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Article(id=1241102736696070250, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241102730337505325, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202306478, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1687881600000, receivedDateStr=2023-06-28, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773831551002, onlineDateStr=2026-03-18, pubDate=1721836800000, pubDateStr=2024-07-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773831551002, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773831551002, creator=13701087609, updateTime=1773831551002, updator=13701087609, issue=Issue{id=1241102730337505325, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='14', pageStart='2497', pageEnd='2688', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773831549486, creator=13701087609, updateTime=1773831697291, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241103350322745680, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241102730337505325, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241103350322745681, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241102730337505325, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=2568, endPage=2573, ext={EN=ArticleExt(id=1241102737572679802, articleId=1241102736696070250, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Analysis of influencing factors of bullying and suicide-related behaviors among primary and secondary school students, Hubei, 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 of bullying and suicide-related behaviors among primary and secondary middle school students in Hubei Province, and to summarize the high-risk groups of bullying and suicide-related behaviors (thoughts/plans/attempts).

Methods

A stratified random sampling method was used to select primary, middle, and high school/vocational high school students from 4 counties in Hubei Province for questionnaire survey. Multivariate logistic regression model was used to analyze the influencing factors of bullying and suicide-related behaviors. The interaction between bullying and related variables was by adding interaction terms.

Results

A total of 1618 students were included in the survey. In the past 12 months, 33.9% of them had been bullied, 17.9%, 12.2%, and 7.8% of them had suicidal ideas, plans, and behavior. The RR values of suicide thoughts, plans, and attempts among bullies were 3.03(95%CI：2.24-4.12), 2.21(95%CI：1.57-3.12), and 2.28(95%CI：1.51-3.45). Middle school students, those with poor relationships with their parents, those who are not confident in their appearance, and those whose friends do not care about them are more likely to be bullied. Students who have been bullied, female students, ethnic minorities, and students who have heard of their classmates’ suicide-related behaviors are more likely to engage in suicide-related behaviors.

Conclusion

The main influencing factors of bullying and suicide-related behaviors among primary and middle school students in Hubei Province were summarized, which could provide a reference for future health interventions.

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目的

分析湖北省中小学生遭受欺凌和自杀相关行为的影响因素，总结遭受欺凌和自杀相关行为（想法/计划/尝试）的高危群体。

方法

采用分层随机抽样方法，在湖北省4个县区抽取小学、初中、高中/职高的学生进行问卷调查。使用多因素logistic回归模型分析遭受欺凌与自杀相关行为的影响因素；通过添加交互项，检验遭受欺凌和相关变量的交互作用。

结果

调查共纳入1 618人。过去12个月，33.9%遭受欺凌，17.9%有自杀想法，12.2%有自杀计划，7.8%有自杀行为。遭受欺凌者出现自杀想法、计划、尝试的RR值分别为3.03(95%CI：2.24~4.12)、2.21(95%CI：1.57~3.12)、2.28(95%CI：1.51~3.45)。中学生相对于小学生、父母关系不好的、对自己外形不自信的、朋友不关心的学生更易遭受欺凌。遭受欺凌的、女生、少数民族、听说过同学有自杀相关行为的学生更易产生自杀相关行为。

结论

总结出湖北省中小学生遭遇欺凌和出现自杀相关行为的主要影响因素，为今后开展健康干预提供参考依据。

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涂画，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=ciU/njXruHsK593y5e5biw==, magXml=PQT0T2gZABg/JqRU4GtKuQ==, pdfUrl=null, pdf=nfjFZkvV/6zJ++1adIagig==, pdfFileSize=554777, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=oCXwP66EFz1nmtN0pk3t0Q==, mapNumber=null, authorCompany=null, fund=null, authors=

马丽娜（1984—），女，硕士，副主任医师，研究方向：健康教育与健康促进

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马丽娜（1984—），女，硕士，副主任医师，研究方向：健康教育与健康促进

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马丽娜（1984—），女，硕士，副主任医师，研究方向：健康教育与健康促进

