阴虚质与初中生抑郁情绪的关系:应激性生活事件和入睡时长的链式中介作用

Chain Mediating Effects of Stressful Life Events and the Time Taken to Fall Asleep in the Relationship between Yin-deficiency Constitution and Depressed Mood in Junior High School Students

背景初中阶段作为青少年心理健康发展的关键阶段,由于该时期心智不够成熟以及身心发展不平衡,使得初中生对抑郁情绪的易感性增加。既往研究表明,阴虚质是青少年抑郁情绪的危险因素之一,研究发现应激性生活事件与入睡时长都能对青少年的抑郁情绪造成影响,但对于四者之间的作用机制尚缺乏系统性探讨。目的探究阴虚质和初中生抑郁情绪之间的关系,以及应激性生活事件和入睡时长在其中的中介作用。方法2022年3月通过方便抽样选取四川省眉山市1所中学的在校初中生为研究对象。收集研究对象的一般资料(性别、民族、生源地、年级),运用7-14岁中医体质量表中的阴虚质亚量表、青少年生活事件量表(ASLEC)、慕尼黑睡眠时型问卷中描述入睡时长的条目和流调中心用抑郁量表(CES-D)对初中生进行测评。分析不同特征初中生阴虚质得分、ASLEC得分、入睡时长、CES-D得分的差异,采用Spearman秩相关分析探讨各变量间的相关性;构建多重中介效应模型以检验应激性生活事件和入睡时长在阴虚质及抑郁情绪之间的中介效应,并进一步使用Bootstrap方法对链式中介效应显著性进行检验。结果共发放调查问卷2620份,回收有效问卷2570份,有效回收率98.1%,抑郁情绪检出率为32.8%(844/2570)。女初中生的阴虚质得分、ASLEC得分、CES-D得分高于男初中生;初二、初三年级学生的阴虚质得分、ASLEC得分和CES-D得分均高于初一年级;非汉族初中生的ASLEC得分高于汉族初中生,汉族初中生的入睡时长高于非汉族初中生,农村生源地初中生的阴虚质得分、ASLEC得分、CES-D得分均高于城镇,差异均有统计学意义(P<0.05)。初中生阴虚质得分为25.0(15.0,40.0)分,应激性生活事件得分为36.0(30.0,44.0)分,入睡时长为15.0(8.6,25.7)min,抑郁情绪得分为11.0(6.0,18.0)分。初中生阴虚质与应激性生活事件、入睡时长以及抑郁情绪得分均呈显著正相关(rs=0.538、0.151、0.470,P<0.05);应激性生活事件与入睡时长、抑郁情绪得分均呈显著正相关(rs=0.224、0.684,P<0.05);入睡时长与抑郁情绪得分呈显著正相关(rs=0.289,P<0.05)。多重中介效应模型结果显示,阴虚质正向预测抑郁情绪(β=0.465,P<0.001);阴虚质正向预测应激性生活事件水平(β=0.511,P<0.001)和入睡时长(β=0.066,P=0.004);应激性生活事件水平正向预测入睡时长(β=0.228,P<0.001)和抑郁情绪(β=0.591,P<0.001);入睡时长正向预测抑郁情绪(β=0.139,P<0.001)。Bootstrap法检验最终结果显示,阴虚质→应激性生活事件→入睡时长→抑郁情绪路径效应显著[中介效应值=0.009,95%CI(0.006,0.012),P<0.001],应激性生活事件与入睡时长在阴虚质和抑郁情绪的链式中介效应成立。结论阴虚质不但可以直接预测初中生的抑郁情绪,还可以通过应激性生活事件和入睡时长的独立中介作用以及应激性生活事件-入睡时长之间的链式中介作用间接影响初中生的抑郁情绪。可通过改善阴虚体质、提高对应激性生活事件的应对能力、缩短入睡时长,降低初中生抑郁情绪的发生,提高其心理健康水平。

