Article(id=1241023850901721546, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241023847537897695, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202407014, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1719763200000, receivedDateStr=2024-07-01, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773812743163, onlineDateStr=2026-03-18, pubDate=1737734400000, pubDateStr=2025-01-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773812743163, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773812743163, creator=13701087609, updateTime=1773812743163, updator=13701087609, issue=Issue{id=1241023847537897695, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='2', pageStart='193', pageEnd='384', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773812742361, creator=13701087609, updateTime=1773812823817, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241024189247845056, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241023847537897695, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241024189247845057, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241023847537897695, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=322, endPage=327, ext={EN=ArticleExt(id=1241023851207905739, articleId=1241023850901721546, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Mediating role of family care in the relationship between life events and insomnia in adolescents with depression, columnId=1228016572451718132, journalTitle=Modern Preventive Medicine, columnName=Health and Social Behavior, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the intrinsic relationships among family functioning, life events and insomnia in adolescents with depression.

Methods

A survey was conducted on 165 adolescents diagnosed with depression who were receiving treatment at a tertiary hospital in Guangzhou. The study utilized a general information questionnaire, Family APGAR Index, Insomnia Severity Index, and Adolescent Life Events Scale. Descriptive and correlation analyses were performed using SPSS, and mediation effects were tested using the Process plugin.

Results

The insomnia rate among adolescent depression patients was 77.58%. There was a significant positive correlation between insomnia and the total score of life events and its dimension factors (P<0.01), while insomnia showed a significant negative correlation with the total score of family functioning and its dimension factors (P<0.01). The results of the Bootstrap test indicate that family care, growth factors and cooperation play a partial mediating role between life events and insomnia in adolescent depression patients (β=0.019, 95% CI: 0.003-0.036; β= 0.013, 95% CI: 0.01-0.026; β= 0.011, 95% CI: 0.000-0.024), accounting for 15.45%, 10.57% and 8.94% of the total effect, respectively.

Conclusion

Adolescents with depression experience moderate to high levels of insomnia. Life events in adolescents with depression can directly affect insomnia, or indirectly influence it through family care.

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目的

探讨青少年抑郁症患者家庭功能、生活事件与失眠之间的内在关系。

方法

采用一般资料问卷、家庭关怀度指数量表、失眠严重程度指数和青少年生活事件量表针对广州市某三级甲等医院内接受诊疗的165例青少年抑郁症患者群体进行调查。采用SPSS对数据进行描述性和相关分析,Process插件进行中介效应检验。

结果

青少年抑郁症患者的失眠发生率为77.58%。青少年抑郁症患者失眠与生活事件总分及因子呈显著正相关(P<0.01),失眠与家庭关怀总分及因子呈显著负相关(P<0.01)。Bootstrap检验结果显示,家庭关怀及其成长度及合作度因子在青少年抑郁症患者生活事件和失眠间起部分中介效应(β=0.019,95%CI:0.003~0.036;β=0.013 ,95%CI:0.01~0.026;β=0.011 ,95%CI:0.000~0.024),分别占总效应的15.45%、10.57%和8.94%。

结论

青少年抑郁症患者的失眠处于中上水平。青少年抑郁症患者的生活事件既可直接影响失眠,亦可通过家庭关怀间接影响。

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骆春柳,E-mail :
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段明玥(2000—),女,在读硕士,研究方向:青少年抑郁症

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段明玥(2000—),女,在读硕士,研究方向:青少年抑郁症

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段明玥(2000—),女,在读硕士,研究方向:青少年抑郁症

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注:***P<0.001,**P<0.01,*P<0.05。

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注:***P<0.001,**P<0.01,*P<0.05。

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注:***P<0.001,**P<0.01,*P<0.05。

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Scores on Different Scales for Adolescents with Depression and Insomnia (, points)