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BMC Public Health, 2016, 16(1): 39., articleTitle=The association of body image distortion with weight controlbehaviors, diet behaviors, physical activity, sadness, and suicidal ideation among Korean high school students: a cross-sectional study, refAbstract=null), Reference(id=1241102749404811988, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102736696070250, doi=null, pmid=null, pmcid=null, year=2002, volume=360, issue=9347, pageStart=1728, pageEnd=1736, url=null, language=null, rfNumber=[19], rfOrder=22, authorNames=Phillips MR, Yang GH, Zhang YP, journalName=Lancet, refType=null, unstructuredReference=Phillips MR, Yang GH, Zhang YP, et al. Risk factors for suicide inChina: a National case-control psychological autopsy study[J]. Lancet, 2002, 360(9347): 1728-1736., articleTitle=Risk factors for suicide inChina: a National case-control psychological autopsy study, refAbstract=null), Reference(id=1241102749497086687, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102736696070250, doi=null, pmid=null, pmcid=null, year=2012, volume=7, issue=7, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[20], rfOrder=23, authorNames=Wang H, Zhou XL, Lu CY, journalName=PLOS One, refType=null, unstructuredReference=Wang H, Zhou XL, Lu CY, et al. Adolescent bullying involvement and psychosocial aspects of family and school Life: a cross-sectional study from Guangdong Province in China[J]. PLOS One, 2012, 7(7): e38619., articleTitle=Adolescent bullying involvement and psychosocial aspects of family and school Life: a cross-sectional study from Guangdong Province in China, refAbstract=null), Reference(id=1241102749585167081, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102736696070250, doi=null, pmid=null, pmcid=null, year=2021, volume=null, issue=12, pageStart=28, pageEnd=34, url=null, language=null, rfNumber=[21], rfOrder=24, authorNames=刘京翠, 赵福江, journalName=中国教育学刊, refType=null, unstructuredReference=刘京翠，赵福江．学生个体因素对校园欺凌的影响研究——基于我国十五省(市)的调查和实验学校的访谈数据[J]．中国教育学刊，2021，（12）：28-34., articleTitle=学生个体因素对校园欺凌的影响研究——基于我国十五省(市)的调查和实验学校的访谈数据, refAbstract=null), Reference(id=1241102749673247473, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102736696070250, doi=null, pmid=null, pmcid=null, year=2021, volume=null, issue=12, pageStart=28, pageEnd=34, url=null, language=null, rfNumber=[21], rfOrder=25, authorNames=Liu JC, Zhao FJ, journalName=Journal of the Chinese Society of Education, refType=null, unstructuredReference=Liu JC, Zhao FJ. Research on the influence of individual factors on campus bullying—— Based on the survey of 15 provinces (cities) in China and the interview data of experimental schools[J]. Journal of the Chinese Society of Education, 2021, (12): 28-34., articleTitle=Research on the influence of individual factors on campus bullying—— Based on the survey of 15 provinces (cities) in China and the interview data of experimental schools, refAbstract=null), Reference(id=1241102749740356344, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102736696070250, doi=null, pmid=null, pmcid=null, year=2010, volume=23, issue=2, pageStart=108, pageEnd=112, url=null, language=null, rfNumber=[22], rfOrder=26, authorNames=Guo QZ, Ma WJ, Nie SP, journalName=Biomedical and Environmental Sciences, refType=null, unstructuredReference=Guo QZ, Ma WJ, Nie SP, et al. Relationships between weight status and bullying victimization among school-aged adolescents in Guangdong Province of China[J]. Biomedical and Environmental Sciences, 2010, 23(2): 108-112., articleTitle=Relationships between weight status and bullying victimization among school-aged adolescents in Guangdong Province of China, refAbstract=null)], funds=[Fund(id=1241102745281810898, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102736696070250, awardId=18BSH073, language=CN, fundingSource=在健康社会决定因素框架下构建我国儿童健康行为测量指标体系(18BSH073), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241102739539808398, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102736696070250, xref=1., ext=[AuthorCompanyExt(id=1241102739548197005, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102736696070250, companyId=1241102739539808398, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Hubei Provincial Center for Disease Control and Prevention, Wuhan, Hubei 430079, China), AuthorCompanyExt(id=1241102739556585614, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102736696070250, companyId=1241102739539808398, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.湖北省疾病预防控制中心，湖北 武汉 430079)]), AuthorCompany(id=1241102739657248916, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102736696070250, xref=2., ext=[AuthorCompanyExt(id=1241102739661443221, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102736696070250, companyId=1241102739657248916, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.武汉市洪山区疾病预防控制中心)]), AuthorCompany(id=1241102739732746394, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102736696070250, xref=3., ext=[AuthorCompanyExt(id=1241102739741135003, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102736696070250, companyId=1241102739732746394, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.宜昌市疾病预防控制中心)])], figs=[ArticleFig(id=1241102744505864569, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102736696070250, language=EN, label=Table 1, caption=

