【作者】 王晓蕾；

【导师】 巴德年； 李鲁；

【作者基本信息】 浙江大学 ， 社会医学与卫生事业管理， 2012， 博士

【副题名】基于心理健康、攻击性和危险性性行为视角的实证研究

【摘要】 [研究目的]我国自上世纪80年代以来一直处于高出生人口性别比状态,如今这部分高性别比人群正逐步迈入适婚年龄段,已产生男性过剩问题,且在今后几十年内会不断加剧,从而可能带来未婚男性身心健康问题和社会不良后果。为此,本课题对适婚却未婚的男性(22-39周岁),从总体、分农村与城市、分大龄与非大龄等角度进行心理健康、攻击性和危险性性行为现状的定量调查,并分析心理健康与攻击性、心理健康与危险性性行为之间的相关性；在定量调查基础上进一步用定性访谈的方法,研究贫困地区大龄未婚男性的失婚原因、心理和生活问题及其深层次原因,从而为解决男性过剩引发的个人及社会问题,提供健康促进、社会支持和政策完善方面的建议。[研究方法]本课题进行了定性与定量相结合的综合研究。定量研究在周密考虑经济发展状况、现场调查的工作条件和质量控制等因素基础上,选择浙江、贵州、云南为调查区域。在这三省份中采用多阶段分层整群抽样的方法,最终获取的研究样本是22-39周岁未婚男性1052名,对照样本是已婚男性1629名和未婚女性936名。定量研究工具主要包括：课题组编制的一般情况及性观念性行为问卷、贝克抑郁量表、罗森伯格自尊量表和攻击性量表等,由样本对象自填完成。调查数据使用SPSS16.0和SPSS AMOS7.0等统计软件作χ2检验、非参数检验、logistic回归、结构方程模型等量化分析。定性研究针对贫困地区大龄未婚男性进行,以目的性抽样的方法选取贵州赤水地区30名大龄未婚男性,进行半结构式录音访谈,内容包括失婚原因、周围人群看法、自身态度、心理状况及原因、对社会的不满程度及其性行为状况等,访谈内容由调查员整理为文字资料,并采用主题分析法进行归纳处理。[研究结果]未婚男性的心理健康：未婚男性总体与已婚男性相比,抑郁水平较高(p<0.05),自尊水平无统计学差异；而≥27岁的男性中,未婚无女友(单身)个体的抑郁水平较高、自尊水平较低(p<0.05)。未婚男性总体与未婚女性相比,抑郁水平较低(p<0.05),自尊水平无统计学差异。此外,未婚男性内部比较发现：(1)与城市地区相比.,农村地区未婚男性的抑郁水平较高、自尊水平较低(p<0.05)。(2)不同年龄段(大龄与非大龄)的未婚男性抑郁、自尊水平均无统计学差异。(3)教育程度较高、年收入较高的未婚男性,抑郁水平较低、自尊水平较高。(4)家庭兄弟姐妹数尤其是兄弟数较少的未婚男性,抑郁水平较低；且大龄组中兄弟数较多的未婚男性,自尊水平较低。(5)因经济、外貌条件差而非自愿单身的男性,抑郁水平较高、自尊水平较低；但因对配偶要求较苛刻而自愿单身的男性,自尊水平反而较高。(6)如果处于这样的社区人文环境中：社区内有大龄未婚男性、社区对大龄未婚男性持关心态度或社区现有大龄未婚男性表现出积极心理行为变化,未婚男性的自尊水平较高；而如果处于对大龄未婚持贬义看法的社区,未婚男性的自尊水平较低；如果处于这样的社区人文环境中：社区现有大龄未婚男性表现出负性心理变化或重男轻女氛围明显,未婚男性的抑郁水平较高、自尊水平较低。多因素分析证实高教育程度、高收入水平、社区内有大龄未婚男性、社区对大龄未婚男性持关心态度可对未婚男性的心理健康产生正性影响；而非自愿单身、社区重男轻女氛围明显、社区现有大龄未婚男性表现出负性心理变化可对未婚男性的心理健康产生负性影响。定性研究则进一步揭示孤独感是贫困地区大龄未婚男性最普遍、突出的负性心理。经济贫困是其负性心理的根本原因；且与定量调查相一致,定性访谈也证实社区人文环境可影响个体心理；此外,社会关系网络薄弱、总体应对方式偏消极和精神生活贫乏也是贫困地区大龄未婚男性负性心理的原因。未婚男性的攻击性：未婚男性总体与已婚男性相比,攻击性水平无统计学差异。未婚男性总体与未婚女性相比,攻击性总水平较低(p<0.05),其中言语攻击、敌意和愤怒水平低于未婚女性,但身体攻击水平却高于未婚女性(p<0.05)。未婚男性内部比较发现：(1)农村地区未婚男性攻击性总水平高于城市地区(p<0.05),其中农村非大龄未婚男性的身体攻击水平高于城市非大龄未婚男性(p<0.05),农村大龄未婚男性的愤怒水平高于城市大龄未婚男性(p<0.05)。(2)不同年龄段的未婚男性攻击性总水平无统计学差异,但大龄未婚男性的身体攻击水平低于非大龄未婚男性(p<0.05)。(3)教育程度较高的未婚男性,攻击性总水平较低。(4)如果处于这样的社区人文环境中：社区对大龄未婚持负性评价、社区现有大龄未婚男性有负性心理行为变化或社区重男轻女氛围明显,未婚男性的攻击性总水平较高；如果处于这样的社区人文环境中：社区对大龄未婚男性持关心或无歧视态度、社区现有大龄未婚男性有积极行为变化,未婚男性的攻击性总水平较低。多因素分析证实教育可减弱未婚男性的攻击性,而社区重男轻女氛围可增强未婚男性的攻击性。定性研究支持定量调查结果,提出大龄未婚男性的攻击性无显著性增高,不构成社会安全威胁。未婚男性的危险性性行为：未婚男性尤其大龄未婚男性危险性性行为报告率及预期发生率均高于已婚男性、未婚女性(p<0.05),其潜在健康危险不容忽视。未婚男性内部比较发现：(1)农村地区大龄未婚男性的危险性性行为报告率比城市地区大龄未婚男性和农村地区非大龄未婚男性均高(p<0.05)；(2)教育程度较低、非独生(有兄弟姐妹)的未婚男性,危险性性行为报告率及预期发生率均较高；(3)性观念较开放、周围婚外恋及商业性性行为较普遍的未婚男性,危险性性行为报告率及预期发生率均较高。多因素分析证实低教育程度、自我放纵的性观念、周围婚外恋及商业性性行为普遍,是未婚男性参与危险性性行为(商业性性行为、多性伴性行为)的危险因素；此外,大龄、非独生也是未婚男性参与商业性性行为的危险因素。定性研究显示部分受访者有参与婚外恋、商业性性行为,且与定量调查相一致,其商业性性行为与同伴影响密不可分。未婚男性心理健康与攻击性、危险性性行为间作用：未婚男性的抑郁可对攻击性产生直接影响,促使攻击性增强；而未婚男性的自尊对攻击性并无直接作用,但可通过抑郁的中介作用对攻击性产生间接影响。未婚男性危险性性行为史可能促发个体产生抑郁、降低自尊,还可能诱使个体继续参与多性伴性行为。此外,定性研究还表明：贫困地区男性大龄未婚的原因主要有：(1)当地传统观念和风俗旧习：结婚讲究排场搞攀比导致结婚费用不断上涨,说媒为主、家风族规、拒绝入赘等局限了择偶渠道；(2)当地经济落后和生活艰苦：地域的贫困、偏僻、闭塞使适婚男女缺乏交流和共同生活的希望；(3)当地适婚年龄段人口性别比失调：当地出生性别比持续偏高导致的适婚年龄段女性数量相对较少,且女性通过打工、婚嫁等形式外流加剧失调；(4)个人家庭原因：个人健康、外貌、个性、职业和收入因素,以及不良嗜好及家庭负担等。研究还反映贫困地区大龄未婚男性对未来生活尤其是养老方面,大多缺乏有效应对措施。[研究结论]未婚男性总体抑郁水平偏高,而自尊水平较稳定(但大龄单身男性负性心理较明显)；未婚男性攻击性水平无显著性增高,不构成社会安全威胁；未婚男性危险性性行为参与率较高,是性传播疾病的高危人群。除社会人口学因素(如教育程度)外,所处的社区人文环境也可对未婚男性的心理行为产生重要影响。未婚男性负性心理可促使攻击性增强,而危险性性行为可能促发负性心理。贫困、适婚年龄段性别比失调分别是男性大龄未婚重要的经济、社会原因。[对策建议]结合研究结果和结论,本文从三方面提出对策：从健康促进层面,开展危险性性行为健康教育,指导高危人群采取有保护的性行为或无害自慰行为；从社会支持层面,建设人际和谐、精神丰富、各得其所的工作、生活环境,提供社交条件和心理干预服务等社会支持系统；从社会政策层面,控制人口性别比恶化,建立和完善保护孤寡弱势人群的社会保障体制。更多还原

【Abstract】 [objectives]China has been in high sex ratio at birth Since the1980s, with the arrival of the marriageable age of these people, there has been a surplus of men. This trend would be more and more obvious in the next few decades, which may cause health problems among unmarried men and result in other social problems. In recognizing this important issue, the quantitative component of this paper investigated the psychological health, aggression and risky sexual behaviors among unmarried men aging from22to39years, who are in the legitimate age to get married, but still be unmarried. It aims to understand these three dimensions from the point of the overall group, the rural group and urban group, the elder age group and younger age group, and to explore the correlation between psychological health and aggression, as well as the correlation between the psychological health and risk sexual behaviors. Upon the findings of the quantitative research, this study further investigated the elderly unmarried men in poor area by qualitative interview. The qualitative part of the study aims to further understand the cause of remaining unmarried, the problems embedding in their psychological and daily life and reasons, which is to provide suggestion for intervention in terms of health promotion, social support and policy promotion.