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Article(id=1241034444849598591, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241034441380917539, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202412517, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1735401600000, receivedDateStr=2024-12-29, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773815268956, onlineDateStr=2026-03-18, pubDate=1749484800000, pubDateStr=2025-06-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773815268956, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773815268956, creator=13701087609, updateTime=1773815268956, updator=13701087609, issue=Issue{id=1241034441380917539, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='11', pageStart='1921', pageEnd='2112', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773815268130, creator=13701087609, updateTime=1773815340947, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241034746873049765, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241034441380917539, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241034746873049766, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241034441380917539, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1980, endPage=1985, ext={EN=ArticleExt(id=1241034445210308744, articleId=1241034444849598591, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Analysis of development trajectories of early depression symptoms in adolescents in the Hunan-Hubei-Chongqing-Guizhou border area based on the GBTM model, columnId=1228016568949474136, journalTitle=Modern Preventive Medicine, columnName=Child and Adolescent Health, Maternal and Child Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the heterogeneous development trajectories of early depression symptoms in adolescents and their influencing factors.

Methods

A cluster sampling method was employed to conduct four follow-up surveys from March 2023 to September 2024, targeting 1 118 seventh-grade students from junior high schools in the Hunan-Hubei-Chongqing-Guizhou border area. Each survey was spaced six months apart, utilizing the Depression Symptoms Scale, Family Support Scale,Peer Relationship Scale, and School Connection Scale. Group-based Trajectory Modeling (GBTM) was used to explore the heterogeneous development trajectories of early depression symptoms in adolescents, while multi-class logistic stepwise regression analysis was performed to identify the relevant factors associated with different latent developmental trajectories.

Results

Four subtypes were identified: “G1: Low Risk-Deterioration Group” (8.27%), “G2: High Risk-Persistent Group”(3.73%), “G3: Low Risk-Stable Group” (78.24%), and “G4: High Risk-Relief Group” (9.76%). Using the G3 group as a reference, the protective factors for the G1 group included being male (OR=0.417, 95%CI: 0.297-0.585), family support (OR=0.870, 95%CI: 0.641-0.923), peer relationships (OR=0.829, 95%CI: 0.740-0.998), and school connection (OR=0.865, 95%CI:0.725-0.906); risk factors included boarding (OR=1.310, 95%CI: 1.154-2.010), being left-behind (OR=2.196, 95%CI: 1.376-3.503), single-parent families (OR=2.247, 95%CI: 1.456-3.468), and low Family Economic Status (FSES) (OR=1.548, 95%CI:1.371-2.451). For the G2 group, protective factors included being male (OR=0.318, 95%CI: 0.263-0.521), family support (OR=0.856, 95%CI: 0.817-0.991), and peer relationships (OR=0.849, 95%CI: 0.711-0.988); risk factors were boarding (OR=1.332,95%CI: 1.022-2.058), being left-behind (OR=1.422, 95%CI: 1.211-3.218), single-parent families (OR=2.953, 95%CI: 1.659-4.256), and low FSES (OR=2.469, 95%CI: 1.188-3.128). For the G4 group, being male (OR=1.350, 95%CI: 1.001-1.513) was identified as a risk factor, while family support (OR=0.892, 95%CI: 0.751-0.943) and school connection (OR=0.846, 95%CI:0.705-0.961) were protective factors.

Conclusion

There is significant group heterogeneity and individual variability in early depression symptoms among adolescents. It is crucial to focus on the “Low Risk-Deterioration Group” and “High Risk-Persistent Group” to enhance the breadth and depth of their interpersonal support networks.

