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Article(id=1241023851866419467, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241023847537897695, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202407151, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1720454400000, receivedDateStr=2024-07-09, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773812743392, onlineDateStr=2026-03-18, pubDate=1737734400000, pubDateStr=2025-01-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773812743392, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773812743392, creator=13701087609, updateTime=1773812743392, 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=267, endPage=273, ext={EN=ArticleExt(id=1241023852361347355, articleId=1241023851866419467, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Analysis of factors influencing anxiety and depression in secondary school students and construction of predictive model based on random forest algorithm, columnId=1228016568949474136, journalTitle=Modern Preventive Medicine, columnName=Child and Adolescent health, Maternal and Child Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the influencing factors on the occurrence of anxiety and depression among secondary school students in Shanxi Province in 2023 based on the random forest algorithm and to construct a prediction model to provide a scientific basis for preventing and controlling the occurrence of negative emotions such as anxiety and depression among secondary school students.

Methods

In September 2023, 104 826 secondary school students in 11 cities of Shanxi Province were selected by stratified random whole-cluster sampling method for questionnaire survey, and the Generalized Anxiety Scale (GAD-7) and the Center for Streamlined Depression Scale (CES-D) were used to investigate anxiety and depression. Epidata was used for database establishment, chi-square test was used for between-group comparisons, logistic regression was used for influencing factor analysis, and Python 3.7 was used to establish a random forest prediction model and rank the importance of each variable.

Results

The detection rates of anxiety and depression among secondary school students in Shanxi Province in 2023 were 33.26% and 23.72%, respectively, and were higher for girls than for boys, and higher for students in general and vocational high schools than for junior high school students. The results of multifactorial regression analysis showed that female students(OR: 1.846、1.655，95% CI: 1.794-1.901、1.602-1.710), high school(OR: 2.019、1.670，95% CI: 1.956-2.083、1.612-1.731), vocational high school(OR: 1.167、1.356，95% CI: 1.085-1.254、1.254-1.466), non-conventional family(OR: 1.105、1.248，95% CI: 1.072-1.140、1.206-1.292), living in school(OR: 1.102、1.117，95% CI: 1.070-1.136、1.080-1.155), eating fried food ≥1 time/day(OR: 1.296、1.375，95% CI: 1.227-1.369、1.297-1.457), being seriously injured(OR: 1.636、1.688，95% CI: 1.524-1.755、1.569-1.816), being bullied in school(OR: 2.315、3.411，95% CI: 2.150-2.492、3.165-3.677), being scolded by parents(OR: 2.881、3.191，95% CI: 2.766-3.001、3.059-3.328), smoking(OR: 1.344、1.435，95% CI: 1.266-1.427、1.349-1.527), drinking alcohol(OR: 2.062、2.113，95% CI: 1.978-2.151、2.022-2.208), and Internet addiction(OR: 3.635、3.976，95% CI: 3.289-4.016、3.611-4.377) were the risk factors for the detection of anxiety and depressive mood in secondary school students, and eating fresh fruits≥1 time/day(OR: 0.824、0.758，95% CI: 0.800-0.849、0.73-0.783), eating breakfast frequently(sometimes: OR: 0.843、0.715，95% CI: 0.781-0.910、0.661-0.773; daily: OR: 0.538、0.384，95% CI: 0.500-0.579、0.356-0.414), doing moderate to high-intensity exercise frequently(1-3 days/week: OR: 0.888、0.821，95% CI: 0.854-0.923、0.787-0.857; ≥4 days/week: OR: 0.931、0.848，95% CI: 0.893-0.971、0.810-0.887), and having a large number of physical education hours(2-3 sessions/week: OR: 0.826、0.859，95% CI: 0.801-0.853、0.829-0.890; ≥4 sessions/week: OR: 0.741、0.758，95% CI: 0.695-0.789、0.705-0.815) were the protective factors for the detection of anxiety and depressive protective factors for mood detection. Drinking sugary drinks≥1 time/day(OR: 1.198，95% CI: 1.122-1.279) and eating vegetables≥1 time/day(OR: 0.861，95% CI: 0.828-0.895) were independent risk factors and independent protective factors for the detection of depressed mood, respectively. The AUC of the Random Forest model predicting the risk of anxiety and depressed mood was 0.999 8 and 0.999 7, with a sensitivity of 99.53% and 99.67%, and a specificity of 99.47% and 98.98%, respectively. Being scolded by parents, Internet addiction and alcohol consumption were the common factors that had a greater degree of influence on anxiety and depression among secondary school students.

Conclusion

The detection rate of anxiety and depression among secondary school students in Shanxi Province is high, being scolded by parents, alcohol consumption and Internet addiction are the factors that have a greater influence on the occurrence of anxiety and depression, and the random forest model has a high predictive value.

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目的

基于随机森林算法分析2023年山西省中学生发生焦虑、抑郁情绪的影响因素并构建预测模型，为防控中学生焦虑和抑郁等负性情绪的发生提供科学依据。

方法

于2023年9月采用分层随机整群抽样方法，在山西省11个市抽取104 826名中学生进行问卷调查，使用广泛性焦虑量表(GAD-7)和流调中心抑郁量表(CES-D)调查焦虑抑郁情况。采用Epidata建立数据库，组间比较采用卡方检验，用logistic回归进行影响因素分析，用Python3.7建立随机森林预测模型及自变量重要性排序。

