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Article(id=1321170120299360906, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1321170080579301694, articleNumber=null, orderNo=null, doi=10.11847/zgggws1144886, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1715011200000, receivedDateStr=2024-05-07, revisedDate=1726156800000, revisedDateStr=2024-09-13, acceptedDate=1732118400000, acceptedDateStr=2024-11-21, onlineDate=1792921102833, onlineDateStr=2026-10-25, pubDate=1736438400000, pubDateStr=2025-01-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1792921102833, onlineIssueDateStr=2026-10-25, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1792921102833, creator=13701087609, updateTime=1792921102833, updator=13701087609, issue=Issue{id=1321170080579301694, tenantId=1146029695717560320, journalId=1319373219989389464, year='2025', volume='41', issue='1', pageStart='1', pageEnd='128', issueExtLink='null', onlineDate='null', pubDate='1736438400000', pubDateStr='2025-01-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1792921093363, creator='13701087609', updateTime=1792921093363, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=61, endPage=67, ext={EN=ArticleExt(id=1321170120483910283, articleId=1321170120299360906, tenantId=1146029695717560320, journalId=1319373219989389464, language=EN, title=Association between depressive symptoms and fertility intentions based on evidence from China family panel studies among reproductive-aged individuals in China, columnId=1320427686514770171, journalTitle=Chinese Journal of Public Health, columnName=Survey and Report, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the relationship between depressive status and changes in depressive status and fertility intentions among Chinese people of childbearing age.

Methods

Using data from the China Family Panel Studies (CFPS), the depressive status of married individuals of childbearing age was assessed based on the CES-D 8 questionnaire, with a score of ≥7 considered indicative of depressive symptoms. First, using the 2020 CFPS data, χ2 tests and logistic regression were used to analyze the relationship between current depressive status and fertility intentions among married individuals of childbearing age. Second, combining the 2018 and 2020 CFPS data, logistic regression was used to analyze the impact of changes in depressive status from 2018 to 2020 on fertility intentions in 2020.

Results

A total of 8 905 married individuals of childbearing age were included in the 2020 CFPS survey, with a mean age of (37.1±7.3) years, of whom 53.7% were female. Among the participants, 1 068 (12.0%) expressed an intention to have children in the next two years. No significant correlation was found between depressive status and fertility intentions among all participants (OR=0.84, 95%CI: 0.69–1.03). Depressive status had an impact on women′s fertility intentions, with women experiencing depressive symptoms showing weaker fertility intentions (OR=0.74, 95%CI: 0.55–0.99), but no significant correlation was observed in men. Combining the 2018 and 2020 data, compared to individuals whose CES-D 8 scores remained unchanged or decreased from 2018 to 2020, individuals whose CES-D 8 scores increased (i.e., worsening depressive symptoms) showed a significant decrease in fertility intentions (OR=0.15, 95%CI: 0.04–0.62).

Conclusions

There is a significant correlation between depressive symptoms and fertility intentions in women, with women experiencing depressive symptoms more likely to exhibit weaker fertility intentions. Furthermore, as the severity of depressive symptoms increases, individuals' fertility intentions gradually weaken.

, authors=Yuhao KONG1, Ning MA1, Xiaoyu LI2, Chunhong LI1, Su WANG2, Zhihui LI1, 3, authorsList=Yuhao KONG, Ning MA, Xiaoyu LI, Chunhong LI, Su WANG, Zhihui LI, authorCompany=null, correspAuthors=Zhihui LI, authorNote=null, correspAuthorsNote=
LI Zhihui, E-mail:
, copyrightStatement=Copyright © 2025 Chinese Journal of Public Health. All rights reserved., 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=1321170120924312204, articleId=1321170120299360906, tenantId=1146029695717560320, journalId=1319373219989389464, language=CN, title=抑郁状态及其变化与生育意愿的关联性——基于中国家庭追踪调查的育龄人群的研究, columnId=1320427686770622717, journalTitle=中国公共卫生, columnName=调查报告与分析, runingTitle=null, highlight=null, articleAbstract=
目的

探究中国育龄人群抑郁状态以及抑郁状态变化与生育意愿之间的关系。

方法

利用中国家庭追踪调查（CFPS）数据，基于CES-D 8问卷调查结果，评估已婚育龄人群的抑郁状态，问卷得分≥7分被视为有抑郁症状。首先，利用2020年CFPS调查数据，采用χ2检验和logistic回归分析已婚育龄人群当前抑郁状态与生育意愿的关系；其次，结合2018年和2020年的CFPS数据，采用logistic回归分析研究对象自2018年至2020年抑郁状态变化对2020年生育意愿的影响。

结果

在2020年CFPS调查中，共纳入8 905名已婚育龄者为研究对象，平均年龄（37.1±7.3）岁，其中53.7%为女性。调查对象中1 068人（12.0%）在未来2年有生育意愿。在所有研究对象中，抑郁状态与生育意愿之间未显示显著相关（OR=0.84， 95%CI=0.69～1.03）。抑郁状态对女性的生育意愿有影响，抑郁状态的女性生育意愿较弱（OR=0.74，95%CI=0.55～0.99），但在男性中未观察到显著相关。结合2018年和2020年数据，相比于2018到2020年CES-D 8分数没有变化或抑郁程度降低的研究对象，当CES-D 8问卷分数增加（即抑郁程度加重）的个体生育意愿显著下降（OR=0.15，95%CI=0.04～0.62）。