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目的

考察青少年早期抑郁症状异质性发展轨迹及其相关影响因素。

方法

采用整群抽样法，于2023年3月—2024年9月对湘鄂渝黔边区初级中学1 118名七年级学生进行四次追踪调查，每次调查间隔半年，使用抑郁症状量表、家庭支持量表、同伴关系量表和学校联结量表进行追踪调查，采用组基轨迹模型（group-based erajectory modeling，GBTM）探索青少年早期抑郁症状的异质性发展轨迹，运用多分类logistic逐步回归分析不同潜在发展轨迹的相关因素。

结果

识别出四个亚型，分别为低风险-恶化组（G1）（8.27%）、高风险-持续组（G2）（3.73%）、低风险-稳定组（G3）（78.24%）和高风险-缓解组（G4）（9.76%）。以G3组为参照组，男生（OR=0.417，95%CI：0.297～0.585）、家庭支持（OR=0.870，95%CI：0.641～0.923）、同伴关系（OR=0.829，95%CI：0.740～0.998）、学校联结（OR=0.865，95%CI：0.725～0.906）是G1组的保护因素；寄宿（OR=1.310，95%CI：1.154～2.010）、留守（OR=2.196，95%CI：1.376～3.503）、单亲家庭（OR=2.247，95%CI：1.456～3.468）、低家庭社会经济地位（FSES）（OR=1.548，95%CI：1.371～2.451）是G1组的风险因素。男生（OR=0.318，95%CI：0.263～0.521）、家庭支持（OR=0.856，95%CI：0.817～0.991）、同伴关系（OR=0.849，95%CI：0.711～0.988）是G2组的保护因素；寄宿（OR=1.332，95%CI：1.022～2.058）、留守（OR=1.422，95%CI：1.211～3.218）、单亲家庭（OR=2.953，95%CI：1.659～4.256）、低FSES（OR=2.469，95%CI：1.188～3.128）是G2组的风险因素。男生（OR= 1.350，95%CI：1.001～1.513）是G4组的风险因素，家庭支持（OR=0.892，95%CI：0.751～0.943）、学校联结（OR= 0.846，95%CI：0.705～0.961）是G4组的保护因素。

结论

青少年早期抑郁症状存在显著的群体异质性和个体差异性，重点关注低风险-恶化组和高风险-持续组，以增加其人际支持网络的广度和深度。

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张新英，E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=ccYu9rPs2emqUme+OLy3pg==, magXml=hLKvysuc2DTUrl8tnVqQtQ==, pdfUrl=null, pdf=zlMiHpyiHGTC6gUWQjK4SA==, pdfFileSize=710773, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=0g59rYX8Kyg2Tb2ograWEw==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=SwRLYRVU7JhZoyamCXH35g==, mapNumber=null, authorCompany=null, fund=null, authors=

周县委（1980—），男，博士，讲师，研究方向：体质研究与健康促进

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周县委（1980—），男，博士，讲师，研究方向：体质研究与健康促进

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Journal of East China Normal University(Educational Sciences), 2022, 40(8): 67-82.(In Chinese), articleTitle=How homestay affects students' mental health?, refAbstract=null)], funds=[Fund(id=1241050837733134756, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034444849598591, awardId=22YJA880086, language=CN, fundingSource=教育部人文社会科学研究一般项目(22YJA880086), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241050826848916434, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034444849598591, xref=1., ext=[AuthorCompanyExt(id=1241050826853110738, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034444849598591, companyId=1241050826848916434, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Physical Education, Jinan University, Jinan, Shandong 250022, China), AuthorCompanyExt(id=1241050826861499347, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034444849598591, companyId=1241050826848916434, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.济南大学体育学院，山东 济南 250022)]), AuthorCompany(id=1241050827364815838, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034444849598591, xref=2., ext=[AuthorCompanyExt(id=1241050827377398754, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034444849598591, companyId=1241050827364815838, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.吉首大学体育科学学院，湖南 吉首 416000)]), AuthorCompany(id=1241050827536782315, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034444849598591, xref=3., ext=[AuthorCompanyExt(id=1241050827540976623, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034444849598591, companyId=1241050827536782315, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.广西师范大学体育与健康学院)])], figs=[ArticleFig(id=1241050835900223831, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034444849598591, language=EN, label=Figure 1, caption=Development tracks of subgroups of depressive symptoms, figureFileSmall=eLIIRQeWchsXrLUDpzn87Q==, figureFileBig=PUbuEkgMw1brUiM1tehL2w==, tableContent=null), ArticleFig(id=1241050836013470045, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034444849598591, language=CN, label=图1, caption=抑郁症状各亚组类别发展轨迹图, figureFileSmall=eLIIRQeWchsXrLUDpzn87Q==, figureFileBig=PUbuEkgMw1brUiM1tehL2w==, tableContent=null), ArticleFig(id=1241050836109939050, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034444849598591, language=EN, label=Table 1, caption=

