Article(id=1324070962211205835, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324070892967428793, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202507378, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1753286400000, receivedDateStr=2025-07-24, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793612717440, onlineDateStr=2026-11-02, pubDate=1766592000000, pubDateStr=2025-12-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793612717440, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793612717440, creator=13701087609, updateTime=1793612717440, updator=13701087609, issue=Issue{id=1324070892967428793, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='24', pageStart='4417', pageEnd='4608', issueExtLink='null', onlineDate='null', pubDate='1766592000000', pubDateStr='2025-12-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793612700931, creator='13701087609', updateTime=1793612772549, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324071193430602023, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324070892967428793, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324071193430602024, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324070892967428793, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=4558, endPage=4563, ext={EN=ArticleExt(id=1324070962496418508, articleId=1324070962211205835, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Association of insufficient sleep and internet addiction with comorbidity depressive and anxiety symptoms among middle school students, Chongqing, columnId=1228016572451718132, journalTitle=Modern Preventive Medicine, columnName=Health and Social Behavior, runingTitle=null, highlight=null, articleAbstract=
Objective

To study the association of insufficient sleep and internet addiction with comorbid depressive and anxiety symptoms among middle school students in Chongqing, and to provide evidence for developing mental health intervention strategies.

Methods

A stratified cluster sampling method was employed to select 68 961 middle school students from 41 districts/counties in Chongqing. The Center for Epidemiologic Studies Depression Scale (CES-D) and the Generalized Anxiety Disorder 7-item scale (GAD-7) were used to assess symptoms of depression and anxiety, respectively. Chi-square tests were conducted to compare the detection rates of depression, anxiety, and comorbidity among different groups of students. Logistic regression models were utilized to analyze the associations between insufficient sleep, internet addiction, and the comorbidity of depression and anxiety.

Results

The prevalence rates of insufficient sleep and internet addiction among middle school students were 67.2% and 4.0%, respectively. The detected rates of depression, anxiety, and comorbidity were 25.3%, 6.8%, and 6.0%, respectively, with significantly higher proportions observed in females, ethnic minorities, and high school students. Logistic regression analysis indicated that insufficient sleep (OR=1.492, 1.529, 1.562, all P<0.001) and internet addiction (OR=5.742, 4.600, 5.069, all P<0.001) are independent risk factors for depression, anxiety, and the comorbidity of depression and anxiety. The students exhibiting both risk factors demonstrate a significantly higher likelihood of developing depression, anxiety, and comorbidity compared to their peers without internet addiction and with sufficient sleep (OR=7.965, 6.481, 7.226, all P<0.001).

Conclusion

Insufficient sleep and internet addiction are significantly associated with increased risks of depressive symptoms, anxiety symptoms, and their comorbidity among middle school students in Chongqing. It is recommended to implement comprehensive interventions through sleep health education, regulation of internet usage, and targeted psychological counseling.

, authors=You HUANG1, 2, Xiao SHU3, Jing ZHANG1, 2, Pei-pei YAN1, 2, Ying XIONG1, 2, authorsList=You HUANG, Xiao SHU, Jing ZHANG, Pei-pei YAN, Ying XIONG, authorCompany=null, correspAuthors=Ying XIONG, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1324070962915848909, articleId=1324070962211205835, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=重庆市中学生抑郁焦虑共患现状及其与睡眠不足和网络成瘾的关系, columnId=1228016572640461823, journalTitle=现代预防医学, columnName=健康与社会行为, runingTitle=null, highlight=null, articleAbstract=
目的

探讨重庆市中学生抑郁焦虑共患现状及其与睡眠不足和网络成瘾的关系,为制定心理健康干预策略提供依据。

方法

采用分层整群抽样法选取重庆市41个区县的68 961名中学生,使用流调中心抑郁量表(CES-D)和广泛性焦虑量表(GAD-7)评估抑郁、焦虑症状,采用logistic回归模型分析睡眠不足和网络成瘾与抑郁焦虑及共患的关联。

