【作者】 李雷雷；

【导师】 汪洋；

【作者基本信息】 重庆医科大学 ， 临床检验诊断学， 2010， 博士

【摘要】 目的首先对《青少年亚健康多维评定问卷》(MSQA)进行考评,了解重庆市中学生亚健康状况及其影响因素;探讨重庆市中学生亚健康与烟酒使用、自杀心理行为及网络成瘾行为的相关性;评价中学生亚健康对3个月内烟酒使用、自杀心理行为及网络成瘾行为的预测作用。方法采用分层整群随机抽样的方法,首先从重庆市两个区(县)分层选取城、乡中学各2所作为初级抽样单位;每所中学随机抽取初一、初二、初三、高一、高二、高三各4~5个班,作为次级抽样单位;每个班的全体同学作为最小抽样单位,共3100名中学生作为研究对象,进行问卷调查。调查内容主要包括中学生基本情况、《青少年亚健康多维评定问卷》、最近一个月烟酒使用情况、1年内自杀心理行为及网络使用情况,并在此基础上对1548名中学生随访3个月,重新进行问卷调查,纳入统计问卷共1310份。随访内容主要包括3个月内烟酒使用情况、3个月内自杀心理行为及3个月内网络使用情况。使用SPSS13.0统计软件进行统计分析,采用t检验、χ2检验、相关分析、Logistic回归进行统计分析。结果MSQA问卷各维度间的相关系数为0.403-0.908(P<0.01),各维度与问卷总分的相关系数为0.450-0.952(P<0.01);SCL-90问卷精神症状部分总得分与MSQA心理亚健康领域问卷总得分的相关系数为0.766(P<0.01),SCL-90问卷精神症状部分的各因子得分与MSQA心理亚健康领域各个维度得分的相关系数范围为0.442-0.765(P<0.01);CMI问卷躯体症状部分总得分与MSQA躯体亚健康领域总得分的相关系数为0.575(P<0.01),CMI问卷躯体症状各部分得分与MSQA躯体亚健康领域各维度得分的相关系数范围为从0.236-0.575(P<0.01);MSQA总问卷、躯体亚健康领域、心理亚健康领域及各维度的重测信度系数分别为0.941、0.926、0.901、0.838、0.822、0.831、0.923、0.913、0.934(P<0.01);MSQA总问卷的Cronbach’sа系数为0.961,分半信度系数为0.938,躯体亚健康领域、心理亚健康领域及各维度的Cronbach’sа系数范围在0.711-0.921,而分半信度系数在0.697-0.915。重庆市中学生身心亚健康的得分为392.20±36.44,其中躯体亚健康得分为181.53±13.53,心理亚健康得分为210.67±26.16。身心亚健康症状检出率为56.9%,其中躯体亚健康症状检出率为36.4%,心理亚健康症状检出率为48.9%;身心亚健康状态检出率为14.4%,其中躯体亚健康状态检出率为14.0%,心理亚健康状态人数检出率为15.5%。总体上来看,重庆市中学男生身心亚健康评分要高于女生(P<0.05),而初中生身心亚健康评分要高于高中生(P<0.05),而城乡中学生之间没有差别(P>0.05)。躯体亚健康方面,男生躯体亚健康评分高于女生(P<0.05);不同年级之间初中生躯体亚健康评分高于高中生,但只有躯体活力不足方面有统计学意义(P<0.05);城乡中学生间均无差异(P>0.05)。心理亚健康方面,男生心理亚健康评分高于女生,差异具有统计学意义(P<0.05);初中心理亚健康评分高于高中生,但品行问题方面无统计学意义(P>0.05);城乡中学生间均无差异(P>0.05)。不同性别在身心亚健康、躯体亚健康及心理亚健康症状检出率上无差异(P>0.05),但女生的亚健康状态检出率要高于男生(P<0.05);城乡中学生的亚健康症状与状态检出率均未发现差异(P>0.05);高中生亚健康、躯体亚健康及心理亚健康的症状与状态检出率要高于初中生,差异具有统计学意义(P<0.05)。单因素logisitic回归分析发现,性别、年龄、体重、BMI指数、家庭所在地、学习负担、大强度运动、小强度运动、吸烟史、饮酒史、人际交往、自评经济水平、睡眠时间、身体发育状况、年级,其亚健康(症状或状态)发生不同,具有统计学意义(P<0.05)。多因素非条件Logistic回归分析得到有统计学意义的相关因素,主要有性别、年龄、家庭所在地、学习负担、大强度运动、吸烟史、饮酒史、人际交往、睡眠时间与自评体型。最近1个月,重庆市中学生吸烟、饮酒及醉酒的检出率分别为10.4%、15.7%、2.3%。男生各组检出率明显要高于女生(P<0.01)。未发现城乡中学生的烟酒检出率有差异(P>0.05)。高中学生的吸烟、饮酒及醉酒检出率要明显高于初中学生(P<0.01)。最近一年来,重庆市中学生自杀意念、自杀计划及自杀未遂的检出率分别为15.7%、8.4%、3.6%。女生各种自杀心理行为的检出率均高于男生(P<0.05)。城乡中学生的自杀心理行为检出率未见统计学差异(P>0.05)。初中生的自杀心理行为的检出率要高于高中生的检出率(P<0.05)。重庆市中学生网络成瘾的检出率为23.3%。男生的网络成瘾检出率要高于女生(P<0.01)。城区中学生网络成瘾检出率要高于乡镇中学生(P<0.05)。高中生的网络成瘾检出率要高于初中生(P<0.01)。最近1个月,重庆市中学女生吸烟、饮酒的检出率随着躯体亚健康症状数的增加而增加(P<0.01),而女生醉酒方面和男生吸烟、饮酒及醉酒方面并未发现此趋势(P>0.05)。中学生吸烟与饮酒的检出率都随着心理亚健康症状的增加而增加(P<0.01),但在醉酒方面未发现此趋势(P>0.05)。全体中学生吸烟与饮酒的检出率都随着身心亚健康症状的增加而增加(P<0.01),但在醉酒方面未发现此趋势(P>0.05)。中学生的自杀意念、自杀计划及自杀未遂的检出率随着躯体亚健康、心理亚健康及身心亚健康症状数的增加而增加(P<0.01)。中学生网络成瘾检出率随着躯体亚健康、心理亚健康及身心亚健康症状数的增加而增加(P<0.01)。中学生的网络成瘾分与躯体亚健康、心理亚健康及身心亚健康评分之间存在着相关(P<0.01)。随访3个月后,重庆市中学生吸烟、饮酒及醉酒的检出率分别为7.6%、20.6%、3.4%。男生烟酒使用的检出率要明显高于女生(P<0.01)。城乡中学生的烟酒使用检出率未发现差别(P>0.05)。高中生的吸烟与饮酒的检出率要高于初中生(P<0.01),而醉酒方面未发现差异(P>0.05)。重庆市中学生的自杀意念、自杀计划及自杀未遂的检出率分别为7.2%、3.5%、2.4%。女生在自杀意念与自杀未遂方面的检出率要高于男生(P<0.01),但在自杀计划的检出率方面未发现差异(P>0.05)。城区中学生自杀心理行为的检出率高于乡镇(P<0.01)。初中生的自杀心理行为的检出率要高于高中生(P<0.01)。重庆市中学生网络成瘾的检出率为19.1%,男生的网络成瘾检出率要高于女生(P<0.01)。城区中学生网络成瘾检出率要高于乡镇中学生(P<0.01)。高中生与初中生的网络成瘾检出率的差异无统计学意义(P>0.05)。随访3个月后,男生醉酒的检出率随着躯体亚健康症状数的增加而增加(P<0.01),中学生及女生饮酒的检出率随着躯体亚健康症状数的增加而增加(P<0.01)。中学生的吸烟、饮酒及醉酒的检出率都随着心理亚健康症状的增加而增加(P<0.01)。除了男生吸烟与饮酒外,中学生吸烟、饮酒及醉酒的检出率都随着身心亚健康症状的增加而增加(P<0.01)。除了女生的自杀未遂检出率外,中学生的自杀意念、自杀计划及自杀未遂的检出率都随着躯体亚健康症状数的增加而增加(P<0.01)。中学生自杀意念、自杀计划及自杀未遂的检出率都随着心理亚健康及身心亚健康症状数的增加而增加(P<0.01)。中学生网络成瘾检出率都随着躯体亚健康、心理亚健康及身心亚健康症状数的增加而增加(P<0.01)。中学生的网络成瘾评分与躯体亚健康、心理亚健康及身心亚健康评分之间存在着相关(P<0.01)。MSQA问卷具有较好的效标效度与结构效度,重测信度比较高,具有良好的内部一致性,是较好的适合重庆市中学生亚健康测评的工具。重庆市中学生亚健康症状与状态的检出率较高,其在不同性别,城乡及年级间存在不同程度的差异。中学生亚健康受自身因素、家庭因素、学校因素及其他等多种因素影响,因此要从多个方面对中学生进行健康教育与心理疏导。中学生亚健康以及烟酒使用、自杀心理行为网络成瘾等问题在重庆市中学生中十分常见,中学生亚健康与上述健康危险行为间存在统计学关联,随访3个月后发现,亚健康对中学生烟酒使用、自杀心理行为及网络成瘾问题具有较好的预测作用。早期筛查中学生亚健康状况,为健康促进干预寻求合适机会,将对中学生身心健康的改善产生积极影响。更多还原

