【作者】 张帆；

【导师】 汪洋；

【作者基本信息】 重庆医科大学 ， 生物医学工程， 2013， 博士

【摘要】 第一部分中国儿童心理弹性现状的系统评价目的：通过循证研究的方法,对目前中国儿童心理弹性的相关研究进行系统评价,从而了解中国儿童心理弹性的现状及目前这一领域的研究现状。方法：全面检索四大中文数据库(CBM、VIP、CNKI和WF)截至2013年2月所发表的中文文献,纳入关于我国儿童心理弹性现状的相关文献。由两名研究人员根据预先制定的纳入排除标准同时独立地对文献进行题目／摘要的筛选以及全文筛选,之后进行数据提取。筛选和提取完成后分别进行交叉核对,如有分歧则通过讨论达成一致,必要时引入第三方意见。运用均数和标准差的统计学合并公式对心理弹性现状的数据进行合并；运用系统评价定量分析工具Review Manager对儿童内部不同群体之间的差异性进行Meta分析；运用定性的研究方法对不能进行定量合并的数据及纳入文献的基本研究信息进行系统全面的总结。结果：共检索到1028篇文献,经两步筛选,最终纳入79篇,共计77项研究,覆盖全国24个省/直辖市/自治区；研究对象包括普通中小学生、幼儿、留守儿童、流浪儿童、受艾滋病影响的儿童、吸毒人员子女、矮小症患儿、癫痫患儿等；使用的研究工具共计24种,包括18种成熟量表和6种自编量表,评分标准和所含维度各有不同。其中使用最多的是胡月琴等学者编制的青少年心理弹性量表(RSCA),共计26项研究。各个量表的定量合并结果均显示,我国儿童心理弹性得分处于中等水平。其中对性别和年级做差异性分析的原始研究最多。对于性别来说,有四种量表的原始研究结果可以进行Meta分析,其中RSCA和心理弹性量表(ER89)的合并结果分别显示,女生的心理弹性得分显著高于男生(p<0.05)；中学生心理弹性量表(HKRA)和中学生社会适应量表-心理弹性分量表的合并结果分别显示,男生的心理弹性得分显著高于女生(p<0.05)。对于年级来说,RSCA的合并结果显示,初二年级学生的心理弹性得分显著高于初一学生(p<0.05)；ER89的合并结果显示,初一年级学生的心理弹性得分显著高于初二年级(p<0.05)。另外,各原始研究还对除性别、年级外的一种或多种因素进行了差异性分析,包括性别、年级、户口所在地、民族、省份、是否独生、是否网络成瘾、是否受艾滋病影响、双亲学历、家庭收入、家庭类型、气质类型、成绩、人际关系、学校类别、住校情况、转学情况、锻炼情况、(曾)留守情况及受灾情况等。结论：目前中国儿童的整体心理弹性水平良好,但是存在内部差异性,其中对不同性别和年级的儿童的心理弹性作比较的原始研究最多。但是各个量表的合并结果并不统一。其中使用最多的量表的合并结果显示,女生心理弹性比男生好,初二心理弹性比初一好。对于研究现状来说,近5年来,心理弹性的研究数目逐年增多,研究对象多是在校的中小学生,研究工具最常使用的是各种成熟量表。研究工具较繁杂,评分标准描述模糊,报告标准不统一,不利于其他研究人员对结果的参照和应用。第二部分心理健康诊断测验与青少年发展与心理弹性问卷的信效度分析目的：分析心理健康诊断测验(MHT)和青少年发展与心理弹性问卷(RYDM)在三峡库区农村儿童中的信效度水平,评估二者在此群体中的适用性。方法：采用多阶段整群随机抽样的方法选取重庆市三峡库区云阳县两所镇中学的964名初一到高三的学生进行定量调查,包括自编基本情况问卷、MHT和RYDM,218人半个月后进行重测。回收问卷的数据统一采用Epidata3.0预先建立的数据库进行双人双录入；使用SPSS17.0软件进行信效度的统计分析,用Cronbach’sα系数、分半信度和重测信度来评价量表的信度,用Spearman相关系数评价量表的标准关联效度。剔除其中MHT得分大于7分的量表。结果：初测、重测各回收有效问卷922份和214份。两量表的信效度分析结果如下：1)MHT：总量表的Cronbach’sα系数为0.897,8个分量表的Cronbach’sα系数在0.520～0.788之间；总量表的斯皮尔曼分半系数为0.834,分量表的斯皮尔曼分半信度在0.500～0.791之间；总量表的重测信度为0.801,分量表的重测信度在0.506～0.769之间。各分量表与总量表之间的相关系数在0.504～0.769之间,各分量表之间的相关系数在0.251～0.442之间。2) RYDM:总量表的Cronbach’sα系数为0.949,外部因素的4个维度与内部因素的6个维度的Cronbach’sα系数在0.524～0.874之间；总量表的斯皮尔曼分半系数为0.869,分量表的斯皮尔曼分半信度在0.512-0.799之间；总量表的重测信度为0.832,分量表的重测信度在0.504-0.771之间。各分量表与总量表之间的相关系数在0.584-0.836之间,各分量表之间的相关系数在0.314-0.696之间。结论：MHT和RYDMF信效度良好,可作为三峡库区农村儿童心理健康和心理弹性研究的有效工具。第三部分三峡库区农村留守儿童心理健康与心理弹性现状及影响因素分析目的：了解三峡库区农村留守儿童的心理健康和心理弹性的现状、人口社会学特征和留守情况；分析心理健康和心理弹性各自的影响因素,二者之间的相关性及心理弹性对心理健康的预测作用。方法：采用多阶段整群随机抽样的方法,在重庆市三峡库区云阳县的三个乡镇中学的初一和高一年级各随机抽取若干个整班做为调查单位。采用自编基本情况问卷、MHT和RYDM对选取班级的所有儿童进行问卷调查,将各班中的非留守儿童作为对照,共包括1562人。采用Epidata3.0建立数据库,双人双录入回收的有效问卷；使用SPSS17.0软件进行统计分析,主要采用的分析方法包括卡方检验、两独立样本t检验、多元线性回归、单因素和多因素Logistic回归分析等。结果：最终纳入分析的有效问卷包括留守儿童的1000份,非留守儿童的502份。1)留守儿童的心理问题阳性检出率是11.5%,各维度阳性检出率从高到低依次是学习焦虑、过敏倾向、身体症状、自责倾向、恐怖倾向、对人焦虑、孤独倾向和冲动倾向。留守儿童的心理健康总均分为38.64±13.27,与非留守儿童没有统计学差异(p>0.05)；具体维度上,留守儿童在对人焦虑和孤独倾向上的得分显著高于非留守儿童(p<0.05),在其它维度上二者没有统计学差异(p>0.05)。留守儿童的心理弹性总均分为2.89±0.42,显著低于非留守儿童(p<0.05)；具体维度上,留守儿童在学校积极参与、同伴亲密关系、社区积极参与、合作与沟通和问题解决上的得分显著低于非留守儿童(p<0.05)2)留守儿童心理健康的影响因素包括性别、家庭经济水平、父母外出打工对性格的影响程度；心理弹性的影响因素包括年级、与监护人的矛盾处理方式(与监护人有矛盾时采用不吭声的方式处理、与监护人有矛盾时采用激烈的方式处理)和对父母外出打工的态度。留守儿童的心理健康总均分除与同伴高期望值、家庭高期望值和自我效能感无显著相关性外,与心理弹性总均分及其它各维度得分均呈显著负相关的关系。心理弹性总均分对心理健康有显著的预测作用；在具体维度上,心理弹性中的学校积极参与、学校附加因子、同伴高期望值、自我效能感、同理、问题解决和自我觉察对心理健康有一定的预测作用。结论：三峡库区农村留守儿童的心理健康与非留守儿童不存在显著差异,但是心理弹性比非留守儿童差。在人口社会学和留守经历方面,留守儿童心理健康和心理弹性的影响因素包括：性别、年级等个体因素；与监护人的矛盾、家庭收入、父母外出打工的影响等家庭因素。心理弹性及部分维度与心理健康有一定的相关性,且能够在一定程度上预测心理健康。更多还原

【Abstract】 Part Ⅰ Mental resilience among Chinese children:a systematic reviewObjective:To do a systematic review on the mental resilience of Chinese children to know its status as well as the status of the studies in the field.Methods:Four electronic databases (CBM, VIP, CNKI and WF) were searched to February2013. References of included studies were reviewed for missing information. Studies that reported the results of mental resilience status of Chinese children were included. Two reviewers independently screened and extracted data and relevant information. Disagreements were resolved by discussion. A third party was involved when necessary. Statistical formula was used to synthesize means and standard deviations of each study to calculate a total score; meta-analysis