上海市中小学校心理健康服务现状与影响因素调查

Status and influencing factors of mental health services in primary and secondary schools in Shanghai

目的调查上海市中小学校心理健康服务现状和影响因素,为加强学校心理健康师资队伍建设、科学有效地开展儿童青少年心理健康服务工作提供依据。方法采用自行设计的中小学校心理健康服务问卷对上海市14个区的422名心理健康教师进行调查。采用Pearson χ^(2)检验和独立样本t检验比较不同学历心理健康教师在学校心理健康服务情况和影响因素评估上的差异,构建结构方程模型分析学生获得心理健康服务的影响因素。结果422名调查对象的毕业专业主要有应用心理学(124人,29.38%)、教育学(117人,27.73%)、发展与教育心理学(65人,15.40%)等。心理健康教师认为学生中最常见的心理健康问题依次是社会/人际问题、家庭问题,焦虑、压力或学校恐惧,以及适应问题。与学校签订协议/合作提供心理健康服务的组织主要有区心理健康中心(376所,89.10%)、社区健康中心(155所,36.73%)、当地医院(106所,25.12%)。在学校提供的心理健康服务、学校提供的预防和早期干预项目、学校收集和留存的数据、学生获得心理健康服务影响因素等方面的一些题目上,硕士学历心理健康教师报告的比例或评分高于本科学历心理健康教师(均P<0.05)。近3年对心理健康服务需求(328所,77.73%)、服务的学生数(314所,74.41%)增加,而心理健康服务的资金(212所,50.24%)、学校心理健康服务体系人员的数量(226所,53.55%)没有变化。学生获得心理健康服务影响因素的结构方程模型包含学校、家庭和社会3个维度,模型拟合指数良好(χ^(2)/df=2.708,近似误差均方根为0.064,规范拟合指数为0.947,拟合优度指数为0.946,调整拟合优度指数为0.912,比较拟合指数为0.965,相对拟合指数为0.926,塔克-刘易斯指数为0.952,增值拟合指数为0.966,均方根残差为0.046)。结论上海市中小学校心理健康工作成效显著,未来仍须加强专职心理健康教师职后培训,通过家校社协同、医教结合等多元化方式保障资源供给,并且要保障心理健康专项经费。

Objective To investigate the status and influencing factors of mental health services in primary and secondary schools in Shanghai,so as to provide evidence for training professional mental health teachers and delivering mental health services to children and adolescents effectively.Methods Totally 422 mental health teachers from 14 districts of Shanghai were investigated with a self-designed questionnaire on mental health services in primary and secondary schools.Pearson Chi-square test and Student’s t test were used to compare the differences in sohool mental health services and influencing factors among mental health teachers with different educational backgrounds,and a structural equation model was constructed to analyze the influencing factors of students’access to mental health services.Results The major of mental health teachers were mainly applied psychology(n=124,29.38%),education(n=117,27.73%),and developmental and educational psychology(n=65,15.40%).The top 3 mental health problems for students were social,interpersonal or family problems,anxiety,stress or school phobia,and adjustment issues.The organizations that had signed agreements or cooperated with school to provide mental health services were primarily the district mental health centers(n=376,89.10%),community health centers(n=155,36.73%)and local hospitals(n=106,25.12%).The proportions or scores of mental health teachers with master’s degree were significantly higher than those with bachelor’s degree for school mental health services,prevention and early intervention programs,data collection,and influencing factors of students’access to mental health services(all P<0.05).The need for mental health services(n=328,77.73%)and the number of students served(n=314,74.41%)were increased,while the funds for mental health services(n=212,50.24%)and the number of school mental health staff(n=226,53.55%)remained unchanged in the past 3 years.A structural equation model with 3 dimensions of school,family and society was constructed for influencing factors of students’access to mental health services(χ^(2)/df=2.708,root mean square error of approximation=0.064,normalized fitting index=0.947,goodness-of-fit index=0.946,adjusted goodness of fit index=0.912,comparing fitting index=0.965,relative fitting index=0.926,Tucker-Lewis index=0.952,increasing fitting index=0.966,root mean square residual=0.046).Conclusion Mental health services in primary and secondary schools in Shanghai has achieved remarkable progress.Post-employment training for full-time mental health teachers needs to be strengthened.The supply of school mental health resources should be guaranteed from multiple pathways,such as coordination of school,family and society,and medicine-education alliance.Special funds for mental health should be guaranteed.