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Article(id=1325531691590373969, tenantId=1146029695717560320, journalId=1256213402557890569, issueId=1325530655635039055, articleNumber=null, orderNo=null, doi=10.16835/j.cnki.1000-9817.2025287, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1746979200000, receivedDateStr=2025-05-12, revisedDate=1753200000000, revisedDateStr=2025-07-23, acceptedDate=null, acceptedDateStr=null, onlineDate=1793960982463, onlineDateStr=2026-11-06, pubDate=1761321600000, pubDateStr=2025-10-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793960982463, onlineIssueDateStr=2026-11-06, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793960982463, creator=13701087609, updateTime=1793960982463, updator=13701087609, issue=Issue{id=1325530655635039055, tenantId=1146029695717560320, journalId=1256213402557890569, year='2025', volume='46', issue='10', pageStart='1369', pageEnd='1520', issueExtLink='null', onlineDate='null', pubDate='1761321600000', pubDateStr='2025-10-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793960735472, creator='13701087609', updateTime=1793960735472, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=1478, endPage=1483, ext={EN=ArticleExt(id=1325531697399485010, articleId=1325531691590373969, tenantId=1146029695717560320, journalId=1256213402557890569, language=EN, title=Association of sleep and circadian rhythm disruption with co-occurring depressive and anxiety symptoms among primary and secondary school students, columnId=1259565855189418448, journalTitle=Chinese Journal of School Health, columnName=Mental Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the association of sleep and circadian rhythm disruption indicators (including chronotype, sleep duration, and social jetlag) with co-occurring depressive and anxiety symptoms among primary and secondary school students, so as to provide a reference for promoting their mental health.

Methods

In October 2023, a total of 15 944 primary and secondary school students were recruited from Nanjing, using a stratified cluster random sampling method. The Morning and Evening Questionnaire-5, Center for Epidemiological Studies Depression, and Generalized Anxiety Disorder-7 were used for the survey. Chi-square test was employed for intergroup comparisons, and Logistic regression model was applied to analyze the independent and joint effects of sleep-related factors on comorbid symptoms of depressive and anxiety among primary and middle school students.

Results

The prevalence of co-occurring depressive and anxiety symptoms among primary and secondary school students in Nanjing was 16.9%. After adjusting for covariates, Logistic regression analysis revealed significant independent associations between evening chronotype (OR=6.55, 95%CI=5.59-7.68), insufficient sleep duration (OR=3.05, 95%CI=2.60-3.59), and social jetlag ≥2 h (OR=2.09, 95%CI=1.85-2.37) with comorbid symptoms of depressive and anxiety among students (all P < 0.05). Concurrent of evening chronotype and insufficient sleep (OR=7.54, 95%CI=3.55-16.01), as well as evening chronotype and social jetlag ≥2 h (OR=4.18, 95%CI=3.01-5.81), were associated with an increased risk of co-occurring depressive and anxiety symptoms (both P < 0.05). In the female and high school student subgroups, the combination of evening chronotype and insufficient sleep or social jetlag ≥2 h showed stronger joint effects on co-occurring depressive and anxiety symptoms [OR(95%CI)=8.46(3.25-22.04) and 15.90(3.66-69.08); 7.87(4.90-12.65) and 4.85(3.10-7.59), respectively; all P < 0.05].

Conclusions

Evening chronotype, insufficient sleep, and social jetlag≥2 h may serve as risk factors for comorbid symptoms of depressive and anxiety in school-aged populations. Paying attention to the coexistence of multiple sleep-related risk factors may help mitigate the occurrence of emotional disorders in this demographic.