结果

中学生睡眠不足和网络成瘾检出率分别为67.2%和4.0%;抑郁、焦虑及共患检出率分别为25.3%、6.8%和6.0%,其中女性、少数民族、高中阶段学生抑郁焦虑及共患检出率较高。logistic回归显示,睡眠不足(OR=1.492,1.529,1.562,均P<0.001)和网络成瘾(OR=5.742,4.600,5.069,均P<0.001)是抑郁、焦虑及抑郁焦虑共患的独立危险因素,两者共存时出现抑郁焦虑及共患的可能性更高(OR=7.965,6.481,7.226,均P<0.001)。

结论

重庆市中学生抑郁焦虑问题与睡眠不足和网络成瘾密切相关,建议通过睡眠健康教育、规范网络使用及针对性心理辅导进行综合干预。

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黄友(1999—),男,硕士,医师,研究方向:学校卫生

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熊鹰,E-mail:
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Nature Reviews Neuroscience, 2017, 18 (7): 404-418., articleTitle=The sleep-deprived human brain, refAbstract=null)], funds=[Fund(id=1324070968485884678, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324070962211205835, awardId=2026KFX086, language=CN, fundingSource=2026年重庆市科卫联合医学科研市卫生健康委重点实验市开放项目(面上项目)(2026KFX086), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1324070963201061582, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324070962211205835, xref=1., ext=[AuthorCompanyExt(id=1324070963209450191, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324070962211205835, companyId=1324070963201061582, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of School Health, Chongqing Center for disease Prevention and Control (Chongqing Academy of Preventive Medicine), Chongqing 400707, China), AuthorCompanyExt(id=1324070963222033104, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324070962211205835, companyId=1324070963201061582, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.重庆市疾病预防控制中心(重庆市预防医学科学院)学校卫生所,重庆 400707)]), AuthorCompany(id=1324070963310113489, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324070962211205835, xref=2., ext=[AuthorCompanyExt(id=1324070963322696402, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324070962211205835, companyId=1324070963310113489, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.重庆市疾病预防控制与公共卫生研究中心)]), AuthorCompany(id=1324070963402388179, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324070962211205835, xref=3., ext=[AuthorCompanyExt(id=1324070963414971092, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324070962211205835, companyId=1324070963402388179, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.四川省疾病预防控制中心职业与辐射卫生所)])], figs=[ArticleFig(id=1324070967697355518, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324070962211205835, language=EN, label=Table 1, caption=

Status of insufficient sleep and Internet addiction among middle school students [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
影响因素人数睡眠不足网络成瘾
人数χ2值P值人数χ2值P值
性别578.685<0.0010.1660.684
男性36 12522 803(63.1)1 440(4.0)
女性32 83623 554(71.7)1 289(3.9)
民族3.9040.0488.7910.003
汉族63 47942 606(67.1)2 471(3.9)
少数民族5 4823 751(68.4)258(4.7)
监测点23.967<0.0010.5570.455
城区55 84637 304(66.8)2 225(4.0)
郊县13 1159 053(69.0)504(3.8)
学段4 799.056<0.00134.452<0.001
初中30 36522 200(73.1)1 128(3.7)
普高27 81320 007(71.9)1 238(4.5)
职高10 7834 150(38.5)363(3.4)
是否住校2 673.448<0.0010.8840.347
否30 95422 379(58.9)1 528(4.0)
是38 00723 978(77.5)1 201(3.9)
合计68 96146 357(67.2)2 729(4.0)
), ArticleFig(id=1324070967789630207, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324070962211205835, language=CN, label=表1, caption=