General demographic characteristics of the research subjects (n=1 118)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量分组人数构成比（%）
性别男47142.13
女64757.87
民族汉族897.96
少数民族1 02992.04
是否独生独生子女32328.89
非独生子女78570.21
是否留守留守29025.94
非留守82874.06
是否单亲家庭单亲家庭776.89
非单亲家庭1 04193.11
是否寄宿寄宿77969.68
走读33930.32
FSES高17015.21
中38934.79
低55950.00
), ArticleFig(id=1241050836239962481, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034444849598591, language=CN, label=表1, caption=

研究对象一般人口学特征(n=1 118)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量分组人数构成比（%）
性别男47142.13
女64757.87
民族汉族897.96
少数民族1 02992.04
是否独生独生子女32328.89
非独生子女78570.21
是否留守留守29025.94
非留守82874.06
是否单亲家庭单亲家庭776.89
非单亲家庭1 04193.11
是否寄宿寄宿77969.68
走读33930.32
FSES高17015.21
中38934.79
低55950.00
), ArticleFig(id=1241050836428706170, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034444849598591, language=EN, label=Table 2, caption=

Correlation coefficient matrix of variables (n=1 118)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量 123456
1抑郁症状(T1)10.52±2.82
2抑郁症状(T2)10.83±2.390.735**
3抑郁症状(T3)11.57±2.230.648**0.775**
4抑郁症状(T4)11.65±2.740.623**0.722**0.866**
5家庭支持(T1)15.14±3.84-0.358**-0.322**-0.298**-0.304**
6学校联结(T1)35.34±6.44-0.221**-0.273**-0.254**-0.248**0.291**
7同伴关系(T1)30.08±7.39-0.242**-0.229**-0.237**-0.231**0.311**0.558**
), ArticleFig(id=1241050836692947330, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034444849598591, language=CN, label=表2, caption=

变量相关系数矩阵（n=1 118）

, figureFileSmall=null, figureFileBig=null, tableContent=
变量 123456
1抑郁症状(T1)10.52±2.82
2抑郁症状(T2)10.83±2.390.735**
3抑郁症状(T3)11.57±2.230.648**0.775**
4抑郁症状(T4)11.65±2.740.623**0.722**0.866**
5家庭支持(T1)15.14±3.84-0.358**-0.322**-0.298**-0.304**
6学校联结(T1)35.34±6.44-0.221**-0.273**-0.254**-0.248**0.291**
7同伴关系(T1)30.08±7.39-0.242**-0.229**-0.237**-0.231**0.311**0.558**
), ArticleFig(id=1241050836906856839, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034444849598591, language=EN, label=Table 3, caption=

Multiclass logistic stepwise regression analysis (n= 1 118)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量G2组G1组G4组
OR值（95%CI）P值OR值（95%CI）P值OR值（95%CI）P值
性别（ref：女）男0.318（0.263～0.521）<0.0010.417（0.297～0.585）<0.0011.350（1.001～1.513）<0.001
民族（ref：汉族）少数民族1.359（0.734～2.516）0.3291.241（0.705～2.184）0.4541.179（0.505～2.754）0.704
独生子女（ref：否）是1.013（0.951～1.079）0.4920.720（0.379～1.369）0.3161.691（0.690～2.145）0.251
寄宿（ref：否）是1.332（1.022～2.058）0.0071.310（1.154～2.010）<0.0011.221（0.539～2.667）0.616
留守（ref：否）是1.422（1.211～3.309）<0.0012.196（1.376～3.503）0.0281.103（0.946～1.385）0.216
单亲家庭（ref：否）是2.953（1.659～4.256）<0.0012.247（1.456～3.468）<0.0011.012（0.962～1.445）0.898
FSES（ref：高）低2.469（1.188～3.128）0.0151.548（1.371～2.451）0.0340.787（0.495～1.251）0.311
中1.166（0.712～1.908）0.5420.803（0.557～1.157）0.2381.055（0.763～1.459）0.745
家庭支持0.856（0.817～0.991）0.0350.870（0.641～0.923）0.0210.892（0.751～0.943）0.032
同伴关系0.849（0.711～0.988）0.0110.829（0.740～0.998）0.0170.988（0.859～1.018）0.430
学校联结0.982（0.854～1.012）0.2380.865（0.725～0.906）0.0450.846（0.705～0.961）<0.001
), ArticleFig(id=1241050837217235345, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241034444849598591, language=CN, label=表3, caption=