, authors=Sheng YE, Yue YANG, Xuelei LU, Heyue JIN, Juntong LI, Hui LIU, Li LIU, authorsList=Sheng YE, Yue YANG, Xuelei LU, Heyue JIN, Juntong LI, Hui LIU, Li LIU, authorCompany=null, correspAuthors=null, authorNote=null, correspAuthorsNote=null, copyrightStatement=Copyright ©2025 Chinese Journal of School 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=1325531702168408659, articleId=1325531691590373969, tenantId=1146029695717560320, journalId=1256213402557890569, language=CN, title=睡眠昼夜节律紊乱与中小学生抑郁焦虑症状共存的相关性, columnId=1259565858817491410, journalTitle=中国学校卫生, columnName=心理卫生, runingTitle=null, highlight=null, articleAbstract=
目的

探讨睡眠昼夜节律紊乱指标(睡眠时型、时长和社会时差)与中小学生抑郁焦虑症状共存的关系，为促进中小学生心理健康提供参考依据。

方法

2023年10月，基于分层整群随机抽样方法选取南京市15 944名中小学生为研究对象，其睡眠时型、抑郁焦虑症状共存情况通过清晨与夜晚型问卷、流调中心抑郁量表和广泛性焦虑障碍量表进行调查。采用χ2检验进行率的组间比较，应用Logistic回归模型分析睡眠时型、时长和社会时差与中小学生抑郁焦虑症状共存的关联。

结果

南京市中小学生抑郁焦虑症状共存检出率为16.9%。调整协变量后，Logistic回归模型结果显示，夜晚型睡眠时型(OR=6.55，95%CI=5.59~7.68)、睡眠不足(OR=3.05，95%CI=2.60~3.59)和社会时差≥2 h(OR=2.09，95%CI=1.85~2.37)与中小学生抑郁焦虑症状共存独立相关(P值均 < 0.05)，独立相关性在性别、学段亚组中始终稳健。同时经历夜晚型睡眠时型和睡眠不足(OR=7.54，95%CI=3.55~16.01)、夜晚型睡眠时型和社会时差≥2 h(OR=4.18，95%CI=3.01~5.81)与抑郁焦虑症状共存风险增加相关(P值均 < 0.05)。女生组、高中生组的夜晚型睡眠时型且睡眠不足、社会时差≥2 h呈现出对抑郁焦虑症状共存更高的联合效应[OR值(95%CI)分别为8.46(3.25~22.04)，15.90(3.66~69.08)；7.87(4.90~12.65)，4.85(3.10~7.59)，P值均 < 0.05]。

结论

夜晚型睡眠时型、睡眠不足和社会时差≥2 h可能是抑郁焦虑症状共存的风险因素。关注多个睡眠风险因素的共存可能有助于减缓中小学生情绪障碍的发生。

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叶盛(1993-)，男，安徽黄山人，硕士，主管医师，主要从事学生常见病防制工作

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Chin J Sch Health, 2024, 45(10): 1465-1470, 1475. (in Chinese), articleTitle=null, refAbstract=null), Reference(id=1325531793939780279, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325531691590373969, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=22, rfOrder=29, authorNames=null, journalName=null, refType=null, unstructuredReference=向波, 牛雅倩, 李婷婷, 等. 大学生睡眠质量轨迹和社会时差与焦虑抑郁症状共患的关联[J]. 中国学校卫生, 2024, 45(5): 640-643, 648., articleTitle=null, refAbstract=null), Reference(id=1325531794828972728, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325531691590373969, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=22, rfOrder=30, authorNames=null, journalName=null, refType=null, unstructuredReference=XIANG B, NIU Y Q, LI T T, et al. Correlation between sleep quality trajectory, social time difference and anxiety and depression symptoms of college students[J]. Chin J Sch Health, 2024, 45(5): 640-643, 648. (in Chinese), articleTitle=null, refAbstract=null), Reference(id=1325531797261669049, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325531691590373969, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=23, rfOrder=31, authorNames=null, journalName=null, refType=null, unstructuredReference=BORISENKOV M F, PETROVA N B, TIMONIN V D, et al. Sleep characteristics, chronotype and winter depression in 10-20-year-olds in northern European Russia[J]. J Sleep Res, 2015, 24(3): 288-295., articleTitle=null, refAbstract=null), Reference(id=1325531797697876666, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325531691590373969, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=24, rfOrder=32, authorNames=null, journalName=null, refType=null, unstructuredReference=LANE J M, VLASAC I, ANDERSON S G, et al. Genome-wide association analysis identifies novel loci for chronotype in 100 420 individuals from the UK Biobank[J]. Nat Commun, 2016, 7: 10889., articleTitle=null, refAbstract=null), Reference(id=1325531798914224827, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325531691590373969, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=25, rfOrder=33, authorNames=null, journalName=null, refType=null, unstructuredReference=SHEAVES B, PORCHERET K, TSANAS A, et al. Insomnia, nightmares, and chronotype as markers of risk for severe mental illness: results from a student population[J]. Sleep, 2016, 39(1): 173-181., articleTitle=null, refAbstract=null), Reference(id=1325531799308489404, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325531691590373969, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=26, rfOrder=34, authorNames=null, journalName=null, refType=null, unstructuredReference=MATHEW G M, HALE L, CHANG A M. Sex moderates relationships among school night sleep duration, social jetlag, and depressive symptoms in adolescents[J]. J Biol Rhythms, 2019, 34(2): 205-217., articleTitle=null, refAbstract=null), Reference(id=1325531799719531197, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325531691590373969, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=27, rfOrder=35, authorNames=null, journalName=null, refType=null, unstructuredReference=ZHANG P, YANG F, HUANG N, et al. Assessment of factors associated with mental well-being among Chinese youths at individual, school, and province levels[J]. JAMA Netw Open, 2023, 6(7): e2324025., articleTitle=null, refAbstract=null)], funds=[Fund(id=1325531758397248151, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325531691590373969, awardId=null, language=CN, fundingSource=南京医科大学科技发展基金项目(NMUB20230279)；南京市疾控中心青年人才科研培育团队项目(NPY2304), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1325531706199134804, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325531691590373969, xref=null, ext=[AuthorCompanyExt(id=1325531706257855061, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325531691590373969, companyId=1325531706199134804, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Section of School Health, Nanjing Municipal Center for Disease Control and Prevention, Nanjing 210003, Jiangsu Province, China), AuthorCompanyExt(id=1325531706316575318, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325531691590373969, companyId=1325531706199134804, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=江苏省南京市疾病预防控制中心学校卫生科，210003)])], figs=[ArticleFig(id=1325531744149197451, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325531691590373969, language=EN, label=Tab.1, caption=