中学生睡眠不足和网络成瘾现状[n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
影响因素人数睡眠不足网络成瘾
人数χ2值P值人数χ2值P值
性别578.685<0.0010.1660.684
男性36 12522 803(63.1)1 440(4.0)
女性32 83623 554(71.7)1 289(3.9)
民族3.9040.0488.7910.003
汉族63 47942 606(67.1)2 471(3.9)
少数民族5 4823 751(68.4)258(4.7)
监测点23.967<0.0010.5570.455
城区55 84637 304(66.8)2 225(4.0)
郊县13 1159 053(69.0)504(3.8)
学段4 799.056<0.00134.452<0.001
初中30 36522 200(73.1)1 128(3.7)
普高27 81320 007(71.9)1 238(4.5)
职高10 7834 150(38.5)363(3.4)
是否住校2 673.448<0.0010.8840.347
否30 95422 379(58.9)1 528(4.0)
是38 00723 978(77.5)1 201(3.9)
合计68 96146 357(67.2)2 729(4.0)
), ArticleFig(id=1324070967877710592, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324070962211205835, language=EN, label=Table 2, caption=

Status of comorbidity depressive and anxiety symptoms among middle school students [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
影响因素人数抑郁焦虑抑郁焦虑共患
人数χ2值P值人数χ2值P值人数χ2值P值
性别272.318<0.00194.509<0.001125.557<0.001
男性36 1258 184(22.7)2 126(5.9)1 808(5.0)
女性32 8369 234(28.1)2 544(7.7)2 308(7.0)
民族155.086<0.00153.671<0.00154.996<0.001
汉族63 47915 649(24.7)4 168(6.6)3 664(5.8)
少数民族5 4821 769(32.3)502(9.2)452(8.2)
学段998.613<0.00176.944<0.00182.491<0.001
初中30 3655 893(19.4)1 769(5.8)1 534(5.1)
普高27 8138 453(30.4)2 093(7.5)1 884(6.8)
职高10 7833 072(28.5)808(7.5)689(6.5)
监测点9.4220.0021.4200.2330.3390.560
城区55 84613 968(25.0)3 751(6.7)3 319(5.9)
郊县13 1153 450(26.3)919(7.0)797(6.1)
是否住校140.336<0.0010.3420.5590.0130.909
否30 9547 146(23.1)2 077(6.7)1 844(6.0)
是38 00710 272(27.0)2 593(6.8)2 272(6.0)
睡眠不足260.396<0.001121.733<0.001125.495<0.001
否22 6044 845(21.4)1 189(5.3)1 022(4.5)
是46 35712 573(27.1)3 481(7.5)3 094(6.7)
网络成瘾2 193.158<0.0011 187.023<0.0011 316.813<0.001
否66 23215 687(23.7)4 042(6.1)3 513(5.3)
是2 7291 731(63.4)628(23.0)603(22.1)
合计68 96117 418(25.3)4 670(6.8)4 116(6.0)
), ArticleFig(id=1324070967986762497, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324070962211205835, language=CN, label=表2, caption=

中学生抑郁焦虑及共患现状[n(%)]

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影响因素人数抑郁焦虑抑郁焦虑共患
人数χ2值P值人数χ2值P值人数χ2值P值
性别272.318<0.00194.509<0.001125.557<0.001
男性36 1258 184(22.7)2 126(5.9)1 808(5.0)
女性32 8369 234(28.1)2 544(7.7)2 308(7.0)
民族155.086<0.00153.671<0.00154.996<0.001
汉族63 47915 649(24.7)4 168(6.6)3 664(5.8)
少数民族5 4821 769(32.3)502(9.2)452(8.2)
学段998.613<0.00176.944<0.00182.491<0.001
初中30 3655 893(19.4)1 769(5.8)1 534(5.1)
普高27 8138 453(30.4)2 093(7.5)1 884(6.8)
职高10 7833 072(28.5)808(7.5)689(6.5)
监测点9.4220.0021.4200.2330.3390.560
城区55 84613 968(25.0)3 751(6.7)3 319(5.9)
郊县13 1153 450(26.3)919(7.0)797(6.1)
是否住校140.336<0.0010.3420.5590.0130.909
否30 9547 146(23.1)2 077(6.7)1 844(6.0)
是38 00710 272(27.0)2 593(6.8)2 272(6.0)
睡眠不足260.396<0.001121.733<0.001125.495<0.001
否22 6044 845(21.4)1 189(5.3)1 022(4.5)
是46 35712 573(27.1)3 481(7.5)3 094(6.7)
网络成瘾2 193.158<0.0011 187.023<0.0011 316.813<0.001
否66 23215 687(23.7)4 042(6.1)3 513(5.3)
是2 7291 731(63.4)628(23.0)603(22.1)
合计68 96117 418(25.3)4 670(6.8)4 116(6.0)
), ArticleFig(id=1324070968070648578, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324070962211205835, language=EN, label=Table 3, caption=