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组别失眠家庭功能青少年生活事件总分
14.59±4.563.65±2.9647.88±20.55
16.34±6.003.97±3.0752.26±20.86
t-1.147-0.400-0.799
P0.2540.6900.426
初中17.47±6.273.28±2.7255.47±22.96
高中14.40±4.644.04±3.1948.04±18.23
t3.099-2.1790.036
P0.0020.0310.047
城市13.85±4.034.54±3.2052.13±13.80
乡镇17.56±6.673.25±2.7660.97±26.44
农村17.69±6.113.27±2.8546.58±21.82
F2.2151.5081.725
P0.0060.1450.015
独生子女15.21±4.964.54±3.0346.54±19.50
非独生子女16.54±6.103.44±2.9154.66±21.65
t-1.2051.954-2.022
P0.2300.0530.045
良好16.20±5.803.88±3.0351.06±21.21
离异15.79±5.963.11±2.6059.37±20.90
t0.2871.045-1.582
P0.7750.2980.116
), ArticleFig(id=1241023860162745173, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023850901721546, language=CN, label=表1, caption=

青少年抑郁症伴失眠患者各量表评分(,分)

, figureFileSmall=null, figureFileBig=null, tableContent=
组别失眠家庭功能青少年生活事件总分
14.59±4.563.65±2.9647.88±20.55
16.34±6.003.97±3.0752.26±20.86
t-1.147-0.400-0.799
P0.2540.6900.426
初中17.47±6.273.28±2.7255.47±22.96
高中14.40±4.644.04±3.1948.04±18.23
t3.099-2.1790.036
P0.0020.0310.047
城市13.85±4.034.54±3.2052.13±13.80
乡镇17.56±6.673.25±2.7660.97±26.44
农村17.69±6.113.27±2.8546.58±21.82
F2.2151.5081.725
P0.0060.1450.015
独生子女15.21±4.964.54±3.0346.54±19.50
非独生子女16.54±6.103.44±2.9154.66±21.65
t-1.2051.954-2.022
P0.2300.0530.045
良好16.20±5.803.88±3.0351.06±21.21
离异15.79±5.963.11±2.6059.37±20.90
t0.2871.045-1.582
P0.7750.2980.116
), ArticleFig(id=1241023860225659740, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023850901721546, language=EN, label=Table 2, caption=

Correlation Analysis of Insomnia, Life Events, and Family Care in Adolescents with Depression(r

, figureFileSmall=null, figureFileBig=null, tableContent=
相关性1234567
1失眠1.000
2青少年生活事件总分0.491b1.000
3人际关系因子0.317b0.793b1.000
4学习压力因子0.461b0.769b0.486b1.000
5受惩罚因子0.412b0.873b0.602b0.682b1.000
6丧失0.1600.638b0.568b0.314b0.417b1.000
7健康适应0.396b0.774b0.462b0.519b0.639b0.539b1.000
8其它0.257b0.716b0.519b0.529b0.659b0.363b0.443b
9家庭关怀总分-0.370b-0.334b-0.268b-0.152-0.260b-0.135-0.217a
10亲密度-0.075-0.230b-0.154-0.057-0.244b-0.068-0.248b
11适应度-0.304b-0.279b-0.205a-0.117-0.191a-0.134-0.215a
12合作度-0.296b-0.275b-0.232b-0.139-0.223a-0.199a-0.146
13成长度-0.321b-0.276b-0.223a-0.149-0.224b-0.046-0.230b
14情感度-0.285b-0.252b-0.224b-0.103-0.197a-0.034-0.129
相关性891011121314
1失眠
2青少年生活事件总分
3人际关系因子
4学习压力因子
5受惩罚因子
6丧失
7健康适应
8其它1.000
9家庭关怀总分-0.291b1.000
10亲密度-0.1360.478b1.000
11适应度-0.276b0.870b0.460b1.000
12合作度-0.255b0.716b0.238b0.578b1.000
13成长度-0.219a0.812b0.402b0.656b0.458b1.000
14情感度-0.235b0.800b0.300b0.691b0.441b0.655b1.000
), ArticleFig(id=1241023860355683177, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023850901721546, language=CN, label=表2, caption=

