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Article(id=1241319154918158817, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241319148798669160, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202412073, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1733241600000, receivedDateStr=2024-12-04, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773883149127, onlineDateStr=2026-03-19, pubDate=1750780800000, pubDateStr=2025-06-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773883149127, onlineIssueDateStr=2026-03-19, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773883149127, creator=13701087609, updateTime=1773883149127, updator=13701087609, issue=Issue{id=1241319148798669160, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='12', pageStart='2113', pageEnd='2304', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773883147667, creator=13701087609, updateTime=1773885555254, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241329247004971040, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241319148798669160, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241329247004971041, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241319148798669160, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=2198, endPage=2204, ext={EN=ArticleExt(id=1241319155295646205, articleId=1241319154918158817, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Analysis of the relationship between adolescent mental health and screen time based on restricted cubic spline model, columnId=1228016568949474136, journalTitle=Modern Preventive Medicine, columnName=Child and Adolescent health, Maternal and Child Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the relationship between screen time and mental health problems of adolescents using restricted cubic spline model.

Methods

A questionnaire survey was conducted among 3 960 junior and senior high school students in Jinan, Weifang and Qingdao cities of Shandong Province from February to March 2023. Logistic regression model and restricted cubic spline model were used to analyze the correlation strength and dose-response relationship between screen time and psychological problems. Result 46.41% of adolescents in middle and high school had mental problems, and 29.70% reported that screen time(ST)>2 h/d. There was a nonlinear dose-response relationship between mild psychological problems and ST on rest day (Pnonlinear＝0.003, Poverall＝0.003), and the curve was approximately "J" shaped, and the risk increased beyond 1.5 h/d. ST>2 h/d on rest days was associated with mild psychological problems (OR=1.300, 95% CI;1.085-1.558). Stratified analysis showed that there was a nonlinear correlation between ST on rest day and mild mental problems (Pnonlinear<0.001), and a linear correlation between ST and moderate mental problems (Pnonlinear>0.05)(Poverall<0.001). Only smartphones and tablets were linearly associated with mild mental health problems (Poverall＝0.004), with increased risk beyond 2.0 h/d.

Conclusion

The average screen time over 1.5 h/d increases the risk of psychological problems. It is suggested to lighten students'study burden after class and reduce the use of electronic devices on rest days.

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目的

采用限制性立方样条模型探讨视屏时间与青少年心理健康问题的关系。

方法

采用自制问卷于2023年2—3月对山东省济南、潍坊、青岛三市3 960名初高中学生进行问卷调查。通过logistic回归和限制性立方样条模型分析屏幕时间与心理问题的关联强度及剂量-反应关系。

结果

初高中青少年心理问题检出率为46.41%，29.70%报告休息日视屏时间(ST)>2 h/d。轻度心理问题与休息日不同设备平均ST存在非线性剂量-反应关系(P非线性＝0.003，P总趋势＝0.003)，曲线近似呈“J”形，超过1.5 h/d风险增大。休息日ST>2 h/d与轻度心理问题(OR＝1.300，95% CI：1.085~1.558)相关。分层分析显示，女性、高中生休息日ST与轻度心理问题呈非线性相关(P非线性<0.001)，与中度以上心理问题呈线性相关(P非线性>0.05)(P总趋势<0.001)。不同视屏设备仅手机/平板与轻度心理问题呈线性相关(P总趋势=0.004)，超过2.0 h/d风险增加。

结论

休息日平均屏幕时间超1.5 h/d增加心理问题发生风险，建议减轻学生课后学习负担，限制休息日电子设备的使用时间。

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高杰，E-mail：
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孔令敏（1998—），女，硕士在读，研究方向：妇幼保健与生殖健康