The association of insufficient sleep and internet addiction with comorbidity depressive and anxiety symptoms among middle school students

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影响因素抑郁焦虑抑郁焦虑共患
OR值(95% CI)P值OR值(95% CI)P值OR值(95% CI)P值
睡眠不足1.492(1.433-1.554)<0.0011.529(1.424-1.643)<0.0011.562(1.447-1.686)<0.001
网络成瘾5.742(5.294-6.228)<0.0014.600(4.183-5.060)<0.0015.069(4.599-5.586)<0.001
), ArticleFig(id=1324070968146146051, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324070962211205835, language=CN, label=表3, caption=

中学生睡眠不足和网络成瘾与抑郁、焦虑及共患的关系

, figureFileSmall=null, figureFileBig=null, tableContent=
影响因素抑郁焦虑抑郁焦虑共患
OR值(95% CI)P值OR值(95% CI)P值OR值(95% CI)P值
睡眠不足1.492(1.433-1.554)<0.0011.529(1.424-1.643)<0.0011.562(1.447-1.686)<0.001
网络成瘾5.742(5.294-6.228)<0.0014.600(4.183-5.060)<0.0015.069(4.599-5.586)<0.001
), ArticleFig(id=1324070968225837828, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324070962211205835, language=EN, label=Table 4, caption=

The joint relationship between insufficient sleep and internet addiction and comorbidity depressive and anxiety symptoms in middle school students

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影响因素抑郁焦虑抑郁焦虑共患
OR值(95% CI)P值OR值(95% CI)P值OR值(95% CI)P值
无网络成瘾+睡眠充足111
无网络成瘾+睡眠不足1.445(1.386-1.506)<0.0011.453(1.348-1.567)<0.0011.479(1.364-1.603)<0.001
网络成瘾+睡眠充足5.766(4.865-6.834)<0.0014.374(3.518-5.137)<0.0014.902(3.922-6.126)<0.001
网络成瘾+睡眠不足7.965(7.228-8.776)<0.0016.481(5.755-7.300)<0.0017.226(6.390-8.174)<0.001
), ArticleFig(id=1324070968339084037, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324070962211205835, language=CN, label=表4, caption=

中学生睡眠不足和网络成瘾与抑郁焦虑共患的联合关联

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影响因素抑郁焦虑抑郁焦虑共患
OR值(95% CI)P值OR值(95% CI)P值OR值(95% CI)P值
无网络成瘾+睡眠充足111
无网络成瘾+睡眠不足1.445(1.386-1.506)<0.0011.453(1.348-1.567)<0.0011.479(1.364-1.603)<0.001
网络成瘾+睡眠充足5.766(4.865-6.834)<0.0014.374(3.518-5.137)<0.0014.902(3.922-6.126)<0.001
网络成瘾+睡眠不足7.965(7.228-8.776)<0.0016.481(5.755-7.300)<0.0017.226(6.390-8.174)<0.001
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重庆市中学生抑郁焦虑共患现状及其与睡眠不足和网络成瘾的关系
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黄友 1, 2 , 舒逍 3 , 张敬 1, 2 , 严佩佩 1, 2 , 熊鹰 1, 2
现代预防医学 | 健康与社会行为 2025,52(24): 4558-4563
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现代预防医学 |健康与社会行为 2025 , 52 (24) : 4558 -4563
重庆市中学生抑郁焦虑共患现状及其与睡眠不足和网络成瘾的关系
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黄友(1999—),男,硕士,医师,研究方向:学校卫生