Basic characteristics of respondents[n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
调查内容遭受欺凌自杀想法
无(n=1 070)有(n=548)无(n=1 329)有(n=289)
性别
男611(57.1)322(58.8)804(60.5)129(44.6)
女459(42.9)226(41.2)525(39.5)160(55.4)
年级
五年级240(22.4)52(9.5)243(18.3)49(17.0)
初二175(16.4)83(15.1)220(16.6)38(13.1)
高一333(31.1)199(36.3)419(31.5)113(39.1)
高二322(30.1)214(39.1)447(33.6)89(30.8)
民族
汉族1 024(95.7)524(95.6)1 272(95.7)276(95.5)
少数民族46(4.3)24(4.4)57(4.3)13(4.5)
户籍
城市503(47.0)205(37.4)572(43.0)136(47.1)
农村567(53.0)343(62.6)757(57.0)153(52.9)
留守儿童
否884(82.6)422(77.0)1 070(80.5)236(81.7)
是186(17.4)126(23.0)259(19.5)53(18.3)
外形自信
其他432(40.4)311(56.8)569(42.8)174(60.2)
是638(59.6)237(43.2)760(57.2)115(39.8)
朋友关心
其他173(16.2)174(31.8)254(19.1)93(32.2)
是897(83.8)374(68.2)1 075(80.9)196(67.8)
父母关系
其他127(11.9)156(28.5)195(14.7)88(30.4)
好943(88.1)392(71.5)1 134(85.3)201(69.6)
是否听说周围同学有自杀想法/计划
无973(90.9)432(78.8)1 235(92.9)170(58.8)
有97(9.1)116(21.2)94(7.1)119(41.2)
调查内容自杀计划自杀尝试总计
(n=1 618)
无(n=1 420)有(n=198)无(n=1 492)有(n=126)
性别
男844(59.4)89(44.9)875(58.6)58(46.0)933(57.7)
女576(40.6)109(55.1)617(41.4)68(54.0)685(42.3)
年级
五年级258(18.2)34(17.2)272(18.2)20(15.9)292(18.0)
初二230(16.2)28(14.1)240(16.1)18(14.3)258(15.9)
高一453(31.9)79(39.9)482(32.3)50(39.7)532(32.9)
高二479(33.7)57(28.8)498(33.4)38(30.2)536(33.1)
民族
汉族1 362(95.9)186(93.9)1 431(95.9)117(92.9)1 548(95.7)
少数民族58(4.1)12(6.1)61(4.1)9 (7.1)70(4.3)
户籍
城市612(43.1)96(48.5)648(43.4)60(47.6)708(43.8)
农村808(56.9)102(51.5)844(56.6)66(52.4)910(56.2)
留守儿童
否1 144(80.6)162(81.8)1 204(80.7)102(81.0)1 306(80.7)
是276(19.4)36(18.2)288(19.3)24(19.0)312(19.3)
外形自信
其他618(43.5)125(63.1)661(44.3)82(65.1)743(45.9)
是802(56.5)73(36.9)831(55.7)44(34.9)875(54.1)
朋友关心
其他278(19.6)69(34.8)297(19.9)50(39.7)347(21.4)
是1 142(80.4)129(65.2)1 195 (80.1)76(60.3)1 271(78.6)
父母关系
其他218(15.4)65(32.8)235(15.8)48(38.1)283(17.5)
好1 202(84.6)133(67.2)1 257(84.2)78(61.9)1 335(82.5)
是否听说周围同学有自杀想法/计划
无1 291(90.9)114(57.6)1 330(89.1)75(59.5)1 405(86.8)
有129(9.1)84(42.4)162(10.9)51(40.5)213(13.2)
), ArticleFig(id=1241102744610722184, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102736696070250, language=CN, label=表1, caption=

调查对象基本特征[n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
调查内容遭受欺凌自杀想法
无(n=1 070)有(n=548)无(n=1 329)有(n=289)
性别
男611(57.1)322(58.8)804(60.5)129(44.6)
女459(42.9)226(41.2)525(39.5)160(55.4)
年级
五年级240(22.4)52(9.5)243(18.3)49(17.0)
初二175(16.4)83(15.1)220(16.6)38(13.1)
高一333(31.1)199(36.3)419(31.5)113(39.1)
高二322(30.1)214(39.1)447(33.6)89(30.8)
民族
汉族1 024(95.7)524(95.6)1 272(95.7)276(95.5)
少数民族46(4.3)24(4.4)57(4.3)13(4.5)
户籍
城市503(47.0)205(37.4)572(43.0)136(47.1)
农村567(53.0)343(62.6)757(57.0)153(52.9)
留守儿童
否884(82.6)422(77.0)1 070(80.5)236(81.7)
是186(17.4)126(23.0)259(19.5)53(18.3)
外形自信
其他432(40.4)311(56.8)569(42.8)174(60.2)
是638(59.6)237(43.2)760(57.2)115(39.8)
朋友关心
其他173(16.2)174(31.8)254(19.1)93(32.2)
是897(83.8)374(68.2)1 075(80.9)196(67.8)
父母关系
其他127(11.9)156(28.5)195(14.7)88(30.4)
好943(88.1)392(71.5)1 134(85.3)201(69.6)
是否听说周围同学有自杀想法/计划
无973(90.9)432(78.8)1 235(92.9)170(58.8)
有97(9.1)116(21.2)94(7.1)119(41.2)
调查内容自杀计划自杀尝试总计
(n=1 618)
无(n=1 420)有(n=198)无(n=1 492)有(n=126)
性别
男844(59.4)89(44.9)875(58.6)58(46.0)933(57.7)
女576(40.6)109(55.1)617(41.4)68(54.0)685(42.3)
年级
五年级258(18.2)34(17.2)272(18.2)20(15.9)292(18.0)
初二230(16.2)28(14.1)240(16.1)18(14.3)258(15.9)
高一453(31.9)79(39.9)482(32.3)50(39.7)532(32.9)
高二479(33.7)57(28.8)498(33.4)38(30.2)536(33.1)
民族
汉族1 362(95.9)186(93.9)1 431(95.9)117(92.9)1 548(95.7)
少数民族58(4.1)12(6.1)61(4.1)9 (7.1)70(4.3)
户籍
城市612(43.1)96(48.5)648(43.4)60(47.6)708(43.8)
农村808(56.9)102(51.5)844(56.6)66(52.4)910(56.2)
留守儿童
否1 144(80.6)162(81.8)1 204(80.7)102(81.0)1 306(80.7)
是276(19.4)36(18.2)288(19.3)24(19.0)312(19.3)
外形自信
其他618(43.5)125(63.1)661(44.3)82(65.1)743(45.9)
是802(56.5)73(36.9)831(55.7)44(34.9)875(54.1)
朋友关心
其他278(19.6)69(34.8)297(19.9)50(39.7)347(21.4)
是1 142(80.4)129(65.2)1 195 (80.1)76(60.3)1 271(78.6)
父母关系
其他218(15.4)65(32.8)235(15.8)48(38.1)283(17.5)
好1 202(84.6)133(67.2)1 257(84.2)78(61.9)1 335(82.5)
是否听说周围同学有自杀想法/计划
无1 291(90.9)114(57.6)1 330(89.1)75(59.5)1 405(86.8)
有129(9.1)84(42.4)162(10.9)51(40.5)213(13.2)
), ArticleFig(id=1241102744736551318, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102736696070250, language=EN, label=Table 2, caption=