Comparison of the detection rates of co-occurring depressive and anxiety symptoms among primary and secondary school students by different groups

, figureFileSmall=null, figureFileBig=null, tableContent=
组别选项人数抑郁焦虑症状共存人数χ2值P值
学段小学5 766592(10.3)418.44< 0.01
初中5 832983(16.9)
高中4 3461 115(25.7)
性别男8 2261 159(14.1)93.78< 0.01
女7 7181 531(19.8)
地区城区8 5981 416(16.5)2.160.14
郊县7 3461 274(17.3)
超重肥胖未检出9 7881 689(17.3)3.060.22
超重3 037503(16.6)
肥胖3 119498(16.0)
吸烟史无15 4242 454(15.9)312.85< 0.01
有519236(45.5)
饮酒史无13 4471 802(13.4)735.71< 0.01
有2 496887(35.5)
每周中高强度活动天数/d< 713 3382 332(17.5)21.75< 0.01
72 605358(13.7)
), ArticleFig(id=1325531745294242444, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325531691590373969, language=CN, label=表1, caption=

不同组别中小学生抑郁焦虑症状共存检出率比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别选项人数抑郁焦虑症状共存人数χ2值P值
学段小学5 766592(10.3)418.44< 0.01
初中5 832983(16.9)
高中4 3461 115(25.7)
性别男8 2261 159(14.1)93.78< 0.01
女7 7181 531(19.8)
地区城区8 5981 416(16.5)2.160.14
郊县7 3461 274(17.3)
超重肥胖未检出9 7881 689(17.3)3.060.22
超重3 037503(16.6)
肥胖3 119498(16.0)
吸烟史无15 4242 454(15.9)312.85< 0.01
有519236(45.5)
饮酒史无13 4471 802(13.4)735.71< 0.01
有2 496887(35.5)
每周中高强度活动天数/d< 713 3382 332(17.5)21.75< 0.01
72 605358(13.7)
), ArticleFig(id=1325531748129591949, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325531691590373969, language=EN, label=Tab.2, caption=

Comparison of co-occurrence rates of depressive and anxiety symptoms among primary and secondary school students by gender based on different SCRD indicators