结论

女性的抑郁症状与生育意愿之间存在显著的相关，抑郁状态的女性更倾向于表现出较弱的生育意愿。此外，随着抑郁症状程度的加重，个体的生育意愿也逐渐减弱。

, authors=孔玉皓1, 马宁1, 李晓谕2, 李春红1, 王素2, 李志徽1, 3, *, *, authorsList=孔玉皓, 马宁, 李晓谕, 李春红, 王素, 李志徽, authorCompany=null, correspAuthors=李志徽, authorNote=

孔玉皓（1997—），博士在读，研究方向：母婴健康

, correspAuthorsNote=
李志徽，E-mail：
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Fertility intentions among young people in the era of China’s three–child policy: a national survey of university students[J]. BMC Pregnancy and Childbirth, 2022, 22(1): 637., articleTitle=null, refAbstract=null), Reference(id=1321170126666314443, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170120299360906, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=4, rfOrder=3, authorNames=null, journalName=null, refType=null, unstructuredReference=Stykes J B. Gender, couples’ fertility intentions, and parents’ depressive symptoms[J]. 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Journal of Abnormal Psychology, 1993, 102(1): 93-100., articleTitle=null, refAbstract=null), Reference(id=1321170128616665808, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170120299360906, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=9, rfOrder=8, authorNames=null, journalName=null, refType=null, unstructuredReference=Angermeyer M C, Holzinger A, Matschinger H, et al. Depression and quality of life: results of a follow-up study[J]. 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Predictors of childbirth fear among pregnant Chinese women: a cross-sectional questionnaire survey[J]. Midwifery, 2015, 31(9): 865-870., articleTitle=null, refAbstract=null), Reference(id=1321170128948015829, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170120299360906, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=14, rfOrder=13, authorNames=null, journalName=null, refType=null, unstructuredReference=Laursen M, Hedegaard M, Johansen C. Fear of childbirth: predictors and temporal changes among nulliparous women in the Danish National Birth Cohort[J]. BJOG: an International Journal of Obstetrics and Gynaecology, 2008, 115(3): 354-360., articleTitle=null, refAbstract=null), Reference(id=1321170129027707606, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170120299360906, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=15, rfOrder=14, authorNames=null, journalName=null, refType=null, unstructuredReference=Kim E H W. Division of domestic labour and lowest-low fertility in South Korea[J]. 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London: Routledge, 2005: 4-22., articleTitle=null, refAbstract=null), Reference(id=1321170129279365849, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170120299360906, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=18, rfOrder=17, authorNames=null, journalName=null, refType=null, unstructuredReference=Margolis R, Myrskylä M. Parental well-being surrounding first birth as a determinant of further parity progression[J]. 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Basic characteristics of the study subjects by age, depressive symptoms, gender, rural/urban residence, education level, employment situation, personal income level, individual social status, satisfaction with partner′s financial contribution, satisfaction with partner′s housework contribution, number of family members, smoking, alcohol consumption, BMI and health condition in the 2020 CFPS survey

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基本特征生育意愿总计人数P值
无意愿人数构成比/%有意愿人数构成比/%
年龄/岁<0.001
　18～<3091511.746943.91 384
　30～<403 49844.653249.84 030
　40～<50342443.7676.33 941
抑郁状态0.003
　无抑郁状态5 67372.481976.76 492
　有抑郁状态2 16427.624923.32 413
性别0.034
　女性4 24054.154150.74 781
　男性3 59745.952749.34 124
居住地0.002
　乡镇3 52345.042439.73 947
　城市4 09352.260256.44 695
　缺失2212.8423.9263
教育水平<0.001
　文盲6748.6545.1728
　小学1 24915.9868.11 335
　初高中4 34055.448044.94 820
　大学及以上1 57420.144841.92 022
就业情况0.580
　无业941.2121.1106
　就业6 76786.391185.37 678
　缺失97612.514513.61 121
个人收入水平0.300
　非常差7559.6928.6847
　比较差1 47318.919117.91 664
　中等4 15753.060056.24 757
　比较好87011.112011.2990
　非常好4796.1565.3535
　缺失1031.390.8112
个人社会地位0.004
　非常差6838.71009.4783
　比较差1 33117.022421.01 555
　中等4 18853.456352.74 751
　比较好1 09614.012011.21 216
　非常好5306.8615.7591
　缺失90.100.09
伴侣经济贡献满意程度0.005
　非常不满意1982.5201.9218
　不满意2823.6282.6310
　一般1 32116.915114.11 472
　满意1 74322.221920.51 962
　非常满意4 28954.765060.94 939
　缺失40.100.04
伴侣家务贡献满意程度0.220
　非常不满意4335.5454.2478
　不满意5787.4676.3645
　一般1 50219.220319.01 705
　满意1 50319.220719.41 710
　非常满意3 82148.754651.14 367
家庭成员数量/人<0.001
　≤55 49970.285780.26 356
　6～102 21328.219418.22 407
　>101251.6171.6142
是否抽烟0.900
　否5 70272.877972.96 481
　是2 13527.228927.12 424
是否饮酒<0.001
　否6 87887.897891.67 856
　是95912.2908.41 049
BMI指数0.540
　正常5 03964.365961.75 698
　体重偏轻3764.8847.9460
　超重2 09726.826524.82 362
　肥胖3254.1605.6385
健康状况<0.001
　不健康6558.4534.9708
　一般6308.0524.9682
　比较健康3 85849.255351.84 411
　很健康1 44518.423622.11 681
　非常健康1 24916.017416.31 423
过去6个月是否患有慢性病0.150
　否7 17891.699292.98 170
　是6598.4767.1735　
合计7 83788.01 06812.08 905
), ArticleFig(id=1321170125722596031, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170120299360906, language=CN, label=表1, caption=