Risk factors for bullying and suicide-related behaviors[RR (95%CI)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量欺凌自杀想法自杀计划自杀尝试
性别
男
女0.95(0.76~1.19)1.74(1.29~2.35)c1.56(1.12~2.19)b1.48(0.99~2.21)
年级
五年级
初二1.88(1.24~2.86)b0.53(0.31~0.91)a0.63(0.34~1.15)0.68(0.33~1.41)
高一2.46(1.72~3.56)c0.83(0.54~1.29)0.89(0.55~1.46)0.94(0.52~1.73)
高二2.71(1.89~3.92)c0.62(0.40~0.98)a0.64(0.39~1.07)0.77(0.42~1.44)
民族
汉族
少数1.19(0.69~2.03)1.47(0.72~2.82)2.28(1.08~4.48)a2.66(1.14~5.66)a
户籍
城市
农村1.25(0.99~1.57)0.66(0.48~0.89)b0.63(0.44~0.89)b0.66(0.44~1.00)a
留守儿童
否
是1.24(0.94~1.63)0.73(0.49~1.07)0.75(0.47~1.14)0.79(0.46~1.29)
父母关系
其他
好0.67(0.53~0.84)c0.70(0.51~0.95)c0.63(0.45~0.90)c0.65(0.43~0.99)c
外形自信
其他
是0.44(0.33~0.58)c0.52(0.36~0.73)a0.49(0.34~0.72)a0.43(0.28~0.66)a
朋友关心
其他
是0.53(0.40~0.69)c0.76(0.54~1.07)0.69(0.48~1.01)0.58(0.38~0.91)a
遭受欺凌
无
有-3.03(2.24~4.12)c2.21(1.57~3.12)c2.28(1.51~3.45)c
是否听说周围同学有自杀想法/计划
否
是-8.08(5.74~11.43)c6.40(4.44~9.22)c4.45(2.90~6.80)c
), ArticleFig(id=1241102744837214626, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102736696070250, language=CN, label=表2, caption=

遭受欺凌和自杀相关行为的危险因素[RR (95%CI)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量欺凌自杀想法自杀计划自杀尝试
性别
男
女0.95(0.76~1.19)1.74(1.29~2.35)c1.56(1.12~2.19)b1.48(0.99~2.21)
年级
五年级
初二1.88(1.24~2.86)b0.53(0.31~0.91)a0.63(0.34~1.15)0.68(0.33~1.41)
高一2.46(1.72~3.56)c0.83(0.54~1.29)0.89(0.55~1.46)0.94(0.52~1.73)
高二2.71(1.89~3.92)c0.62(0.40~0.98)a0.64(0.39~1.07)0.77(0.42~1.44)
民族
汉族
少数1.19(0.69~2.03)1.47(0.72~2.82)2.28(1.08~4.48)a2.66(1.14~5.66)a
户籍
城市
农村1.25(0.99~1.57)0.66(0.48~0.89)b0.63(0.44~0.89)b0.66(0.44~1.00)a
留守儿童
否
是1.24(0.94~1.63)0.73(0.49~1.07)0.75(0.47~1.14)0.79(0.46~1.29)
父母关系
其他
好0.67(0.53~0.84)c0.70(0.51~0.95)c0.63(0.45~0.90)c0.65(0.43~0.99)c
外形自信
其他
是0.44(0.33~0.58)c0.52(0.36~0.73)a0.49(0.34~0.72)a0.43(0.28~0.66)a
朋友关心
其他
是0.53(0.40~0.69)c0.76(0.54~1.07)0.69(0.48~1.01)0.58(0.38~0.91)a
遭受欺凌
无
有-3.03(2.24~4.12)c2.21(1.57~3.12)c2.28(1.51~3.45)c
是否听说周围同学有自杀想法/计划
否
是-8.08(5.74~11.43)c6.40(4.44~9.22)c4.45(2.90~6.80)c
), ArticleFig(id=1241102744963043763, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102736696070250, language=EN, label=Table 3, caption=