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黄友(1999—),男,硕士,医师,研究方向:学校卫生

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黄友1, 2, 舒逍3, 张敬1, 2, 严佩佩1, 2, 熊鹰1, 2
作者信息
  • 1.重庆市疾病预防控制中心(重庆市预防医学科学院)学校卫生所,重庆 400707
  • 2.重庆市疾病预防控制与公共卫生研究中心
  • 3.四川省疾病预防控制中心职业与辐射卫生所
通讯作者:
熊鹰,E-mail:
作者简介:

黄友(1999—),男,硕士,医师,研究方向:学校卫生

Association of insufficient sleep and internet addiction with comorbidity depressive and anxiety symptoms among middle school students, Chongqing
You HUANG1, 2, Xiao SHU3, Jing ZHANG1, 2, Pei-pei YAN1, 2, Ying XIONG1, 2
Affiliations
  • Department of School Health, Chongqing Center for disease Prevention and Control (Chongqing Academy of Preventive Medicine), Chongqing 400707, China
出版时间: 2025-12-25 doi: 10.20043/j.cnki.MPM.202507378
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目的

探讨重庆市中学生抑郁焦虑共患现状及其与睡眠不足和网络成瘾的关系,为制定心理健康干预策略提供依据。

方法

采用分层整群抽样法选取重庆市41个区县的68 961名中学生,使用流调中心抑郁量表(CES-D)和广泛性焦虑量表(GAD-7)评估抑郁、焦虑症状,采用logistic回归模型分析睡眠不足和网络成瘾与抑郁焦虑及共患的关联。

结果

中学生睡眠不足和网络成瘾检出率分别为67.2%和4.0%;抑郁、焦虑及共患检出率分别为25.3%、6.8%和6.0%,其中女性、少数民族、高中阶段学生抑郁焦虑及共患检出率较高。logistic回归显示,睡眠不足(OR=1.492,1.529,1.562,均P<0.001)和网络成瘾(OR=5.742,4.600,5.069,均P<0.001)是抑郁、焦虑及抑郁焦虑共患的独立危险因素,两者共存时出现抑郁焦虑及共患的可能性更高(OR=7.965,6.481,7.226,均P<0.001)。

结论

重庆市中学生抑郁焦虑问题与睡眠不足和网络成瘾密切相关,建议通过睡眠健康教育、规范网络使用及针对性心理辅导进行综合干预。

抑郁  /  焦虑  /  共患  /  成瘾  /  睡眠不足  /  学生
Objective

To study the association of insufficient sleep and internet addiction with comorbid depressive and anxiety symptoms among middle school students in Chongqing, and to provide evidence for developing mental health intervention strategies.

Methods

A stratified cluster sampling method was employed to select 68 961 middle school students from 41 districts/counties in Chongqing. The Center for Epidemiologic Studies Depression Scale (CES-D) and the Generalized Anxiety Disorder 7-item scale (GAD-7) were used to assess symptoms of depression and anxiety, respectively. Chi-square tests were conducted to compare the detection rates of depression, anxiety, and comorbidity among different groups of students. Logistic regression models were utilized to analyze the associations between insufficient sleep, internet addiction, and the comorbidity of depression and anxiety.

Results

The prevalence rates of insufficient sleep and internet addiction among middle school students were 67.2% and 4.0%, respectively. The detected rates of depression, anxiety, and comorbidity were 25.3%, 6.8%, and 6.0%, respectively, with significantly higher proportions observed in females, ethnic minorities, and high school students. Logistic regression analysis indicated that insufficient sleep (OR=1.492, 1.529, 1.562, all P<0.001) and internet addiction (OR=5.742, 4.600, 5.069, all P<0.001) are independent risk factors for depression, anxiety, and the comorbidity of depression and anxiety. The students exhibiting both risk factors demonstrate a significantly higher likelihood of developing depression, anxiety, and comorbidity compared to their peers without internet addiction and with sufficient sleep (OR=7.965, 6.481, 7.226, all P<0.001).

