农村中学生睡眠质量抑郁症状及其与非自杀性自伤的关联

Association of sleep quality, depressive symptoms with non-suicidal self-injury among rural middle school students

目的 探讨农村中学生睡眠质量和抑郁症状及其交互作用与非自杀性自伤(non-suicidal self-injury, NSSI)的关联,为农村中学生NSSI的预防和早期干预提供参考依据。方法 采用多阶段整群抽样的方法,在江苏省徐州市随机抽取4所农村中学,按照学校年级分层、班级随机选取的原则对1 723名中学生进行调查。使用纸质调查问卷(包括人口学因素、自伤行为评估简表、匹兹堡睡眠质量指数量表、抑郁自评量表)进行问卷调查,采用Logistic回归模型分析农村中学生睡眠质量和抑郁症状及其交互作用与NSSI的关联。结果 30.5%的中学生存在NSSI行为;单因素分析结果显示,女生NSSI报告率(33.0%)比男生(27.3%)高,有睡眠障碍和抑郁症状者NSSI报告率更高,分别为46.8%和43.6%。多因素Logistic回归分析结果显示,存在睡眠障碍的学生发生NSSI的风险是无睡眠障碍者的1.80倍(OR值95%CI=1.42~2.28,P<0.01);存在抑郁症状的学生发生NSSI的风险是无抑郁症状者的3.32倍(OR值95%CI=2.60~4.24,P<0.01)。交互作用结果显示,睡眠障碍和抑郁症状对农村中学生NSSI行为的发生存在相加交互作用,超额危险度、归因比和交互作用指数分别为1.80,0.30和1.57。结论 存在睡眠障碍和抑郁症状是农村中学生NSSI的相关因素,且两者存在相加交互作用。

Objective To investigate the association of sleep quality, depressive symptoms and their interaction with non-suicidal self-injury(NSSI) among rural middle school students, so as to provide a reference for early prevention and control of NSSI among rural middle school students. Methods A multi-stage cluster sampling method was used to randomly select four rural middle schools in Xuzhou, Jiangsu Province. A total of 1 723 middle school students were investigated according to the principle of grade stratification and class random selection. Paper questionnaires(including demographic factors, Non-Suicidal Self-Injury Short Scale, Pittsburgh Sleep Quality Index, Patient Health Questionnare-9) were used to conduct the questionnaire survey. Logistic regression model was used to analyze the association of sleep quality, depressive symptoms and their interaction with NSSI among rural middle school students. Results Totally 30.5% of middle school students had NSSI. Univariate results showed that girls(33.0%) had a higher incidence of NSSI than boys(27.3%), and those with sleep disorders and depressive symptoms had a higher incidence of NSSI, which was 46.8%, 43.6%. The results of multivariate Logistic regression showed that the risk of NSSI in students with sleep disorder was 1.80 times that in those without sleep disorder(OR 95%CI=1.42-2.28, P<0.01). The risk of NSSI in students with depressive symptoms was 3.32 times higher than that in those without depressive symptoms(OR 95%CI=2.60-4.24, P<0.01). The interaction results showed that there was additive interaction between sleep disturbance and depressive symptoms on the occurrence of NSSI behavior in rural middle school students, and the relative excess risk, attributable proportion and synergy index were 1.80, 0.30 and 1.57, respectively. Conclusion Sleep disorder and depressive symptoms are risk factors for NSSI among rural middle school students, and there is additive interaction between them.