Background The period of junior high school age is a key development stage of adolescent mental health,during which mental maturity and physical and mental development imbalance may greatly increase the susceptibility of the students to depressed mood.Previous studies have shown that yin-deficiency constitution is a risk factor for depressed mood in adolescents,which has also been reported to be impacted by stressful life events and the time taken to fall asleep,but there is no systematic discussion about the mechanism of action in the relationships between the four factors.Objective To explore the relationship between yin-deficiency constitution and depressed mood in junior high school students,as well as the mediating effect of stressful life events and the time taken to fall asleep.Methods On March 2022,a convenient sample of junior high school students from a middle school in Meishan City,Sichuan Province were surveyed on their general data(gender,ethnicity,region of origin,grade),prevalence of yin-deficiency constitution assessed using the yin-deficiency Constitution subscale of the Traditional Chinese Medicine Constitution Scale for 7-14-year-olds,prevalence of stressful life events assessed using the Adolescent Self-Rating Life Events Checklist(ASLEC),and the time taken to fall asleep assessed using the items assessing how long it takes to fall asleep in the Munich Chronotype Questionnaire(MCTQ),and prevalence of depressed mood assessed using the Center for Epidemiologic Studies Depression(CES-D).The scores of yin-deficiency constitution,ASLEC and CES-D as well as the time taken to fall asleep were compared across the students by demographic characteristics.Spearman correlation analysis was used to explore the correlation between the variables.A multiple-mediator model was constructed to examine the mediating effect of stressful life events and the time taken to fall asleep on yin-deficiency constitution and depressed mood,and the significance of chain mediating effect was tested using bootstrap method.Results The survey achieved a response rate of 98.1%(2570/2620)in the 2620 surveyed students.The detection rate of depressed mood in the respondents was 32.8%(844/2570).Female students had higher scores of yin-deficiency constitution,ASLEC and CES-D than male students(P<0.05).The yin-deficiency score,ASLEC score and CES-D score in grade 2 and grade 3 students was higher than that of grade 1 students(P<0.05).The ASLEC score in non-Han students was longer than that of Han students(P<0.05).The time taken to fall asleep in Han students was longer than that of non-Han students(P<0.05).The yin-deficiency constitution score,ASLEC score and CED-S score of students from rural areas was higher than that of those from towns(P<0.05).The average yindeficiency constitution score,ASLEC score,the time taken to fall asleep and CES-D score in all respondents were 25.0(15.0,40.0)points,36.0(30.0,44.0)points,15.0(8.6,25.7)min and 11.0(6.0,18.0)points,respectively.The yindeficiency constitution score was positively correlated with ASLEC score,the time taken to fall asleep and CES-D score(rs=0.538,0.151,0.470,P<0.05).The ASLEC score was positively correlated with the time taken to fall asleep and CES-D score(rs=0.224,0.684,P<0.05).The time taken to fall asleep was positively correlated with CES-D score(rs=0.289,P<0.05).Multiple mediator model-based analysis showed that yin-deficiency constitution positively predicted depressed mood(β=0.465,P<0.001).And it also positively predicted the level of stressful life events(β=0.511,P<0.001)and the time taken to fall asleep(β=0.066,P=0.004).The level of stressful life events positively predicted the time taken to fall asleep(β=0.228,P<0.001)and depressed mood(β=0.591,P<0.001).The time taken to fall asleep positively predicted depressed mood(β=0.139,P<0.001).The final results of Bootstrap test showed that significant effect of path dependence was found in the path of yindeficiency constitution→stressful life events→the time taken to fall asleep→depressed mood〔mediating effect value=0.009,95%CI(0.006,0.012),P<0.001〕,indicating that the chain mediating effect of stressful life events and the time taken to fall asleep on yin-deficiency constitution and depressed mood was valid.Conclusion Yin-deficiency constitution can be used as a direct predictor of depressed mood in junior high school students,but it also can directly affect their depressed mood through its role played between stressful life events and the time taken to fall asleep as an independent mediator or a chain mediator.To reduce the incidence of depressed mood and improve mental health in this population,measures can be taken to improve the yindeficiency constitution,improve the ability to cope with stressful life events and shorten the time taken to fall asleep.