Conclusion

Insufficient sleep and internet addiction are significantly associated with increased risks of depressive symptoms, anxiety symptoms, and their comorbidity among middle school students in Chongqing. It is recommended to implement comprehensive interventions through sleep health education, regulation of internet usage, and targeted psychological counseling.

Depression  /  Anxiety  /  Comorbidity  /  Addictive  /  Insufficient sleep  /  Students
黄友, 舒逍, 张敬, 严佩佩, 熊鹰. 重庆市中学生抑郁焦虑共患现状及其与睡眠不足和网络成瘾的关系. 现代预防医学, 2025 , 52 (24) : 4558 -4563 . DOI: 10.20043/j.cnki.MPM.202507378
You HUANG, Xiao SHU, Jing ZHANG, Pei-pei YAN, Ying XIONG. Association of insufficient sleep and internet addiction with comorbidity depressive and anxiety symptoms among middle school students, Chongqing[J]. Modern Preventive Medicine, 2025 , 52 (24) : 4558 -4563 . DOI: 10.20043/j.cnki.MPM.202507378
抑郁和焦虑是我国中学生常见的心理健康问题,其不仅与吸烟、酗酒等不良行为密切相关,还可能进一步造成自残、自杀等严重后果[1]。研究表明,我国中学生抑郁[2]、焦虑[3]症状检出率分别为28.4%和23.7%,高于其他研究估计的全球平均水平(25.2%和20.5%)[4]。随着互联网的发展和普及,手机、电脑等电子产品也成为了学生学习和生活的重要工具之一,但由于儿童青少年缺乏自制力,容易过度依赖和沉迷网络,引起网络成瘾[5]。数据显示[6],我国初中和高中学生平均睡眠时间仅有7.48 h和6.50 h,睡眠不足发生率较高。而睡眠不足会降低机体免疫力,与网络成瘾共发时可对健康损害产生协同作用,增加学生抑郁焦虑等紧张情绪的发生风险[7-9]。因此,本研究探讨重庆市中学生抑郁焦虑共患现状及其与网络成瘾和睡眠不足两者之间的关系,为制定相应的抑郁焦虑防治策略提供科学依据。
2024年9月至11月,采用分层整群抽样方法在重庆市41个区县中选取研究对象。具体抽样方法如下:首先在每个城区各抽取2所初中、2所普通高中(普高)和1所中等职业学校(职高),每个郊县抽取2所初中和1所普通高中;其次以班级为单位,将抽中班级全体学生纳入研究,每所学校每年级至少抽取2个班且不少于80人,若不足则由辖区内同类型学校进行补充,共计抽取68 961名中学生。其中男生36 125名,女生32 836名,城区55 846名,郊县13 115名;初中30 365名,普高27 813名,职高10 785名;平均年龄(14.91±1.776)岁。本研究已通过重庆市疾病预防控制中心伦理审查委员会批准(批件号:KY-2025-013-1),所有研究对象及学生家长均知情同意。
数据来源于2024年重庆市学生常见病和健康影响因素监测和干预项目,采用中国疾病预防控制中心统一编制的问卷进行调查。调查内容包括性别、年龄、民族、年级、是否住校等一般人口学信息;抑郁、焦虑等心理健康问题检出信息,以及睡眠时间、网络成瘾等相关信息。