多分类logistic逐步回归分析（n=1 118）

, figureFileSmall=null, figureFileBig=null, tableContent=
变量G2组G1组G4组
OR值（95%CI）P值OR值（95%CI）P值OR值（95%CI）P值
性别（ref：女）男0.318（0.263～0.521）<0.0010.417（0.297～0.585）<0.0011.350（1.001～1.513）<0.001
民族（ref：汉族）少数民族1.359（0.734～2.516）0.3291.241（0.705～2.184）0.4541.179（0.505～2.754）0.704
独生子女（ref：否）是1.013（0.951～1.079）0.4920.720（0.379～1.369）0.3161.691（0.690～2.145）0.251
寄宿（ref：否）是1.332（1.022～2.058）0.0071.310（1.154～2.010）<0.0011.221（0.539～2.667）0.616
留守（ref：否）是1.422（1.211～3.309）<0.0012.196（1.376～3.503）0.0281.103（0.946～1.385）0.216
单亲家庭（ref：否）是2.953（1.659～4.256）<0.0012.247（1.456～3.468）<0.0011.012（0.962～1.445）0.898
FSES（ref：高）低2.469（1.188～3.128）0.0151.548（1.371～2.451）0.0340.787（0.495～1.251）0.311
中1.166（0.712～1.908）0.5420.803（0.557～1.157）0.2381.055（0.763～1.459）0.745
家庭支持0.856（0.817～0.991）0.0350.870（0.641～0.923）0.0210.892（0.751～0.943）0.032
同伴关系0.849（0.711～0.988）0.0110.829（0.740～0.998）0.0170.988（0.859～1.018）0.430
学校联结0.982（0.854～1.012）0.2380.865（0.725～0.906）0.0450.846（0.705～0.961）<0.001
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基于GBTM模型的湘鄂渝黔边区青少年早期抑郁症状发展轨迹分析
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周县委 1, 2 , 张新英 1 , 马渊源 2 , 陈依依 2 , 徐涛 3 , 张天成 2 , 刘阳 2
现代预防医学 | 儿少卫生与妇幼保健 2025,52(11): 1980-1985
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现代预防医学 | 儿少卫生与妇幼保健 2025, 52(11): 1980-1985
基于GBTM模型的湘鄂渝黔边区青少年早期抑郁症状发展轨迹分析
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周县委1, 2, 张新英1 , 马渊源2, 陈依依2, 徐涛3, 张天成2, 刘阳2
作者信息
  • 1.济南大学体育学院，山东 济南 250022
  • 2.吉首大学体育科学学院，湖南 吉首 416000
  • 3.广西师范大学体育与健康学院

    • 周县委（1980—），男，博士，讲师，研究方向：体质研究与健康促进

通讯作者:

张新英，E-mail:
Analysis of development trajectories of early depression symptoms in adolescents in the Hunan-Hubei-Chongqing-Guizhou border area based on the GBTM model
Xian-wei ZHOU1, 2, Xin-ying ZHANG1 , Yuan-yuan MA2, Yi-yi CHEN2, Tao XU3, Tian-cheng ZHANG2, Yang LIU2
Affiliations
  • School of Physical Education, Jinan University, Jinan, Shandong 250022, China
出版时间: 2025-06-10 doi: 10.20043/j.cnki.MPM.202412517
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摘要
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目的

