Article(id=1321169507779981318, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1321169495406785472, articleNumber=null, orderNo=null, doi=10.11847/zgggws1146933, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1736784000000, receivedDateStr=2025-01-14, revisedDate=1745164800000, revisedDateStr=2025-04-21, acceptedDate=1752249600000, acceptedDateStr=2025-07-12, onlineDate=1792920956796, onlineDateStr=2026-10-25, pubDate=1762704000000, pubDateStr=2025-11-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1792920956796, onlineIssueDateStr=2026-10-25, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1792920956796, creator=13701087609, updateTime=1792920956796, updator=13701087609, issue=Issue{id=1321169495406785472, tenantId=1146029695717560320, journalId=1319373219989389464, year='2025', volume='41', issue='11', pageStart='1281', pageEnd='1408', issueExtLink='null', onlineDate='null', pubDate='1762704000000', pubDateStr='2025-11-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1792920953847, creator='13701087609', updateTime=1793011176900, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1321547918390178721, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1321169495406785472, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1321547918390178722, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1321169495406785472, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=1317, endPage=1322, ext={EN=ArticleExt(id=1321169508014862343, articleId=1321169507779981318, tenantId=1146029695717560320, journalId=1319373219989389464, language=EN, title=Association between health literacy and suicide-related behavior among junior high school students in Chongqing city: a cross-sectional study, columnId=1321169498275689409, journalTitle=Chinese Journal of Public Health, columnName=Special Report—Advancing Mental Health and Building Mental Health Care Systems, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the influence of different dimensions of health literacy on different stages of suicidal behavior among junior high school students and the gender differences, so as to provide a reference for the prevention and control of suicidal behavior.

Methods

From May to June 2023, a multi-stage stratified cluster sampling method was used to select 7 360 junior high school students from three districts and counties in Chongqing city to conduct a survey on health literacy and suicidal behavior. Chi-square test, t-test, F-test, binary logistic regression, and multiple logistic regression were used for statistical analysis.

Results

The reported rate of suicidal behavior among junior high school students in Chongqing city was 15.48%, with girls (18.66%) higher than boys (12.19%) (P < 0.01). The functional (154.19 ± 20.25), interactive (53.75 ± 9.22), and critical (42.00 ± 6.93) health literacy scores of students with positive suicidal behavior were all lower than those of students with negative suicidal behavior (156.60 ± 21.41), (56.26 ± 9.75), and (42.63 ± 7.10), respectively (all P < 0.01). Binary logistic regression analysis showed that interactive health literacy (OR = 0.98, 95%CI: 0.97–0.99) and critical health literacy (OR = 1.02, 95%CI: 1.00–1.03) were associated with suicidal behavior. Multiple logistic regression analysis showed that interactive health literacy was associated with suicidal ideation (OR = 0.98, 95%CI: 0.97–0.99) and suicide plan (OR = 0.96, 95%CI: 0.95–0.98), while critical health literacy was only associated with suicide plan (OR = 1.03, 95%CI: 1.00–1.06). Stratified analysis showed that interactive health literacy was significantly associated with suicidal ideation only in males (OR = 0.97, 95%CI: 0.95–0.98).

Conclusions

Interactive health literacy is a influencing factor for suicidal ideation and suicide plan among junior high school students in Chongqing city, and there are gender differences.

, authors=Siwei YANG, Zhouyan WANG, Aini LIU, Yu LUO, Ronghuinan ZHANG, Chang PENG, Hong WANG, authorsList=Siwei YANG, Zhouyan WANG, Aini LIU, Yu LUO, Ronghuinan ZHANG, Chang PENG, Hong WANG, authorCompany=null, correspAuthors=Chang PENG, Hong WANG, authorNote=null, correspAuthorsNote=
PENG Chang, E-mail:
WANG Hong, 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=1321169508941803533, articleId=1321169507779981318, tenantId=1146029695717560320, journalId=1319373219989389464, language=CN, title=重庆市初中生健康素养与自杀相关行为关联:一项横断面研究, columnId=1321169498439267267, journalTitle=中国公共卫生, columnName=专题报道——关注心理健康,加强精神卫生服务体系建设, runingTitle=null, highlight=null, articleAbstract=
目的