【Abstract】 ObjectiveTo evaluate the use of Multidimensional Sub-health Questionnaire of Adolescents (MSQA) in Chongqing middle school students, to investigate the status and influencing factors of sub-health, to find the relationship between sub-health of middle school students and health risk behaviors of tobacco and alcohol abuse, suicidal behavior and psychological behavior, and internet addiction, and to evaluate the predictive value of sub-health of middle school students for tobacco and alcohol abuse, suicidal behavior and psychological behavior and internet addiction within 3 months.MethodA stratified cluster random sampling method was used. Firstly, two urban and rural middle schools were selected from two districts of Chongqing as the primary unit, then, 4-5 classes were selected randomly from every school as the second unit, at last, all the students in every class as our the least unit. Finally, a total of 3100 students were selected as our study subjects to conduct a questionnaire survey. The survey included basic information of students, MSQA, tobacco and alcohol abuse within one month, suicidal psychology and behaviors within one year and internet addiction behaviors. After that, 1548 students were followed up for 3 months, and 1310 questionnaires were analyzed. Then, tobacco and alcohol abuse within three month, suicidal psychology and behaviors within three month and internet addiction behaviors within three month were investigated. SPSS 13.0 statistical software was used for analysis by using t test, x2 test, Pearson correlation and logistic regression analysis.ResultsThe correlation coefficients among the various dimensions of MSQA questionnaire were 0.403-0.908 (P<0.01), and the correlation coefficients between the dimensions scores and the total scores of MSQA were 0.450-0.952 (P<0.01). The correlation coefficient between the scores of psychiatric part of SCL-90 and the scores of mental sub-health domain was 0.766 (P<0.01), the range of correlation coefficients between psychiatric part of SCL-90 questionnaire and each dimensions of MSQA was 0.442-0.765 (P<0.01). The correlation coefficient between the scores of physical part of CMI and the score of somatic sub-health domain was 0.575 (P<0.01), the range of correlation coefficients between physical part of CMI questionnaire and each dimension of MSQA was 0.236-0.575(P<0.01). The retest reliability coefficients of whole questionnaire, somatic sub-health domain, mental sub-health domain and each dimension were 0.941,0.926, 0.901, 0.838, 0.822, 0.831, 0.923, 0.913, 0.934 (P<0.01). The Cronbach’sαcoefficient of MSQA was 0.961, split-half reliability coefficient was 0.938, the Cronbach’sαcoefficients of each dimensions and each domains of MSQA were 0.711-0.921, while split-half reliability coefficient were 0.697-0.915.The score of total Sub-health in Chongqing middle school students was 392.20±36.44, in which the somatic sub-health score was 181.53±13.53, mental sub-health score was 210.67±26.16. The detection rate of sub-health symptoms was 56.9%, of which somatic symptoms of sub-health was 36.4%, psychological symptoms of sub-health was 48.9%. The detection rate of sub-health state was 14.4%, of which the somatic sub-health state detection rate was 14.0%, and the mental sub-health detection rate of 15.5%. Overall, boys got higher score than girls on sub-health (P<0.05), while the junior high school students score higher than high school students on sub-health (P<0.05), however, there is no difference between urban and rural middle school students (P>0.05). For somatic sub-health, the boys’score was higher than girls’(P<0.05), the junior high school students’score was higher than high school students’on sub-health (P<0.05), but there was a statistically significance only in the dimension of the lack of physical activity (P<0.05). There