上海市中小学生自杀行为及心理社会相关因素的研究

目的 了解上海市中小学生自杀行为的现状，探索自杀行为的相关危险因素。方法 采用分级整群随机抽样方法，选取上海市9所学校：小学5年级、预备初中（预初）、初一、初二、高一和高二年级学生进行匿名自评问卷调查。问卷包括一般情况问卷、流行病学调查中心用抑郁量表、焦虑自评量表、青少年生活事件量表和贝克绝望量表，根据美国疾病控制预防中心（CDC）青少年危险行为调查所采用的方式设置最近12个月的自杀意念、自杀计划和自杀未遂行为调查。自杀行为的年级和性别差异用卡方检验，自杀意念的相关因素分析采用单因素和多因素Logistic回归模型。结果 ①发放问卷2 513份，当场收回有效问卷2 416份，其中男1 190份，女1 226份；调查人群年龄10~17岁；②调查人群中有自杀意念者368名（15.23%，368/2 416），有自杀计划者141名（5.84%，141/2 416），自杀未遂者42名（1.74%，42/2 416）；③自杀行为的性别差异：男生有自杀意念者178名（14.96%,178/1 190），有自杀计划者80名(6.72%，80/1 190)，自杀未遂者24名(2.02%，24/1 190)；女生有自杀意念者190名（15.50%，190/1 226），自杀计划者61名(4.98%，61/1 226)，自杀未遂者18名(1.47%，18/1 226)。男、女生自杀行为差异无统计学意义（P>0.05）；④自杀意念的发生随年级上升而升高（P<0.05）。调查显示高二年级学生自杀未遂的发生率最高（5.17%，6/116）,其次为预初年级（2.52%，13/516）, 小学5年级最低（0.86%，3/347）（P<0.05）。自杀计划的发生率各年级间差异无统计学意义（P>0.05）；⑤小学生自杀意念与所在学校、家庭住房条件显著相关；初中生的自杀意念与同伴关系、父亲文化水平和母子沟通显著相关；高中生的自杀意念与学习成绩、自由支配空余时间和父子沟通显著相关。所有年级学生的自杀意念均与青少年生活事件量表、抑郁量表、焦虑自评量表和贝克绝望量表分呈显著相关。结论 ①上海市中小学生自杀行为状况不容乐观，必须引起高度重视；②不同学习阶段学生的自杀行为影响因素有所不同，干预措施应有所侧重；③应及时发现和积极治疗情绪障碍，努力培养青少年应对不良生活事件的能力，以降低自杀行为发生。

Suicide behaviors and their related psychosocial factors among adolescent students in Shanghai

Objective To investigate the prevalence of suicide behaviors and their related factors among adolescent students in Shanghai. Methods The self-completed anonymous questionnaires, which included center for epidemiologic studies depression scale (CES-D), self-rating anxiety scale (SAS), adolescent self-rating life events check list (ASLEC), beck hopelessness scale and a general questionnaire were administered to a random sample of grade 5-9, grade 10 and 11 students from 9 primary to high schools in Shanghai in late April 2003. The concept of the suicide behaviors in this study was defined according to the youth risk behaviors surveillance system(YRBSS) from American Center for Disease Control and Prevention(CDC). It included suicide ideation, suicide plan and suicide attempt. Chi-square test was used to assess the gender and grade differences of suicide behaviors. Logistic regression model was applied to identify the factors associated with the suicide ideation in the students. Results 2 416 completed questionnaires were obtained from 2 513 participants. Male: 1 190; female:1 226, aged from 10-17 years old. During the 12 months preceding the survey, there were 368(15.23%,368/2 416) students had ever experienced suicidal ideation, 141(5.84%,141/2 416) students made suicide plans and 42(1.74%,42/2 416)students had actually attempted suicide. Suicide ideation was reported in 178(14.96%,178/1 190)boys and 190(15.50%,190/1 226) girls. Eighty (6.72%,80/1 190) boys and 61 (4.98%,61/1 226) girls reported suicide plans, while 24 (2.02%,24/1 190) boys and 18(1.47%,18/1 226) girls reported suicide attempts. There was no statistical significant difference between the rates of these suicide behaviors in boys and those in girls(P>0.05). The suicide ideation was increased by the student's grade of school(P<0.05 ). The highest rate of suicide attempt was in grade 11(5.17%,6/116), the second was in grade 6(2.52%,13/516), and the lowest one was in grade 5(0.86%,3/347),(P<0.05). Among all students, suicide ideation was strongly related to the scores of CES-D, SAD, ASLEC and Beck's hopeless scale. Suicide ideation was also related to the school, family's residency status in the students of primary schools (grade 5). Among the students of middle schools, suicide ideation was also related to the peer relationship, father's educational level and child-mother communication. Among the students of high schools, suicide ideation was related to school achievement, free time and child-father communication.Conclusions Suicide behaviors among the adolescent students in Shanghai should be seriously concerned. Different key points of intervention for suicide behaviors should be put on different age groups of students. Early recognition and treatment of emotional disorders among the adolescent students and raising their ability to cope with the negative life events will be helpful to reduce the suicide behaviors in adolescent students.