探讨不同维度健康素养对初中生自杀行为不同阶段的影响及性别差异,为防控自杀行为提供参考依据。

方法

于2023年5—6月,采用多阶段分层整群抽样方法,抽取重庆市3个区县的7 360名初中生进行健康素养和自杀相关行为调查(自杀意念、自杀计划、自杀尝试)。采用χ2检验、t检验、F检验、二元logistic回归、多元logistic回归对数据进行统计分析。

结果

重庆市初中生自杀意念报告率为11.45%,自杀计划报告率为2.74%,自杀尝试报告率为1.27%;自杀相关行为者的功能性(154.19±20.25)、互动性(53.75±9.22)、批判性(42.00±6.93)健康素养得分均低于无自杀行为报告存在者的(156.60±21.41)、(56.26±9.75)、(42.63±7.10)分(均P<0.01)。二元logistic回归分析结果显示,互动性健康素养(OR=0.98,95%CI=0.97~0.99)、批判性健康素养(OR=1.02,95%CI=1.00~1.03)与自杀行为相关。多元logistic回归分析结果显示,互动性健康素养与自杀意念(OR=0.98,95%CI=0.97~0.99)和自杀计划(OR=0.96,95%CI=0.95~0.98)相关;而批判性健康素养仅与自杀计划相关(OR=1.03,95%CI=1.00~1.06)。分层分析显示,互动性健康素养与自杀意念仅在男性中存在显著关联(OR=0.97,95%CI=0.95~0.98)。

结论

重庆市初中生互动性健康素养是自杀意念、自杀计划的相关影响因素且存在性别差异。

, authors=杨思维, 王周艳, 刘爱妮, 罗宇, 张荣慧楠, 彭畅*, *, 王宏*, *, authorsList=杨思维, 王周艳, 刘爱妮, 罗宇, 张荣慧楠, 彭畅, 王宏, authorCompany=null, correspAuthors=彭畅, 王宏, authorNote=

杨思维(1999—),硕士在读,研究方向:儿童青少年卫生及疾病控制策略

, correspAuthorsNote=
彭畅,E-mail:
王宏,E-mail:
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杨思维(1999—),硕士在读,研究方向:儿童青少年卫生及疾病控制策略

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Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century[J]. Health Promotion International, 2000, 15(3): 259-267., articleTitle=null, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1321169509185073166, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169507779981318, xref=null, ext=[AuthorCompanyExt(id=1321169509197656079, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169507779981318, companyId=1321169509185073166, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Center for Medical and Social Development Research, College of Public Health, Chongqing Medical University, Chongqing 400016, China), AuthorCompanyExt(id=1321169509206044688, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169507779981318, companyId=1321169509185073166, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=重庆医科大学公共卫生学院 医学与社会发展研究中心,重庆 400016)])], figs=[ArticleFig(id=1321169516499939393, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169507779981318, language=EN, label=Tab.1, caption=

Comparison of reported suicidal-related behavior rates among junior high school students with different characteristics

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变量人数构成比/%未报告自杀相关行为报告自杀相关行为χ2值P值
人数报告率/%人数报告率/%
性别58.84<0.01
 男生362549.253 18387.8144212.19
 女生373550.75303881.3469718.66
家庭居住地1.640.20
 农村341746.432 90885.1050914.90
 城镇394353.573 31384.0263015.98
住校2.090.15
 是2 63335.772 20483.7142916.29
 否472764.23401784.9871015.02
父母受教育程度0.850.93
 小学及以下6959.4459185.0410414.96
 初中350747.652 95484.2355315.77
 高中或中专1 71823.341 45084.4026815.60
 大学或大专及以上83811.3971284.9612615.04
 不清楚6028.1851485.388814.62
家庭经济收入7.290.03
 低75010.1961081.3314018.67
 中等514269.86435484.6878815.32
 高1 46819.951 25785.6321114.37
学习成绩4.130.13
 差2 87739.092 40183.4547616.55
 中等2 49133.852 12285.1936914.81
 好1 99227.071 69885.2429414.76
学习压力138.90<0.01
 大300540.832 36378.6464221.36
 适度371150.423 27088.1244111.88
 小6448.7558891.30568.70
亲密朋友数量/个30.14<0.01
 0~22 33631.741 90981.7242718.28
 3~53 10842.232 62984.5947915.41
 ≥61 91626.031 68387.8423312.16
吸烟2.250.13
 是74310.1061482.6412917.36
 否661789.90560784.741 01015.26
饮酒20.76<0.01
 是2 50133.982 04781.8545418.15
 否485966.02417485.9068514.10
), ArticleFig(id=1321169516617379906, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169507779981318, language=CN, label=表1, caption=