考察青少年早期抑郁症状异质性发展轨迹及其相关影响因素。

方法

采用整群抽样法，于2023年3月—2024年9月对湘鄂渝黔边区初级中学1 118名七年级学生进行四次追踪调查，每次调查间隔半年，使用抑郁症状量表、家庭支持量表、同伴关系量表和学校联结量表进行追踪调查，采用组基轨迹模型（group-based erajectory modeling，GBTM）探索青少年早期抑郁症状的异质性发展轨迹，运用多分类logistic逐步回归分析不同潜在发展轨迹的相关因素。

结果

识别出四个亚型，分别为低风险-恶化组（G1）（8.27%）、高风险-持续组（G2）（3.73%）、低风险-稳定组（G3）（78.24%）和高风险-缓解组（G4）（9.76%）。以G3组为参照组，男生（OR=0.417，95%CI：0.297～0.585）、家庭支持（OR=0.870，95%CI：0.641～0.923）、同伴关系（OR=0.829，95%CI：0.740～0.998）、学校联结（OR=0.865，95%CI：0.725～0.906）是G1组的保护因素；寄宿（OR=1.310，95%CI：1.154～2.010）、留守（OR=2.196，95%CI：1.376～3.503）、单亲家庭（OR=2.247，95%CI：1.456～3.468）、低家庭社会经济地位（FSES）（OR=1.548，95%CI：1.371～2.451）是G1组的风险因素。男生（OR=0.318，95%CI：0.263～0.521）、家庭支持（OR=0.856，95%CI：0.817～0.991）、同伴关系（OR=0.849，95%CI：0.711～0.988）是G2组的保护因素；寄宿（OR=1.332，95%CI：1.022～2.058）、留守（OR=1.422，95%CI：1.211～3.218）、单亲家庭（OR=2.953，95%CI：1.659～4.256）、低FSES（OR=2.469，95%CI：1.188～3.128）是G2组的风险因素。男生（OR= 1.350，95%CI：1.001～1.513）是G4组的风险因素，家庭支持（OR=0.892，95%CI：0.751～0.943）、学校联结（OR= 0.846，95%CI：0.705～0.961）是G4组的保护因素。

结论

青少年早期抑郁症状存在显著的群体异质性和个体差异性，重点关注低风险-恶化组和高风险-持续组，以增加其人际支持网络的广度和深度。

青少年  /  抑郁症状  /  发展轨迹  /  组基轨迹模型
Objective

To investigate the heterogeneous development trajectories of early depression symptoms in adolescents and their influencing factors.

Methods

A cluster sampling method was employed to conduct four follow-up surveys from March 2023 to September 2024, targeting 1 118 seventh-grade students from junior high schools in the Hunan-Hubei-Chongqing-Guizhou border area. Each survey was spaced six months apart, utilizing the Depression Symptoms Scale, Family Support Scale,Peer Relationship Scale, and School Connection Scale. Group-based Trajectory Modeling (GBTM) was used to explore the heterogeneous development trajectories of early depression symptoms in adolescents, while multi-class logistic stepwise regression analysis was performed to identify the relevant factors associated with different latent developmental trajectories.

Results

Four subtypes were identified: “G1: Low Risk-Deterioration Group” (8.27%), “G2: High Risk-Persistent Group”(3.73%), “G3: Low Risk-Stable Group” (78.24%), and “G4: High Risk-Relief Group” (9.76%). Using the G3 group as a reference, the protective factors for the G1 group included being male (OR=0.417, 95%CI: 0.297-0.585), family support (OR=0.870, 95%CI: 0.641-0.923), peer relationships (OR=0.829, 95%CI: 0.740-0.998), and school connection (OR=0.865, 95%CI:0.725-0.906); risk factors included boarding (OR=1.310, 95%CI: 1.154-2.010), being left-behind (OR=2.196, 95%CI: 1.376-3.503), single-parent families (OR=2.247, 95%CI: 1.456-3.468), and low Family Economic Status (FSES) (OR=1.548, 95%CI:1.371-2.451). For the G2 group, protective factors included being male (OR=0.318, 95%CI: 0.263-0.521), family support (OR=0.856, 95%CI: 0.817-0.991), and peer relationships (OR=0.849, 95%CI: 0.711-0.988); risk factors were boarding (OR=1.332,95%CI: 1.022-2.058), being left-behind (OR=1.422, 95%CI: 1.211-3.218), single-parent families (OR=2.953, 95%CI: 1.659-4.256), and low FSES (OR=2.469, 95%CI: 1.188-3.128). For the G4 group, being male (OR=1.350, 95%CI: 1.001-1.513) was identified as a risk factor, while family support (OR=0.892, 95%CI: 0.751-0.943) and school connection (OR=0.846, 95%CI:0.705-0.961) were protective factors.