青少年抑郁症患者失眠、生活事件与家庭关怀度的相关性分析(r

, figureFileSmall=null, figureFileBig=null, tableContent=
相关性1234567
1失眠1.000
2青少年生活事件总分0.491b1.000
3人际关系因子0.317b0.793b1.000
4学习压力因子0.461b0.769b0.486b1.000
5受惩罚因子0.412b0.873b0.602b0.682b1.000
6丧失0.1600.638b0.568b0.314b0.417b1.000
7健康适应0.396b0.774b0.462b0.519b0.639b0.539b1.000
8其它0.257b0.716b0.519b0.529b0.659b0.363b0.443b
9家庭关怀总分-0.370b-0.334b-0.268b-0.152-0.260b-0.135-0.217a
10亲密度-0.075-0.230b-0.154-0.057-0.244b-0.068-0.248b
11适应度-0.304b-0.279b-0.205a-0.117-0.191a-0.134-0.215a
12合作度-0.296b-0.275b-0.232b-0.139-0.223a-0.199a-0.146
13成长度-0.321b-0.276b-0.223a-0.149-0.224b-0.046-0.230b
14情感度-0.285b-0.252b-0.224b-0.103-0.197a-0.034-0.129
相关性891011121314
1失眠
2青少年生活事件总分
3人际关系因子
4学习压力因子
5受惩罚因子
6丧失
7健康适应
8其它1.000
9家庭关怀总分-0.291b1.000
10亲密度-0.1360.478b1.000
11适应度-0.276b0.870b0.460b1.000
12合作度-0.255b0.716b0.238b0.578b1.000
13成长度-0.219a0.812b0.402b0.656b0.458b1.000
14情感度-0.235b0.800b0.300b0.691b0.441b0.655b1.000
), ArticleFig(id=1241023860460540788, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023850901721546, language=EN, label=Table 3, caption=

Mediating effect of family care between life events and insomnia

, figureFileSmall=null, figureFileBig=null, tableContent=
变量效应类型效应值(95%CISEP效应占比(%)
家庭关怀总分总效应0.123(0.086-0.160)0.019<0.0
直接效应0.104(0.065-0.143)0.020<0.0584.55
中介效应0.019(0.003-0.036)0.009<0.0515.45
合作度总效应0.123(0.086-0.160)0.019<0.05
直接效应0.112(0.074-0.150)0.019<0.0591.06
中介效应0.011(0.000-0.024)0.006<0.058.94
成长度总效应0.123(0.086-0.160)0.019<0.05
直接效应0.110(0.072-0.148)0.019<0.0589.43
中介效应0.013(0.010-0.026)0.006<0.0510.57
), ArticleFig(id=1241023860557009789, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023850901721546, language=CN, label=表3, caption=

家庭关怀在生活事件与失眠之间中介效应

, figureFileSmall=null, figureFileBig=null, tableContent=
变量效应类型效应值(95%CISEP效应占比(%)
家庭关怀总分总效应0.123(0.086-0.160)0.019<0.0
直接效应0.104(0.065-0.143)0.020<0.0584.55
中介效应0.019(0.003-0.036)0.009<0.0515.45
合作度总效应0.123(0.086-0.160)0.019<0.05
直接效应0.112(0.074-0.150)0.019<0.0591.06
中介效应0.011(0.000-0.024)0.006<0.058.94
成长度总效应0.123(0.086-0.160)0.019<0.05
直接效应0.110(0.072-0.148)0.019<0.0589.43
中介效应0.013(0.010-0.026)0.006<0.0510.57
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家庭关怀在青少年抑郁症患者生活事件与失眠间的中介作用
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段明玥 1 , 黄婉敏 2 , 蒋丹凤 3 , 邓艳芳 3 , 廖超 1 , 骆春柳 3
现代预防医学 | 健康与社会行为 2025,52(2): 322-327
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现代预防医学 | 健康与社会行为 2025, 52(2): 322-327
家庭关怀在青少年抑郁症患者生活事件与失眠间的中介作用
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段明玥1, 黄婉敏2, 蒋丹凤3, 邓艳芳3, 廖超1, 骆春柳3
作者信息
  • 1.暨南大学护理学院,广东 广州 510632
  • 2.广州市番禺区中心医院
  • 3.暨南大学附属第一医院
  • 段明玥(2000—),女,在读硕士,研究方向:青少年抑郁症

通讯作者:

骆春柳,E-mail :
Mediating role of family care in the relationship between life events and insomnia in adolescents with depression
Ming-yue DUAN1, Wan-min HUANG2, Dan-feng JIANG3, Yan-fang DENG3, Chao LIAO1, Chun-liu LUO3
Affiliations
  • School of Nursing, Jinan University, Guangzhou, Guangdong 510632, China
出版时间: 2025-01-25 doi: 10.20043/j.cnki.MPM.202407014
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目的

探讨青少年抑郁症患者家庭功能、生活事件与失眠之间的内在关系。

方法

采用一般资料问卷、家庭关怀度指数量表、失眠严重程度指数和青少年生活事件量表针对广州市某三级甲等医院内接受诊疗的165例青少年抑郁症患者群体进行调查。采用SPSS对数据进行描述性和相关分析,Process插件进行中介效应检验。

结果

青少年抑郁症患者的失眠发生率为77.58%。青少年抑郁症患者失眠与生活事件总分及因子呈显著正相关(P<0.01),失眠与家庭关怀总分及因子呈显著负相关(P<0.01)。Bootstrap检验结果显示,家庭关怀及其成长度及合作度因子在青少年抑郁症患者生活事件和失眠间起部分中介效应(β=0.019,95%CI:0.003~0.036;β=0.013 ,95%CI:0.01~0.026;β=0.011 ,95%CI:0.000~0.024),分别占总效应的15.45%、10.57%和8.94%。

结论

青少年抑郁症患者的失眠处于中上水平。青少年抑郁症患者的生活事件既可直接影响失眠,亦可通过家庭关怀间接影响。

抑郁症  /  青少年  /  失眠  /  家庭关怀  /  生活事件
Objective

To investigate the intrinsic relationships among family functioning, life events and insomnia in adolescents with depression.

Methods

A survey was conducted on 165 adolescents diagnosed with depression who were receiving treatment at a tertiary hospital in Guangzhou. The study utilized a general information questionnaire, Family APGAR Index, Insomnia Severity Index, and Adolescent Life Events Scale. Descriptive and correlation analyses were performed using SPSS, and mediation effects were tested using the Process plugin.

Results

The insomnia rate among adolescent depression patients was 77.58%. There was a significant positive correlation between insomnia and the total score of life events and its dimension factors (P<0.01), while insomnia showed a significant negative correlation with the total score of family functioning and its dimension factors (P<0.01). The results of the Bootstrap test indicate that family care, growth factors and cooperation play a partial mediating role between life events and insomnia in adolescent depression patients (β=0.019, 95% CI: 0.003-0.036; β= 0.013, 95% CI: 0.01-0.026; β= 0.011, 95% CI: 0.000-0.024), accounting for 15.45%, 10.57% and 8.94% of the total effect, respectively.

Conclusion

Adolescents with depression experience moderate to high levels of insomnia. Life events in adolescents with depression can directly affect insomnia, or indirectly influence it through family care.