2020年CFPS调查研究对象的基本特征

, figureFileSmall=null, figureFileBig=null, tableContent=
基本特征生育意愿总计人数P值
无意愿人数构成比/%有意愿人数构成比/%
年龄/岁<0.001
　18～<3091511.746943.91 384
　30～<403 49844.653249.84 030
　40～<50342443.7676.33 941
抑郁状态0.003
　无抑郁状态5 67372.481976.76 492
　有抑郁状态2 16427.624923.32 413
性别0.034
　女性4 24054.154150.74 781
　男性3 59745.952749.34 124
居住地0.002
　乡镇3 52345.042439.73 947
　城市4 09352.260256.44 695
　缺失2212.8423.9263
教育水平<0.001
　文盲6748.6545.1728
　小学1 24915.9868.11 335
　初高中4 34055.448044.94 820
　大学及以上1 57420.144841.92 022
就业情况0.580
　无业941.2121.1106
　就业6 76786.391185.37 678
　缺失97612.514513.61 121
个人收入水平0.300
　非常差7559.6928.6847
　比较差1 47318.919117.91 664
　中等4 15753.060056.24 757
　比较好87011.112011.2990
　非常好4796.1565.3535
　缺失1031.390.8112
个人社会地位0.004
　非常差6838.71009.4783
　比较差1 33117.022421.01 555
　中等4 18853.456352.74 751
　比较好1 09614.012011.21 216
　非常好5306.8615.7591
　缺失90.100.09
伴侣经济贡献满意程度0.005
　非常不满意1982.5201.9218
　不满意2823.6282.6310
　一般1 32116.915114.11 472
　满意1 74322.221920.51 962
　非常满意4 28954.765060.94 939
　缺失40.100.04
伴侣家务贡献满意程度0.220
　非常不满意4335.5454.2478
　不满意5787.4676.3645
　一般1 50219.220319.01 705
　满意1 50319.220719.41 710
　非常满意3 82148.754651.14 367
家庭成员数量/人<0.001
　≤55 49970.285780.26 356
　6～102 21328.219418.22 407
　>101251.6171.6142
是否抽烟0.900
　否5 70272.877972.96 481
　是2 13527.228927.12 424
是否饮酒<0.001
　否6 87887.897891.67 856
　是95912.2908.41 049
BMI指数0.540
　正常5 03964.365961.75 698
　体重偏轻3764.8847.9460
　超重2 09726.826524.82 362
　肥胖3254.1605.6385
健康状况<0.001
　不健康6558.4534.9708
　一般6308.0524.9682
　比较健康3 85849.255351.84 411
　很健康1 44518.423622.11 681
　非常健康1 24916.017416.31 423
过去6个月是否患有慢性病0.150
　否7 17891.699292.98 170
　是6598.4767.1735　
合计7 83788.01 06812.08 905
), ArticleFig(id=1321170125810676416, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170120299360906, language=EN, label=Tab.2, caption=

Correlation analysis of depressive status and fertility intention among women of childbearing age in China in 2020 [OR (95%CI)]

, figureFileSmall=null, figureFileBig=null, tableContent=
模型总体性别现有子女个数
男性女性无1个≥2个
00.80（0.68～0.94）1.00（0.81～1.29）0.66（0.52～0.82）0.97（0.61～1.53）0.99（0.75～1.31）0.77（0.61～0.98）
10.83（0.69～0.99）1.01（0.79～1.30）0.67（0.50～0.88）1.03（0.60～1.77）1.01（0.74～1.39）0.74（0.56～0.99）
20.86（0.71～1.04）1.01（0.78～1.31）0.73（0.54～0.97）1.20（0.68～2.13）1.05（0.76～1.45）0.74（0.56～0.99）
30.84（0.69～1.03）0.97（0.75～1.27）0.74（0.55～0.99）1.35（0.75～2.45）1.00（0.72～1.40）0.72（0.54～0.96）
), ArticleFig(id=1321170125894562497, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170120299360906, language=CN, label=表2, caption=

2020年中国育龄人群抑郁状态与生育意愿的相关分析[OR （95%CI）]