was conducted using Review Manager software for comparison between different groups; and qualitative method was used to summarize the information not suitable for quantitative synthesis.Results:Of the1028papers,79papers including77studies were included for the final analysis. The target population were common students in middle school, children in kindergarten, left-behind children, street children, HIV-infected children, offspring of drug addicts, and children with nanism or epilepsy in24provinces/municipality/autonomous region. A total of24questionnaires were used, among which the Resilience Scale for Chinese Adolescents was most popular. Quantitative synthesis results showed that the mental resilience of Chinese children was modest, not high or not low. There were meta-analysis for4scales. Meta-analysis results of RSCA and ER89showed that girls’total resilience score were significantly higher than that of boys’while results of HKRA showed the opposite results. Meta-analysis results of RSCA showed that total resilience score of students in Grade7was higher than that in Grade8while results of ER89showed the opposite results. Besides gender and grade, the included studies also compared resilience among different groups, such as different rural/urban, minority, providence, number of brothers or sisters, addiction to internet, influence of HIV, education background of parents, family income, divorce of parents, temperament, communication skill, physical exercise, whether left-behind, disaster severity and so on.Conclusion:The resilience of Chinese children is modest with differences among different groups. There are difference between synthesis results of different scales. The number of studies has been increasing sharply in the last five years. The most studied subjects are students in primary or middle schools. Compared with questionnaires that proposed and revised by researchers themselves, the ones that have been modified and revised by other experts or scholars in China before are used more often. The questionnaires are various with different standard without clear description in the papers, which is a barrier for other scholars to apply the results. Part II Reliability and validity of Mental Health Test and Resilience Youth Development Module among children in rural Three Gorges AreaObjective:To analyze the reliability and validity of two scales, Mental Health Test and Resilience Youth Development Module, among children in rural Three Gorges Area.Methods:Using the multistage clustering sampling method,964students from Grade7to12in two middle schools in two towns were selected and investigated using the Mental Health Test and Resilience Youth Development Module.218of them were re-investigated after half a month. The software of Epidata3.0and SPSS17.0were used for data management and analysis. The reliability analyzed included the Cronbach alpha coefficient, Spearman Brown Split-half coefficient and test-retest coefficient and the validity analyzed was the criterion-related validity.Results:A total of922and214valid questionnaires were included for the final analysis. The reliability and validity of the two scales were as the following:1) Mental Health Test:The Cronbach’s a of the total scale was0.897and that of the sub scales were between0.520and0.788. The split-half coefficient of the total scale was0.834and that of the sub scales were between0.506and0.769. The test-retest coefficient of the total scale was0.801and that of the sub scales were between0.500and0.791. The correlations between the total scale and sub-scales were between0.504and0.769. The correlation between the sub scales were between0.251and0.442.2) The Cronbach’s α of the total scale was0.949and that of the sub scales were between0.524and0.874. The split-half coefficient of the total scale was0.869and that of the sub scales were between0.512and0.799. The test-retest coefficient of the total scale was0.832and that of the sub scales were