Relative risk of suicidal thoughts/plans/attempts by bullies[RR(95%CI)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量想法计划尝试
RR（95% CI）P交互RR（95% CI）P交互RR（95% CI）P交互
年级
五年级4.40(1.54~12.45)Ref3.21(1.46~6.97)Ref2.68(1.13~6.19)Ref
初二2.10(0.67~6.68)0.4723.30(1.43~7.75)0.6572.88(1.12~7.54)0.198
高一2.65(1.31~5.50)0.6933.05(1.83~5.16)0.6662.34(1.32~4.19)0.494
高二1.93(0.93~4.08)0.9113.24(1.89~5.66)0.5981.94(1.04~3.68)0.366
留守儿童
否2.37(1.51~3.74)Ref3.24(2.32~4.55)Ref2.39(1.65~3.49)Ref
是1.97(0.69~5.94)0.4112.47(1.17~5.35)0.2491.47(0.61~3.60)0.817
父母关系
其他2.54(1.22~5.60)Ref3.80(2.06~7.24)Ref2.67(1.38~5.38)Ref
好2.30(1.39~3.82)0.6452.98(2.07~4.29)0.8772.19(1.45~3.31)0.891
是否听说周围同学自杀想法/计划
否2.17(1.30~3.64)Ref3.25(2.27~4.68)Ref2.08(1.36~3.18)Ref
是3.49(1.64~7.95)0.3162.82(1.56~5.19)0.7072.79(1.51~5.26)0.617
性别
男2.00(1.14~3.55)Ref3.20(2.09~4.92)Ref2.45(1.52~3.97)Ref
女2.73(1.49~5.09)0.5442.95(1.90~4.61)0.2251.99(1.21~3.28)0.523
户籍
城市2.21(1.25~3.98)Ref2.74(1.80~4.22)Ref1.88(1.17~3.05)Ref
农村2.50(1.36~4.63)0.3823.44(2.22~5.37)0.3622.76(1.67~4.55)0.999
), ArticleFig(id=1241102745097261503, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102736696070250, language=CN, label=表3, caption=

遭受欺凌者的自杀想法/计划/尝试的相对风险[RR (95% CI)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量想法计划尝试
RR（95% CI）P交互RR（95% CI）P交互RR（95% CI）P交互
年级
五年级4.40(1.54~12.45)Ref3.21(1.46~6.97)Ref2.68(1.13~6.19)Ref
初二2.10(0.67~6.68)0.4723.30(1.43~7.75)0.6572.88(1.12~7.54)0.198
高一2.65(1.31~5.50)0.6933.05(1.83~5.16)0.6662.34(1.32~4.19)0.494
高二1.93(0.93~4.08)0.9113.24(1.89~5.66)0.5981.94(1.04~3.68)0.366
留守儿童
否2.37(1.51~3.74)Ref3.24(2.32~4.55)Ref2.39(1.65~3.49)Ref
是1.97(0.69~5.94)0.4112.47(1.17~5.35)0.2491.47(0.61~3.60)0.817
父母关系
其他2.54(1.22~5.60)Ref3.80(2.06~7.24)Ref2.67(1.38~5.38)Ref
好2.30(1.39~3.82)0.6452.98(2.07~4.29)0.8772.19(1.45~3.31)0.891
是否听说周围同学自杀想法/计划
否2.17(1.30~3.64)Ref3.25(2.27~4.68)Ref2.08(1.36~3.18)Ref
是3.49(1.64~7.95)0.3162.82(1.56~5.19)0.7072.79(1.51~5.26)0.617
性别
男2.00(1.14~3.55)Ref3.20(2.09~4.92)Ref2.45(1.52~3.97)Ref
女2.73(1.49~5.09)0.5442.95(1.90~4.61)0.2251.99(1.21~3.28)0.523
户籍
城市2.21(1.25~3.98)Ref2.74(1.80~4.22)Ref1.88(1.17~3.05)Ref
农村2.50(1.36~4.63)0.3823.44(2.22~5.37)0.3622.76(1.67~4.55)0.999
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湖北省中小学生遭受欺凌和自杀相关行为的影响因素分析
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马丽娜 1 , 徐静东 1 , 徐丹丹 2 , 方敏 3 , 涂画 1
现代预防医学 | 儿少卫生与妇幼保健 2024,51(14): 2568-2573
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现代预防医学 | 儿少卫生与妇幼保健 2024, 51(14): 2568-2573
湖北省中小学生遭受欺凌和自杀相关行为的影响因素分析
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马丽娜1, 徐静东1, 徐丹丹2, 方敏3, 涂画1
作者信息
  • 1.湖北省疾病预防控制中心，湖北 武汉 430079
  • 2.武汉市洪山区疾病预防控制中心
  • 3.宜昌市疾病预防控制中心

    • 马丽娜（1984—），女，硕士，副主任医师，研究方向：健康教育与健康促进

通讯作者:

涂画，E-mail：
Analysis of influencing factors of bullying and suicide-related behaviors among primary and secondary school students, Hubei
Li-na MA1, Jing-dong XU1, Dan-dan XU2, Min FANG3, Hua TU1
Affiliations
  • Hubei Provincial Center for Disease Control and Prevention, Wuhan, Hubei 430079, China
出版时间: 2024-07-25 doi: 10.20043/j.cnki.MPM.202306478
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摘要
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目的

分析湖北省中小学生遭受欺凌和自杀相关行为的影响因素，总结遭受欺凌和自杀相关行为（想法/计划/尝试）的高危群体。

方法

采用分层随机抽样方法，在湖北省4个县区抽取小学、初中、高中/职高的学生进行问卷调查。使用多因素logistic回归模型分析遭受欺凌与自杀相关行为的影响因素；通过添加交互项，检验遭受欺凌和相关变量的交互作用。

结果

调查共纳入1 618人。过去12个月，33.9%遭受欺凌，17.9%有自杀想法，12.2%有自杀计划，7.8%有自杀行为。遭受欺凌者出现自杀想法、计划、尝试的RR值分别为3.03(95%CI：2.24~4.12)、2.21(95%CI：1.57~3.12)、2.28(95%CI：1.51~3.45)。中学生相对于小学生、父母关系不好的、对自己外形不自信的、朋友不关心的学生更易遭受欺凌。遭受欺凌的、女生、少数民族、听说过同学有自杀相关行为的学生更易产生自杀相关行为。

结论

总结出湖北省中小学生遭遇欺凌和出现自杀相关行为的主要影响因素，为今后开展健康干预提供参考依据。

学生  /  欺凌  /  自杀  /  影响因素
Objective

To analyze the influencing factors of bullying and suicide-related behaviors among primary and secondary middle school students in Hubei Province, and to summarize the high-risk groups of bullying and suicide-related behaviors (thoughts/plans/attempts).

Methods

A stratified random sampling method was used to select primary, middle, and high school/vocational high school students from 4 counties in Hubei Province for questionnaire survey. Multivariate logistic regression model was used to analyze the influencing factors of bullying and suicide-related behaviors. The interaction between bullying and related variables was by adding interaction terms.

Results

A total of 1618 students were included in the survey. In the past 12 months, 33.9% of them had been bullied, 17.9%, 12.2%, and 7.8% of them had suicidal ideas, plans, and behavior. The RR values of suicide thoughts, plans, and attempts among bullies were 3.03(95%CI：2.24-4.12), 2.21(95%CI：1.57-3.12), and 2.28(95%CI：1.51-3.45). Middle school students, those with poor relationships with their parents, those who are not confident in their appearance, and those whose friends do not care about them are more likely to be bullied. Students who have been bullied, female students, ethnic minorities, and students who have heard of their classmates’ suicide-related behaviors are more likely to engage in suicide-related behaviors.

Conclusion

The main influencing factors of bullying and suicide-related behaviors among primary and middle school students in Hubei Province were summarized, which could provide a reference for future health interventions.