, figureFileSmall=null, figureFileBig=null, tableContent=
模型总体性别现有子女个数
男性女性无1个≥2个
00.80（0.68～0.94）1.00（0.81～1.29）0.66（0.52～0.82）0.97（0.61～1.53）0.99（0.75～1.31）0.77（0.61～0.98）
10.83（0.69～0.99）1.01（0.79～1.30）0.67（0.50～0.88）1.03（0.60～1.77）1.01（0.74～1.39）0.74（0.56～0.99）
20.86（0.71～1.04）1.01（0.78～1.31）0.73（0.54～0.97）1.20（0.68～2.13）1.05（0.76～1.45）0.74（0.56～0.99）
30.84（0.69～1.03）0.97（0.75～1.27）0.74（0.55～0.99）1.35（0.75～2.45）1.00（0.72～1.40）0.72（0.54～0.96）
), ArticleFig(id=1321170125965865666, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170120299360906, language=EN, label=Tab.3, caption=

Correlation analysis between changes in CES-D 8 scores and fertility intention among Chinese women of childbearing age [OR (95%CI)]

, figureFileSmall=null, figureFileBig=null, tableContent=
模型总体性别现有子女个数
男性（n=3 122）女性（n=3 781）无（n=1 061）1个（n=1 964）≥2个（n=3 878）
00.80（0.67～0.94）0.72（0.56～0.91）0.89（0.70～1.12）0.96（0.59～1.56）0.90（0.67～1.20）0.73（0.51～1.04）
10.76（0.63～0.91）0.70（0.54～0.91）0.83（0.63～1.09）1.05（0.62～1.77）0.88（0.64～1.21）0.58（0.38～0.87）
20.78（0.67～0.94）0.72（0.56～0.94）0.85（0.64～1.13）1.04（0.61～1.77）0.89（0.64～1.23）0.58（0.38～0.88）
30.77（0.64～0.94）0.72（0.55～0.94）0.85（0.64～1.13）1.06（0.61～1.82）0.89（0.64～1.22）0.55（0.36～0.83）
), ArticleFig(id=1321170126045557443, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170120299360906, language=CN, label=表3, caption=

中国育龄人群CES-D 8分数变化与生育意愿的相关分析[OR （95%CI）]

, figureFileSmall=null, figureFileBig=null, tableContent=
模型总体性别现有子女个数
男性（n=3 122）女性（n=3 781）无（n=1 061）1个（n=1 964）≥2个（n=3 878）
00.80（0.67～0.94）0.72（0.56～0.91）0.89（0.70～1.12）0.96（0.59～1.56）0.90（0.67～1.20）0.73（0.51～1.04）
10.76（0.63～0.91）0.70（0.54～0.91）0.83（0.63～1.09）1.05（0.62～1.77）0.88（0.64～1.21）0.58（0.38～0.87）
20.78（0.67～0.94）0.72（0.56～0.94）0.85（0.64～1.13）1.04（0.61～1.77）0.89（0.64～1.23）0.58（0.38～0.88）
30.77（0.64～0.94）0.72（0.55～0.94）0.85（0.64～1.13）1.06（0.61～1.82）0.89（0.64～1.22）0.55（0.36～0.83）
), ArticleFig(id=1321170126116860612, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170120299360906, language=EN, label=Tab.4, caption=

Correlation analysis between changes in depressive symptoms and fertility intention from 2018 to 2020 [OR (95%CI)]

, figureFileSmall=null, figureFileBig=null, tableContent=
模型一直没有抑郁症状
（n=4 196）		抑郁症状变为无抑郁症状
（n=825）		无抑郁症状变为抑郁症状
（n=975）		一直有抑郁症状
（n=907）
01.000.79（0.56～1.11）0.83（0.65～1.07）0.58（0.40～0.85）
11.000.88（0.60～1.28）0.84（0.64～1.11）0.63（0.41～0.96）
21.000.82（0.56～1.20）0.89（0.67～1.18）0.63（0.41～0.98）
31.000.82（0.56～1.20）0.87（0.66～1.16）0.62（0.40～0.96）
), ArticleFig(id=1321170126196552389, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170120299360906, language=CN, label=表4, caption=

2018—2020年抑郁症状的变化与生育意愿的相关分析[OR （95%CI）]

, figureFileSmall=null, figureFileBig=null, tableContent=
模型一直没有抑郁症状
（n=4 196）		抑郁症状变为无抑郁症状
（n=825）		无抑郁症状变为抑郁症状
（n=975）		一直有抑郁症状
（n=907）
01.000.79（0.56～1.11）0.83（0.65～1.07）0.58（0.40～0.85）
11.000.88（0.60～1.28）0.84（0.64～1.11）0.63（0.41～0.96）
21.000.82（0.56～1.20）0.89（0.67～1.18）0.63（0.41～0.98）
31.000.82（0.56～1.20）0.87（0.66～1.16）0.62（0.40～0.96）
), ArticleFig(id=1321170126263661254, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170120299360906, language=EN, label=Tab.5, caption=

Correlation analysis between changes in CES-D 8 scores from 2018 to 2020 and fertility intention [OR (95%CI)]

, figureFileSmall=null, figureFileBig=null, tableContent=
模型≤–10 （n=63）（–10，0）（n=2 943）[0，10 ）（n=3 814）≥10 （n=83）
01.000.33 （0.15～0.69）0.27 （0.13～0.58）0.18 （0.06～0.54）
11.000.37 （0.15～0.87）0.28 （0.12～0.66）0.13 （0.03～0.52）
21.000.43 （0.18～1.04）0.33 （0.14～0.80）0.16 （0.04～0.63）
31.000.41 （0.17～0.98）0.31 （0.13～0.76）0.15 （0.04～0.62）
), ArticleFig(id=1321170126326575815, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170120299360906, language=CN, label=表5, caption=