不同特征初中生自杀相关行为报告率比较

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变量人数构成比/%未报告自杀相关行为报告自杀相关行为χ2值P值
人数报告率/%人数报告率/%
性别58.84<0.01
 男生362549.253 18387.8144212.19
 女生373550.75303881.3469718.66
家庭居住地1.640.20
 农村341746.432 90885.1050914.90
 城镇394353.573 31384.0263015.98
住校2.090.15
 是2 63335.772 20483.7142916.29
 否472764.23401784.9871015.02
父母受教育程度0.850.93
 小学及以下6959.4459185.0410414.96
 初中350747.652 95484.2355315.77
 高中或中专1 71823.341 45084.4026815.60
 大学或大专及以上83811.3971284.9612615.04
 不清楚6028.1851485.388814.62
家庭经济收入7.290.03
 低75010.1961081.3314018.67
 中等514269.86435484.6878815.32
 高1 46819.951 25785.6321114.37
学习成绩4.130.13
 差2 87739.092 40183.4547616.55
 中等2 49133.852 12285.1936914.81
 好1 99227.071 69885.2429414.76
学习压力138.90<0.01
 大300540.832 36378.6464221.36
 适度371150.423 27088.1244111.88
 小6448.7558891.30568.70
亲密朋友数量/个30.14<0.01
 0~22 33631.741 90981.7242718.28
 3~53 10842.232 62984.5947915.41
 ≥61 91626.031 68387.8423312.16
吸烟2.250.13
 是74310.1061482.6412917.36
 否661789.90560784.741 01015.26
饮酒20.76<0.01
 是2 50133.982 04781.8545418.15
 否485966.02417485.9068514.10
), ArticleFig(id=1321169516768374851, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169507779981318, language=EN, label=Tab.2, caption=

Comparison of health literacy scores among junior high school students with different suicidal-related behaviors

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变量功能性健康素养互动性健康素养批判性健康素养
自杀相关行为
 否156.60±21.4156.26±9.7542.63±7.10
 是154.19±20.2553.75±9.2242.00±6.93
  t值 3.66 8.37 2.73
  P值<0.01<0.01<0.01
自杀相关行为
 无156.60±21.41 cd56.26±9.75 fgh42.63±7.10
 自杀意念155.29±18.29d54.21±8.77 agh42.17±6.70
 自杀计划152.04±23.09a52.65±10.24af41.70±7.06
 自杀尝试148.91±28.05ab52.02±10.44af41.15±8.48i
  F值 7.5424.143.23
  P值<0.01<0.010.02
), ArticleFig(id=1321169516869038148, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169507779981318, language=CN, label=表2, caption=

不同自杀相关行为组别初中生健康素养得分比较

, figureFileSmall=null, figureFileBig=null, tableContent=
变量功能性健康素养互动性健康素养批判性健康素养
自杀相关行为
 否156.60±21.4156.26±9.7542.63±7.10
 是154.19±20.2553.75±9.2242.00±6.93
  t值 3.66 8.37 2.73
  P值<0.01<0.01<0.01
自杀相关行为
 无156.60±21.41 cd56.26±9.75 fgh42.63±7.10
 自杀意念155.29±18.29d54.21±8.77 agh42.17±6.70
 自杀计划152.04±23.09a52.65±10.24af41.70±7.06
 自杀尝试148.91±28.05ab52.02±10.44af41.15±8.48i
  F值 7.5424.143.23
  P值<0.01<0.010.02
), ArticleFig(id=1321169516982284357, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169507779981318, language=EN, label=Tab.3, caption=

Logistic regression analysis of health literacy and suicidal-related behavior among junior high school students

, figureFileSmall=null, figureFileBig=null, tableContent=
自变量比较组参照组β $ S_{\overline{x}} $Wald χ2值P值OR值95%CI
性别女生男生0.430.0740.51<0.011.541.35~1.76
家庭经济收入低高0.020.120.040.841.030.80~1.31
中等–0.030.090.120.730.970.82~1.15
学习压力大小0.880.1534.76<0.012.401.79~3.21
适度0.270.153.340.071.320.98~1.77
亲密朋友数量/个0~2≥60.280.099.070.031.321.10~1.58
3~50.150.093.020.081.170.98~1.38
饮酒是否0.230.0711.39<0.011.261.10~1.45
功能性健康素养0.000.000.060.811.001.00~1.00
互动性健康素养–0.020.0023.73<0.010.980.97~0.99
批判性健康素养0.020.016.80<0.011.021.00~1.03
), ArticleFig(id=1321169517238136902, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169507779981318, language=CN, label=表3, caption=

