湖北省部分城市及农村青少年1 498名心理相关问题抽样调查

背景青少年心理健康问题发生率越来越高,逐渐成为其健康成长的重要影响因素.目的调查湖北省部分城市及农村青少年心理健康水平,分析其影响因素.设计整群分层随机抽样,横断面调查.单位华中科技大学同济医学院儿少卫生与妇幼保健学系.对象于2003-03/06依据全国学生体质健康监测所选用的调查点,采取整群分层随机抽样法选取具有代表性的湖北省城市(武汉市、黄石市)和乡村(郧县、仙桃市、孝感市)16～18岁青少年1 498人进行调查.城市组605人,农村组893人.方法采用自制调查表进行一般情况调查,内容包括学生年龄、父母职业、父母文化程度、家庭类型、社会风气、学校类型及风气、人际关系;采用症状自评量表调查学生心理健康状况,以躯体化、强迫症状、人际关系、抑郁、焦虑、敌对、恐怖、偏执、精神病性9个因子作为观察指标,采用5级评分法,凡某一因子分≥3,或总分≥160分则判定为有心理卫生问题.采用父母教育方式问卷调查家庭教育方式,内容包括积极的教育方式(情感温暖、理解)和消极的教育方式(惩罚、严厉,过分干涉,偏爱,拒绝、否认,过度保护);采用家庭环境量表调查家庭环境情况,选用其中具有较高信度和效度的四个分量表(亲密度、矛盾性、知识性、娱乐性)作为指标.使用匿名问卷法,由统一培训的专职调查人员按统一指导语讲解填写要求,以指导学生填表.表格由班主任收集后上交调查组.观察城乡青少年症状自评量表得分情况,以及其与家庭一般情况、父母教育方式、家庭环境质量的相关关系,并以症状自评量表总分为因变量进行相关因素的逐步回归分析.主要观察指标①湖北省部分城市及农村青少年心理卫生问题发生率及其性别,地区差异.②青少年症状自评男表评分及与全国常模分值比较.③症状自评量表总分与家庭一般情况,父母教育方式的相关分析.结果①湖北省1 498名青少年心理卫生问题发生率总发生率为18.13%.男少年为18.20%,女少年为18.04%,男女差别无统计学意义(P＞0.05).农村明显高于城市为23.74%(212/893),16.69%(101/605),P＜0.05];在心理卫生问题中,以强迫、人际关系敏感、敌对、偏执和抑郁较多见.②与全国常模分值比较湖北省青少年症状自评量表各因子分、家庭环境质量各因子分明显低于全国常模水平.③单因素分析青少年症状自评量表总分与年龄、性别、父母文化、父母期望、学校风气等有明显的相关性(P均＞0.01);与积极的教育方式(情感温暖、理解)呈负相关,(P均＞0.01);与消极的教育方式(惩罚、严厉、过分干涉、偏爱及拒绝、否认等)呈正相关;与矛盾性呈明显的正相关,与亲密性、知识性、娱乐性呈明显的负相关,(P均＞0.01).⑥多因素分析学生心理卫生状况与年龄、性别、父母文化、父母对子女的期望、人际关系以及学校风气、父母教育方式、家庭环境质量均有密切的关系.结论湖北省部分城市及农村青少年心理卫生问题发生率较高,症状自评量表各因子评分均高于全国常模,心理健康水平较差.除与家庭诸因素中年龄、性别、父母文化、父母期望、学校风气等有明显的相关性外,家庭环境质量、父母教育方式是影响其心理健康成长的主要因素.