结果

1次/天(OR：0.824、0.758，95%CI：0.800~0.849、0.733~0.783)、吃早餐频次高(有时吃：OR：0.843、0.715，95%CI：0.781~0.910、0.661~0.773；天天吃：OR：0.538、0.384，95%CI：0.500~0.579、0.356~0.414)、中高强度运动频次高(1~3天/周：OR：0.888、0.821，95%CI：0.854~0.923、0.787~0.857；≥4天/周：OR：0.931、0.848，95%CI：0.893~0.971、0.810~0.887)、体育课时数多(2~3节/周：OR：0.826、0.859，95%CI：0.801~0.853、0.829~0.890；≥4节/周：OR：0.741、0.758，95%CI：0.695~0.789、0.705~0.815)是焦虑、抑郁情绪检出的保护因素。喝含糖饮料≥1次/天(OR：1.198，95%CI：1.122~1.279)、吃蔬菜≥1次/天(OR：0.861，95%CI：0.828~0.895)分别是抑郁情绪检出的独立危险因素和独立保护因素。随机森林模型预测焦虑、抑郁情绪发生风险的ROC曲线下面积分别为0.999 8、0.999 7，灵敏度为99.53%、99.67%，特异度为99.47%、98.98%。被家长打骂、网瘾和饮酒是中学生焦虑和抑郁情绪影响程度较大的共同因素。

结论

山西省中学生焦虑、抑郁情绪检出率较高，被家长打骂、饮酒、网瘾是焦虑和抑郁情绪发生影响较大的因素，随机森林模型具有较高的预测价值。

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陈靖，E-mail：
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高红霞(1998—)，女，硕士在读，研究方向：流行病学

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高红霞(1998—)，女，硕士在读，研究方向：流行病学

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高红霞(1998—)，女，硕士在读，研究方向：流行病学

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2．山西医科大学公共卫生学院流行病学教研室
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The study on the directivity of association between cumulative social-ecological risk factors and clustering health risk behaviors among adolescents[D]. Hefei: Anhui Medical University, 2024. (In Chinese), articleTitle=The study on the directivity of association between cumulative social-ecological risk factors and clustering health risk behaviors among adolescents, refAbstract=null), Reference(id=1241023870065504494, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023851866419467, doi=null, pmid=null, pmcid=null, year=2022, volume=14, issue=22, pageStart=4831, pageEnd=null, url=null, language=null, rfNumber=[21], rfOrder=27, authorNames=Reales-Moreno M, Tonini P, Escorihuela RM, journalName=Nutrients, refType=null, unstructuredReference=Reales-Moreno M, Tonini P, Escorihuela RM, et al. Ultra-Processed foods and drinks consumption is associated with psychosocial functioning in adolescents[J]. 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BMC Public Health, 2024, 24(1): 1832., articleTitle=Association between 29 food groups of diet quality questionnaire and perceived stress in Chinese adults: a prospective study from China health and nutrition survey, refAbstract=null)], funds=[Fund(id=1241023865321746448, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023851866419467, awardId=2024155, language=CN, fundingSource=山西省卫生健康委员会卫生健康科研课题(2024155), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241023856002003356, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023851866419467, xref=1．, ext=[AuthorCompanyExt(id=1241023856052335008, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023851866419467, companyId=1241023856002003356, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Academy of Medical Sciences, Shanxi Medical University, Taiyuan, Shanxi 030001, China), AuthorCompanyExt(id=1241023856090083747, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023851866419467, companyId=1241023856002003356, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1．山西医科大学医学科学院，山西　太原　030001)]), AuthorCompany(id=1241023856224301481, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023851866419467, xref=2．, ext=[AuthorCompanyExt(id=1241023856245273005, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023851866419467, companyId=1241023856224301481, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2．山西医科大学公共卫生学院流行病学教研室)]), AuthorCompany(id=1241023856413045176, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023851866419467, xref=3．, ext=[AuthorCompanyExt(id=1241023856417239481, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023851866419467, companyId=1241023856413045176, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3．山西省疾病预防控制中心学校卫生科)])], figs=[ArticleFig(id=1241023864281559984, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023851866419467, language=EN, label=Fig.1, caption=Importance ranking of variables, figureFileSmall=PQjVC2KEShX2tNaCbvXZlw==, figureFileBig=gM7eWmTwgL/EAH8DU7+yPQ==, tableContent=null), ArticleFig(id=1241023864361251765, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023851866419467, language=CN, label=图1, caption=变量重要性排序

注：(A)焦虑情绪的变量重要性排序；(B)抑郁情绪的变量重要性排序。

, figureFileSmall=PQjVC2KEShX2tNaCbvXZlw==, figureFileBig=gM7eWmTwgL/EAH8DU7+yPQ==, tableContent=null), ArticleFig(id=1241023864638075858, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023851866419467, language=EN, label=Fig.2, caption=Random forest algorithm predicts ROC curves for risk of anxiety and depression, figureFileSmall=Qg/8PBlXGTmWZ1WyTDwiaw==, figureFileBig=CzvKo+5tfctlo0sf2JLWVg==, tableContent=null), ArticleFig(id=1241023864742933467, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023851866419467, language=CN, label=图2, caption=随机森林算法预测焦虑、抑郁情绪风险的ROC曲线

注：(A)预测焦虑情绪风险的ROC曲线；(B)预测抑郁情绪风险的ROC曲线。

, figureFileSmall=Qg/8PBlXGTmWZ1WyTDwiaw==, figureFileBig=CzvKo+5tfctlo0sf2JLWVg==, tableContent=null), ArticleFig(id=1241023864851985381, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023851866419467, language=EN, label=Table 1, caption=