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Children, 2023, 10(5): 770., articleTitle=Beyond screen time: the different longitudinal relations between adolescents’ smartphone use content and their mental health, refAbstract=null)], funds=[Fund(id=1241319164338566108, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319154918158817, awardId=SDQY20210211, language=CN, fundingSource=2021年度山东省青少年研究规划一般课题(SDQY20210211), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241319158080664166, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319154918158817, xref=1., ext=[AuthorCompanyExt(id=1241319158089052777, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319154918158817, companyId=1241319158080664166, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Shandong Second Medical University, Weifang, Shandong 261053, China), AuthorCompanyExt(id=1241319158093247081, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319154918158817, companyId=1241319158080664166, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.山东第二医科大学公共卫生学院，山东 潍坊 261053)]), AuthorCompany(id=1241319158160355953, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319154918158817, xref=2., ext=[AuthorCompanyExt(id=1241319158168744562, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319154918158817, companyId=1241319158160355953, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.青岛大学附属山东省妇幼保健院妇幼健康发展与医院管理研究中心)])], figs=[ArticleFig(id=1241319162539209562, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319154918158817, language=EN, label=Fig.1, caption=Dose-response relationship between ST on rest days and risk of psychological problems, figureFileSmall=DjAQC/RX64LeUc3K5vUPGQ==, figureFileBig=3FVUlcBg94J5pO364bFctw==, tableContent=null), ArticleFig(id=1241319162660844387, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319154918158817, language=CN, label=图1, caption=休息日ST与轻度心理问题风险的剂量-反应关系, figureFileSmall=DjAQC/RX64LeUc3K5vUPGQ==, figureFileBig=3FVUlcBg94J5pO364bFctw==, tableContent=null), ArticleFig(id=1241319162916696950, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319154918158817, language=EN, label=Fig.2, caption=The relationship between screen time on rest day and the risk of psychological problems based on gender and grade stratification, figureFileSmall=WsrSj83SB+XSJ5lWU0/XZA==, figureFileBig=ZECi3bItJGiTn2/RZX6xlw==, tableContent=null), ArticleFig(id=1241319163046720389, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319154918158817, language=CN, label=图2, caption=性别、年级分层下休息日视屏时间与心理问题发生风险的关系

注：A、B、C分别表示女性、高中生、初中生ST与轻度心理问题发生风险；D、E表示女性、高中生ST与中度及以上心理问题发生风险的剂量-反应关系。

, figureFileSmall=WsrSj83SB+XSJ5lWU0/XZA==, figureFileBig=ZECi3bItJGiTn2/RZX6xlw==, tableContent=null), ArticleFig(id=1241319163180938128, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319154918158817, language=EN, label=Fig.3, caption=Dose-response relationship between screen time of smartphones and tablets on rest days and mild psychological problems, figureFileSmall=z79W4iVLnZv5k+H2c+WkmQ==, figureFileBig=byQ1z02R5vOEfYbibhLm6g==, tableContent=null), ArticleFig(id=1241319163323544474, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319154918158817, language=CN, label=图3, caption=休息日手机/平板视屏时间与轻度心理问题的剂量-反应关系, figureFileSmall=z79W4iVLnZv5k+H2c+WkmQ==, figureFileBig=byQ1z02R5vOEfYbibhLm6g==, tableContent=null), ArticleFig(id=1241319163436790687, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319154918158817, language=EN, label=Table 1, caption=

Comparison of mental health problems among adolescents with different characteristics