抑郁症状采用流调中心抑郁量表[10](Center for Epidemiological Studies Depressions Scale,CES-D)评价,该量表共20个条目,每个条目有4个等级,以0~3分进行评分,其中积极情绪的4个条目为反向计分,其余为正向计分,总分0~60分,得分≥16分认为存在抑郁症状。本研究中抑郁量表Cronbach α=0.880,KMO=0.955,信效度良好。
焦虑症状采用广泛性焦虑量表[11](Generalized Anxiety Disorder-7,GAD-7)评价,该量表共7个条目,每个条目以0~3分进行评分,总分0~21分,得分≥10分认为存在焦虑症状[12]。本研究中焦虑量表Cronbach α=0.931,KMO=0.940,信效度良好。
根据我国中小学生睡眠时间[13]要求,初中生每日睡眠时间不应少于9 h,高中生不少于8 h,低于此标准认定为睡眠不足。
采用网络成瘾量表进行评价,该量表根据第5版《精神障碍与统计手册》[14]提出的网络游戏成瘾定义的9个症状改编,包括“经常上网,即使不上网,脑中也一直浮现与网络有关的事情”等9个条目,若同时出现量表中9个条目中的5项及以上则认为存在网络成瘾。本研究中网络成瘾量表Cronbach α=0.821,KMO=0.898,信效度良好。
采用Epi Data 3.1进行数据双录入,使用SPSS 25.0软件进行统计分析。计数资料采用频数和构成比表示,不同组别间睡眠不足、网络成瘾、抑郁焦虑及共患检出率的差异采用χ2检验,抑郁焦虑和睡眠不足与网络成瘾之间的关系采用logistic回归模型。检验水准α=0.05。
本次调查睡眠不足和网络成瘾检出率分别为67.2%和4.0%,其中女性、少数民族、监测点为郊县和住校的学生睡眠不足检出率较高(均P<0.05);此外,少数民族学生网络成瘾检出率较高(P<0.01)。见表1。
本次调查重庆市中学生抑郁症状检出率为25.3%,焦虑症状检出率为6.8%,抑郁和焦虑共患检出率为6.0%。存在睡眠不足和网络成瘾的中学生抑郁、焦虑及共患检出率更高(均P<0.001);不同性别、民族、学段的中学生抑郁、焦虑和共患检出率差异具有统计学意义,其中女性和少数民族学生抑郁、焦虑及共患检出率高于男性和汉族(均P<0.001);此外,监测点为郊县和住校的学生抑郁检出率更高(均P<0.01)。见表2。
采用二分类logistic回归模型,以抑郁症状、焦虑症状、抑郁焦虑症状共患检出与否分别作为因变量(0=否,1=是),控制性别、民族、学段、监测点和是否住校5个变量,分析睡眠不足(0=否,1=是)和网络成瘾(0=否,1=是)与抑郁焦虑及共患的关系。结果显示,与睡眠充足的学生相比,睡眠不足者检出抑郁焦虑及共患的可能性更高(OR=1.492、1.529、1.562,均P<0.001)。与不存在网络成瘾的学生相比,网络成瘾者检出抑郁、焦虑及抑郁焦虑共患的可能性更高(OR=5.742、4.600、5.069,均P<0.01)。
以抑郁症状、焦虑症状、抑郁焦虑症状共患检出与否分别作为因变量(0=否,1=是),控制性别、民族、学段、监测点和是否住校5个变量,分析有无网络成瘾(0=否,1=是)或(和)是否存在睡眠不足(0=否,1=是)与抑郁焦虑及共患的关系。结果显示:与睡眠充足且无网络成瘾的中学生相比,睡眠不足且无网络成瘾、睡眠充足且存在网络成瘾、睡眠不足且网路成瘾的中学生检出抑郁、焦虑及共患症状的可能性更高(均P<0.01),其中同时存在网络成瘾和睡眠不足的中学生检出抑郁、焦虑及共患症状的可能性最高(均P<0.01)。
本次调查结果显示,重庆市中学生网络成瘾检出率为4.0%,低于上海市[5](4.7%),而高于湖南省[15](2.69%)和内蒙古[16](2.15%)的学生网络成瘾检出率;提示重庆市中学生网络成瘾检出率处于较高水平,相关部门应当加强宣传,以减少学生非学习目的使用手机、电脑等电子设备的时间和频率。本次调查重庆市中学生睡眠不足检出率为67.2%,其中女性、少数民族、监测点为郊县以及住校的学生睡眠不足检出率较高,这与既往部分研究[17]结果一致。而睡眠不足不仅会影响机体免疫力而损害健康,同时还能引发抑郁焦虑等心理健康问题[18-19]。