Basic information and detection of anxiety and depression in secondary school students[n (%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量调查人数焦虑情绪抑郁情绪
检出人数
(检出率)		χ2P检出人数
(检出率)		χ2P
性别969.483<0.001343.729<0.001
男52 239(50.29)15 009(28.73)11 118(21.28)
女51 638(49.71)19 537(37.83)13 517(26.18)
学段2 904.002<0.0011 430.670<0.001
初中62 823(60.48)17 003(27.06)12 364(19.68)
高中36 185(34.83)15 851(43.81)10 829(29.93)
职高4 869(4.69)1 692(34.75)1 442(29.62)
学校位置10.2880.0014.5330.033
城区22 085(21.26)7 544(34.16)5 357(24.26)
郊县81 792(78.74)27 002(33.01)19 278(23.57)
家庭类型99.887<0.001327.901<0.001
常态家庭75 319(72.51)24 371(32.36)16 754(22.24)
非常态家庭28 558(27.49)10 175(35.63)7 881(27.60)
住校528.509<0.001498.880<0.001
否46 465(44.73)13 717(29.52)9 497(20.44)
是57 412(55.27)20 829(36.28)15 138(26.37)
喝含糖饮料188.860<0.001522.195<0.001
<1次/天97 648(94.00)31 979(32.75)22 414(22.95)
≥1次/天6 229(6.00)2 567(41.21)2 221(35.66)
吃油炸食物565.024<0.001796.507<0.001
<1次/天96 075(92.49)31 000(32.27)21 765(22.65)
≥1次/天7 802(7.51)3 546(45.45)2 870(36.79)
吃新鲜水果687.117<0.0011 116.754<0.001
<1次/天40 945(39.42)15 562(38.01)11 949(29.18)
≥1次/天62 932(60.58)18 984(30.17)12 686(20.16)
吃蔬菜61.618<0.001409.488<0.001
<1次/天22 028(21.21)7 813(35.47)6 358(28.86)
≥1次/天81 849(78.79)26 733(32.66)18 277(22.33)
吃早餐1 634.485<0.0012 997.774<0.001
从来不吃3 629(3.49)1 713(47.20)1 576(43.43)
有时吃25 616(24.66)10 740(41.93)8 641(33.73)
天天吃74 632(71.85)22 093(29.60)14 418(19.32)
中高强度运动614.095<0.001784.884<0.001
0天17 755(17.09)7 310(41.17)5 643(31.78)
1~3天49 021(47.19)15 716(32.06)11 046(22.53)
≥4天37 101(35.72)11 520(31.05)7 946(21.42)
体育课时数876.420<0.001658.143<0.001
0~1节28 213(27.16)11 290(40.02)8 194(29.04)
2~3节68 517(65.96)21 396(31.23)15 131(22.08)
≥4节7 147(6.88)1 860(26.02)1 310(18.33)
受到严重伤害765.334<0.001953.936<0.001
没有99 869(96.14)32 404(32.45)22 869(22.90)
有4 008(3.86)2 142(53.44)1 766(44.06)
遭受校园欺凌1 096.171<0.0012 253.879<0.001
没有100 237(96.50)32 411(32.33)22 575(22.52))
有3 640(3.50)2 135(58.65)2 060(56.59)
被家长打骂3 796.898<0.0014 895.486<0.001
没有90 474(87.10)26 952(29.79)18 241(20.16)
有13 403(12.90)7 594(56.66)6 394(47.71)
吸烟1 682.796<0.0012 431.476<0.001
否96 979(93.36)30 701(31.66)21 316(21.98)
是6 898(6.64)3 845(55.74)3 319(48.12)
饮酒4 026.470<0.0014 575.562<0.001
否88 478(85.18)26 001(29.39)17 688(19.99)
是15 399(14.82)8 545(55.49)6 947(45.11)
网瘾1 989.317<0.0012 869.869<0.001
否101 415(97.63)32 697(32.24)22 934(22.61)
是2 462(2.37)1 849(75.10)1 701(69.09)
), ArticleFig(id=1241023864977814516, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023851866419467, language=CN, label=表1, caption=

中学生基本情况以及焦虑、抑郁情绪检出情况[n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量调查人数焦虑情绪抑郁情绪
检出人数
(检出率)		χ2P检出人数
(检出率)		χ2P
性别969.483<0.001343.729<0.001
男52 239(50.29)15 009(28.73)11 118(21.28)
女51 638(49.71)19 537(37.83)13 517(26.18)
学段2 904.002<0.0011 430.670<0.001
初中62 823(60.48)17 003(27.06)12 364(19.68)
高中36 185(34.83)15 851(43.81)10 829(29.93)
职高4 869(4.69)1 692(34.75)1 442(29.62)
学校位置10.2880.0014.5330.033
城区22 085(21.26)7 544(34.16)5 357(24.26)
郊县81 792(78.74)27 002(33.01)19 278(23.57)
家庭类型99.887<0.001327.901<0.001
常态家庭75 319(72.51)24 371(32.36)16 754(22.24)
非常态家庭28 558(27.49)10 175(35.63)7 881(27.60)
住校528.509<0.001498.880<0.001
否46 465(44.73)13 717(29.52)9 497(20.44)
是57 412(55.27)20 829(36.28)15 138(26.37)
喝含糖饮料188.860<0.001522.195<0.001
<1次/天97 648(94.00)31 979(32.75)22 414(22.95)
≥1次/天6 229(6.00)2 567(41.21)2 221(35.66)
吃油炸食物565.024<0.001796.507<0.001
<1次/天96 075(92.49)31 000(32.27)21 765(22.65)
≥1次/天7 802(7.51)3 546(45.45)2 870(36.79)
吃新鲜水果687.117<0.0011 116.754<0.001
<1次/天40 945(39.42)15 562(38.01)11 949(29.18)
≥1次/天62 932(60.58)18 984(30.17)12 686(20.16)
吃蔬菜61.618<0.001409.488<0.001
<1次/天22 028(21.21)7 813(35.47)6 358(28.86)
≥1次/天81 849(78.79)26 733(32.66)18 277(22.33)
吃早餐1 634.485<0.0012 997.774<0.001
从来不吃3 629(3.49)1 713(47.20)1 576(43.43)
有时吃25 616(24.66)10 740(41.93)8 641(33.73)
天天吃74 632(71.85)22 093(29.60)14 418(19.32)
中高强度运动614.095<0.001784.884<0.001
0天17 755(17.09)7 310(41.17)5 643(31.78)
1~3天49 021(47.19)15 716(32.06)11 046(22.53)
≥4天37 101(35.72)11 520(31.05)7 946(21.42)
体育课时数876.420<0.001658.143<0.001
0~1节28 213(27.16)11 290(40.02)8 194(29.04)
2~3节68 517(65.96)21 396(31.23)15 131(22.08)
≥4节7 147(6.88)1 860(26.02)1 310(18.33)
受到严重伤害765.334<0.001953.936<0.001
没有99 869(96.14)32 404(32.45)22 869(22.90)
有4 008(3.86)2 142(53.44)1 766(44.06)
遭受校园欺凌1 096.171<0.0012 253.879<0.001
没有100 237(96.50)32 411(32.33)22 575(22.52))
有3 640(3.50)2 135(58.65)2 060(56.59)
被家长打骂3 796.898<0.0014 895.486<0.001
没有90 474(87.10)26 952(29.79)18 241(20.16)
有13 403(12.90)7 594(56.66)6 394(47.71)
吸烟1 682.796<0.0012 431.476<0.001
否96 979(93.36)30 701(31.66)21 316(21.98)
是6 898(6.64)3 845(55.74)3 319(48.12)
饮酒4 026.470<0.0014 575.562<0.001
否88 478(85.18)26 001(29.39)17 688(19.99)
是15 399(14.82)8 545(55.49)6 947(45.11)
网瘾1 989.317<0.0012 869.869<0.001
否101 415(97.63)32 697(32.24)22 934(22.61)
是2 462(2.37)1 849(75.10)1 701(69.09)
), ArticleFig(id=1241023865099449343, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023851866419467, language=EN, label=Table 2, caption=