, figureFileSmall=null, figureFileBig=null, tableContent=
变量调查人数
(n=3 667)		心理健康问题H/χ2趋势值P值
健康
(n=1 965)		轻度
(n=1 189)		中度及以上
(n=513)
年龄（岁）16(14, 17)15(14, 17)16(15, 17)17(15, 17)178.37<0.001
性别25.97<0.001
男性1 828(49.85)1 066(54.25)531(44.66)231(45.03)
女性1 838(50.15)899(45.75)658(55.34)282(54.97)
民族0.260.610
汉族3 625(98.85)1 941(98.78)1 176(98.91)508(99.03)
其他42(1.15)24(1.22)13(1.09)5(0.97)
地区17.08<0.001
济南815(22.22)317(16.13)334(28.09)164(31.97)
潍坊1 430(39.00)913(46.46)372(31.29)145(28.27)
青岛1 422(38.78)735(37.40)483(40.62)204(39.77)
年级228.48<0.001
初中1 537(41.91)1 071(54.50)329(27.67)137(26.71)
高中2 130(58.09)894(45.50)860(72.33)376(73.29)
BMI0.090.760
偏瘦150(4.09)75(3.82)48(4.04)27(5.26)
正常2 338(63.76)1 259(64.07)773(65.01)306(59.65)
超重489(13.33)247(12.57)163(13.71)79(15.40)
肥胖690(18.82)384(19.54)205(17.24)101(19.69)
居住地15.95<0.001
城市居住891(24.30)461(23.46)299(25.15)131(25.54)
中小城市/县区978(26.67)453(23.05)362(30.45)163(31.77)
农村1 798(49.03)1 051(53.49)528(44.41)219(42.69)
独生子女0.6600.416
是997(27.18)516(26.26)344(28.93)137(26.71)
否2 670(72.81)1 449(73.74)845(71.07)376(73.29)
家庭月收入（元）1.490.222
>8 0001 358(37.03)691(35.17)488(41.04)179(34.89)
≤8 0002 309(62.97)1 274(64.83)701(58.96)334(65.11)
家庭结构8.110.004
核心家庭3 393(92.53)1 830(93.13)1 108(93.19)455(88.69)
单亲家庭226(6.16)115(5.85)63(5.30)48(9.36)
隔代抚养48(1.31)20(1.02)18(1.51)10(1.95)
近视等级17.93<0.001
不近视1 181(32.21)692(35.22)328(27.59)161(31.38)
轻度997(27.19)542(27.58)325(27.33)130(25.34)
中度1 266(34.52)634(32.26)449(37.76)183(35.67)
重度223(6.08)97(4.94)87(7.32)39(7.60)
学习成绩93.17<0.001
好758(20.68)497(25.29)193(16.23)68(13.31)
中2 511(68.48)1 320(67.18)843(70.90)348(67.84)
差396(20.67)148(25.29)153(16.23)95(13.26)
睡眠时间101.43<0.001
充足2 294(62.56)1 381(70.28)653(54.92)260(50.68)
不充足1 373(37.44)584(29.72)536(45.08)253(49.32)
睡眠质量611.81<0.001
好2 681(73.11)1 742(88.65)739(62.15)200(38.99)
差986(26.89)223(11.35)450(37.85)313(61.01)
锻炼达标14.22<0.001
是1 652(45.05)933(47.48)522(43.90)197(38.40)
否2 015(54.95)1 032(52.52)667(56.10)316(61.60)
自发锻炼53.46<0.001
是1 815(49.50)1 111(56.54)486(40.87)218(42.50)
否1 852(50.50)854(43.46)703(59.13)295(57.50)
工作日视屏时间(h)0.040.842
>2312(8.51)178(9.06)82(6.90)52(10.14)
≤23 355(91.49)1 787(90.94)1 107(93.10)461(89.86)
休息日视屏时间(h)25.77<0.001
>21 089(29.70)513(26.11)393(33.05)183(35.67)
≤22 578(70.30)1 452(73.89)796(66.95)330(64.33)
), ArticleFig(id=1241319163566814121, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319154918158817, language=CN, label=表1, caption=