[Methods]This study used the quantitative and qualitative mixed research paradigm:In the quantitative study, with the consideration of the economic status, the accessibility of field for investigation, the quality control, and other related factors, Zhejiang, Guizhou and Yunnan province were selected as the participating areas. In these three provinces, multi-stage stratified cluster sampling method was used to select the sample, which was composed of1052unmarried men who aged22-39,1629married men and936unmarried women. The instruments used in the survey include the demographic questionnaire, sexual concept and behavior questionnaire, Beck depression inventory, Rosenberg self-esteem scale and Aggression scale, which were self-administered by participants. All data was entered into the database, which was set up by the Epidata3.0. statistical methods such as%tests, non-parameter tests, logistic regressions, and structural equation models were used to analyze the data by SPSS16.0and SPSS AMOS7.0software. The qualitative research enrolled30elderly unmarried men by purposive sampling from the Chishui area in Guizhou province. Semi-structured interview were conducted to explore the cause of remaining unmarried, other people’s attitude about their unmarried status, self-evaluation of being unmarried, mental health and deep reasons behind the problems, the degree of dissatisfaction toward the society, and the status of sexual behavior, et al. All interviews were audiotaped with the consent of participants, which were transcribed into words and analyzed with the theme analysis approach.[Results]The mental health of unmarried men: The unmarried men have higher level of depression than the married men (p<0.05), the self-esteem differences between unmarried men and married men are not significant, but in the men older than27yeas, the single men have lower level of self-esteem than the men with partners(including wife or girlfriend)(p<0.05). The unmarried men have lower level of depression than unmarried women (p<0.05), but there is no significant difference of self-esteem between unmarried men and unmarried women. In addition, by the comparison of different characteristics of the unmarried men, we found that:(1) Compared to the urban unmarried men, the rural unmarried men have higher level of depression, and lower level of self-esteem (p<0.05).(2) There is no significant differences in depression and self-esteem between different age groups(<27and≥27).(3) Those unmarried men with higher education, higher income, have lower level of depression and higher level of self-esteem.(4) The unmarried men with fewer siblings especially fewer brothers, get lower level of depression; the elderly unmarried group with more brothers have lower lever of self-esteem.(5) The men who were single for lower economic status or not good appearance have higher level of depression and lower level of self-esteem; but those are unmarried for the much higher expectation of the spouse have higher level of self-esteem.(6) If the unmarried men live in a community with the cultural environment like these:there are other elderly unmarried men in the community, the community concern about the elderly unmarried men, or other elderly unmarried men around show positive psychological and behavioral change, the self-esteem of the unmarried men investigated would be higher; but if the unmarried men live in the communities where look down upon the elderly unmarried men, or the other elderly unmarried men around show negative psychological change, or the son preference culture is obvious, these unmarried men investigated would show higher depression and lower self-esteem. Multivariate analysis shows that