Logistic regression analysis of anxiety and depression among secondary school students

, figureFileSmall=null, figureFileBig=null, tableContent=
变量焦虑情绪抑郁情绪
OR(95%CI)POR(95%CI)P
性别（以男生为参照）
女生1.846(1.794~1.901)<0.0011.655(1.602~1.710)<0.001
学段（以初中为参照）
高中2.019(1.956~2.083)<0.0011.670(1.612~1.731)<0.001
职高1.167(1.085~1.254)<0.0011.356(1.254~1.466)<0.001
学校位置（以城区为参照）
郊县1.012(0.976~1.050)0.5051.040(0.999~1.084)0.058
家庭类型（以常态家庭为参照）
非常态家庭1.105(1.072~1.140)<0.0011.248(1.206~1.292)<0.001
住校（以否为参照）
是1.102(1.070~1.136)<0.0011.117(1.080~1.155)<0.001
喝含糖饮料（以<1次/天为参照）
≥1次/天1.010(0.949~1.074)0.7601.198(1.122~1.279)<0.001
吃油炸食物（以<1次/天为参照）
≥1次/天1.296(1.227~1.369)<0.0011.375(1.297~1.457)<0.001
吃新鲜水果（以<1次/天为参照）
≥1次/天0.824(0.800~0.849)<0.0010.758(0.733~0.783)<0.001
吃蔬菜（以<1次/天为参照）
≥1次/天1.027(0.992~1.065)0.1350.861(0.828~0.895)<0.001
吃早餐（以从来不吃为参照）
有时吃0.843(0.781~0.910)<0.0010.715(0.661~0.773)<0.001
天天吃0.538(0.500~0.579)<0.0010.384(0.356~0.414)<0.001
中高强度运动（以0天为参照）
1~3天0.888(0.854~0.923)<0.0010.821(0.787~0.857)<0.001
≥ 4天0.931(0.893~0.971)0.0010.848(0.810~0.887)<0.001
体育课时数（以0~1节为参照）
2~3节0.826(0.801~0.853)<0.0010.859(0.829~0.890)<0.001
≥ 4节0.741(0.695~0.789)<0.0010.758(0.705~0.815)<0.001
受到严重伤害（以没有为参照）
有1.636(1.524~1.755)<0.0011.688(1.569~1.816)<0.001
遭受校园欺凌（以没有为参照）
有2.315(2.150~2.492)<0.0013.411(3.165~3.677)<0.001
被家长打骂（以没有为参照）
有2.881(2.766~3.001)<0.0013.191(3.059~3.328)<0.001
吸烟（以否为参照）
是1.344(1.266~1.427)<0.0011.435(1.349~1.527)<0.001
饮酒（以否为参照）
是2.062(1.978~2.151)<0.0012.113(2.022~2.208)<0.001
网瘾（以否为参照）
是3.635(3.289~4.016)<0.0013.976(3.611~4.377)<0.001
常量0.377<0.0010.359<0.001
), ArticleFig(id=1241023865191723014, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023851866419467, language=CN, label=表2, caption=