不同特征青少年心理健康问题情况比较

, figureFileSmall=null, figureFileBig=null, tableContent=
变量调查人数
(n=3 667)		心理健康问题H/χ2趋势值P值
健康
(n=1 965)		轻度
(n=1 189)		中度及以上
(n=513)
年龄（岁）16(14, 17)15(14, 17)16(15, 17)17(15, 17)178.37<0.001
性别25.97<0.001
男性1 828(49.85)1 066(54.25)531(44.66)231(45.03)
女性1 838(50.15)899(45.75)658(55.34)282(54.97)
民族0.260.610
汉族3 625(98.85)1 941(98.78)1 176(98.91)508(99.03)
其他42(1.15)24(1.22)13(1.09)5(0.97)
地区17.08<0.001
济南815(22.22)317(16.13)334(28.09)164(31.97)
潍坊1 430(39.00)913(46.46)372(31.29)145(28.27)
青岛1 422(38.78)735(37.40)483(40.62)204(39.77)
年级228.48<0.001
初中1 537(41.91)1 071(54.50)329(27.67)137(26.71)
高中2 130(58.09)894(45.50)860(72.33)376(73.29)
BMI0.090.760
偏瘦150(4.09)75(3.82)48(4.04)27(5.26)
正常2 338(63.76)1 259(64.07)773(65.01)306(59.65)
超重489(13.33)247(12.57)163(13.71)79(15.40)
肥胖690(18.82)384(19.54)205(17.24)101(19.69)
居住地15.95<0.001
城市居住891(24.30)461(23.46)299(25.15)131(25.54)
中小城市/县区978(26.67)453(23.05)362(30.45)163(31.77)
农村1 798(49.03)1 051(53.49)528(44.41)219(42.69)
独生子女0.6600.416
是997(27.18)516(26.26)344(28.93)137(26.71)
否2 670(72.81)1 449(73.74)845(71.07)376(73.29)
家庭月收入（元）1.490.222
>8 0001 358(37.03)691(35.17)488(41.04)179(34.89)
≤8 0002 309(62.97)1 274(64.83)701(58.96)334(65.11)
家庭结构8.110.004
核心家庭3 393(92.53)1 830(93.13)1 108(93.19)455(88.69)
单亲家庭226(6.16)115(5.85)63(5.30)48(9.36)
隔代抚养48(1.31)20(1.02)18(1.51)10(1.95)
近视等级17.93<0.001
不近视1 181(32.21)692(35.22)328(27.59)161(31.38)
轻度997(27.19)542(27.58)325(27.33)130(25.34)
中度1 266(34.52)634(32.26)449(37.76)183(35.67)
重度223(6.08)97(4.94)87(7.32)39(7.60)
学习成绩93.17<0.001
好758(20.68)497(25.29)193(16.23)68(13.31)
中2 511(68.48)1 320(67.18)843(70.90)348(67.84)
差396(20.67)148(25.29)153(16.23)95(13.26)
睡眠时间101.43<0.001
充足2 294(62.56)1 381(70.28)653(54.92)260(50.68)
不充足1 373(37.44)584(29.72)536(45.08)253(49.32)
睡眠质量611.81<0.001
好2 681(73.11)1 742(88.65)739(62.15)200(38.99)
差986(26.89)223(11.35)450(37.85)313(61.01)
锻炼达标14.22<0.001
是1 652(45.05)933(47.48)522(43.90)197(38.40)
否2 015(54.95)1 032(52.52)667(56.10)316(61.60)
自发锻炼53.46<0.001
是1 815(49.50)1 111(56.54)486(40.87)218(42.50)
否1 852(50.50)854(43.46)703(59.13)295(57.50)
工作日视屏时间(h)0.040.842
>2312(8.51)178(9.06)82(6.90)52(10.14)
≤23 355(91.49)1 787(90.94)1 107(93.10)461(89.86)
休息日视屏时间(h)25.77<0.001
>21 089(29.70)513(26.11)393(33.05)183(35.67)
≤22 578(70.30)1 452(73.89)796(66.95)330(64.33)
), ArticleFig(id=1241319163713614770, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319154918158817, language=EN, label=Table 2, caption=

Correlation coefficient (r) between screen time of different equipment and scores of mental health dimension on rest day

, figureFileSmall=null, figureFileBig=null, tableContent=
心理健康维度休息日视屏时间（h/d)
手机/平板电脑电视机
强迫0.114c0.0390.056a
偏执0.119c0.0400.061a
敌对0.111c0.0380.058a
抑郁0.123c0.0320.059a
焦虑0.147c0.0460.060a
学习压力0.180c0.052a0.040
适应不良0.137c0.059a0.062b
人际关系紧张敏感0.124c0.0370.048a
情绪不稳定0.164c0.054a0.069b
心理不平衡0.114c0.0390.045
总均分0.148c0.0450.058a
), ArticleFig(id=1241319163831055290, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319154918158817, language=CN, label=表2, caption=

休息日不同设备视屏时间与心理健康维度得分的相关系数（r）

, figureFileSmall=null, figureFileBig=null, tableContent=
心理健康维度休息日视屏时间（h/d)
手机/平板电脑电视机
强迫0.114c0.0390.056a
偏执0.119c0.0400.061a
敌对0.111c0.0380.058a
抑郁0.123c0.0320.059a
焦虑0.147c0.0460.060a
学习压力0.180c0.052a0.040
适应不良0.137c0.059a0.062b
人际关系紧张敏感0.124c0.0370.048a
情绪不稳定0.164c0.054a0.069b
心理不平衡0.114c0.0390.045
总均分0.148c0.0450.058a
), ArticleFig(id=1241319164007216073, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319154918158817, language=EN, label=Table 3, caption=

Multivariate logistic regression analysis of screen time and mental health problems

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变量轻度心理问题中度及以上心理问题
模型1模型2模型1模型2
OR(95% CI)P值OR(95% CI)P值OR(95% CI)P值OR(95% CI)P值
休息日ST≤2 h1.0001.0001.0001.000
休息日ST>2 h1.551(1.306~1.841)<0.0011.300(1.085~1.558)0.0051.705(1.359~2.138)<0.0011.180(0.923~1.509)0.187
工作日ST≤2h1.0001.0001.0001.000
工作日ST>2h0.653(0.373~1.145)0.1370.787(0.577~1.073)0.1301.424(0.786~2.578)0.2441.186(0.802~1.754)0.393
), ArticleFig(id=1241319164162405328, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241319154918158817, language=CN, label=表3, caption=