higher education, higher income, with other elderly unmarried men in the community, and the concern attitude toward elderly unmarried men in community, may positively influence the psychological health of unmarried men investigated; however, the unwanted single status, the son-preference culture in community, the negative psychological change of other elderly unmarried men may negatively influence the psychological health of unmarried men investigated.With the interview, we found that most obvious psychological problem bothering these elderly unmarried men in poor area is the loneliness. Poverty is the most fundamental reason for their negative problems; and being consistent with the result from the quantitative research, the qualitative research indicates that the cultural environment of the community can influence the person’s psychology. In addition, the weaker social network, the more negative copying style and poorer mental life are other reasons contributing to the negative psychological health of these elderly unmarried men in poor area.The aggression of unmarried men:There is no significant difference in the overall aggressive level between the unmarried and married men. Although the unmarried women have higher level of overall aggressive level than the unmarried men, as well as the verbal aggression, hostility and anger (p<0.05), the unmarried men do have higher level of physical aggression than the unmarried women (p<0.05). By comparing different groups within the unmarried men, we found:(1) The unmarried men live in rural area, have more obvious overall aggression than those living in the urban area (p<0.05) furthermore, the unmarried men younger than27living in rural area have more obvious physical aggression than those living in urban area (p<0.05), for the unmarried men over27years old, the anger is more obvious in those from rural area than those from urban area(p<0.05).(2) There is no significant difference in the level of aggression between two age groups; but the older unmarried men have lower level of physical aggression than younger ones (p<0.05).(3) The unmarried men who got higher education have lower level of overall aggression.(4) If the unmarried men live in the community with a cultural environment like these:the community look down upon the elderly unmarried men, other elderly unmarried men in community show negative psychological and behavioral change, or son preference culture in community is obvious, the aggression of unmarried men investigated would be relatively more obvious; but if the unmarried men live in the community with a cultural environment like these:the communities concern the elderly unmarried men or other elderly unmarried men in community show positive behavior change, the aggression of unmarried men investigated would be relatively less obvious. Multivariate analysis shows that education may reduce the level of aggression among unmarried men, the son-preference culture in community may enhance the aggression of unmarried men.Being consistent with quantitative research, the qualitative research shows the aggression of elderly unmarried men hasn’t been enhanced, and they wouldn’t cause obvious social security problems.The risky sexual behavior of unmarried men:The self-report rate and future participate rate estimated of the risky sexual behavior among unmarried men, especially the elderly unmarried men, are significantly higher than the married men and unmarried women(p<0.05), and the potential health risk shouldn’t be neglected. By doing the group comparison within the unmarried men, we found:(1) Compared to the elderly unmarried men in urban area and the unmarried men who are younger than27, the self-report rate of the risky sexual behavior among elderly unmarried men live in rural area is higher (p<0.05);(2) The unmarried men who were less educated, had siblings, have higher self-report rate and future participate rate of risky sexual behavior;(3) The unmarried men who take more open sexual concept, have common out-marriage love or commercial sex around, have relatively higher self-report rate and future participate rate of risky sexual behavior. Multivariate analysis