中学生焦虑、抑郁情绪的多因素logistic分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量焦虑情绪抑郁情绪
OR(95%CI)POR(95%CI)P
性别（以男生为参照）
女生1.846(1.794~1.901)<0.0011.655(1.602~1.710)<0.001
学段（以初中为参照）
高中2.019(1.956~2.083)<0.0011.670(1.612~1.731)<0.001
职高1.167(1.085~1.254)<0.0011.356(1.254~1.466)<0.001
学校位置（以城区为参照）
郊县1.012(0.976~1.050)0.5051.040(0.999~1.084)0.058
家庭类型（以常态家庭为参照）
非常态家庭1.105(1.072~1.140)<0.0011.248(1.206~1.292)<0.001
住校（以否为参照）
是1.102(1.070~1.136)<0.0011.117(1.080~1.155)<0.001
喝含糖饮料（以<1次/天为参照）
≥1次/天1.010(0.949~1.074)0.7601.198(1.122~1.279)<0.001
吃油炸食物（以<1次/天为参照）
≥1次/天1.296(1.227~1.369)<0.0011.375(1.297~1.457)<0.001
吃新鲜水果（以<1次/天为参照）
≥1次/天0.824(0.800~0.849)<0.0010.758(0.733~0.783)<0.001
吃蔬菜（以<1次/天为参照）
≥1次/天1.027(0.992~1.065)0.1350.861(0.828~0.895)<0.001
吃早餐（以从来不吃为参照）
有时吃0.843(0.781~0.910)<0.0010.715(0.661~0.773)<0.001
天天吃0.538(0.500~0.579)<0.0010.384(0.356~0.414)<0.001
中高强度运动（以0天为参照）
1~3天0.888(0.854~0.923)<0.0010.821(0.787~0.857)<0.001
≥ 4天0.931(0.893~0.971)0.0010.848(0.810~0.887)<0.001
体育课时数（以0~1节为参照）
2~3节0.826(0.801~0.853)<0.0010.859(0.829~0.890)<0.001
≥ 4节0.741(0.695~0.789)<0.0010.758(0.705~0.815)<0.001
受到严重伤害（以没有为参照）
有1.636(1.524~1.755)<0.0011.688(1.569~1.816)<0.001
遭受校园欺凌（以没有为参照）
有2.315(2.150~2.492)<0.0013.411(3.165~3.677)<0.001
被家长打骂（以没有为参照）
有2.881(2.766~3.001)<0.0013.191(3.059~3.328)<0.001
吸烟（以否为参照）
是1.344(1.266~1.427)<0.0011.435(1.349~1.527)<0.001
饮酒（以否为参照）
是2.062(1.978~2.151)<0.0012.113(2.022~2.208)<0.001
网瘾（以否为参照）
是3.635(3.289~4.016)<0.0013.976(3.611~4.377)<0.001
常量0.377<0.0010.359<0.001
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基于随机森林算法的中学生焦虑、抑郁影响因素分析及预测模型构建
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高红霞 1, 2 , 陈靖 1, 2, 3 , 张晓红 1, 2, 3 , 侯丽明 3 , 王丽洁 3 , 孟亚清 3 , 高雯 3 , 黄亚欣 3
现代预防医学 | 儿少卫生与妇幼保健 2025,52(2): 267-273
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现代预防医学 | 儿少卫生与妇幼保健 2025, 52(2): 267-273
基于随机森林算法的中学生焦虑、抑郁影响因素分析及预测模型构建
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高红霞1, 2, 陈靖1, 2, 3 , 张晓红1, 2, 3, 侯丽明3, 王丽洁3, 孟亚清3, 高雯3, 黄亚欣3
作者信息
  • 1．山西医科大学医学科学院，山西　太原　030001
  • 2．山西医科大学公共卫生学院流行病学教研室
  • 3．山西省疾病预防控制中心学校卫生科

    • 高红霞(1998—)，女，硕士在读，研究方向：流行病学

通讯作者:

陈靖，E-mail：
Analysis of factors influencing anxiety and depression in secondary school students and construction of predictive model based on random forest algorithm
Hong-xia GAO1, 2, Jing CHEN1, 2, 3 , Xiao-hong ZHANG1, 2, 3, Li-ming HOU3, Li-jie WANG3, Ya-qing MENG3, Wen GAO3, Ya-xin HUANG3
Affiliations
  • Academy of Medical Sciences, Shanxi Medical University, Taiyuan, Shanxi 030001, China
出版时间: 2025-01-25 doi: 10.20043/j.cnki.MPM.202407151
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摘要
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目的

基于随机森林算法分析2023年山西省中学生发生焦虑、抑郁情绪的影响因素并构建预测模型，为防控中学生焦虑和抑郁等负性情绪的发生提供科学依据。

方法

于2023年9月采用分层随机整群抽样方法，在山西省11个市抽取104 826名中学生进行问卷调查，使用广泛性焦虑量表(GAD-7)和流调中心抑郁量表(CES-D)调查焦虑抑郁情况。采用Epidata建立数据库，组间比较采用卡方检验，用logistic回归进行影响因素分析，用Python3.7建立随机森林预测模型及自变量重要性排序。

结果

1次/天(OR：0.824、0.758，95%CI：0.800~0.849、0.733~0.783)、吃早餐频次高(有时吃：OR：0.843、0.715，95%CI：0.781~0.910、0.661~0.773；天天吃：OR：0.538、0.384，95%CI：0.500~0.579、0.356~0.414)、中高强度运动频次高(1~3天/周：OR：0.888、0.821，95%CI：0.854~0.923、0.787~0.857；≥4天/周：OR：0.931、0.848，95%CI：0.893~0.971、0.810~0.887)、体育课时数多(2~3节/周：OR：0.826、0.859，95%CI：0.801~0.853、0.829~0.890；≥4节/周：OR：0.741、0.758，95%CI：0.695~0.789、0.705~0.815)是焦虑、抑郁情绪检出的保护因素。喝含糖饮料≥1次/天(OR：1.198，95%CI：1.122~1.279)、吃蔬菜≥1次/天(OR：0.861，95%CI：0.828~0.895)分别是抑郁情绪检出的独立危险因素和独立保护因素。随机森林模型预测焦虑、抑郁情绪发生风险的ROC曲线下面积分别为0.999 8、0.999 7，灵敏度为99.53%、99.67%，特异度为99.47%、98.98%。被家长打骂、网瘾和饮酒是中学生焦虑和抑郁情绪影响程度较大的共同因素。

结论

山西省中学生焦虑、抑郁情绪检出率较高，被家长打骂、饮酒、网瘾是焦虑和抑郁情绪发生影响较大的因素，随机森林模型具有较高的预测价值。

焦虑  /  抑郁  /  影响因素  /  随机森林  /  预测模型
Objective

To analyze the influencing factors on the occurrence of anxiety and depression among secondary school students in Shanxi Province in 2023 based on the random forest algorithm and to construct a prediction model to provide a scientific basis for preventing and controlling the occurrence of negative emotions such as anxiety and depression among secondary school students.