初中生健康素养与自杀相关行为的logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
自变量比较组参照组β $ S_{\overline{x}} $Wald χ2值P值OR值95%CI
性别女生男生0.430.0740.51<0.011.541.35~1.76
家庭经济收入低高0.020.120.040.841.030.80~1.31
中等–0.030.090.120.730.970.82~1.15
学习压力大小0.880.1534.76<0.012.401.79~3.21
适度0.270.153.340.071.320.98~1.77
亲密朋友数量/个0~2≥60.280.099.070.031.321.10~1.58
3~50.150.093.020.081.170.98~1.38
饮酒是否0.230.0711.39<0.011.261.10~1.45
功能性健康素养0.000.000.060.811.001.00~1.00
互动性健康素养–0.020.0023.73<0.010.980.97~0.99
批判性健康素养0.020.016.80<0.011.021.00~1.03
), ArticleFig(id=1321169517338800199, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169507779981318, language=EN, label=Tab.4, caption=

Multiple logistic regression of health literacy and suicide-related behaviors among junior high school students of different genders

, figureFileSmall=null, figureFileBig=null, tableContent=
变量自杀意念自杀计划自杀尝试
OR值95%CIP值OR值95%CIP值OR值95%CIP值
模型一(总人群)
 功能性健康素养1.001.00~1.010.471.000.99~1.000.390.990.98~1.000.07
 互动性健康素养0.980.97~0.99<0.010.960.95~0.98<0.010.970.95~1.000.05
 批判性健康素养1.011.00~1.030.071.031.00~1.06<0.051.020.99~1.060.23
模型二(男生)
 功能性健康素养1.011.00~1.010.170.990.98~1.010.320.990.97~1.000.03
 互动性健康素养0.970.95~0.98<0.010.970.94~1.000.020.970.92~1.010.12
 批判性健康素养1.020.99~1.040.171.020.98~1.060.361.050.99~1.110.10
模型三(女生)
 功能性健康素养1.000.99~1.010.911.000.99~1.010.881.000.98~1.010.59
 互动性健康素养0.990.98~1.000.130.970.94~0.990.010.980.94~1.010.19
 批判性健康素养1.010.99~1.030.251.031.00~1.070.071.000.96~1.050.92
), ArticleFig(id=1321169517615624264, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169507779981318, language=CN, label=表4, caption=

不同性别初中生健康素养与自杀相关行为的多元logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量自杀意念自杀计划自杀尝试
OR值95%CIP值OR值95%CIP值OR值95%CIP值
模型一(总人群)
 功能性健康素养1.001.00~1.010.471.000.99~1.000.390.990.98~1.000.07
 互动性健康素养0.980.97~0.99<0.010.960.95~0.98<0.010.970.95~1.000.05
 批判性健康素养1.011.00~1.030.071.031.00~1.06<0.051.020.99~1.060.23
模型二(男生)
 功能性健康素养1.011.00~1.010.170.990.98~1.010.320.990.97~1.000.03
 互动性健康素养0.970.95~0.98<0.010.970.94~1.000.020.970.92~1.010.12
 批判性健康素养1.020.99~1.040.171.020.98~1.060.361.050.99~1.110.10
模型三(女生)
 功能性健康素养1.000.99~1.010.911.000.99~1.010.881.000.98~1.010.59
 互动性健康素养0.990.98~1.000.130.970.94~0.990.010.980.94~1.010.19
 批判性健康素养1.010.99~1.030.251.031.00~1.070.071.000.96~1.050.92
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重庆市初中生健康素养与自杀相关行为关联:一项横断面研究
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杨思维 , 王周艳 , 刘爱妮 , 罗宇 , 张荣慧楠 , 彭畅 *, * , 王宏 *, *
中国公共卫生 | 专题报道——关注心理健康,加强精神卫生服务体系建设 2025,41(11): 1317-1322
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中国公共卫生 |专题报道——关注心理健康,加强精神卫生服务体系建设 2025 , 41 (11) : 1317 -1322
重庆市初中生健康素养与自杀相关行为关联:一项横断面研究
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杨思维, 王周艳, 刘爱妮, 罗宇, 张荣慧楠, 彭畅*, * , 王宏*, *
作者信息
  • 重庆医科大学公共卫生学院 医学与社会发展研究中心,重庆 400016
通讯作者:
彭畅,E-mail:
王宏,E-mail:
作者简介:

杨思维(1999—),硕士在读,研究方向:儿童青少年卫生及疾病控制策略

Association between health literacy and suicide-related behavior among junior high school students in Chongqing city: a cross-sectional study
Siwei YANG, Zhouyan WANG, Aini LIU, Yu LUO, Ronghuinan ZHANG, Chang PENG , Hong WANG
Affiliations
  • Center for Medical and Social Development Research, College of Public Health, Chongqing Medical University, Chongqing 400016, China
  • Corresponding Author:
    PENG Chang, E-mail:
    WANG Hong, E-mail:
出版时间: 2025-11-10 doi: 10.11847/zgggws1146933
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目的

探讨不同维度健康素养对初中生自杀行为不同阶段的影响及性别差异,为防控自杀行为提供参考依据。

方法

于2023年5—6月,采用多阶段分层整群抽样方法,抽取重庆市3个区县的7 360名初中生进行健康素养和自杀相关行为调查(自杀意念、自杀计划、自杀尝试)。采用χ2检验、t检验、F检验、二元logistic回归、多元logistic回归对数据进行统计分析。

结果

重庆市初中生自杀意念报告率为11.45%,自杀计划报告率为2.74%,自杀尝试报告率为1.27%;自杀相关行为者的功能性(154.19±20.25)、互动性(53.75±9.22)、批判性(42.00±6.93)健康素养得分均低于无自杀行为报告存在者的(156.60±21.41)、(56.26±9.75)、(42.63±7.10)分(均P<0.01)。二元logistic回归分析结果显示,互动性健康素养(OR=0.98,95%CI=0.97~0.99)、批判性健康素养(OR=1.02,95%CI=1.00~1.03)与自杀行为相关。多元logistic回归分析结果显示,互动性健康素养与自杀意念(OR=0.98,95%CI=0.97~0.99)和自杀计划(OR=0.96,95%CI=0.95~0.98)相关;而批判性健康素养仅与自杀计划相关(OR=1.03,95%CI=1.00~1.06)。分层分析显示,互动性健康素养与自杀意念仅在男性中存在显著关联(OR=0.97,95%CI=0.95~0.98)。

结论

重庆市初中生互动性健康素养是自杀意念、自杀计划的相关影响因素且存在性别差异。

自杀相关行为  /  健康素养  /  互动性健康素养  /  初中生  /  重庆市
Objective

To investigate the influence of different dimensions of health literacy on different stages of suicidal behavior among junior high school students and the gender differences, so as to provide a reference for the prevention and control of suicidal behavior.

Methods

From May to June 2023, a multi-stage stratified cluster sampling method was used to select 7 360 junior high school students from three districts and counties in Chongqing city to conduct a survey on health literacy and suicidal behavior. Chi-square test, t-test, F-test, binary logistic regression, and multiple logistic regression were used for statistical analysis.

Results

The reported rate of suicidal behavior among junior high school students in Chongqing city was 15.48%, with girls (18.66%) higher than boys (12.19%) (P < 0.01). The functional (154.19 ± 20.25), interactive (53.75 ± 9.22), and critical (42.00 ± 6.93) health literacy scores of students with positive suicidal behavior were all lower than those of students with negative suicidal behavior (156.60 ± 21.41), (56.26 ± 9.75), and (42.63 ± 7.10), respectively (all P < 0.01). Binary logistic regression analysis showed that interactive health literacy (OR = 0.98, 95%CI: 0.97–0.99) and critical health literacy (OR = 1.02, 95%CI: 1.00–1.03) were associated with suicidal behavior. Multiple logistic regression analysis showed that interactive health literacy was associated with suicidal ideation (OR = 0.98, 95%CI: 0.97–0.99) and suicide plan (OR = 0.96, 95%CI: 0.95–0.98), while critical health literacy was only associated with suicide plan (OR = 1.03, 95%CI: 1.00–1.06). Stratified analysis showed that interactive health literacy was significantly associated with suicidal ideation only in males (OR = 0.97, 95%CI: 0.95–0.98).