抑郁、焦虑是我国学生群体常见的心理健康问题,若不加以有效干预会产生更为严重的健康危害。本次调查重庆市中学生抑郁、焦虑检出率为25.3%和6.8%,虽低于山西省[20](33.26%和23.72%)和安徽省[13](27.03%和8.94%)的调查结果,但仍处于较高水平,应当采取有效措施积极应对。抑郁和焦虑存在共同的发病基础和危险因素,常相伴发生,本次调查抑郁焦虑共患检出率为6.0%,低于安徽省[13](8.04%)和湖南省[21](9.0%)的调查结果。女性抑郁、焦虑及共患检出率均高于男性,这与既往研究[12,21]结果一致,其原因可能与两性在遗传、激素表达和神经调节等方面存在差异有关[22]。普高和职高学生抑郁、焦虑及共患检出率高于初中学生,其原因可能与高中阶段学业负担较重,升学或就业压力较大有关,这与陈国平等[14]的研究报道一致。此外,少数民族学生抑郁、焦虑及共患检出率较汉族更高,提示在日常的教学活动当中,应重点关注女性、少数民族和高中学生,对存在情绪异常的学生及时加以引导,避免其出现抑郁焦虑等心理健康问题。
睡眠不足对心理健康的负面影响已得到广泛证实,本研究结果显示,睡眠不足与抑郁、焦虑和抑郁焦虑共患呈正相关,这与既往研究[9]结果一致。存在睡眠不足的学生出现抑郁、焦虑及共患的可能性是睡眠充足者的1.492、1.529和1.562倍;睡眠不足能够干扰神经递质如血清素、多巴胺的调节和代谢,影响激素分泌,改变大脑神经可塑性,促使抑郁焦虑的发生[23]。此外,我们发现网络成瘾者具有更高的抑郁、焦虑及抑郁焦虑共患检出风险,究其原因可能是因为过度沉迷网络使现实社交减少、生活规律紊乱,网络成瘾者长期沉浸虚拟世界,社会支持系统薄弱,面对生活压力时易产生无助感和孤独感,从而容易诱发抑郁、焦虑情绪[24]。
睡眠不足和网络成瘾对心理健康危害显著,是抑郁焦虑的危险因素。本次调查还发现,与睡眠充足且无网络成瘾的中学生相比,同时存在睡眠不足和网络成瘾的中学生抑郁、焦虑及抑郁焦虑共患的可能性更高。研究表明[25],睡眠不足会影响大脑前额叶功能,损害认知功能和情绪调节能力,而情绪调节障碍可能会促使个体通过网络使用逃避负面体验;同样,过度的网络使用也会减少睡眠时间。因此,通过睡眠健康教育和行为疗法改善睡眠质量,以及制定合理的网络使用规范和心理辅导帮助个体摆脱网络成瘾,或许是未来预防中学生发生抑郁焦虑的重要举措。
本研究还存在一定局限性:首先,数据资料来源于学生的自我报告,可能存在一定的回忆偏倚;其次,本研究受调查的限制,未纳入学生成绩等其它与青少年情绪障碍密切相关的因素,可能造成潜在混杂偏倚,影响结果解释;此外,本研究为横断面研究,无法验证睡眠不足和网络成瘾与抑郁焦虑及共患的因果关系;未来可以采用队列研究,纳入更多影响抑郁焦虑的指标,进一步研究睡眠不足和网络成瘾与抑郁焦虑之间的作用机制。
  • 2026年重庆市科卫联合医学科研市卫生健康委重点实验市开放项目(面上项目)(2026KFX086)
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2025年第52卷第24期
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doi: 10.20043/j.cnki.MPM.202507378
  • 接收时间:2025-07-24
  • 首发时间:2026-11-02
  • 出版时间:2025-12-25
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  • 收稿日期:2025-07-24
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2026年重庆市科卫联合医学科研市卫生健康委重点实验市开放项目(面上项目)(2026KFX086)
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    1.重庆市疾病预防控制中心(重庆市预防医学科学院)学校卫生所,重庆 400707
    2.重庆市疾病预防控制与公共卫生研究中心
    3.四川省疾病预防控制中心职业与辐射卫生所

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