屏幕时间与心理健康问题多因素logistic回归分析

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变量轻度心理问题中度及以上心理问题
模型1模型2模型1模型2
OR(95% CI)P值OR(95% CI)P值OR(95% CI)P值OR(95% CI)P值
休息日ST≤2 h1.0001.0001.0001.000
休息日ST>2 h1.551(1.306~1.841)<0.0011.300(1.085~1.558)0.0051.705(1.359~2.138)<0.0011.180(0.923~1.509)0.187
工作日ST≤2h1.0001.0001.0001.000
工作日ST>2h0.653(0.373~1.145)0.1370.787(0.577~1.073)0.1301.424(0.786~2.578)0.2441.186(0.802~1.754)0.393
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基于限制性立方样条模型分析青少年心理健康与视屏时间的关系
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孔令敏 1 , 冉晓妤 1 , 张庆雯 1 , 田秋月 2 , 高杰 2
现代预防医学 | 儿少卫生与妇幼保健 2025,52(12): 2198-2204
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现代预防医学 | 儿少卫生与妇幼保健 2025, 52(12): 2198-2204
基于限制性立方样条模型分析青少年心理健康与视屏时间的关系
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孔令敏1, 冉晓妤1, 张庆雯1, 田秋月2, 高杰2
作者信息
  • 1.山东第二医科大学公共卫生学院，山东 潍坊 261053
  • 2.青岛大学附属山东省妇幼保健院妇幼健康发展与医院管理研究中心

    • 孔令敏（1998—），女，硕士在读，研究方向：妇幼保健与生殖健康

通讯作者:

高杰，E-mail：
Analysis of the relationship between adolescent mental health and screen time based on restricted cubic spline model
Ling-min KONG1, Xiao-yu RAN1, Qing-wen ZHANG1, Qiu-yue TIAN2, Jie GAO2
Affiliations
  • Shandong Second Medical University, Weifang, Shandong 261053, China
出版时间: 2025-06-25 doi: 10.20043/j.cnki.MPM.202412073
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摘要
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目的

采用限制性立方样条模型探讨视屏时间与青少年心理健康问题的关系。

方法

采用自制问卷于2023年2—3月对山东省济南、潍坊、青岛三市3 960名初高中学生进行问卷调查。通过logistic回归和限制性立方样条模型分析屏幕时间与心理问题的关联强度及剂量-反应关系。

结果

初高中青少年心理问题检出率为46.41%，29.70%报告休息日视屏时间(ST)>2 h/d。轻度心理问题与休息日不同设备平均ST存在非线性剂量-反应关系(P非线性＝0.003，P总趋势＝0.003)，曲线近似呈“J”形，超过1.5 h/d风险增大。休息日ST>2 h/d与轻度心理问题(OR＝1.300，95% CI：1.085~1.558)相关。分层分析显示，女性、高中生休息日ST与轻度心理问题呈非线性相关(P非线性<0.001)，与中度以上心理问题呈线性相关(P非线性>0.05)(P总趋势<0.001)。不同视屏设备仅手机/平板与轻度心理问题呈线性相关(P总趋势=0.004)，超过2.0 h/d风险增加。

结论

休息日平均屏幕时间超1.5 h/d增加心理问题发生风险，建议减轻学生课后学习负担，限制休息日电子设备的使用时间。

心理健康  /  视屏时间  /  限制性立方样条模型  /  分层分析
Objective

To explore the relationship between screen time and mental health problems of adolescents using restricted cubic spline model.

Methods

A questionnaire survey was conducted among 3 960 junior and senior high school students in Jinan, Weifang and Qingdao cities of Shandong Province from February to March 2023. Logistic regression model and restricted cubic spline model were used to analyze the correlation strength and dose-response relationship between screen time and psychological problems. Result 46.41% of adolescents in middle and high school had mental problems, and 29.70% reported that screen time(ST)>2 h/d. There was a nonlinear dose-response relationship between mild psychological problems and ST on rest day (Pnonlinear＝0.003, Poverall＝0.003), and the curve was approximately "J" shaped, and the risk increased beyond 1.5 h/d. ST>2 h/d on rest days was associated with mild psychological problems (OR=1.300, 95% CI;1.085-1.558). Stratified analysis showed that there was a nonlinear correlation between ST on rest day and mild mental problems (Pnonlinear<0.001), and a linear correlation between ST and moderate mental problems (Pnonlinear>0.05)(Poverall<0.001). Only smartphones and tablets were linearly associated with mild mental health problems (Poverall＝0.004), with increased risk beyond 2.0 h/d.