Methods

In September 2023, 104 826 secondary school students in 11 cities of Shanxi Province were selected by stratified random whole-cluster sampling method for questionnaire survey, and the Generalized Anxiety Scale (GAD-7) and the Center for Streamlined Depression Scale (CES-D) were used to investigate anxiety and depression. Epidata was used for database establishment, chi-square test was used for between-group comparisons, logistic regression was used for influencing factor analysis, and Python 3.7 was used to establish a random forest prediction model and rank the importance of each variable.

Results

The detection rates of anxiety and depression among secondary school students in Shanxi Province in 2023 were 33.26% and 23.72%, respectively, and were higher for girls than for boys, and higher for students in general and vocational high schools than for junior high school students. The results of multifactorial regression analysis showed that female students(OR: 1.846、1.655，95% CI: 1.794-1.901、1.602-1.710), high school(OR: 2.019、1.670，95% CI: 1.956-2.083、1.612-1.731), vocational high school(OR: 1.167、1.356，95% CI: 1.085-1.254、1.254-1.466), non-conventional family(OR: 1.105、1.248，95% CI: 1.072-1.140、1.206-1.292), living in school(OR: 1.102、1.117，95% CI: 1.070-1.136、1.080-1.155), eating fried food ≥1 time/day(OR: 1.296、1.375，95% CI: 1.227-1.369、1.297-1.457), being seriously injured(OR: 1.636、1.688，95% CI: 1.524-1.755、1.569-1.816), being bullied in school(OR: 2.315、3.411，95% CI: 2.150-2.492、3.165-3.677), being scolded by parents(OR: 2.881、3.191，95% CI: 2.766-3.001、3.059-3.328), smoking(OR: 1.344、1.435，95% CI: 1.266-1.427、1.349-1.527), drinking alcohol(OR: 2.062、2.113，95% CI: 1.978-2.151、2.022-2.208), and Internet addiction(OR: 3.635、3.976，95% CI: 3.289-4.016、3.611-4.377) were the risk factors for the detection of anxiety and depressive mood in secondary school students, and eating fresh fruits≥1 time/day(OR: 0.824、0.758，95% CI: 0.800-0.849、0.73-0.783), eating breakfast frequently(sometimes: OR: 0.843、0.715，95% CI: 0.781-0.910、0.661-0.773; daily: OR: 0.538、0.384，95% CI: 0.500-0.579、0.356-0.414), doing moderate to high-intensity exercise frequently(1-3 days/week: OR: 0.888、0.821，95% CI: 0.854-0.923、0.787-0.857; ≥4 days/week: OR: 0.931、0.848，95% CI: 0.893-0.971、0.810-0.887), and having a large number of physical education hours(2-3 sessions/week: OR: 0.826、0.859，95% CI: 0.801-0.853、0.829-0.890; ≥4 sessions/week: OR: 0.741、0.758，95% CI: 0.695-0.789、0.705-0.815) were the protective factors for the detection of anxiety and depressive protective factors for mood detection. Drinking sugary drinks≥1 time/day(OR: 1.198，95% CI: 1.122-1.279) and eating vegetables≥1 time/day(OR: 0.861，95% CI: 0.828-0.895) were independent risk factors and independent protective factors for the detection of depressed mood, respectively. The AUC of the Random Forest model predicting the risk of anxiety and depressed mood was 0.999 8 and 0.999 7, with a sensitivity of 99.53% and 99.67%, and a specificity of 99.47% and 98.98%, respectively. Being scolded by parents, Internet addiction and alcohol consumption were the common factors that had a greater degree of influence on anxiety and depression among secondary school students.

Conclusion

The detection rate of anxiety and depression among secondary school students in Shanxi Province is high, being scolded by parents, alcohol consumption and Internet addiction are the factors that have a greater influence on the occurrence of anxiety and depression, and the random forest model has a high predictive value.