Depression  /  Adolescents  /  Insomnia  /  Family care  /  Life events
段明玥, 黄婉敏, 蒋丹凤, 邓艳芳, 廖超, 骆春柳. 家庭关怀在青少年抑郁症患者生活事件与失眠间的中介作用. 现代预防医学, 2025 , 52 (2) : 322 -327 . DOI: 10.20043/j.cnki.MPM.202407014
Ming-yue DUAN, Wan-min HUANG, Dan-feng JIANG, Yan-fang DENG, Chao LIAO, Chun-liu LUO. Mediating role of family care in the relationship between life events and insomnia in adolescents with depression[J]. Modern Preventive Medicine, 2025 , 52 (2) : 322 -327 . DOI: 10.20043/j.cnki.MPM.202407014
青春期是一个生理、心理和社会发展迅速的阶段,同时也是抑郁症发病的高危期之一[1],青少年情绪问题的发生发展和维持过程中,睡眠扮演着举足轻重的角色[2]。先前的研究揭示,青少年面临的最普遍睡眠挑战主要集中在睡眠时长不足以及失眠问题[3]。失眠可能导致情绪问题加剧,使得抑郁症状更加严重。以往的研究显示,大约2/3的青少年抑郁症患者都有失眠的经历[4]。青少年抑郁症状与失眠之间可能存在更强的相关性,青少年抑郁症患者失眠情况更值得考察[5]。生活事件是一种长期的压力来源,如果得不到很好的疏导,会对个人的身心造成很大的影响[6]。生活事件对青少年抑郁症患者的影响不仅限于情绪状态,还可能影响其睡眠质量和睡眠模式[7]。之前研究表明家庭冲突、学业压力、虐待经历等负性生活事件与睡眠问题之间存在显著相关性[8]。这些事件可能触发青少年的情绪困扰和心理不适,进而影响其睡眠质量。家庭对青少年的成长和社会化最为直接、最为关键的社会环境,在青少年身心健康中的作用是长期而深远的[9]。有研究发现,良好的家庭支持和积极的家庭氛围可以缓解青少年因负性生活事件而引发的不良情绪问题[10]。在较低的家庭关怀程度下,则更易缺乏安全感等,从而引起睡眠障碍[11]。综合审视,深入探讨青少年抑郁症患者的失眠问题及其相关影响因素,显得尤为必要和迫切。这不仅有助于本研究更全面地理解这一群体所面临的困境,还能为制定更为精准有效的干预策略提供重要依据。
前期研究表明,生活事件、家庭关怀与失眠之间具有相互关联,但目前尚未有在青少年抑郁症患者中探讨三种因素之间的内在关系。在充分参考了既有的理论与实证研究后,本研究核心提出了以下假设:生活事件可以直接预测青少年抑郁症患者的失眠行为,家庭关怀可在生活事件和失眠间起中介作用。
本研究采用便利抽样法在2023年1月—10月于广州市某三级甲等医院精神医学科就诊的165位青少年抑郁症患者进行问卷调查。纳入标准:(1)符合DSM-5抑郁障碍诊断标准;(2)年龄12~19周岁(初高中生);(3)能配合完成相关问卷和量表填写;(4)患者及其家属知情同意。排除标准:(1)同时患有其他精神疾病的个体;(2)存在严重躯体疾病的并发症患者;(3)患有严重脑器质性病变的群体。本研究已通过暨南大学附属第一医院医学伦理委员会批准(伦理号:KY-2022-208)。
自制一般资料问卷,包括性别、年龄、受教育阶段、生源地、父母婚姻状况、是否独生子女等。
由五个重要维度(每个维度只有一个条目)适应度、合作度、成长度、情感度和亲密度构成。每个条目0~2分,总分为0~10分,总分越高,表明家庭效能和关怀程度越高[12]。本研究中,该量表的Cronbach α为0.809。
用于评估青少年生活事件的频率和压力强度[13]。这个量表一共有27个不同的条目,这些条目全面覆盖了人际关系、学习压力、惩罚、丧失、健康适应和其他六个维度。每个条目0~5分,总分为0~135分,分数越高,则意味着负性生活事件对青少年的影响更为显著[14]。本研究中,该量表的Cronbach α为0.915。
该量表用于评估受试者过去一个月内的失眠情况,包括失眠的性质、严重程度以及对日常生活功能的影响。问卷中的各项项目总和即为问卷的总分,每个条目0~4分,总分为0~28分,总分≥8分表示出现有临床意义的失眠,总分越高,表明失眠情况越严重[15]。本研究中,该量表的Cronbach α为0.909。