Conclusions

Interactive health literacy is a influencing factor for suicidal ideation and suicide plan among junior high school students in Chongqing city, and there are gender differences.

suicidal-related behavior  /  health literacy  /  interactive health literacy  /  junior high school students  /  Chongqing city
杨思维, 王周艳, 刘爱妮, 罗宇, 张荣慧楠, 彭畅, 王宏. 重庆市初中生健康素养与自杀相关行为关联:一项横断面研究. 中国公共卫生, 2025 , 41 (11) : 1317 -1322 . DOI: 10.11847/zgggws1146933
Siwei YANG, Zhouyan WANG, Aini LIU, Yu LUO, Ronghuinan ZHANG, Chang PENG, Hong WANG. Association between health literacy and suicide-related behavior among junior high school students in Chongqing city: a cross-sectional study[J]. Chinese Journal of Public Health, 2025 , 41 (11) : 1317 -1322 . DOI: 10.11847/zgggws1146933
自杀是全球广泛关注的公共卫生问题,WHO报告显示,2019年自杀是15~19岁青少年的第四大死因[1]。自杀行为是一个连续性过程,主要包括4个阶段:自杀意念、自杀计划、自杀尝试和自杀死亡[2–4]。一项涉及中国5省份16 271名学生的研究显示,自杀意念、自杀计划和自杀尝试的报告率分别为15.1%、7.2%、3.5%[5]。鉴于青少年自杀相关行为的高发性,制定并实施有效的公共卫生策略以预防自杀行为已迫在眉睫。自杀相关行为的影响因素众多[6–9],其中包括健康素养[10]。健康素养是指个人获取和理解基本健康信息和服务,并运用这些信息和服务做出正确决策,以维护和促进自身健康的能力[11–12]。Nutbeam D[13]提出健康素养三级模型,将健康素养分为功能性健康素养、互动性健康素养与批判性健康素养3个维度。既往研究指出,互动性健康素养是自杀行为的保护性因素[10],但不同维度健康素养(功能性健康素养、互动性健康素养、批判性健康素养)对自杀行为不同阶段(自杀意念、自杀计划、自杀未遂)的影响尚不明确,这些影响是否存在性别差异还有待探讨。明确这些影响及潜在性别差异对于制定精准预防和干预策略至关重要。基于此,本研究于2023年5—6月对重庆市7 360名初中生进行问卷调查,深入分析不同维度健康素养对自杀行为不同阶段的影响及性别差异,为有效预防和干预青少年自杀行为提供参考依据。
于2023年5—6月,采用多阶段分层整群抽样方法,参考重庆市功能区域划分和区县功能定位,从三大功能区(渝东北生态涵养发展区、城市发展新区、都市功能核心区)中各抽取1个调查区(县),每个调查区(县)各抽取4所初中(城乡各2所),每所学校初一至初三年级各抽取4~5个班级,对抽取班级调查当日全部在校学生进行问卷调查。共回收调查问卷7 491份,删除缺失、无效数据后,有效问卷7 360份,有效回收率为98.25%。本研究经重庆医科大学伦理委员会批准(批号:2023028)。参与调查学生均知情同意。
为自行编制。内容包括家庭居住地、性别、住校、父母受教育程度(取父母双方受教育程度较高者)[9]、自评家庭经济收入、自评学习成绩、自评学习压力、亲密朋友数量、吸烟、饮酒等。亲密朋友定义为与调查对象关系紧密且能提供切实支持与帮助的朋友,通过问题“你有多少个关系密切,可以得到支持和帮助的朋友?”来调查研究对象的亲密朋友数量[14];通过问题“你是否曾尝试过吸烟,即使只吸过一口、两口?”来调查研究对象的吸烟行为,回答“是”被定义为有吸烟行为,回答“否”被定义为无吸烟行为[15];通过问题“你是否喝过一杯酒?”来调查研究对象的饮酒行为,回答“是”被定义为有饮酒行为,回答“否”被定义为无饮酒行为[16]。