Anxiety  /  Depression  /  Influencing factors  /  Random forest  /  Prediction model
高红霞, 陈靖, 张晓红, 侯丽明, 王丽洁, 孟亚清, 高雯, 黄亚欣. 基于随机森林算法的中学生焦虑、抑郁影响因素分析及预测模型构建. 现代预防医学, 2025 , 52 (2) : 267 -273 . DOI: 10.20043/j.cnki.MPM.202407151
Hong-xia GAO, Jing CHEN, Xiao-hong ZHANG, Li-ming HOU, Li-jie WANG, Ya-qing MENG, Wen GAO, Ya-xin HUANG. Analysis of factors influencing anxiety and depression in secondary school students and construction of predictive model based on random forest algorithm[J]. Modern Preventive Medicine, 2025 , 52 (2) : 267 -273 . DOI: 10.20043/j.cnki.MPM.202407151
正文
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全球疾病负担研究显示，10~19岁学生中，约1/7存在精神障碍，占该年龄段总疾病负担的13%[1]，抑郁和焦虑分别是第四和第六位的致残原因[2]。一项Meta分析表明我国中学生抑郁检出率为28.4%，高于欧洲、北美洲、亚洲发达国家[3]。近三年研究表明我国中学生焦虑检出率为12.3%~34.6%[4-6]。作为常见的精神疾病，焦虑、抑郁成为重大公共卫生问题，探讨其影响因素对早期预防和精准干预有重要意义。
有关中学生焦虑和抑郁情绪的影响因素已有研究报道，但对于其重要性排序及风险评估研究较少，且多采用传统的统计学方法探讨个体患病风险，易出现过拟合、预测效度低等问题。近年来，随机森林算法在疾病风险预测、预警和预后中广泛应用，而多因素logistic回归能通过OR值对影响因素进行定量分析并作出直观解释，弥补随机森林算法解释困难的缺陷[7]。本研究拟用随机森林和logistic回归相结合的方法分析2023年山西省中学生焦虑和抑郁情绪的现况及影响因素并构建预测模型，为识别高危人群和防控中学生焦虑和抑郁情绪的发生提供科学依据。
1　对象与方法
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1.1　对象
于2023年9月采用分层随机整群抽样方法，抽取山西省11个市117个县(市、区)初中、普通高中和职业高中的一至三年级学生，按城区和郊县分层，每个城区5所中学(每区初中2所，高中2所，职高1所)，每个郊县3所中学(每县初中2所，高中1所)，每个年级抽取2个班级，确保每年级至少80名学生，以整班为单位开展调查。所有研究对象均签署知情同意书，研究经山西省疾病预防控制中心伦理审查委员会审核批准(审批号：SXCDCIRBYJ2024 093001)。本次调查共回收问卷104 826份，剔除信息不完整的问卷，得到有效问卷103 877份，有效回收率99.1%。
1.2　方法
1.2.1　调查方法
采用国家编制的《2023年全国学生常见病和健康影响因素监测与干预工作方案》中的“学生健康状况及影响因素调查表(中学版)”[8]进行调查，问卷内容主要包括基本信息(学校类型、学段、学生年级、性别、家庭类型等)、饮食运动行为(过去一周喝含糖饮料、吃油炸食物、吃蔬菜水果、吃早餐频次、每天中高强度运动频次及体育课频次)、伤害相关行为(受到严重伤害、遭受校园欺凌及被家长打骂)、吸烟饮酒行为、网络使用情况(是否有网瘾)等。由经过统一培训的疾控中心人员担任调查员，通过学生自填问卷开展调查。
1.2.2　焦虑情绪
采用Spitzer等[9]编制的广泛性焦虑量表(Generalized Anxiety Disorder, GAD-7)测量，该量表由7个条目组成，用来评估过去两周焦虑情绪的发生频率，每个条目按0~3分进行4级评估，选项0~3分别表示没有、有几天、一周有一半以上时间、几乎每天都有。总分0~21分，分数越高表明焦虑情绪越严重，总分≥5分提示存在焦虑症状，分值5、10、15分别为轻、中、重度焦虑程度分界值。
1.2.3　抑郁情绪
采用Radloff[10]编制的流调中心抑郁量表(Center for Epidermiologic Studies Depression Scale, CES-D)测量，包括抑郁情绪、积极情绪、躯体症状与活动迟滞、人际共4个因素，按照过去1周出现相应情况的频度进行自评，采用0~3分4级计分制，没有或偶尔=0分，有时=1分，时常或一半时间=2分，多数时间或持续=3分，第4、8、12、16题为反向计分，总分范围为0~60分，得分≥16分为出现抑郁风险的标准，得分越高抑郁程度越严重。
1.2.4　随机森林算法
随机森林是基于决策树的机器学习算法，它通过集成多个决策树对数据进行综合分类、关联性检验，将训练数据按照一定比例抽样，训练一个决策树，通过投票或平均等方式得出最终的预测结果[7]。
1.3　质量控制
由经过统一培训的调查员现场发放问卷，学生采用无记名方式独立填写问卷，完成后由调查员回收问卷并核查信息完整性。以双人双录入方式进行一致性检验。
1.4　统计学方法
采用EpiData建立数据库录入数据，用SPSS 26.0软件进行统计分析。计数资料采用构成比或率的形式进行统计描述，用Pearson χ2检验比较焦虑、抑郁情绪检出率在不同人口学特征的组间差异，用非条件logistic回归进行影响因素分析，检验水准为双侧α=0.05。按照SMOTE算法[11]处理数据不平衡问题，用Python 3.7软件对自变量进行重要性排序，建立预测中学生发生焦虑和抑郁情绪的随机森林模型，选用灵敏度、特异度及受试者工作特征曲线(Receiver Operating Characteristic, ROC曲线)下面积(Area Under Curve, AUC)评价预测模型的性能。
2　结果
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2.1　一般人口学特征
本研究共纳入103 877名中学生，其中男生52 239人(50.29%)，女生51 638人(49.71%)；城区22 085人(21.26%)，郊县81 792人(78.74%)；初中生62 823人(60.48%)，普通高中生36 185人(34.83%)，职业高中生4 869人(4.69%)；来自常态家庭学生75 319人(72.51%)，非常态家庭学生28 558人(27.49%)；住校学生57 412人(55.27%)，非住校学生46 465人(44.73%)。
2.2　中学生焦虑、抑郁情绪检出情况及单因素分析