shows that less education, self-indulgence in sexual concept and the persons around participating in prostitution or extra marriage affair frequently may be the risk factors which promote the unmarried men to participate in risky sexual behavior; the elderly age, and the status of having siblings, are additional risk factors promoting the unmarried men to participate in commercial sex.The qualitative research shows that some elderly unmarried men interviewed had participated in the extramarital or commercial sex, and being consistent with quantitative research, the qualitative research shows that the peer influence is one of important reasons for their commercial sex behavior.The structure equation analysis shows that:The depression may impact aggression directly, in other words, the depression may enhance the unmarried men’s aggression directly; the self-esteem can’t impact the aggression directly, however, the self-esteem may impact the unmarried men’s aggression indirectly by the mediating effect of depression. The risky sexual behavior history may increase the level of depression and reduce the level of self-esteem among unmarried men; and the risky sexual behavior history also may induce the unmarried men to continue participating in the risky sexual behavior in future.In addition, by qualitative research, we also found that:The reasons for men unmarried in the poor area include these:(1) The traditional concept and customs in local place:it causes more and more expensive wedding expense resulting from the unnecessary comparison, the matchmaking dominated style, rules in the extended family and some feudal traditional thoughts and so on reduced the approaches to find a partner;(2) The poor and hard life in local area:The economy is less developed in local area, the communities are too poor and remote, the transport conditions are also too poor, these limits communication opportunity between men and women at marriageable age and life together with women;(3) The sex ratio in local area:the sex ratio at birth has been high for so many years that the women in marriageable age are relatively less than the men, then the outmigration of women for marriage or work worsens the imbalance in the local sex ratio;(4) Personal and family related factors:such as personal health status, appearance, income status, personality traits, bad habits and family economic burden, etc.Most of elderly unmarried men in poor area are lack of effective coping methods for the future life, especially the endowment.[Conclusions]The level of depression in unmarried men is relatively higher, however, the overall self-esteem level is relatively stable (the negative psychology is more obvious among elderly unmarried men); the aggression of unmarried men hasn’t increased significantly, they won’t bring obvious social security problems; the participant rate of risky sexual behavior among unmarried men is relatively higher, they are high-risk in sexually transmitted disease.Besides the social and demographic characteristics (including education level), the social culture environment also can influence the psychological and behavioral health among unmarried men.The negative psychology may increase the aggression of unmarried men, the risky sexual behavior may increase the negative psychology of unmarried men.Poverty is the important economic reason for unmarried status in the elderly unmarried men; the imbalance sex ratio in marriageable age population is the important social reason for their unmarried status.[Suggestions]Combing the results and discussion of this paper, we suggest:From the angle of health promotion:implementing the health education on risky sexual behavior, guiding the protective sexual behavior or masturbation among high-risk health group.From the angle of social support: constructing the working and living environment where the interpersonal relation is harmony, spirit life is rich and each person has his proper place; providing social interaction opportunity and psychological intervention services.From the angle of social policy:modifying the high sex ratio and improving the security system to protect the single disadvantaged people.更多还原