在王翎懿等[17–18]编制的“初中生健康素养评价量表”基础上,引入Nutbeam D[13]提出的健康素养三级模型,借鉴《中国公民健康素养——基本知识与技能》[19],结合中学生身心发育特点,自行编制“青少年健康素养评价量表”。内容包括功能性健康素养(反映个人有效地阅读、理解和表达健康信息的能力,37个条目)、互动性健康素养(涵盖个体发挥个人认知和社交技能通过各种传播途径获得权威健康信息并将其转化为健康行为的能力。14个条目)、批判性健康素养(强调个体运用批判性思维对健康信息进行评价和分析的能力,10个条目)3个维度[20],共61个条目。条目采用Likert 5级评分法,从“非常不同意”(或“完全不符合”)到“非常同意”(或“完全符合”)分别赋值1~5分,满分为305分,分数越高代表健康素养水平越高[21]。经验证,量表信效度良好[21–22]。本次调查中,3个维度健康素养的Cronbach′s α系数为0.902~0.967。
采用以下问题评估研究对象过去1年的自杀相关行为(自杀意念、自杀计划、自杀尝试):(1)是否想过自杀;(2)是否想过自杀并做过如何自杀的计划;(3)是否曾经采取措施试图自杀;每个问题对应的选项为“是”“否”[7,23]。由于一些参与者同时存在自杀意念、自杀计划、自杀尝试,根据自杀行为的严重程度,将所有样本分为四类:0=无(没有任何自杀行为)、1=自杀意念(只有自杀意念)、2=自杀计划(有自杀计划但没有自杀尝试)和3=自杀尝试(有自杀尝试)[24]。若研究对象属于类别1~3,则判定为存在自杀相关行为。
由经过统一培训的重庆医科大学公共卫生学院研究生作为调查员对问卷录入人员进行统一培训。现场调查时,在调查学校的配合下,以班级为单位进行调查,发放问卷时强调填写注意事项,承诺对数据保密且只用于人群研究。要求学生现场独立完成,调查员当场核查,对存在漏填项与填写错误项的问卷当场返还给学生进行补充完善。调查后统一建立数据库,删除缺失、无效问卷后再进行数据分析。
采用Epi Data 3.1软件建立数据库,采用IBM SPSS 26.0软件进行数据处理和统计分析。连续型变量采用$\bar x \pm s $表示;分类变量采用例数(n)和百分比(%)表示。采用χ2检验对不同特征初中生自杀行为报告率差异进行组间比较;采用t检验和F检验对健康素养得分进行组间比较;采用二元logistic回归分析各维度健康素养与自杀行为的关联;以性别为分层依据,采用多元logistic回归分析各维度健康素养与自杀行为不同阶段的关联及性别差异。以P<0.05为差异有统计学意义。
本研究最终纳入7 360名初中生,其中男生3 625人(49.25%),女生3 735人(50.75%);农村学生3 417人(46.43%),城镇学生3 943人(53.57%)。研究对象年龄为11~19岁,平均年龄(14.39 ± 0.89)岁。初中生自杀相关行为报告率为15.48%(1 139/7 360),其中有自杀意念者843人(11.45%)、自杀计划者202人(2.74%),自杀尝试者94人(1.27%)。女生自杀相关行为报告率为18.66%(697/3 735),高于男生的12.19%(442/3 625)(P<0.01);自杀相关行为报告率在不同家庭经济收入、学习压力、亲密朋友数量、饮酒方面差异均有统计学意义(均P<0.05)。
无自杀相关行为者3个维度(功能性、互动性、批判性)健康素养得分均高于报告有自杀相关行为者(均P<0.01)。无自杀相关行为者的功能性健康素养高于自杀计划者和自杀尝试者(均P<0.05);无自杀相关行为者的互动性健康素养最高(均P<0.05);无自杀相关行为者的批判性健康素养高于自杀尝试者(P<0.05)。
以自杀相关行为(0=否,1=是)为因变量,将单因素分析差异有统计学意义的因素(性别、家庭经济收入、学习压力、亲密朋友数量、饮酒)作为自变量,进行二元logistic回归分析。结果显示,互动性健康素养(OR=0.98,95%CI=0.97~0.99,P<0.01)、批判性健康素养(OR=1.02,95%CI=1.00~1.03,P<0.01)与自杀相关行为关联;女生、学习压力大、亲密朋友数量少、饮酒者自杀相关行为发生风险更高。
以自杀相关行为(0=无,1=自杀意念,2=自杀计划,3=自杀尝试)为因变量,采用多元logistic回归分析不同维度健康素养与自杀行为不同阶段的关联。结果显示,控制混杂因素后,互动性健康素养与自杀意念(OR=0.98,95%CI=0.98~0.99,P<0.01)、自杀计划(OR=0.96,95%CI=0.95~0.98,P<0.01)相关;批判性健康素养与自杀计划相关(OR=1.03,95%CI=1.00~1.06,P<0.05)。按性别进行分层,男生互动性健康素养与自杀意念(OR=0.97,95%CI=0.95~0.98,P<0.01)、自杀计划(OR=0.97,95%CI=0.94~1.00,P<0.05)相关;功能性健康素养与自杀尝试相关(OR=0.99,95%CI=0.97~1.00,P<0.05)。女生互动性健康素养与自杀计划相关(OR=0.97,95%CI=0.94~0.99,P<0.01)。
