领悟支持和自我污名化情况对医学生抑郁程度(β值分别为-0.32，-0.53)和人际关系敏感度(β值分别为-0.31，0.58)有显著影响(P值均 < 0.01)。通过专家访谈可知，学校与家庭、高校、社会三方联动具有积极意义。结论社会领悟支持和自我污名化情况对医学生的心理健康状况有着显著影响。家庭、高校、社会三方联动有助于改善医学生心理健康状况。
- 精神卫生 /
- 回归分析 /
- 模型，结构 /
- 学生
Abstract: Objective To analyze factors impacting mental health status of medical students based on ecological systems theory, so as to provide reference for the mental health promotion system for medical students. Methods In June 2024, 1 760 medical school students randomly selected from 19 different kinds of medical colleges in eastern China by stratified cluster were surveyed using questionnaires and expert interviews. Descriptive statistics, cross-analysis, hierarchical linear regression analysis, structural equation models were used for data analysis. Results Medical school students had higher satisfaction with the school (65.85%) and a great sense of perceived social support (57.16%). Furthermore, 91.14% of the students had normal interpersonal relationships. However, 44.89% reported that their mental health was impacted by high level of depression. The hierarchical linear regression analysis showed that the mental health outcomes of the medical students were positively predicted by higher perceived social support scores (β=-11.40), institutional satisfaction (β=-4.85), and lower help-seeking stigma scores (β=9.31) (P < 0.05). The structural equation modeling showed that the status of both perceived social support and self-help-seeking stigma had significant impacts on depression severity (β=-0.32, -0.53) and interpersonal relationship sensitivity (β=-0.31, 0.58) among medical students (P < 0.01).Through expert interviews, collaborations between the school and the tripartite organization (families, universities and society) was of growing importance. Conclusions Perceived social support and self-stigma have a significant impact on the mental health status of medical students. The problem of self-stigma of medical students should be paid attention to. Therefore, families, universities and society should work together to improve the mental health of medical students.
- Mental health /
- Regression analysis /
- Models, structural /
- Students
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表 1 不同高校类型学生学校满意度、社会领悟支持及心理健康状况分布比较

Table 1. Comparison of the distribution of institutional satisfaction, perceived social support, and mental health status among students from different university types

高校类型	人数	对学校的满意度					社会领悟支持
高校类型	人数	非常不满意	不满意	一般	满意	非常满意	低支持水平	中间支持水平	高支持水平
“双一流”高校	570	3(0.53)	16(2.81)	166(29.12)	302(52.98)	83(14.56)	11(1.93)	189(33.16)	370(64.91)
普通高等院校	556	1(0.18)	7(1.26)	188(33.81)	273(49.10)	87(15.65)	7(1.26)	221(39.75)	328(58.99)
职业技术学校	634	3(0.47)	16(2.52)	201(31.70)	261(41.17)	153(24.13)	9(1.42)	317(50.00)	308(48.58)

高校类型	人数	抑郁					人际关系敏感
高校类型	人数	不易抑郁		一般		易抑郁	较为正常	一般	较为敏感
“双一流”高校	570	157(27.54)		178(31.23)		235(41.23)	511(89.65)	46(8.07)	13(2.28)
普通高等院校	556	197(35.43)		137(24.64)		222(39.93)	506(91.01)	37(6.65)	13(2.34)
职业技术学校	634	154(24.29)		147(23.19)		333(52.52)	587(92.59)	39(6.15)	8(1.26)
注： ()内数字为构成比/%。

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表 2 医学生心理健康状况影响因素的分层线性回归分析(n=1 760)

Table 2. Hierarchical linear regression analysis of determinants of mental health status among medical students(n=1 760)

常数与自变量	分层1		分层2		分层3		分层4
常数与自变量	β值	t值	β值	t值	β值	t值	β值	t值
常数	75.31^**	30.19	86.02^**	27.01	86.56^**	25.19	87.20^**	24.55
年龄	0.05	1.29	0.06	1.41	0.06	1.49	0.06	1.44
是否独生子女	-2.18^**	-2.75	-1.71^*	-2.18	-1.71^*	-2.16	-1.59^*	-1.97
性别	0.39	0.47	0.61	0.73	0.65	0.78	0.64	0.78
社会领悟支持得分	-13.67^**	-18.53	-11.38^**	-14.89	-11.42^**	-14.91	-11.40^**	-14.88
所读高校类型			0.67	1.42	0.67	1.40	0.61	1.25
专业类型			-0.36	-0.88	-0.35	-0.86	-0.35	-0.86
对学校的满意度			-4.85^**	-9.34	-4.85^**	-9.33	-4.85^**	-9.33
父母从事的职业					-0.65	-1.20	-0.58	-1.06
父母的文化程度					0.47	1.53	0.49	1.58
所属生源地							-0.58	-0.71
污名化得分							9.31^**	11.32
注： ^P < 0.05，^*P < 0.01。

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表 3 医学生心理健康影响因素结构方程模型路径关系检验结果

Table 3. Results of path relationships test in structural equation modeling for determinants of mental health among medical students

路径关系	非标准化系数	标准误	临界比值	P值
社会领悟支持→抑郁	-0.32	0.01	-13.54	< 0.01
社会领悟支持→人际交往	-0.31	0.01	-15.40	< 0.01
污名化→抑郁	0.53	0.02	16.61	< 0.01
污名化→人际交往	0.58	0.03	22.00	< 0.01

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