Conclusion

The average screen time over 1.5 h/d increases the risk of psychological problems. It is suggested to lighten students'study burden after class and reduce the use of electronic devices on rest days.

Mental health  /  Screen time  /  Restricted cubic spline model  /  Stratified analysis
孔令敏, 冉晓妤, 张庆雯, 田秋月, 高杰. 基于限制性立方样条模型分析青少年心理健康与视屏时间的关系. 现代预防医学, 2025 , 52 (12) : 2198 -2204 . DOI: 10.20043/j.cnki.MPM.202412073
Ling-min KONG, Xiao-yu RAN, Qing-wen ZHANG, Qiu-yue TIAN, Jie GAO. Analysis of the relationship between adolescent mental health and screen time based on restricted cubic spline model[J]. Modern Preventive Medicine, 2025 , 52 (12) : 2198 -2204 . DOI: 10.20043/j.cnki.MPM.202412073
正文
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青少年时期是身心快速发展的重要阶段，也是心理健康问题的高发期[1]。全球14%的10~19岁青少年受心理健康问题困扰，占该年龄段疾病总负担的13%[2]。过去二十年间智能手机的普及和社交媒体的无序发展对青少年心理健康有损害趋势[3]。过度屏幕暴露不仅与睡眠质量下降[4]、户外活动减少以及久坐时间加剧等情况显著相关，还加剧神经炎症[5]，对认知发展、语言能力和社会情感适应产生持续性的负面影响[6]。青少年脑认知发展纵向研究发现，屏幕时间与青少年所有心理健康症状呈前瞻性相关[7]。但大多数研究观察两者效应较小[8]。限制性立方样条（restricted cubic spline, RCS）模型能精准地揭示自变量与因变量之间的复杂非线性关系[9]。可直观、准确地展现随视屏时间的变化，心理健康风险的变化趋势。为此，本研究运用RCS模型量化视屏时间与青少年心理问题发生风险的剂量-反应关系，旨在为相关防控措施制定提供参考依据。
1　对象与方法
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1.1　研究对象
采用分层多阶段整群随机抽样方法，按山东省行政区划和地理位置分为东部、中部和西部地区，每个地区随机抽取1个市，每市各随机抽取1个城区和1个乡镇，在城区和乡镇分别随机抽取1所初中和1所高中，从各学校各年级中随机抽取4个班，以班内所有学生为调查对象进行线上与线下相结合的问卷调查。本次研究共发放问卷3 960份，回收问卷3 799份，有效问卷3 667份，有效率为96.53%，满足总体样本量需求。本研究获得山东省妇幼保健院伦理委员会批准(批准号:No.2023-042)，所有对象均签署知情同意书。
1.2　研究方法
1.2.1　心理健康状况调查
采用王极盛等[10]编制的中国中学生心理健康量表(Mental Health Inventory of Middle-school Students, MMHI-60)对心理健康水平进行评估，该量表信、效度理想，本研究中量表Cronbach α 系数和 KMO 值分别为0.986和0.991，信效度理想。量表共有60个条目、10个维度，分别为强迫、偏执、敌对、人际关系紧张敏感、抑郁、焦虑、学习压力、适应不良、情绪不稳定和心理不平衡。所有条目采用5级评分法，得分越高表示心理问题越严重，总均分<2.00为心理健康，2.00~2.99为轻度心理问题，>3.00为中度及以上心理问题。
1.2.2　视屏时间调查
问卷调查最近7天视屏时间，本研究中视屏时间等于工作日和休息日使用三类设备（手机/平板、电脑、电视）时长的平均水平。根据《中国儿童青少年身体活动指南》建议将每日视屏时间分为≤2 h/d和>2 h/d，视屏时间>2 h/d界定为视屏时间超标[11]。一周平均每日视屏时间＝（工作日ST×5+休息日ST×2）/7。