在患者就诊之日,研究者会通过统一的陈述式调查问卷来收集相关数据。问卷收集完毕后,研究者会进行多次严格的审核,以确保数据的录入和整理工作既准确又完整,从而保障研究结果的可靠性和严谨性。
使用SPSS 26.0进行统计分析时,对于计数资料,本研究采用Pearson卡方检验来进行组间差异的比较;而对于计量资料,本研究则通过进行描述,并应用t检验来对比不同组间的差异。此外,本研究还运用了Pearson相关分析来探讨各变量之间的相关程度,并借助Bootstrap法来验证中介效应的存在。检验水准α=0.05。
采用Harman单因素检验法对共同方法偏差进行检验,结果显示本研究中不存在明显的共同方法偏差。首个因子的方差解释率仅为 30.25%,这明显低于通常设定的40%临界值。
调查对象165例,女生137例(83.0%),男生28例(17.0%);初中90例(54.5%),高中75例(45.5%);独生子女47例(28.5%),非独生子女118例(71.5%);生源地是城市70例(42.4%),乡镇36例(21.8%),农村59例(35.8%);父母婚姻状态良好144例(87.3%),离异21例(12.7%)。失眠方面,本研究采用 ISI≥8 作为是否失眠的划分标准,结果显示患者共 128例,未失眠患者为37例。青少年抑郁症患者的失眠率为77.58%,男女性别、独生子女和父母婚姻状况差异不显著。青少年抑郁症伴失眠患者各量表评分见表1
青少年抑郁症患者失眠与生活事件总分(r=0.49,P<0.01)及人际关系因子、学习压力因子、受惩罚因子、健康适应因子、其他因子呈显著正相关(r=0.32,r=0.46,r=0.41,r=0.40,r=0.26,P均<0.01),失眠与家庭关怀总分(r=0.37,P<0.01)及适应度、合作度、成长度和情感度因子呈显著负相关(r=0.30,r=0.30,r=0.32,r=0.29,P均<0.01)。生活事件与家庭关怀呈显著负相关(P<0.05)。见表2
结果显示,生活事件、家庭关怀、失眠三者之间存在两两相关,且家庭关怀总分及其因子(除亲密度)都存在相关。通过SPSS宏程序 PROCESS对中介效应进行验证。结果显示以生活事件为自变量,失眠为因变量,家庭关怀总分为中介变量,并控制在不同就读阶段、生源地的协变量影响后,家庭关怀在生活事件及失眠之间起部分中介作用。见图1。进一步针对家庭关怀的维度因子进行中介效应分析,发现合作度及成长度因子具有统计学意义。见图23
通过运用Bootstrap方法进行深入验证,本研究发现家庭关怀总分、合作度及成长度因子的总效应、直接效应和间接效应的95%置信区间均不包含零值,这充分验证了部分中介效应的存在,具体见表3。家庭关怀维度因子中的成长度中介效应占比最高,占总效应的10.57%。
本研究结果显示,青少年抑郁症患者失眠发生率为77.58%,与先前研究结果相似[16],但略高于另三项针对中国青少年抑郁症患者失眠的研究结果[17-18]。究其原因,可能由于本研究样本量中女性患者占主要部分,也可能与调查问卷不一致和样本来源于不同地区等有关。但目前来看,青少年抑郁症患者的失眠发生率情况是不容乐观的,这值得我们重点关注。本研究发现在不同就读阶段的青少年抑郁症患者中,初中生较高中生的失眠问题更为严重,可能由于高中生在情绪调控能力都优于初中学生[19],失眠问题也会有所下降。应有针对性地对其不同年龄阶段的青少年抑郁症患者的不同的心理认知水平及失眠的成因进行干预。此外,生源地来自农村的患者的失眠得分高于乡镇和城市,我们需要意识到不同地区的差异性,农村地区的青少年可能更具心理压力和挑战。
青少年抑郁症患者失眠与生活事件总分及人际关系、学习压力、受惩罚、健康适应和其他因子呈显著正相关。这意味着,青少年抑郁症患者在面对压力、挑战的负面事件时,更容易出现失眠问题。其中,学习压力因子是最值得关注的,可能由于青春期的患者正处于高强度学业压力时期会面临更大的心理负担,从而更容易影响其情绪和睡眠质量。因此,注重有效管理学习压力、减少负面反馈,可能有助于改善其睡眠和抑郁症状。失眠与家庭关怀总分及适应度、合作度、成长度和情感度因子呈显著负相关。这提示我们缺乏家庭关怀会增加青少年的心理压力和焦虑,从而影响其睡眠质量。在充满爱与温暖的家庭氛围中,青少年能够更好形成健康稳定的心理状态[20],有助于青少年降低失眠的发生。因此,在青少年抑郁症的治疗和管理上,可以从改善家庭环境方面入手,通过提供持续、稳定的情感和心理支持,有效缓解睡眠问题。