2018—2020年CES-D 8分数变化与生育意愿的相关分析[OR （95%CI）]

, figureFileSmall=null, figureFileBig=null, tableContent=
模型≤–10 （n=63）（–10，0）（n=2 943）[0，10 ）（n=3 814）≥10 （n=83）
01.000.33 （0.15～0.69）0.27 （0.13～0.58）0.18 （0.06～0.54）
11.000.37 （0.15～0.87）0.28 （0.12～0.66）0.13 （0.03～0.52）
21.000.43 （0.18～1.04）0.33 （0.14～0.80）0.16 （0.04～0.63）
31.000.41 （0.17～0.98）0.31 （0.13～0.76）0.15 （0.04～0.62）
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孔玉皓 1 , 马宁 1 , 李晓谕 2 , 李春红 1 , 王素 2 , 李志徽 1, 3, *, *
中国公共卫生 | 调查报告与分析 2025,41(1): 61-67
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中国公共卫生 |调查报告与分析 2025 , 41 (1) : 61 -67
抑郁状态及其变化与生育意愿的关联性——基于中国家庭追踪调查的育龄人群的研究
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孔玉皓1, 马宁1, 李晓谕2, 李春红1, 王素2, 李志徽1, 3, *, *
作者信息
  • 1清华大学万科公共卫生与健康学院，北京 100084
  • 2清华大学社会科学学院，北京 100084
  • 3清华大学健康中国研究院，北京 100084
通讯作者:
李志徽，E-mail：
作者简介:

孔玉皓（1997—），博士在读，研究方向：母婴健康

Association between depressive symptoms and fertility intentions based on evidence from China family panel studies among reproductive-aged individuals in China
Yuhao KONG1, Ning MA1, Xiaoyu LI2, Chunhong LI1, Su WANG2, Zhihui LI1, 3
Affiliations
  • 1Vanke School of Public Health, Tsinghua University, Beijing 100084, China
  • 2School of Social Sciences, Tsinghua University, Beijing 100084, China
  • 3Institute for Healthy China, Tsinghua University, Beijing 100084, China
    • Corresponding Author:
    LI Zhihui, E-mail:
出版时间: 2025-01-10 doi: 10.11847/zgggws1144886
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摘要
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目的

探究中国育龄人群抑郁状态以及抑郁状态变化与生育意愿之间的关系。

方法

利用中国家庭追踪调查（CFPS）数据，基于CES-D 8问卷调查结果，评估已婚育龄人群的抑郁状态，问卷得分≥7分被视为有抑郁症状。首先，利用2020年CFPS调查数据，采用χ2检验和logistic回归分析已婚育龄人群当前抑郁状态与生育意愿的关系；其次，结合2018年和2020年的CFPS数据，采用logistic回归分析研究对象自2018年至2020年抑郁状态变化对2020年生育意愿的影响。

结果

在2020年CFPS调查中，共纳入8 905名已婚育龄者为研究对象，平均年龄（37.1±7.3）岁，其中53.7%为女性。调查对象中1 068人（12.0%）在未来2年有生育意愿。在所有研究对象中，抑郁状态与生育意愿之间未显示显著相关（OR=0.84， 95%CI=0.69～1.03）。抑郁状态对女性的生育意愿有影响，抑郁状态的女性生育意愿较弱（OR=0.74，95%CI=0.55～0.99），但在男性中未观察到显著相关。结合2018年和2020年数据，相比于2018到2020年CES-D 8分数没有变化或抑郁程度降低的研究对象，当CES-D 8问卷分数增加（即抑郁程度加重）的个体生育意愿显著下降（OR=0.15，95%CI=0.04～0.62）。

结论

女性的抑郁症状与生育意愿之间存在显著的相关，抑郁状态的女性更倾向于表现出较弱的生育意愿。此外，随着抑郁症状程度的加重，个体的生育意愿也逐渐减弱。

抑郁  /  心理健康  /  生育意愿  /  生育行为
Objective

To investigate the relationship between depressive status and changes in depressive status and fertility intentions among Chinese people of childbearing age.

Methods

Using data from the China Family Panel Studies (CFPS), the depressive status of married individuals of childbearing age was assessed based on the CES-D 8 questionnaire, with a score of ≥7 considered indicative of depressive symptoms. First, using the 2020 CFPS data, χ2 tests and logistic regression were used to analyze the relationship between current depressive status and fertility intentions among married individuals of childbearing age. Second, combining the 2018 and 2020 CFPS data, logistic regression was used to analyze the impact of changes in depressive status from 2018 to 2020 on fertility intentions in 2020.