Student  /  Bullying  /  Suicide  /  Influencing factors
马丽娜, 徐静东, 徐丹丹, 方敏, 涂画. 湖北省中小学生遭受欺凌和自杀相关行为的影响因素分析. 现代预防医学, 2024 , 51 (14) : 2568 -2573 . DOI: 10.20043/j.cnki.MPM.202306478
Li-na MA, Jing-dong XU, Dan-dan XU, Min FANG, Hua TU. Analysis of influencing factors of bullying and suicide-related behaviors among primary and secondary school students, Hubei[J]. Modern Preventive Medicine, 2024 , 51 (14) : 2568 -2573 . DOI: 10.20043/j.cnki.MPM.202306478
正文
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Dan Olweus为代表的学者们将欺凌定义为：一个学生被其他学生故意地骚扰[1]。它不仅可以直接造成严重人身伤害，也会导致一系列健康问题比如焦虑、抑郁、自我伤害，是一个全球性的公共卫生问题。一项涵盖40个欧洲和北美洲国家的研究发现，在2005年有12.6%学龄儿童/青少年遭遇过欺凌[2]；一项2017年的马来西亚全国性调查发现13~17岁青少年中，有16.2%在过去30天遭遇过欺凌[3]。在中国，欺凌正在演变成一个严峻的社会问题。既往研究发现，中国遭受欺凌的儿童的比例因地区而异，从19%到40%[4]。青少年自杀同样是一个严峻的全球性社会问题。一项2010年的覆盖16个国家的研究显示，有16%的学生在过去12个月内有过自杀想法。一项2022年开展的全国性调查发现约有22.3%的中国青少年在过去12个月中有过自杀想法[5]；另一项2017年湖北省的调查显示有7.1%的中学生有过自杀尝试[6]。
已经有充分的流行病学证据表明遭受欺凌会增加自杀念头/尝试[7-9]。根据一个meta分析，2012年以前的研究显示欺凌会使自杀念头的风险增加123%，使自杀尝试的风险增加155%[10]。研究发现相对于未遭遇欺凌的学生，遭遇欺凌的学生更易出现自杀想法[11]。在2022年，一项覆盖中国11个省的研究表明遭受欺凌和自杀想法的风险呈正相关[5]。但学界仍然缺少欺凌对自杀相关行为影响的弱势群体的证据。此外，虽然已经有证据显示部分群体更易遭受欺凌或更容易产生自杀相关行为，比如在城市读书的农村子弟和农村地区的留守儿童，但仍没有研究系统地总结过这些群体，尤其同时讨论欺凌和自杀这两大全球性的社会问题，因此，政策制定者和教育工作者缺少用于指导改善欺凌和自杀问题的证据。本研究于2020年在湖北省部分地区开展了相关调查，以探索和分析遭遇欺凌对自杀相关行为（想法/计划/尝试）影响的弱势群体，并系统总结遭受欺凌和自杀相关行为的主要影响因素和高危群体。
1　对象与方法
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1.1　对象
本调查项目为国家社会科学基金项目“在健康社会决定因素框架下构建我国儿童健康行为测量指标体系”的重要组成部分。调查对象的选取按照《2020年全国学生健康行为调查工作方案》的统一规定，使用分层随机抽样方法，考虑城市经济发展水平，兼顾城/乡，在湖北省选择武汉市洪山区、宜昌市伍家岗区、天门市和秭归县4个县区。在每个县区随机抽取小学、初中、高中、职业高中各1所，兼顾了公立和民办学校，以及普通和重点学校。从抽样学校所需年级里（小学五年级，初二，高一，高二）每个年级随机抽取2个班级，抽中班级内的全部学生全部参与调查，如果一个班学生不足45人，则增加一个班级的全班学生参与调查。本研究经中国社会科学院大学伦理审查委员会审查通过，在调查前向所有调查对象发放知情同意书，在调查前调查对象阅读知情同意声明，说明调查目的、内容和意义；取得调查对象知情同意后，调查对象可选择是否参加调查，调查中对象可以拒绝回答不愿意回答的问题，并可随时结束调查。
1.2　方法
1.2.1　调查问卷
本次调查采用的问卷为《中国青少年健康行为网络调查问卷》，该问卷由“在健康社会决定因素框架下构建我国儿童健康行为测量指标体系”课题组根据世界卫生组织-学龄儿童健康行为研究模型，结合我国青少年健康行为现状，经过多轮专家研讨确定。
1.2.2　指标及定义
通过问卷调查学生在过去12个月是否遭受过欺凌，以及频率。基于既往研究以及以Dan Olweus为代表的学者们对欺凌的定义，本研究针对以下10种情况了解调查对象是否遭受过欺凌，存在其中一种视为遭受过欺凌：(1) 被别人取过侮辱性外号、被取笑、被恶意戏弄，(2) 或被其他同学故意冷落过、被排除在他们的朋友群体之外，(3) 或被打过、踢过、推过、挤来挤去或被锁在室内，(4) 或被其他同学编谎话或散布谣言来让其他人讨厌，(5) 或由于宗教信仰，被起过恶意的绰号或被恶意评论过，(6) 或由于身体残疾，被起过恶意的绰号或被恶意评价过，(7) 或被其他同学开色情玩笑或对自己有不尊重的举止，(8) 或在校外被高年级同学拦截要过东西，(9) 或曾被本校或外校同学打骂过，(10) 或遭受过性骚扰或性侵害。
调查询问了受访者在过去12个月是否有过自杀相关行为（想法/计划/尝试），以及是否听说过周围同学有自杀想法/计划。还收集了受访者父母的关系（好：非常亲近/比较亲近；其他：一般/不亲近/非常不亲近），是否对自己外形自信（是：非常赞同/比较赞同/赞同，其他：不赞同也不反对/不赞同/非常不赞同），朋友是否关心自己（是：非常赞同/比较赞同，其他：不赞同也不反对/不赞同/非常不赞同）等信息。
1.2.3　统计学分析
使用多因素logistic回归模型分析遭受欺凌与自杀相关行为的影响因素。在遭受欺凌的回归模型中调整了性别、年级、民族、户籍、是否留守儿童、父母关系、是否对外形自信、朋友是否关心自己；在自杀相关行为的回归模型中进一步调整了是否听说过同学有自杀想法/计划。通过亚组分析评估了遭受欺凌对自杀相关行为在不同年级，留守/非留守儿童，父母关系，是否听说同学自杀想法/计划，不同性别，不同户籍学生中的强度。并通过在回归模型中添加交互项，检验了潜在的交互作用（检验水准α=0.05）。