, figureFileSmall=null, figureFileBig=null, tableContent=
SCRD指标选项男生女生总体
人数共存人数χ2值人数共存人数χ2值人数共存人数χ2值
睡眠时型清晨型4 393296(6.7)547.15**3 549297(8.4)724.59**7 942593(7.5)1 324.07**
中间型3 367679(20.2)3 522917(26.0)6 8891 596(23.2)
夜晚型466184(39.5)647317(49.0)1 113501(45.0)
睡眠时长充足1 80087(4.8)163.09**1 33492(6.9)169.83**3 134179(5.7)346.39**
不足6 4261 072(16.7)6 3841 439(22.5)12 8102 511(19.6)
社会时差/h< 13 949499(12.6)36.47**3 543490(13.8)354.45**7 492989(13.2)325.94**
1~ < 23 175442(13.9)3 129620(19.8)6 3041 062(16.8)
≥21 102218(19.8)1 046421(40.2)2 148639(29.7)
), ArticleFig(id=1325531749123641998, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325531691590373969, language=CN, label=表2, caption=

不同SCRD指标不同性别中小学生抑郁焦虑症状共存检出率比较

, figureFileSmall=null, figureFileBig=null, tableContent=
SCRD指标选项男生女生总体
人数共存人数χ2值人数共存人数χ2值人数共存人数χ2值
睡眠时型清晨型4 393296(6.7)547.15**3 549297(8.4)724.59**7 942593(7.5)1 324.07**
中间型3 367679(20.2)3 522917(26.0)6 8891 596(23.2)
夜晚型466184(39.5)647317(49.0)1 113501(45.0)
睡眠时长充足1 80087(4.8)163.09**1 33492(6.9)169.83**3 134179(5.7)346.39**
不足6 4261 072(16.7)6 3841 439(22.5)12 8102 511(19.6)
社会时差/h< 13 949499(12.6)36.47**3 543490(13.8)354.45**7 492989(13.2)325.94**
1~ < 23 175442(13.9)3 129620(19.8)6 3041 062(16.8)
≥21 102218(19.8)1 046421(40.2)2 148639(29.7)
), ArticleFig(id=1325531750260298383, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325531691590373969, language=EN, label=Tab.3, caption=

Comparison of co-occurrence rates of depressive and anxiety symptoms among primary and secondary school students by educational stage based on different SCRD indicators

, figureFileSmall=null, figureFileBig=null, tableContent=
SCRD指标选项小学生初中生高中生
人数共存人数χ2值人数共存人数χ2值人数共存人数χ2值
睡眠时型清晨型4 255273(6.4)341.33**2 807212(7.6)472.13**880108(12.3)190.70**
中间型1 415273(19.3)2 645594(22.5)2 829729(25.8)
夜晚型9646(47.9)380177(46.6)637278(43.6)
睡眠时长充足1 47256(3.8)89.61**1 27388(6.9)114.87**38935(9.0)346.39**
不足4 294536(12.5)4 559895(19.6)3 9571 080(27.3)
社会时差/h< 14 345389(9.0)34.53**1 691281(16.6)51.83**1 456319(21.9)325.94**
1~ < 21 091150(13.7)3 165463(14.6)2 048449(21.9)
≥233053(16.1)976239(24.5)842347(41.2)
), ArticleFig(id=1325531751682167440, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325531691590373969, language=CN, label=表3, caption=

不同SCRD指标不同学段中小学生抑郁焦虑症状共存检出率比较

, figureFileSmall=null, figureFileBig=null, tableContent=
SCRD指标选项小学生初中生高中生
人数共存人数χ2值人数共存人数χ2值人数共存人数χ2值
睡眠时型清晨型4 255273(6.4)341.33**2 807212(7.6)472.13**880108(12.3)190.70**
中间型1 415273(19.3)2 645594(22.5)2 829729(25.8)
夜晚型9646(47.9)380177(46.6)637278(43.6)
睡眠时长充足1 47256(3.8)89.61**1 27388(6.9)114.87**38935(9.0)346.39**
不足4 294536(12.5)4 559895(19.6)3 9571 080(27.3)
社会时差/h< 14 345389(9.0)34.53**1 691281(16.6)51.83**1 456319(21.9)325.94**
1~ < 21 091150(13.7)3 165463(14.6)2 048449(21.9)
≥233053(16.1)976239(24.5)842347(41.2)
), ArticleFig(id=1325531752365838993, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325531691590373969, language=EN, label=Tab.4, caption=