is no difference between urban and rural middle school students (P>0.05). For mental sub-health, the boys’score was higher than girls (P<0.05), the junior high school students’score was higher than high school students’on sub-health (P<0.05), but there was a statistically significance only in the dimension of conduct problem (P<0.05). There was no difference between urban and rural middle school students (P>0.05). There was no difference in detection rate of sub-health symptoms between different gender (P>0.05), but the detection rate of sub-health state in girls was higher than in boys (P<0.05). The detection rate of sub-health symptoms and state in high school was higher than junior high school students, the difference is statistically significance (P<0.05). There was no difference in detection rate of sub-health symptoms between urban and rural school students (P>0.05).Sex, age, weight, BMI index, home location, learning burden, high-intensity exercise, low-intensity exercise, smoking, alcohol abuse, interpersonal relationships, self-assessment economic level, sleeping time, self-assessment body style, physical development status, grade were found difference in sub-health (symptom or state) by using univariate logistic regression analysis(P<0.05). Multivariate non-conditional logistic regression analysis found relevant factors which were statistically significant, which were sex, age, home location, learning burden, high-intensity exercise, smoking history, alcohol abuse, interpersonal relationships, sleeping time, self-assessment body style and grade.Last 1 month, the detection rate of smoking and drinking and drunkenness in Middle School Students of Chongqing was 10.4%, 15.7%, 2.3%, and the rate for boys was significantly higher than girls (P<0.01). There was no difference for the rate between urban and rural school students (P>0.05). The detection rate for high school students was significantly higher than junior high school students (P<0.01). Last 1 year, the detection rates of suicidal ideation, suicide plans and suicide attempts in middle school students of Chongqing were 15.7%, 8.4%, 3.6%. The rate for girls was higher than boys (P<0.05). There was no difference for the rate between urban and rural school students (P>0.05). Junior high school is higher than the high school students (P<0.05). The detection rate of internet addiction for middle school students of Chongqing was 23.3%. The detection rate of addiction for boys was higher than girls (P<0.01). There was no difference for the rate between urban and rural school students (P>0.05), but score of internet addiction for the urban middle school students was higher than rural school students (P<0.05). The detection rate in internet addiction of high school students was higher than junior high school students (P<0.01).Last 1 month, the detection rate of smoking, alcohol abuse for girls was increased with the number of somatic sub-health symptoms increased (P<0.01), but there was no the trend in drunkenness for girls and in smoking, alcohol abuse and drunkenness for boys (P>0.05). The detection rate of smoking, alcohol abuse for middle school students was increased with the number of mental sub-health symptoms increased (P<0.01), but there was no the trend in drunkenness (P>0.05). The detection rate of suicidal ideation, suicide plans and suicide attempts was increased with the number of somatic sub-health symptoms, mental sub-health symptoms and sub-health symptoms increased (P<0.01), while the detection rate of internet addiction had the same trend for middle school students (P<0.01), and there was a correlation the score of internet addiction and the score of somatic sub-health, mental sub-health and total sub-health (P<0.01).Within 