2　结果
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2.1　调查对象基本情况
本研究在湖北省4个县区共调查小学及中学生1 639人，排除相关信息缺失的问卷后，获取有效问卷1 618份。调查显示，男生占比57.7%，高中生占比66.0%，农村户籍占比56.2%，留守儿童占比19.3%。在过去12个月里，有33.9%的学生遭受过欺凌， 17.9%有过自杀想法，12.2%有过自杀计划，7.8%有过自杀尝试，见表1。
2.2　遭受欺凌和自杀相关行为的影响因素分析
多因素logistic回归模型的结果显示，在调整了潜在混杂因素后，与过去12个月内未遭受欺凌者相比，遭受欺凌者出现自杀想法、计划、尝试的相对风险（RR）显著增加，分别为3.03(95%CI：2.24~4.12)、2.21(95%CI：1.57~3.12)、2.28(95%CI：1.51~3.45)。此外，中学生相对于小学生有更高的遭受欺凌的风险（RR>1且有统计学意义）；父母关系好的、对自己外形自信的、朋友关心自己的学生遭受欺凌的风险更低（RR<1且有统计学意义）。三种自杀相关行为影响因素基本一致，分析结果显示，女生、少数民族、过去12个月听说过同学有自杀相关行为的学生出现自杀相关行为的风险更高（RR >1且有统计学意义）；初二/高二、农村户籍、父母关系好、对自己外形自信、朋友关心自己的学生出现自杀相关行为的风险更低（RR<1且有统计学意义），见表2。
2.3　遭受欺凌者自杀相关行为的相对风险分析
为探索和分析遭遇欺凌对自杀相关行为（想法/计划/尝试）影响的弱势群体，分析相关群体遭遇欺凌与自杀相关行为的交互作用，选取遭受欺凌风险较高的中学生、父母关系不好者以及自杀行为风险相对较高的女生、听说周围同学有自杀想法/计划的人群，同时，结合既往研究选取当下社会所关注的留守儿童以及农村儿童教育工作者容易识别的特征，进行了交互作用分析。交互项分析显示遭受欺凌和自杀相关行为之间的关系强度并未被其他因素改变，即没有发现该关系的弱势群体（表3，所有P交互>0.05）。
3　讨论
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本次调查发现中学生相对于小学生、父母关系不好、对自己外形不自信、朋友不关心自己的学生更易遭受欺凌。相对于未遭受欺凌者，遭受欺凌者出现自杀想法、计划、尝试的风险显著增加了203%，121%，128%。女生、少数民族、城市户籍、听说过同学有自杀相关行为的学生、父母关系不好的，对外形不自信的、朋友不关心自己的学生更易产生自杀相关行为。
本次调查发现的自杀相关行为的一些危险因素，基本和其他研究的发现一致。2003年开展的一项研究发现，国内遭受欺凌者的自杀想法的相对风险（RR）是2.03(95%CI：1.85~2.23)[11]；2017年在湖北省的研究表明遭受欺凌者的自杀想法的比值比 (OR) 是1.4(95%CI：1.0~1.9)，自杀尝试的OR是1.7(95%CI：0.9~3.0)[6]；2022年开展的覆盖国内11个省的研究显示遭受欺凌者的自杀想法的OR是1.34(95%CI：1.18~1.53)[5]。然而，本次调查的关联性更强。原因可能是调查对象在2020年1月到4月期间所经历/听说的由COVID-19导致的相关经历使得他们的心理健康已经处于被损害的状态（如抑郁）[12]，从而对欺凌的心理损伤作用反应更强烈[13]。本次研究显示女生更容易出现自杀相关行为，这与其他研究基本一致[14-16]，可能与女生本身的敏感性、青春期变化以及压力承受力有关。此外，父母关系不好、对自己外形不自信、人际关系较差（没有朋友关心）、听说过同学/身边的人有自杀相关行为也是自杀相关行为的危险因素[17-19]。本次研究显示城市户籍更容易产生自杀相关行为，这与以前的研究不一致。此前的研究发现家庭经济条件低的学生相对于家庭经济条件好的学生更容易产生自杀相关行为，而城市户籍的经济条件总体上好于农村户籍[17]。关于欺凌危险因素的发现也基本和其他研究的发现一致：良好的人际关系可以减少遭受欺凌的风险[13,20]；对外形不自信的更容易遭受欺凌[20]，这与一项基于国内15个省市的调查相一致[21]；父母关系不好会增加孩子遭受欺凌的可能性[22]。
通过本次研究，发现并总结了湖北省中小学生遭遇欺凌和出现自杀相关行为的主要影响因素和高危群体，帮助政策制定者和教育工作者更好地关注遭受欺凌和产生自杀相关行为的高危群体，有针对性地控制欺凌和自杀相关行为，做到早发现、早干预、早预防，从而减少这两类社会问题和公共卫生问题带来的伤害。
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  • 在健康社会决定因素框架下构建我国儿童健康行为测量指标体系(18BSH073)
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2024年第51卷第14期
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doi: 10.20043/j.cnki.MPM.202306478
  • 接收时间：2023-06-28
  • 首发时间：2026-03-18
  • 出版时间：2024-07-25
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  • 收稿日期：2023-06-28
基金
在健康社会决定因素框架下构建我国儿童健康行为测量指标体系(18BSH073)
作者信息
    1.湖北省疾病预防控制中心，湖北 武汉 430079
    2.武汉市洪山区疾病预防控制中心
    3.宜昌市疾病预防控制中心

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