中学生抑郁症状的影响因素分析

目的 探讨中学生出现抑郁症状的影响因素，建立风险预测的列线图模型，为防控中学生抑郁提供理论依据。方法 采用分层整群抽样的方法，抽取大连市城市和农村中学生共3 470名，使用学生健康行为调查表及抑郁量表进行问卷调查；采用多因素logistic回归分析抑郁症状的影响因素，并建立列线图，预测中学生出现抑郁症状的风险。 结果 中学生的抑郁症状检出率为24.12%，肯定有抑郁症状的检出率为16.22%。遭受校园欺凌（OR = 2.748，95%CI:2.257～3.346）、被家长打骂（OR = 2.025，95%CI:1.679～2.433）、学段（职高:OR = 1.883，95%CI:1.286～2.758；高中:OR = 1.242，95%CI:1.001～1.541）、上网时间越长（≥3 h:OR = 1.773，95%CI:1.366～2.302；2～＜3 h:OR = 1.525，95%CI:1.190～1.954）、女生（OR = 1.352，95%CI:1.141～1.603）、农村地区（OR = 1.351，95%CI:1.126～1.622）均是中学生抑郁症状检出的危险因素；体育课时数多（2 节:OR = 0.685，95%CI:0.504～0.931；≥3 节:OR = 0.583，95%CI:0.425～0.799）、睡眠时间充足（OR = 0.676，95%CI:0.562～0.812）都是中学生抑郁症状检出的保护因素；基于以上影响因素建立的列线图模型具有较好的区分度（一致性指数C - index = 0.700，95%CI:0.680～0.721）和准确度（Hosmer - Lemeshow检验χ2 = 2.885，P = 0.941）。 结论 遭受校园欺凌、被家长打骂、职高或高中、上网时间越长、女生、来自农村地区、体育课时数少、睡眠时间不足的中学生更容易出现抑郁症状，可以利用列线图直观、有效地预测中学生出现抑郁症状的风险，从而有针对性地对高危群体及时采取干预措施。

Analysis of influencing factors of depressive symptoms among middle school students

Objective To explore the influencing factors of depressive symptoms, and to establish a risk prediction model for visual analysis, so as to provide a theoretical basis for preventing and intervening the occurrence and development of depressive symptoms in middle school students. Methods A total of 3 470 middle school students from urban and suburban areas of Dalian city were selected by stratified cluster sampling method. The students’ health behavior questionnaire and Depression Scale were used for questionnaire survey. The influencing factors of depressive symptoms were analyzed by multivariate logistic regression, and the risk prediction of depressive symptoms was established by using nomogram. Results The detection rate of depressive symptoms was 24.12% and the detection rate of identifying depressive symptoms was 16.22%. Being bullied on campus (OR=2.748, 95%CI: 2.257-3.346), being beaten and scolded by parents (OR=2.025, 95%CI: 1.679-2.433), schooling terms (professional high school: OR=1.883, 95%CI: 1.286-2.758; senior middle school: OR=1.242, 95%CI: 1.001-1.541), online time (≥3 h: OR=1.773, 95%CI: 1.366-2.302; 2 to 3 hours: OR=1.525, 95%CI: 1.190-1.954), girls (OR=1.352, 95%CI: 1.141-1.603) and rural areas (OR=1.351, 95%CI: 1.126-1.622) were all risk factors for depressive symptoms in middle school students. The protective factors of depressive symptoms in middle school students were the number of physical education class (2 sessions: OR=0.685, 95%CI: 0.504-0.931; ≥3 sessions: OR=0.583, 95%CI: 0.425-0.799) and sufficient sleep time (OR=0.676, 95%CI:0.562-0.812). Based on these influencing factors, a risk predictive nomogram model was constructed and it had a better discrimination (C-index=0.700, 95%CI: 0.680-0.721) and accuracy (Hosmer-Lemeshow test:χ2=2.885, P=0.941). Conclusion Middle school students who suffer from campus bullying, being beaten and scolded by their parents, at professional high school or senior middle school, having longer online time, girls, in rural areas, with less physical education classes and insufficient sleep time are more likely to have depressive symptoms. The nomogram can be used to directly and effectively predict the risk of depressive symptoms among middle school students in Dalian, and targeted intervention measures should be taken for high-risk groups.