1.2.3　其他情况调查
包括年龄、性别、民族、年级（初中/高中）、BMI（根据《学龄儿童青少年营养不良筛查》（WS/T 456—2014）[12]和《学龄儿童青少年超重与肥胖筛查》（WS/T586—2018）[13]评估分为正常/低体重/超重/肥胖）、家庭结构（核心家庭/单亲家庭/隔代抚养）、运动达标情况（以出汗为标准，≥60 min/d为达标[14]）、视力情况〔不近视；轻度近视（近视50~300度之间）；中度近视（近视300~600度之间）；高度近视（近视600度以上）〕、自评学习情况（学习成绩好/中/差）、自评睡眠状况（时间是否充足、质量好/差）、家庭月收入、居住地及其他基本情况。
1.3　质量控制
设计问卷时，查阅国内外相关文献，咨询相关领域专家，并进行预调查。本研究选取的6所学校中有1所为寄宿制学校，采用线下调查，其余5所学校通过问卷星系统调查。线上与线下调查采用相同的调查问卷、样本选取和统计分析方法。线下调查在获得知情同意后，由经过培训的班主任统一讲解问卷的填写方法，由学生独立匿名完成问卷。问卷回收前，检查问卷完整性，如有遗漏现场补全。
1.4　统计学方法
采用SAS 9.4和R 4.3.3软件进行统计分析。定量资料采用中位数（四分位间距）表示，分类变量以频数（构成比）表示。采用Kruskal-Wallis H秩和检验（非正态分布）和Mantel-Haenszel卡方检验比较组间差异。Spearman分析三种设备视屏时间与心理健康的相关性。采用多因素logistic回归分析视屏时间对青少年心理健康问题的影响。运用rms包及ggplot2包绘制限制性立方样条图分析不同条件下轻度和中度以上心理问题与屏幕时间之间的剂量-反应关系。检验水准 α＝0.05。
2　结果
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2.1　中学生心理健康问题分布情况
在纳入3 667名中学生中，存在心理健康问题1 702人（46.41%），其中轻度1 189名（32.42%）、中度及以上513名（13.99%）。不同年龄、性别、年级、家庭结构、居住地、运动达标情况、视力情况、学习成绩、睡眠质量、睡眠充足、休息日视屏时间与不同程度心理健康问题分布差异具有统计学意义（P<0.05）（见表1）。
2.2　中学生视屏时间与心理维度相关情况
工作日和休息日视屏时间>2 h中学生分别占8.51%和29.70%，休息日高于工作日。初中生平均一周中位视屏时间为1.00 h/d，高中生为0.57 h/d。Spearman相关性分析显示，休息日使用手机/平板与各心理维度得分均呈正相关（P<0.001），与学习压力相关性最强，其次是情绪不稳定和焦虑（见表2）。
2.3　屏幕时间与心理健康问题的logistic回归分析
模型1未调整变量，休息日屏幕时间>2h增加轻度、中度以上心理问题发生风险（轻度：OR＝1.551，95% CI：1.306~1.841；中度以上：OR＝1.705，95% CI：1.359~1.996）。模型2调整性别、年级、BMI、家庭结构等混杂因素，结果显示，与休息日ST≤2 h相比，休息日ST>2 h的中学生轻度心理问题报告率更高(OR＝1.300，95% CI：1.085~1.558)。工作日屏幕时间与心理健康问题未见统计学关联。（见表3）。
2.4　休息日屏幕时间与心理健康问题之间的剂量-反应关系
RCS模型分析（模型中节点数为3个）结果表明，在调整年龄、性别、年级、BMI、家庭结构、家庭月收入、居住地、运动达标情况、视力情况、学习情况、睡眠状况后，休息日平均屏幕时间与轻度心理问题风险呈非线性相关（P非线性＝0.003，P总 趋势＝0.003）。当休息日平均ST在0.66~1.5小时之间OR小于1，对轻度心理问题发生风险起到保护作用，曲线最低点为1.0 h/d；平均ST>1.5 h/d，OR>1，说明休息日平均屏幕时间超过1.5小时轻度心理问题发生风险逐渐加大（见图1）。
2.5　分层分析
通过性别、年级分层，女性、高中生休息日平均屏幕时间与轻度心理问题呈非线性相关（P非线性<0.001, P总趋势<0.001），女性休息日ST在0.66~1.5 h/d区间内，高中生0.25~1.5 h/d区间，OR<1；与中度及以上心理问题呈线性相关（见图2）。曲线拐点均为1.50，说明女性、高中生休息日平均屏幕时间超过1.5h/d会增加不同程度心理问题的发生风险。初中生休息日平均ST与轻度心理问题呈线性相关（P非线性＝0.643, P总趋势＝0.013）。分层分析显示，仅智能手机和平板电脑休息日视屏时间与轻度心理问题的发生风险呈线性相关（P非线性＝0.314, P总趋势＝0.004），使用超过2.0 h将增加轻度心理问题的发生风险。（见图3）