Results

A total of 8 905 married individuals of childbearing age were included in the 2020 CFPS survey, with a mean age of (37.1±7.3) years, of whom 53.7% were female. Among the participants, 1 068 (12.0%) expressed an intention to have children in the next two years. No significant correlation was found between depressive status and fertility intentions among all participants (OR=0.84, 95%CI: 0.69–1.03). Depressive status had an impact on women′s fertility intentions, with women experiencing depressive symptoms showing weaker fertility intentions (OR=0.74, 95%CI: 0.55–0.99), but no significant correlation was observed in men. Combining the 2018 and 2020 data, compared to individuals whose CES-D 8 scores remained unchanged or decreased from 2018 to 2020, individuals whose CES-D 8 scores increased (i.e., worsening depressive symptoms) showed a significant decrease in fertility intentions (OR=0.15, 95%CI: 0.04–0.62).

Conclusions

There is a significant correlation between depressive symptoms and fertility intentions in women, with women experiencing depressive symptoms more likely to exhibit weaker fertility intentions. Furthermore, as the severity of depressive symptoms increases, individuals' fertility intentions gradually weaken.

depression  /  mental health  /  fertility intention  /  fertility behavior
孔玉皓, 马宁, 李晓谕, 李春红, 王素, 李志徽. 抑郁状态及其变化与生育意愿的关联性——基于中国家庭追踪调查的育龄人群的研究. 中国公共卫生, 2025 , 41 (1) : 61 -67 . DOI: 10.11847/zgggws1144886
Yuhao KONG, Ning MA, Xiaoyu LI, Chunhong LI, Su WANG, Zhihui LI. Association between depressive symptoms and fertility intentions based on evidence from China family panel studies among reproductive-aged individuals in China[J]. Chinese Journal of Public Health, 2025 , 41 (1) : 61 -67 . DOI: 10.11847/zgggws1144886
正文
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近年来，中国人口发展面临着转折性的变化，总人口增长势头有所减弱。根据《2022年中国卫生健康统计年鉴》报告显示，2021年中国人口出生率为7.52‰，相比2020年下降了1个千分点[1]。少子化为我国人口高质量发展带来了巨大的挑战，包括劳动力的缺失、社会生产力降低以及养老负担加重等[2]。因此，增加育龄人群的生育意愿，提升全社会的生育水平具有重要的战略意义和现实价值。现有的国内外部分研究表明，心理健康是影响其生育意愿的重要因素[3–4]。焦虑、抑郁、身份转变以及对未来的担忧可能都会影响人们的生育意愿。因此，本研究利用具有代表性的中国家庭追踪调查（China family panel studies，CFPS）数据，探究育龄人群抑郁状态及其变化与生育意愿的相关性，以期能为政策制定者提供实证依据，促进有效的人口政策制定，以应对人口出生率下降带来的挑战。
1　对象与方法
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1.1　调查对象
利用2018年和2020年的CFPS调查数据。CFPS是一项具有全国代表性的长期追踪调查项目，样本覆盖了25个省（自治区、直辖市）约16 000户家庭，家庭中的所有成员均完成问卷调查和信息采集。该项目于2010年开始基线调查，之后每2年进行一次全样本追踪。CFPS收集了涉及个体、家庭和社区3个层次的数据，包括经济活动、教育成果、家庭关系与家庭动态、健康等多个研究主题，本研究使用2020年数据分析育龄人群当前的抑郁状态与其生育意愿的相关性。首先，选取调查时年龄在18～49岁的已婚育龄人群为研究对象，并剔除抑郁状态与生育意愿相关信息不完整的个体，最终纳入8 905人；其次, 使用2020年的数据和2018年数据进行匹配，进一步探究2年间抑郁状态的变化对2020年已婚育龄人群（18～49岁）生育意愿的影响。剔除2次调查中抑郁状态评估缺失的个体，以及2020年调查中生育意愿信息缺失的个体，最终纳入6 903人。