Comparison of co-occurrence rates of depressive and anxiety symptoms among primary and secondary school students by educational stage based on different SCRD indicators[OR(95%CI)]

, figureFileSmall=null, figureFileBig=null, tableContent=
SCRD指标选项性别学段总体(n=15 944)
男生(n=8 226)女生(n=7 718)小学(n=5 766)初中(n=5 832)高中(n=4 346)
睡眠时型清晨型1.001.001.001.001.001.00
中间型2.84(2.42~3.32)**3.13(2.68~3.65)**3.31(2.75~3.99)**2.94(2.47~3.49)**2.40(1.92~3.00)**2.98(2.67~3.32)**
夜晚型6.02(4.73~7.65)**6.99(5.64~8.68)**10.51(6.75~16.36)**7.45(5.76~9.64)**4.70(3.62~6.12)**6.55(5.59~7.68)**
睡眠时长充足1.001.001.001.001.001.00
不足3.00(2.38~3.78)**3.17(2.53~3.99)**3.45(2.60~4.61)**2.66(2.09~3.37)**3.42(2.39~4.90)**3.05(2.60~3.59)**
社会时差/h< 11.001.001.001.001.001.00
1~ < 20.93(0.81~1.08)1.22(1.06~1.41)**1.55(1.26~1.91)**0.96(0.81~1.13)1.01(0.85~1.20)1.07(0.97~1.18)
≥21.34(1.11~1.61)**3.07(2.59~3.64)**1.63(1.18~2.27)**1.80(1.47~2.22)**2.49(2.05~3.01)**2.09(1.85~2.37)**
), ArticleFig(id=1325531752915292818, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325531691590373969, language=CN, label=表4, caption=

不同SCRD指标不同学段中小学生抑郁焦虑症状共存检出率比较[OR值(95%CI)]

, figureFileSmall=null, figureFileBig=null, tableContent=
SCRD指标选项性别学段总体(n=15 944)
男生(n=8 226)女生(n=7 718)小学(n=5 766)初中(n=5 832)高中(n=4 346)
睡眠时型清晨型1.001.001.001.001.001.00
中间型2.84(2.42~3.32)**3.13(2.68~3.65)**3.31(2.75~3.99)**2.94(2.47~3.49)**2.40(1.92~3.00)**2.98(2.67~3.32)**
夜晚型6.02(4.73~7.65)**6.99(5.64~8.68)**10.51(6.75~16.36)**7.45(5.76~9.64)**4.70(3.62~6.12)**6.55(5.59~7.68)**
睡眠时长充足1.001.001.001.001.001.00
不足3.00(2.38~3.78)**3.17(2.53~3.99)**3.45(2.60~4.61)**2.66(2.09~3.37)**3.42(2.39~4.90)**3.05(2.60~3.59)**
社会时差/h< 11.001.001.001.001.001.00
1~ < 20.93(0.81~1.08)1.22(1.06~1.41)**1.55(1.26~1.91)**0.96(0.81~1.13)1.01(0.85~1.20)1.07(0.97~1.18)
≥21.34(1.11~1.61)**3.07(2.59~3.64)**1.63(1.18~2.27)**1.80(1.47~2.22)**2.49(2.05~3.01)**2.09(1.85~2.37)**
), ArticleFig(id=1325531754014200467, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325531691590373969, language=EN, label=Tab.5, caption=

Stratified Logistic regression analysis of chronotype, sleep duration and co-occurring depressive and anxiety symptoms among primary and secondary students[OR(95%CI)]

, figureFileSmall=null, figureFileBig=null, tableContent=
SCRD指标睡眠时长性别学段总体(n=15 944)
男生(n=8 226)女生(n=7 718)小学(n=5 766)初中(n=5 832)高中(n=4 346)
清晨型时型充足1.001.001.001.001.001.00
不足2.20(1.58~3.06)**1.80(1.28~2.52)**2.79(1.94~4.01)**1.24(0.88~1.76)2.38(1.01~5.62)*1.97(1.55~2.49)**
中间型时型充足1.001.001.001.001.001.00
不足2.62(1.85~3.70)**3.41(2.44~4.77)**3.26(1.96~5.43)**3.23(2.34~4.67)**2.72(1.80~4.11)**3.00(2.36~3.82)**
夜晚型时型充足1.001.001.001.001.001.00
不足5.75(1.68~19.73)**8.46(3.25~22.04)**9.74(1.98~47.86)**4.73(1.54~14.59)**15.90(3.66~69.08)**7.54(3.55~16.01)**
), ArticleFig(id=1325531754978890388, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325531691590373969, language=CN, label=表5, caption=