3　讨论
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本研究显示山东省29.70%的青少年休息日ST>2 h/d，低于铜仁市（32.3%）[15]和Zhang等人研究结果[16]。初中生中位视屏时间（1.00 h/d）高于高中生（0.57 h/d）。这与中国教育生态特征相符——相比于初中生，高中生需应对高考，学校与家长对电子设备的管控力度普遍增强。结果显示，屏幕时间与心理问题的关联仅在休息日存在显著关联。这与先前的相关研究相符[17]。工作日结果不一致可能与样本中包含寄宿制学校有关，需进一步验证。
本研究发现休息日视屏时间与青少年各维度心理健康问题之间的相关关系在使用不同设备时有差异，手机/平板类可移动设备比电视、电脑类固定设备关联性更强，与相关研究结果一致[18-19]。研究发现，屏幕的类型、用途和内容都会影响两者之间的关系[20]。与抑郁症状关联最大的屏幕类型是聊天、发短信、视频和游戏[7]。本研究表明周末手机/平板使用时间与各维度心理问题均有关，尤其是学习压力、情绪不稳定和焦虑情绪。Schmidt-Persson等人也发现减少休闲屏幕时间可以减轻青少年的心理症状[21]。高强度的学业压力可能导致负面情绪增加，引发休息日补偿性屏幕依赖。也提示青少年休息日屏幕使用的家庭监管缺失[22]。建议合理规划周末视屏时间，避免过度屏幕依赖。屏幕时间与睡眠持续时间具有负相关性并通过大脑执行功能共同影响心理内化、外化症状[23]。鉴于睡眠与屏幕时间的相关性演变，针对这两种行为的青少年健康促进措施可能更加有效[24]。
周末平均屏幕时间与青少年轻度心理问题的不良关联升高在1.5小时后，早于瑞典和美国研究的4~5小时[25-26]。分层结果显示屏幕时间与心理健康存在群体异质性，总人群、女性、高中生的休息日视屏时间与轻度心理问题呈现非线性剂量-反应关系，曲线呈现J型，说明低暴露ST(0.66~1.5 h/d)可能对心理问题具有保护作用（如社交媒体互动[27]）；而超过拐点值后，认知超载与睡眠剥夺主导，轻度心理问题风险增高。初中生周末平均ST与轻度心理问题以及女性、高中生休息日ST与中度以上心理问题发生风险呈线性剂量-反应关系。与高中阶段女性的心理健康更容易受到屏幕时间影响一致[17]。提示休息日视屏时间可能对于初高中生的心理健康状况负面影响具有累积效应。高中生非线性曲线弯曲程度较高，低暴露ST可能改善高中生轻度心理健康问题效果更显著。建议青少年休息日各种设备的平均屏幕使用时间不超过1.5小时，智能手机和平板电脑使用时间小于2小时。
本研究的创新之处在于系统地探讨休息日屏幕时间与青少年心理问题风险的剂量-反应关系，并通过性别、年级、视屏设备类型分层分析。但仍存在一定的局限性。首先，横断面设计难以确立因果关系；其次，未区分教育类与娱乐类视屏内容，适度教育类视屏可能具有保护效应[28]；最后，疫情期间数据收集可能引入特殊情景偏差，需结合纵向数据验证结论的普适性。
综上，休息日屏幕时间与青少年心理健康问题相关，尤其是学习压力。除了减轻学生课后学习负担，应提倡家长和学校为学生提供多元化的降压方式，减少休息日电子设备的使用。
基金
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  • 2021年度山东省青少年研究规划一般课题(SDQY20210211)
文献
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2025年第52卷第12期
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doi: 10.20043/j.cnki.MPM.202412073
  • 接收时间：2024-12-04
  • 首发时间：2026-03-19
  • 出版时间：2025-06-25
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  • 收稿日期：2024-12-04
基金
2021年度山东省青少年研究规划一般课题(SDQY20210211)
作者信息
    1.山东第二医科大学公共卫生学院，山东 潍坊 261053
    2.青岛大学附属山东省妇幼保健院妇幼健康发展与医院管理研究中心

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