1.2　研究内容
1.2.1　抑郁状态评估
调查对象的抑郁状态的评定基于第8版流行病学调查中心抑郁量表（Center for Epidemiological Studies Depression Scales, CES-D）。CES-D 8是一项测量成人抑郁症状的自评量表，主要询问研究对象在过去一周内各种感受或行为的发生频率，主要包括以下8个条目：①我感到情绪低落；②我觉得做任何事都很费劲；③我的睡眠不好；④我感到愉快；⑤我感到孤独；⑥我生活快乐；⑦我感到悲伤难过；⑧我觉得生活无法继续。各条目包含以下4个选项：几乎没有（不到一天）、有些时候（1～2天）、经常有（3～4天）、大多数时候（5～7天），分别赋值0～3分（其中条目4和条目6反向赋值），总分范围为0～24分，得分越高代表研究对象的抑郁症状水平越高。参照既往在中国人群中进行的调查，将CES-D 8分数≥7分定义为伴有抑郁状态[5]。对于抑郁症状的变化，本研究首先计算了研究对象在2020年和2018年CES-D 8分数的差值，根据CES-D 8分数的变化对抑郁症状的变化情况进行评定；此外，本研究还根据2次调查中研究对象抑郁症状的分组（是否伴有抑郁状态）将其抑郁症状的变化情况分为“一直没有抑郁症状”“抑郁症状变为无抑郁症状”“无抑郁症状变为抑郁症状”和“一直有抑郁症状”4类进行分析。
1.2.2　生育意愿
根据2020年研究对象对CFPS中“未来2年内是否会要子女？”的回答判定生育意愿。
1.2.3　其他协变量
通过问卷收集研究对象的个人社会经济学特征（年龄、居住地、职业、个人收入水平、社会地位）、家庭相关特征（家庭成员个数、伴侣经济贡献满意度、伴侣家务贡献满意度）和个人健康情况（抽烟、饮酒、当前健康状态、BMI、慢性病状态）。根据研究对象居住地省份将其划分为东部、中部、西部和东北4个地区。
1.3　统计分析
使用人数和构成比描述分析研究对象的一般人口学特征。对于抑郁状态及其变化与生育意愿关系的研究，首先，使用2020年调查数据，采用logistic回归分析研究对象当前抑郁状态与生育意愿之间的关系。在分析过程中，分步调整3类可能的混杂因素。① 模型0调整年龄、性别和地区；②模型1进一步调整个人社会经济学特征（包括居住地、教育水平、就业情况、个人收入水平和个人社会地位）；③模型2进一步调整家庭相关特征（伴侣经济贡献满意度、伴侣家务贡献满意度、家庭成员数量）；④模型3进一步调整个人健康情况（是否抽烟、是否饮酒、BMI指数、健康状况以及过去6个月是否患有慢性病）。其次使用2018年和2020年两轮追踪调查数据评估研究对象抑郁状态的变化，并通过logistic回归分析研究了其与生育意愿之间的相关性。模型0到模型3混杂因素的调整如上所述，并在分析过程中，所有模型都额外调整了基线时的CES-D 8分数。对于有缺失值的变量，使用多重插补的方法处理。此外，根据研究对象的性别和子女个数进行了亚组分析。以Stata 16.0分析软件处理数据，采用双侧检验，显著性水平设定为α=0.05。
2　结　果
收起
2.1　调查对象特征概况（表1）
2020年CFPS调查共纳入8 905名的研究对象中，平均年龄（37.1±7.3）岁，女性占53.7%，52.7%的人居住在城镇。有1 068（12.0%）人在未来两年有生育意愿，其中无抑郁症状人群的生育意愿（12.6%）高于有抑郁症状的人群（10.3%，P=0.003）。
2.2　当前抑郁症状与生育意愿的相关性（表2）
在完全调整模型中，是否伴有抑郁状态与生育意愿的相关性在全人群中并不显著（OR=0.84，95%CI=0.69～1.03），但关联存在性别差异。女性抑郁状态对女性的生育意愿有影响，相较于心理健康的女性而言，抑郁状态的女性其生育意愿较弱（OR=0.74， 95%CI=0.55～0.99）。在男性中未观察到抑郁状态与生育意愿的显著相关（OR=0.97，95%CI=0.75～1.27）。根据研究对象现有子女数进行的亚组分析，当研究对象现在无子女（OR=1.35，95%CI=0.75～2.45）或者只有1个子女时（OR=1.00，95%CI=0.72～1.40），抑郁状态与生育意愿的相关不显著；然而，当研究对象已有2个或以上子女时，抑郁状态与生育意愿显著相关，有抑郁状态的对象的生育意愿比没有抑郁状态的弱（OR=0.72，95%CI=0.54～0.96）。
2.3　抑郁症状的变化与生育意愿的相关性（表3～5）
从2018到2020年，相比于CES-D 8分数没有明显变化或抑郁程度降低的研究对象，CES-D 8分数增加的研究对象的生育意愿更弱（OR=0.77，95%CI=0.64～0.94）。其中女性的抑郁症状的变化与生育意愿无显著的相关（OR=0.85，95%CI=0.64～1.13），而当男性的CES-D 8的分数增长时，生育意愿显著降低（OR=0.72，95%CI=0.55～0.94）。以子女个数分析，只有2个及以上子女的研究对象的生育意愿受到抑郁症状的变化的影响。具体表现为，当此组研究对象的CES-D 8的分数增加时，其生育意愿越弱（OR=0.55，95%CI=0.36～0.83），见表3。此外，根据研究对象2018年到2020年抑郁的状态变化分类，当研究对象一直患有抑郁症状时，其生育意愿减弱（OR=0.62，95%CI=0.40～0.96），见表4。进一步根据CES-D 8两年间的分数变化对生育意愿的影响分析，相较于CES-D 8分数下降的人群，CES-D 8分数上升（即抑郁症状加重），其生育意愿减弱（增加0～10分：OR=0.31，95%CI=0.13～0.76；增加10分以上：OR=0.15，95%CI=0.04～0.62），见表5。
3　讨　论
收起