Conclusion

There is significant group heterogeneity and individual variability in early depression symptoms among adolescents. It is crucial to focus on the “Low Risk-Deterioration Group” and “High Risk-Persistent Group” to enhance the breadth and depth of their interpersonal support networks.

Adolescents  /  Depression symptoms  /  Development trajectories  /  Group-based trajectory model
周县委, 张新英, 马渊源, 陈依依, 徐涛, 张天成, 刘阳. 基于GBTM模型的湘鄂渝黔边区青少年早期抑郁症状发展轨迹分析. 现代预防医学, 2025 , 52 (11) : 1980 -1985 . DOI: 10.20043/j.cnki.MPM.202412517
Xian-wei ZHOU, Xin-ying ZHANG, Yuan-yuan MA, Yi-yi CHEN, Tao XU, Tian-cheng ZHANG, Yang LIU. Analysis of development trajectories of early depression symptoms in adolescents in the Hunan-Hubei-Chongqing-Guizhou border area based on the GBTM model[J]. Modern Preventive Medicine, 2025 , 52 (11) : 1980 -1985 . DOI: 10.20043/j.cnki.MPM.202412517
正文
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抑郁症是以持续心境低落为核心症状的情绪障碍，常伴认知功能受损及行为异常，重症患者可发展为自伤或自杀行为[1]。该疾病高度异质复杂，进入青春期发病率陡升，全球约34%的10～19岁青少年存在抑郁风险，我国青少年患病率介于15%～20%之间，其中约半数为在校学生[2-3]。此外，阈下抑郁在儿童青少年群体中亦呈快速增长趋势，且存在显著地域差异。一项覆盖全国10省22 693名儿童青少年调查显示，中西部地区（19.2%～19.6%）及东北地区（18.6%）的发生率显著高于东部地区（15.0%）[4]。此类症状若未及时识别和干预，可能导致症状加重，损害学业表现及社会功能，并增加成年期罹患抑郁障碍的概率[5]。
湘鄂渝黔边区作为以土家族、苗族为主的少数民族聚居区，横跨湖南、湖北、重庆及贵州四省市交界地带。受地理独特性、文化多元性及经济欠发达等因素影响，该边区青少年情绪困扰问题可能较为突出。研究表明，家庭支持、学校联结、同伴关系均对抑郁症状起缓解效应[6-10]，但相关研究多聚焦于城市或发达地区，针对该边区青少年抑郁症状发展轨迹的研究则较为匮乏。组基轨迹模型（group-based trajectory modeling, GBTM）作为识别纵向数据异质性亚群的统计方法，能够有效揭示症状演变规律[11]。鉴于此，本研究拟运用GBTM方法探究该边区青少年早期抑郁症状的演变轨迹及其影响因素，为制定精准干预策略提供循证依据。
1　对象与方法
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1.1　研究对象
采用随机整群抽样法从湘鄂渝黔边区抽取8所初级中学，每所学校七年级抽取4个班，以32个班级的全体学生为调查对象，于2023年3月（T1）、9月（T2）及2024年3月（T3）、9月（T4）进行4次追踪，4次施测人数分别为1 368、1 329、1 297和1 156人，排除患有智力缺陷以及因转学或其他原因未能完成问卷的学生，最终获得有效样本1118份。所有调查对象均签署了知情同意书，本次调查获得了吉首大学医学伦理委员会审批（No. JSDX-2023-0034）。