3 months, the detection rate of smoking, alcohol abuse and drunkenness in middle school students of Chongqing was 7.6%, 20.6%, 3.4%, and the rate for boys was significantly higher than girls (P<0.01). There was no difference for the rate between urban and rural school students (P>0.05). The detection rate for high school students was significantly higher than junior high school students (P<0.01), except in drunkenness (P>0.05). The detection rates of suicidal ideation, suicide plans and suicide attempts in middle school students of Chongqing were 7.2%, 3.5%, 2.4%. The rate for girls was higher than boys (P<0.05), except in suicide plans (P>0.05). The detection rate for urban school students was higher than rural school students (P<0.05). Junior high school was higher than the high school students (P<0.05). The detection rate of internet addiction for middle school students of Chongqing was 19.1%. The detection rate of addiction for boys was higher than girls (P<0.01). The detection rate of addiction for urban school students was higher than rural students (P<0.01), and the same as the score for urban and rural students (P<0.01). There was no difference in the detection rate in internet addiction between high school students and junior high school students (P>0.05).Within 3 months, the detection rate of alcohol abuse for all the students and girls and drunkenness for boys was increased with the number of somatic sub-health symptoms increased (P<0.01). The detection rate of smoking, alcohol abuse and drunkenness for middle school students was increased with the number of mental sub-health symptoms increased (P<0.01). The detection rate of smoking, alcohol abuse and drunkenness for middle school students was increased with the number of mental sub-health symptoms increased (P<0.01), except for the rate of smoking and alcohol abuse for boys (P>0.05). Except for the detection rate of suicide attempts for girls, the detection rate of suicidal ideation, suicide plans and suicide attempts was increased with the number of somatic sub-health symptoms, mental sub-health symptoms and sub-health symptoms increased (P<0.01), while the detection rate of internet addiction had the same trend for middle school students (P<0.01), and there was a correlation the score of internet addiction and the score of somatic sub-health, mental sub-health and sub-health (P<0.01).ConclusionWith good criterion validity and construct validity, high test-retest reliability, and well internal consistency, MSQA questionnaire was better suited to evaluate the sub-health status of middle school students in Chongqing .The detection rate of sub-health symptoms and status of Middle school students in Chongqing City detection was a little bit high. There were difference in gender, urban and rural school and different grade with different degrees. The sub-health of middle school students was influenced by their own sub-health factors, family factors, school factors and other factors, therefore, health education and psychological counseling for middle school should be conducted from different aspects.Sub-health, alcohol and tobacco abuse, suicide, internet addiction and other psychological and behavioral problems was very common in middle school. There was a statistically correlation between sub-health of students and tobacco and alcohol abuse, suicide and internet addiction, and sub-health was a better predictive value for tobacco and alcohol abuse, suicide and internet addiction within 3 months. Early screening for sub-health status of middle school students was a right opportunity for health-promoting interventions, which would have a positive impact on the improvement of mental and physical health of middle school students.更多还原