本研究使用具有全国代表性的CFPS数据探索抑郁症状及其变化与生育意愿的相关性。研究发现，女性的抑郁症状与生育意愿之间存在显著相关，抑郁状态的女性表现出更弱的生育意愿。此外，随着抑郁症状程度的加重，研究对象的生育意愿也呈降低趋势。一直伴有抑郁症状的人群，处理信息、应对压力的能力也会降低[6]。作为心理脆弱的群体，抑郁症状通常伴随着情感困扰和负面情绪。例如，伴有抑郁症状的患者通常会感知到较弱的伴侣支持度[7]，这可能导致个体对当前家庭幸福感的满意程度降低，进一步导致对未来育儿责任的担忧和焦虑，从而降低了生育意愿[8]。其次，抑郁症状可能导致个体的生活质量下降，使他们更难以承受育儿所带来的额外压力和责任[9]。进一步的抑郁症状可能影响个体的决策能力和未来规划，更加谨慎和保守，承担新的家庭责任对其来说将是一个巨大的挑战[10]。因此，在支持育龄人群做出明智的生育决策方面，提供及时的心理健康支持和干预措施尤为重要。这有助于帮助那些可能受到抑郁症状影响的个体更好地理解和管理心理健康状况，从而更加自信并积极地参与到生育决策中。
此外，本研究进一步揭示了心理健康与生育意愿在女性中存在显著的相关性，但在男性中关联并不明显。这一现象可能源于女性在处理生育问题时通常承受更多的生理和心理双重压力。一项针对中国群体的研究显示，在即将迎来育儿责任时，女性相对于男性更易常经历更高的压力和更重的心理负担；女性不仅需要经历怀孕和分娩的过程，还要应对产后身体康复的挑战[11]。研究表明，约有7%～26%的孕产妇会经历严重的分娩恐惧，其中包括对分娩过程的恐惧、害怕疼痛和出血，以及担心在分娩中发生不可预测的问题等等[12]。分娩恐惧常常与女性的年龄、心理健康状况、过往生育经验和教育水平等因素相关[12–13]。特别是心理健康状态较差的女性更容易出现分娩恐惧[14]。从社会文化结构的角度来看，女性在抚育子女的过程中通常承担着更多的责任，包括家务、育儿护理和子女教育等[15]。此外，生育往往使女性更难以平衡家庭与职场关系，可能导致就业和晋升机会的减少以及更大的经济压力[16]。因此，对于伴有抑郁症状的女性来说，生育可能会加重她们的心理负担，在处理由生育带来的额外压力时更为困难。这些挑战可能包括情感波动、焦虑、产后抑郁症的风险增加以及对育儿责任的不安感。因此，应特别关注和支持这一群体，以确保她们的心理健康在生育过程中得到充分的关注和支持。
相对于无子女的人，已经有两个或更多子女的研究对象的生育意愿更容易受到抑郁状态的影响。已有研究发现，未曾育有子女的人生育意愿更多地与当前的经济状况和社会状态相关[17]。然而，是否想要第三胎的生育意愿更多地与生育经验、家庭状况、个体情绪，以及过去育儿的经验相关；对于已有2个或更多子女的父母，在生育和抚养子女过程中通常意味着面临一系列复杂且加剧的挑战，包括经济负担、照顾多个子女的身心压力，以及职业生涯发展的潜在阻碍等[18]。而对多胎父母来说，这些负面因素可能会影响他们对再生育的看法；特别是当家庭成员出现抑郁状态时，这种心理状态无疑会放大对生育的消极认知，显著抑制继续生育的意愿。无子女的家庭可能由于缺乏经验，其生育意向受抑郁情绪的不利波及则相对较轻。因此，良好的生育经验和良好的心理状态对于增加生育意愿至关重要。提供充足的心理健康支持和情感帮助以及与育儿相关的资源和服务，将有助于创造更有利的育儿环境，从而增加生育意愿。
当然，本研究也存在一些局限性。首先，本研究基于横断面数据，无法直接揭示抑郁症状与生育意愿之间的因果关系，只能提供相关性信息；其次，本研究的研究对象仅为已婚人员，由于数据限制，无法探究单身或未婚人士中抑郁症状与生育意愿的相关性，在未来的研究中需进一步验证；最后，由于数据的特殊性，对抑郁状态的评定只能依赖研究对象的自我测评，因此存在自我报告偏差的潜在问题，可能会对研究结果产生一定影响，需要谨慎解释和外推。
综上所述，本研究探讨了抑郁症状及其变化与生育意愿之间的关系，特别关注了性别差异对生育意愿的影响。研究结果表明，女性的抑郁症状与生育意愿之间存在显著的相关，抑郁状态的女性更倾向于表现出较低的生育意愿。这一发现强调了女性在育儿决策中心理健康的重要性以及提供心理健康支持的紧迫性。此外，性别差异在心理健康与生育意愿之间发挥关键作用，女性通常承受更多的生理和心理双重压力。最后，随着抑郁症状程度的加重，个体的生育意愿逐渐下降，表明提供及时的心理健康支持和干预的必要性，尤其是对于那些可能受到抑郁症状影响的个体。这些发现有助于指导政策和社会支持措施，以创造更有利的育儿环境，鼓励积极的生育决策，并确保育龄人群的心理健康得到关注。

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2025年第41卷第1期
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doi: 10.11847/zgggws1144886
  • 接收时间：2024-05-07
  • 首发时间：2026-10-25
  • 出版时间：2025-01-10
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  • 收稿日期：2024-05-07
  • 修回日期：2024-09-13
  • 录用日期：2024-11-21
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    1清华大学万科公共卫生与健康学院，北京 100084
    2清华大学社会科学学院，北京 100084
    3清华大学健康中国研究院，北京 100084

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Number of
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Number of
species		 占总种数比例
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total species (%)		 属
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Number of
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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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