1.2　测量工具
1.2.1　基本信息问卷
基于研究目的，基本信息问卷包含性别、民族、留守状态、独生与否、寄宿情况、单亲背景及家庭社会经济地位（family socioeconomic status, FSES）；依父母教育、职业、家庭财产资源计分，分低、中、高三类）[12]。
1.2.2　抑郁症状量表
采用简短抑郁症状自评量表（PHQ-9），评估个体近2周症状风险程度[13]。含9个条目，4级评分，0～27分，分高症重，≥4分判有抑郁症状本研究于T1至T4阶段施测，各阶段Cronbach α值分别为0.811、0.802、0.835、0.821。
1.2.3　家庭支持量表
采用姜乾金[14]领悟性社会支持量表中的家庭支持分量表评估。4条目，7点计分，1～7分对应极不同意至极同意，得分高则家庭支持感强，于T1阶段施测，Cronbach α系数0.864。
1.2.4　同伴关系量表
采用Raja等[15]编制的同伴关系量表中的信任与沟通维度。共8题，5点计分，1～5分对应非常不符合至非常符合，总分8～40分，高分代表关系佳，于T1阶段施测，Cronbach α系数0.823。
1.2.5　学校联结量表
采用喻承甫等[16]编制的量表，含同伴支持（4题，4～20分）、教师支持（3题，3～15分）、学校归属感（3题，3～15分）3维度，共10题，5点计分，1～5分对应非常不符合至非常符合，总分10～50分，高分代表学校联结强，于T1阶段施测，Cronbach α系数0.871。
1.3　质量控制
为保证问卷调查质量，调查前，对调查人员统一培训、质控，确保数据可靠。问卷以班级为单位，采用“编号式”纸质形式便于管理追踪。调查中，班主任协助现场监督、答疑，强调信息保密原则，回收时，检查填写情况。调查后，调查员当场发放与回收问卷。问卷调查从设计、调查、录入及核查等实施全流程监控。
1.4　统计方法
采用SPSS 25.0软件对数据进行描述性统计及相关分析，计数资料用（%）表示，计量资料用（）表示。应用Stata 16.0构建基于删失正态分布的GBTM模型。系统评估不同亚组数目下截距、线性及高次项的拟合效能，通过最大似然估计筛选最优轨迹模型。模型优选遵循迭代优化策略，从高阶项和最小亚组数起始，依据BIC（值小优）、AvePP（>0.7）和熵（值大优）综合判定最佳类别[11]。基于确定的潜在亚型作为因变量进行多分类logistic逐步回归，分析其与预设因素的关联性。检验水准α=0.05。
2　结果
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2.1　描述性统计及相关分析
共纳入1 118名研究对象，T1阶段有效样本平均年龄为（12.29±0.32）岁，其中，男生471人（42.13%）、女生647人（57.87%），汉族89人（7.96%）、少数民族1 029人（92.04%）。是否独生、留守、单亲家庭、寄宿情况等结果，见表1。相关性分析显示：PHQ-9得分从T1（10.52±2.82）分升至T4（11.65±2.74）分，4次施测点两两正相关（P<0.01）；抑郁症状与家庭支持、学校联结、同伴关系负相关（P<0.01）；家庭支持、学校联结、同伴关系三者正相关（P<0.01）。见表2。
2.2　青少年早期抑郁症状发展轨迹分析
设置2～4种类别模型，经对比BIC、AIC、AvePP等指标，选定平方函数（2 2 2 2）为最佳多项式阶数，确定4种亚型（BIC=-9 731.32，AIC=-9 691.17，Entropy=0.853）：G1组首测PHQ-9得分低，后风险渐增，故将其称之为低风险-恶化组；G2组人数最少，PHQ-9得分持续高，故将其命名为高风险-持续组；G3组人数最多，PHQ-9得分持续低，称低风险-稳定组；G4组则与G1相反，初测PHQ-9得分高，后风险降低，故将其界定为高风险-缓解组。见图1。
2.3　青少年早期抑郁症状发展轨迹的影响因素分析
多分类logistic逐步回归结果显示，相较于G3组，G1组的保护因素为男生、家庭支持、同伴关系及学校联结，而风险因素为寄宿、留守、单亲家庭和低FSES；G2组保护因素则与G1组部分重合（男生、家庭支持、同伴关系），但风险因素与之一致。G4组男生转为风险因素，而保护因素为家庭支持与学校联结。见表3。