本研究结果显示,重庆市初中生自杀相关行为报告率为15.48%,其中,自杀意念、自杀计划、自杀尝试的报告率分别为11.45%,2.74%,1.27%。女生自杀行为报告率高于男生,这与既往研究结果一致[25–26]。可能是由于情绪加工能力存在性别差异,相较于男生,女生负性情绪易感性更强且通过认知策略调节负性情绪的能力更弱,这种差异致使女生容易出现自杀行为[27–28]。提示相关部门在应对学生自杀问题时,需重点关注女生,积极采取科学的方式帮助她们缓解内心的情绪困扰。研究结果显示,指出自杀相关行为阳性者功能性、互动性、批判性健康素养均低于无自杀相关行为者,表明较低的健康素养与不良健康结果密切相关[29]。
本研究结果显示,不同维度健康素养对自杀相关行为的影响不同,批判性健康素养与自杀相关行为呈正相关,而功能性健康素养与自杀行为的关联不显著,这与罗宇等[30]研究结果不一致。功能性健康素养主要反映的是研究对象对健康知识的识读能力而非应用能力[31]。因此,在面对复杂的心理压力时,个体可能难以将这些健康知识有效地应用于日常生活,减轻消极情绪。当前关于批判性健康素养与自杀相关行为之间的研究相对较少,两者的关联尚需要更多研究加以验证。本研究还显示,互动性健康素养与自杀行为呈负相关,与Guo C Y等[10]研究结果一致。互动性健康素养强调通过各种传播途径获得权威健康信息并将其转化为健康行为的能力[32],互动性健康素养越高,个体发挥个人认知和社交技能寻求健康信息并运用其改变自身健康状况的能力越强,这种能力可能有助于个体更有效地识别和处理潜在的心理健康问题,降低自杀风险。
3个维度健康素养对自杀相关行为3个阶段的影响不同,批判性健康素养仅与自杀计划相关,互动性健康素养仅对自杀行为的早期阶段(自杀意念和自杀计划)有遏制作用,与自杀尝试阶段未发现显著关联。互动性健康素养特别有助于提高个体根据知识或建议采取行动的动力和自信心[32]。当自杀行为发展至严重的自杀尝试阶段,个体心理状态和行为模式可能已经发生深刻的变化。此刻仅依靠来源于互动性健康素养的动力和自信心不足应对,个体通常需要更为专业且深入的心理健康干预。提示针对自杀意念者和自杀计划者,可将健康素养作为制定干预策略的切入点,借助同伴教育等有效手段,重点提升互动性健康素养。例如可以通过角色扮演、情景假设、案例研究等形式,增强学生在健康场景中运用健康知识的实践能力,激励高危学生发挥主观能动性寻求心理健康服务和支持,从而有效阻止早期自杀行为(自杀意念和自杀计划)向自杀尝试甚至自杀死亡等不良后果发展。此外,探讨性别差异在不同维度健康素养对自杀行为不同阶段影响的研究较少。本研究发现,互动性健康素养与自杀意念的关联存在性别差异,仅在男性中存在显著关联。这提示自杀干预策略应因性别而异,针对男生和女生不同特点制定个性化干预方案。
本研究存在一定局限性:首先,样本仅覆盖重庆市3个区县,可能存在区域局限性,未来应开展多中心研究提高结果普适性;其次,研究采用自我报告的形式收集数据,可能存在回忆偏倚,未来研究可利用多种混合性调查,减少偏倚;最后,研究采用横断面设计,无法进行因果推断,未来应采用队列研究或干预性研究设计进一步验证健康素养与自杀行为的因果关联。

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2025年第41卷第11期
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doi: 10.11847/zgggws1146933
  • 接收时间:2025-01-14
  • 首发时间:2026-10-25
  • 出版时间:2025-11-10
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  • 收稿日期:2025-01-14
  • 修回日期:2025-04-21
  • 录用日期:2025-07-12
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    重庆医科大学公共卫生学院 医学与社会发展研究中心,重庆 400016

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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
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