目的 探究中学生烟酒-过度网络使用和睡眠不足与抑郁症状的关联，为改善中学生心理健康状况提供参考。方法 采用整群随机抽样方法，于2022年9-11月抽取上海市18 484名初、高中学生作为研究对象，按照学生常见病和健康影响因素监测调查问卷中的相关条目判定烟酒-过度网络使用、睡眠不足和抑郁症状。采用x2检验进行组间比较，采用Logistic回归分析和似然比检验分析烟酒-过度网络使用和睡眠不足与抑郁症状的独立和聚合关联。结果 中学生烟酒-过度网络使用、睡眠不足和抑郁症状的自我报告率分别为14。7％，73。5％和16。3％。Logistic回归分析结果显示，烟酒-过度网络使用(OR=2。69，95％CI=2。44～2。97)和睡眠不足(OR=1。76，95％CI=1。58～1。95)与抑郁症状均呈正相关(P值均＜0。05);与"无烟酒-过度网络使用且睡眠充足"中学生相比，"有烟酒-过度网络使用且睡眠不足"中学生检出抑郁症状更高(OR=4。71，95％CI=4。08～5。44，P＜0。05)。进一步分层分析结果显示，相较于男生组和高中组，烟酒-过度网络使用和睡眠不足与抑郁症状的单独/联合关联在女生组和初中组中更加明显[烟酒-过度网络使用OR值(95％CI)分别为3。09(2。68～3。56)和 4。74(3。86～5。83);睡眠不足 OR 值(95％CI)分别为 1。86(1。60～2。17)和 2。00(1。58～2。53);二者联合关联 OR 值(95％CI)分别为6。05(5。01～7。31)和9。15(6。98～11。99)，P值均＜0。05]。结论 烟酒-过度网络使用和睡眠不足与中学生抑郁症状有关。应关注性别和学校类型间差异，着眼于健康相关行为，制定中学生心理健康防控策略。
Association of tobacco/alcohol-excessive Internet usage and insufficient sleep with depressive symptoms among middle school students
Objective To explore the association of tobacco/alcohol-excessive Internet usage and insufficient sleep with depres-sive symptoms among middle school students,so as to provide a reference for improving mental health of middle school students.Methods In accordance with the cluster random sampling method,a total of 18 484 middle school students in Shanghai were sur-veyed from September to November 2022.Tobacco/alcohol-excessive Internet usage and sleep duration with depressive symptoms were assessed using the relevant scale items included in the questionnaire of Surveillance for Common Disease and Health Risk Fac-tors among Students.The x2 test was used for inter group comparison,Logistic regression analysis and likelihood ratio test were used to analyze the independent and aggregated associations of tobacco/alcohol-excessive Internet use and insufficient sleep wiht depres-sive symptoms.Results Self-reported rates of tobacco/alcohol-excessive Internet usage,insufficient sleep and depressive symp-toms among adolescents were 14.7％,73.5％and 16.3％,respectively.Tobacco/alcohol-excessive Internet usage(OR=2.69,95％CI=2.44-2.97)and insufficient sleep(OR=1.76,95％CI=1.58-1.95)were associated with depressive symptoms(P＜0.05).Compared to middle school students with no tobacco/alcohol-excessive Internet usage and sufficient sleep,those with both tobacco/alcohol-excessive Internet usage and insufficient sleep showed the higher rate of depressive symptoms(OR=4.71,95％CI=4.08-5.44,P＜0.05).Further stratified analysis results showed that,compared to the boys and the high school students,the separate and joint association of tobacco/alcohol-excessive Internet usage and insufficient sleep with depressive symptoms were more pronounced in the girls and the middle-school students[OR(95％CI)for tobacco/alcohol-excessive Internet usage were 3.09(2.68-3.56)and 4.74(3.86-5.83),respectively;OR(95％CI)for insufficient sleep were 1.86(1.60-2.17)and 2.00(1.58-2.53),respectively;and the OR(95％CI)for the joint association were 6.05(5.01-7.31)and 9.15(6.98-11.99),respectively,P＜0.05].Conclusions Tobacco/alcohol-excessive Internet usage and insufficient sleep are associated with depressive symptoms in middle school students.Prevention and control strategies for adolescent mental health should be developed with consideration of health-related behaviors,and also need to be tailored by focusing on gender and grade differences.
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