2023年山西省中学生发生焦虑情绪34 546人，焦虑情绪检出率为33.26%，24 635人有抑郁风险，抑郁情绪检出率为23.72%。女生、高中、城区、非常态家庭、住校、喝含糖饮料≥1次/天、吃油炸食物≥1次/天、吃新鲜水果<1次/天、吃蔬菜<1次/天、从来不吃早餐、从来不做中高强度运动、一周上体育课节数、受到严重伤害、遭受校园欺凌、被家长打骂、吸烟、饮酒、有网瘾的中学生焦虑情绪和抑郁情绪检出率明显较高，差别均有统计学意义(P<0.05)。见表1。
2.3　中学生焦虑、抑郁情绪的多因素分析
依据GAD-7≥5分划分为焦虑组和非焦虑组，CES-D≥16分划分为抑郁组和非抑郁组，将单因素分析中有意义的影响因素纳入多因素logistic分析。结果显示，女生、高中、职高、非常态家庭、住校、吃油炸食物≥1次/天、受到严重伤害、遭受校园欺凌、被家长打骂、吸烟、饮酒、网瘾是焦虑、抑郁情绪检出的危险因素(OR：1.102~3.635、1.117~3.976)；吃新鲜水果≥1次/天、吃早餐频次高、中高强度运动频次高、体育课时数多是焦虑和抑郁检出的保护因素(OR：0.538~0.931、0.384~0.859)。见表2。
2.4　基于logistic回归分析结果构建随机森林模型
2.4.1　自变量重要性排序
利用机器学习的随机化原则，将SMOTE算法处理过的数据按8:2比例拆分为训练集和验证集，构建随机森林模型，以变量重要性评分来评价各自变量对因变量的影响程度大小。结果显示，影响焦虑情绪的前五位因素是被家长打骂、饮酒、遭受校园欺凌、受到严重伤害和网瘾，影响抑郁情的前五位因素是被家长打骂、饮酒、网瘾、中高强度运动和吃新鲜水果，见图1。
2.4.2　模型验证
利用随机森林算法在训练集构建中学生焦虑和抑郁情绪发生的风险预测模型并对测试集进行预测，结果显示，焦虑情绪风险预测模型的灵敏度为99.53%，特异度为99.47%，AUC为0.999 8；抑郁情绪风险预测模型的灵敏度为99.67%，特异度为98.98%，AUC为0.999 7，见图2。
3　讨论
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一项系统综述显示[12]，全球中学生焦虑检出率为2.32%~58.79%，抑郁检出率为2.21%~63.76%；我国中学生焦虑、抑郁检出率分别为28.0%(95%CI：20.0~29.0%)、28.4%(95%CI：24.4~32.4%)[13]。本研究中学生焦虑和抑郁检出率分别为33.26%、23.72%，检出率差异可能源于地域、经济、学习阶段构成等因素，这也表明山西地区中学生焦虑抑郁现状不容乐观，应及早识别风险因素并干预。
随机森林广泛应用于学龄儿童、老年人及孕产妇等特殊人群的焦虑抑郁风险预测模型[14-15]，中学生的相关研究较少。本研究构建的中学生焦虑抑郁风险模型AUC值接近1，具有较好的预测效能。但随机森林算法输出的预测概率易受到不平衡数据的影响而造成偏倚。本研究用SMOTE方法进行数据处理，将随机森林算法结合多因素logistic回归进行直观解释，结果与其他文献报道[16-18]一致，女生、高中和职高、来自非常态家庭及住校的学生容易出现焦虑抑郁情绪，如被家长打骂、受到严重伤害、遭受校园欺凌、吸烟、饮酒、网瘾等不良经历是重要预测因素，而健康饮食(吃新鲜水果和蔬菜、吃早餐)则是焦虑抑郁的保护因素。这些因素涵盖社会人口学特征、学校和家庭、健康危险行为等方面，充分表明中学生心理健康促进工作的综合性。
女生可能由于青春早期雌激素水平的变化，社会化的性别角色期望和不平等，更倾向于负面思维模式。高中生面临较高的父母期望和较繁重的学习任务，家庭结构不完整导致安全感和亲子沟通的缺失，在增加焦虑抑郁情绪的同时，还会导致不健康饮食、缺乏体育活动、物质滥用以及欺凌伤害等健康风险行为的发生。有研究[19]表明长期生活在充斥家庭和校园暴力环境的学生，通过吸烟、饮酒、沉迷网络等以“自我治疗假说”解释的行为来逃避现实生活，这些行为多协同发生，其累积负性水平与焦虑抑郁呈显著剂量反应关系[20]。此外，饮食行为对于心理健康的影响开始受到关注。食用甜味饮料、油炸食品等西方膳食模式在纵向研究中已被证实与焦虑抑郁风险增加有关[21]，而摄入水果蔬菜、吃早餐等健康的生活方式可能通过减少氧化应激和炎性细胞因子来改变神经递质的浓度，进而减轻不良情绪[22]。有研究[18]表明上述健康风险行为具有协同效应，且风险行为和焦虑抑郁之间可能存在双向关系，尚需进一步基于聚类和潜在类别分析探讨。
本研究存在一定局限性。第一，问卷中的数据信息多来源于调查对象的主观回忆，可能存在一定的回忆偏倚。第二，本研究属于横断面调查，可反映焦虑、抑郁情绪的危险因素，但不能确定变量间的因果关系，也不能排除研究对象的既往史、家族史等可能的混杂因素。第三，由于研究对象仅为山西地区中学生且未进行外部验证，该模型的推广和应用仍需要增加样本量和前瞻性研究来进一步验证和改进。
4　结论
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综上所述，2023年山西省中学生焦虑、抑郁情绪的检出率较高，除性别、学段等基本人口学特征外，其健康风险行为与焦虑、抑郁情绪呈正相关，而健康饮食和体育锻炼有利于降低焦虑抑郁情绪的风险。随机森林模型具有较好的预测能力，可获知各个特征的重要性。在公共卫生工作中，可构建专业化的随机森林模型对焦虑和抑郁高危人群进行识别和筛选，并采取相应措施，开展心理健康筛查，早期预测与识别，促进青少年学生心理的健康成长。
基金
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  • 山西省卫生健康委员会卫生健康科研课题(2024155)
文献
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doi: 10.20043/j.cnki.MPM.202407151
  • 接收时间：2024-07-09
  • 首发时间：2026-03-18
  • 出版时间：2025-01-25
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  • 收稿日期：2024-07-09
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山西省卫生健康委员会卫生健康科研课题(2024155)
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    1．山西医科大学医学科学院，山西　太原　030001
    2．山西医科大学公共卫生学院流行病学教研室
    3．山西省疾病预防控制中心学校卫生科

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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
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
栓菌属 Trametes 5 2.39
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