在青少年抑郁症患者中家庭关怀在生活事件和失眠间起部分中介效应。这表明生活事件不仅会对青少年抑郁症患者的失眠产生直接影响,还会通过家庭关怀这一中介因素间接影响失眠的发生和程度。这一发现支持了生态系统理论,该理论认为家庭环境是青少年行为的重要影响因素[21]。具体而言,对于处于抑郁状态的青少年来说,经历负性生活事件后,情绪波动和心理压力往往会增加,进而导致失眠的出现。既往的研究表明,生活事件与睡眠密切相关,生活事件所带来的压力影响睡眠质量[7]。然而,家庭关怀在这一过程中起到了缓冲作用。先前的研究已经确定了家庭关系与儿童青少年的情绪问题、睡眠质量之间的联系[22]。良好的家庭关怀能够有效降低生活事件带来的负面影响,减轻抑郁情绪,从而减少失眠的发生。因此,家庭关怀对于缓解青少年抑郁症患者的失眠问题具有重要意义,增强家庭关怀可以有效减少生活事件对他们的负面影响。
研究显示,家庭关怀中的合作度和成长度因子发挥了部分中介效应。其中,成长度因子中介效应占比最大,占总效应的10.57%。家庭关怀的成长度具体是指在身心发展上得到其他成员的支持与引导的程度。青少年抑郁症患者在处于生理和心理发育阶段,其负性生活事件往往会对加重其抑郁等负性情绪造成不利影响,导致压力增加,从而诱发或加剧失眠[8]。家庭在青少年的社交过程中起着核心作用,父母提供了情感联系、行为约束和模范[23]。当青少年能够得到足够的情感支持和正向的行为引导,这些可以部分缓解生活事件带来的负面影响,从而减少抑郁与失眠的交互作用。家庭关怀中的合作度指家庭成员间互相分担责任、解决问题和做决定的方式。研究表明,抑郁症与失眠往往存在相互关系[24],而生活事件可能通过加重焦虑和心理压力,导致失眠问题的出现。如果家庭能够通过积极合作减少生活事件带来的负面影响,青少年抑郁症患者的的负性情绪可能减轻,从而间接改善其睡眠状况。因此,家庭支持性互动和合作不仅在情感层面上有助于青少年抑郁症患者的康复,也可能通过改善其应对压力的方式,减少生活事件对睡眠质量的影响。总之,家庭功能、生活事件和失眠之间存在着复杂且密切的关系。这提示我们不仅要关注生活事件对青少年抑郁症的影响,也要注重加强家庭支持系统的建设,通过家庭干预、家庭教育与辅导及个性化治疗等来改善患者的整体身心健康。这种多维度的干预能够提高治疗效果,减少失眠的发生,促进心理复原力建设,最终改善其生活质量。
本研究存在一定的局限性。(1)本研究采用问卷调查的方式收集资料,可能存在报告偏倚及回忆偏倚。未来可以结合行为学实验以及生理层面的数据测量,会使得研究结果更加客观准确;(2)本研究属于横断性研究范畴,无法直接确立其中的因果关系。未来可进行纵向追踪研究,以验证变量之间的关联;(3)本研究的样本仅来源于一所三甲医院,只能反映来该院就诊的青少年抑郁症患者情况,样本的代表性需要考虑,且样本量过小,可能检验效能低。未来可以进一步扩大样本量、多中心区域进行探讨。
  • 暨南大学第一临床医学院护理科研专项项目(2022104)
  • 暨南大学护理学院2023年科研人才培育基金项目(JHA20230609)
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doi: 10.20043/j.cnki.MPM.202407014
  • 接收时间:2024-07-01
  • 首发时间:2026-03-18
  • 出版时间:2025-01-25
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  • 收稿日期:2024-07-01
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暨南大学第一临床医学院护理科研专项项目(2022104)
暨南大学护理学院2023年科研人才培育基金项目(JHA20230609)
作者信息
    1.暨南大学护理学院,广东 广州 510632
    2.广州市番禺区中心医院
    3.暨南大学附属第一医院

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
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