between0.504and0.771. The correlations between the total scale and sub-scales were between0.584and0.836. The correlation between the sub scales were between0.314and0.696.Conclusion:Reliability and validity of the two scales are psychometrically qualified. They are suitable tool for analyzing the mental health and mental resilience among children in rural Three Gorges Area. Part III Mental health and resilience among children in rural Three Gorges AreaObjective:1) To know the mental health and mental resilience status of the left-behind children in rural Three Gorges Area as well as their sociology and left-behind information.2) To analyze protective and risk factors of mental health and resilience, the relationships between them and the prediction of resilience to mental health.Methods:Using the multistage clustering sampling method,1000left-behind children and non-left-behind children from Grade7and Grade10in three middle schools in three towns were selected and investigated using the Mental Health Test and Resilience Youth Development Module. The information of the questionnaires was double-entered into the software of Epidata3.0and SPSS17.0was used to analyze the data. The main statistical methods used were chi-square test, independent-samples T test, multiple linear regression, uni-variable logistic regression and multi-variable logistic regression.Results:The detection rate of mental problem among the left-behind children was11.5%. The detection rates of the sub scales were listed from the highest one to the smallest as the following:learning anxiety, superresponse tendency, physical symptom, self-accusation tendency, fear tendency, anxiety with people, loneliness tendency and impulse tendency. The total score of the Mental Health Test was38.64±13.27and there was no significant difference between left-behind children and non-left-behind children (p>0.05). For sub scales, the scores of anxiety with people and loneliness tendency among the left-behind children were significantly higher than that of the non-left-behind children (p<0.05). The total score of mental resilience among the left-behind children was2.89±0.42, which was significantly lower than that of the non-left-behind children (p<0.05). For sub scales, the scores of the school meaningful participation, peer caring relationship, community meaningful participation, cooperation and communication and problem solving were significantly lower than that of the non-left-behind children (p<0.05). The impact factors of mental health among the left-behind children were gender, family income, impact of parents’working out on personality while the factors for mental resilience were grade at school, reaction to conflict with the guardian (keep quiet; extreme reaction such as quarrel) and support for parents’working out. Except for the peer high expectation, family high expectation and self-self-efficacy, there was obvious negative relationship between the scores of other sub scales and the total score of resilience and the total score of mental health. The score of the mental resilience could predict the score of mental health. For the sub scale of the mental resilience, the predictive factors included the add school connectedness scale, school meaningful participation, peer high expectation, self-efficacy, empathy, problem-solving and self-awareness.Conclusion:There is no difference in mental health between left-behind and non-left-behind children. But they are different in some specific aspect. The mental resilience of the left-behind children is lower than that of the non-left-behind children. The factors of sociology and left-behind information that influence the mental health and resilience include gender, grade, conflict with guardians, reaction to conflict, family income and impact of parents’ working out. There is obvious relationship between resilience and mental health. Resilience as well as some of its specific aspects are the predictive factors for mental health.更多还原