Sampling investigation into the problems related to mental health in 1 498 adolescents in some cities and rural areas in Hubei province

BACKGROUND: The incidence of mental problems in adolescents is increasingly higher and has gradually become an important factor affecting their health and growth.OBJECTIVE: To probe into the mental health status and its influencing factors in adolescents in some cities and rural areas in Hubei Province.DESIGN: Clustering stratified random sampling, cross-sectional survey.SETTING: Department of Maternal, Child and Adolescent Health, Tongji Medical College, Huazhong University of Science and Technology.PARTICIPANTS: According to the selected investigation spots of National Surveillance of Constitution and Health of Students, we selected representative urban areas (Wuhan City and Huangshi City) and rural areas (Yun County, Xiantao City, and Xiaogan City) in Hubei Province as sample spots. Totally 1 498 adolescents, aged 16-18 years, were surveyed by clustering stratified random sampling. There were 605 adolescents in urban group and 893 in rural group.METHODS: The self-made survey scale was used to investigate general conditions, such as age, parents' occupation and educational level, family type, social atmosphere, school type and atmosphere, and interpersonal relationship. Symptom Checklist-90 (SCL-90) was used to determine the adolescents' mentalhealth status; 9 subscales (somatization, obsessivecompulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychosis) were set as the observation indexes. SCL-90 is an inventory which is rated on a 5-point scale. Factor score of SCL-90 ≥ 3 or total score ≥ 160 was considered mental disorders. The family educational pattern was investigated through Egma Minnen av Bardndosnaupporstran(EMBU) by questionnaires. It contained positive rearing pattern and negative rearing pattern. Positive rearing pattern (namely, affectional warmth and understanding) contributes to mental health, while negative rearing pattern (e.g. punishment, firm control, excessive interference, partialism or rejection, denial and excessive protection) is adverse to mental health. The family environment was investigated with Family Environment Scale(FES). Four subscales (intimacy, conflict, intellectual-cultural orientation, and positive-recreational orientation) with high reliability and validity were set as indexes. All participants were given unified instructions and required to fill in anonymous questionnaires. The questionnaires were then collected by the teacher in charge of the class.Some indexes of adolescents in the urban and rural areas were observed including the score of SCL-90 and its relation with general conditions,parental rearing pattern and family environment quality. The total scores of symptom checklist 90 were set as dependent variables for stepwise regression analysis of related factors.MAIN OUTCOME MEASURES:①The incidence of mental health ,gender and regional difference of adolescents in some cities and rural areas in Hubei province; ②The score of SCL-90 and its comparison with national norm;③Correlation analysis of the total scores of SCL-90 with general condition and parents' educational type.RESULTS: ① The general incidence of mental disorders was 18.13 ％ in the 1 498 adolescents in Hubei province. It was 18.20% in boys and 18.04% in girls with no significant difference (P ＞ 0.05). Regional differences: The incidence in rural areas 23.74% (212/893)] was significantly higher than that in urban areas 16.69% (101/605), P ＜ 0.05]. Among all kinds of mental disorders, compulsion, interpersonal sensitivity, hostility,paranoid ideation, and depression were more common. ② Comparison with the national norm: The factor scores of SCL-90 and family environmentalquality were significantly lower that those of the national norm.③ Single factor analysis: The total score of SCL-90 was obviously correlated with age, gender, parents' educational level and expectation, and school atmosphere (P ＞ 0.01). It was negatively correlated with positive rearing pattern (affectional warm, understanding) (P ＞ 0.01), but positively correlated with negative rearing pattern (punishment, firm control, excessive interference,partialism or rejection, and denial). It had significant positive correlation with conflict and significant negative correlation with intimacy, intellectualcultural orientation and positive-recreational orientation (P ＞ 0.01). ④Multiple factor analysis: The mental health status of the students was closely related to age, gender, parents' educational level and expectation, interpersonal sensitivity as well as school atmosphere, parental rearing pattern,and quality of family environment.CONCLUSION: The incidence of mental problems in adolescents in some urban and rural areas in Hubei Province is relatively high. Score factors of SCL-90 are all higher than those of the national norm and the mental health level is poor. This has obvious correlation with family factors including age, gender, parents' educational level and expectation, and school atmosphere. Moreover, the quality of family environment and parental rearing pattern are the major factors affecting their mental health.