3　讨论
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本研究显示，湘鄂渝黔边区青少年抑郁症状风险上升，与全国青少年抑郁症状年龄特征相符。全国超24.6%中小学生有抑郁症状风险，初中生检出率（24.3%）较小学生（14.5%）增近1倍[17]。此变化或与青春期身心剧变致情绪调节失衡、人际关系支持不足及学习压力等因素交互作用相关。
本研究发现，抑郁症状发展含4种异质轨迹，与既有研究分类互证[18]。G3组占比最高，与以往研究结果[19]相近。这可能与较强的家庭支持、学校联结及有效应对策略相关；G1组初期症状轻但随时间加重，这或与长期暴露于压力源且缺乏社会支持缓冲机制有关；此外，虽然G2组与G4组初始症状水平相当，但前者可能与正性情感加工失调相关，而后者或与及时的心理干预、社会支持及环境适应相关。既往研究显示，青少年抑郁症状可随时间自然消解，但仍有39%～72%的患者在5年内易复发[20]。因此，精准识别青少年抑郁症状亚型对有效干预至关重要，建议通过家校协同的心理健康教育优化保护性因素，同时定期监测、追踪变化并防范其他健康风险行为的发生。
本研究显示，女生相较于男生更易归入G2组，性别作为抑郁发展的核心预测因素，女性因社会角色及生物易感性而风险更高[21]。男生更易归入G1组，而女生在G4组具有优势，这或与男性对新环境适应力较强及女性抑郁情绪早现的性别效应相关[18]。此轨迹异质性强调要实施以性别特异性的干预措施。此外，单亲家庭、低FSES（资源剥夺/代际压力）[22-23]、留守（情感缺失）[24]及寄宿（同伴传染）[25]青少年更易归入抑郁风险轨迹组，这可能是个体易感性与环境压力交互作用的结果。尽管这一青少年群体心理健康问题并非必然，但亟需给予更多的支持与关爱。
本研究表明，家庭支持、同伴关系与学校联结构成青少年抑郁发展的核心保护因素。家庭作为社会化起点，通过情感联结强化与功能完整性促进心理韧性，降低抑郁症状风险[7-8]；同伴关系经由情绪调节自我效能感影响心理健康，高质量同伴接纳减少情绪失调，而排斥经历可能通过反刍思维加重症状[9]；学校归属感缺失易引发孤立体验，反之则与低抑郁水平及学业成就正相关[6,10]。基于此，建议构建多维支持网络并强化早期干预以促进青少年心理健康与福祉。
本研究存以下两方面局限性：其一，受限于样本的地域特殊性（跨省边区、多民族聚居），研究结论的外部效度需谨慎对待，不宜直接推广。未来需进一步扩大跨区域、多民族样本以增强生态效度。其二，当前研究仅聚焦基线期变量对早期症状的影响，变量间动态关系和组合作用未充分揭示，后续可采用交叉滞后模型、模糊定性比较分析等方法，系统揭示变量间的时变关系及组态效应。
基金
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  • 教育部人文社会科学研究一般项目(22YJA880086)
文献
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2025年第52卷第11期
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文章信息
doi: 10.20043/j.cnki.MPM.202412517
  • 接收时间：2024-12-29
  • 首发时间：2026-03-18
  • 出版时间：2025-06-10
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  • 收稿日期：2024-12-29
基金
教育部人文社会科学研究一般项目(22YJA880086)
作者信息
    1.济南大学体育学院，山东 济南 250022
    2.吉首大学体育科学学院，湖南 吉首 416000
    3.广西师范大学体育与健康学院

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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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