中小学生睡眠时型、时长与抑郁焦虑症状共存相关性的Logistic回归分层分析[OR值(95%CI)]

, figureFileSmall=null, figureFileBig=null, tableContent=
SCRD指标睡眠时长性别学段总体(n=15 944)
男生(n=8 226)女生(n=7 718)小学(n=5 766)初中(n=5 832)高中(n=4 346)
清晨型时型充足1.001.001.001.001.001.00
不足2.20(1.58~3.06)**1.80(1.28~2.52)**2.79(1.94~4.01)**1.24(0.88~1.76)2.38(1.01~5.62)*1.97(1.55~2.49)**
中间型时型充足1.001.001.001.001.001.00
不足2.62(1.85~3.70)**3.41(2.44~4.77)**3.26(1.96~5.43)**3.23(2.34~4.67)**2.72(1.80~4.11)**3.00(2.36~3.82)**
夜晚型时型充足1.001.001.001.001.001.00
不足5.75(1.68~19.73)**8.46(3.25~22.04)**9.74(1.98~47.86)**4.73(1.54~14.59)**15.90(3.66~69.08)**7.54(3.55~16.01)**
), ArticleFig(id=1325531756291707541, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325531691590373969, language=EN, label=Tab.6, caption=

Stratified Logistic regression analysis of chronotype, social jetlag and co-occurring depressive and anxiety symptoms among primary and secondary students[OR(95%CI)]

, figureFileSmall=null, figureFileBig=null, tableContent=
SCRD指标社会时差/h性别学段总体(n=15 944)
男生(n=8 226)女生(n=7 718)小学(n=5 766)初中(n=5 832)高中(n=4 346)
清晨型时型< 11.001.001.001.001.001.00
1~ < 20.84(0.60~1.18)1.28(0.91~1.79)1.57(1.17~2.11)**1.31(0.75~2.30)0.37(0.04~3.35)1.05(0.82~1.33)
≥20.64(0.41~1.00)1.66(1.08~2.57)*1.12(0.66~1.90)0.55(0.27~1.10)1.91(0.21~17.10)1.02(0.75~1.39)
中间型时型< 11.001.001.001.001.001.00
1~ < 21.35(1.11~1.64)**1.38(1.15~1.64)**1.17(0.85~1.62)1.34(1.08~1.65)**1.50(1.23~1.84)**1.35(1.18~1.54)**
≥22.18(1.68~2.82)**3.71(2.95~4.67)**0.60(0.29~1.27)3.21(2.43~4.23)**3.79(2.97~4.83)**2.94(2.48~3.48)**
夜晚型时型< 11.001.001.001.001.001.00
1~ < 21.20(0.76~1.88)3.44(2.21~5.35)**1.61(0.50~5.19)2.34(1.35~4.06)**2.18(1.45~3.28)**2.01(1.48~2.73)**
≥22.23(1.36~3.63)**7.87(4.90~12.65)**3.37(1.07~10.60)*4.36(2.41~7.89)**4.85(3.10~7.59)**4.18(3.01~5.81)**
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中小学生睡眠时型、社会时差与抑郁焦虑症状共存相关性的Logistic回归分层分析[OR值(95%CI)]

, figureFileSmall=null, figureFileBig=null, tableContent=
SCRD指标社会时差/h性别学段总体(n=15 944)
男生(n=8 226)女生(n=7 718)小学(n=5 766)初中(n=5 832)高中(n=4 346)
清晨型时型< 11.001.001.001.001.001.00
1~ < 20.84(0.60~1.18)1.28(0.91~1.79)1.57(1.17~2.11)**1.31(0.75~2.30)0.37(0.04~3.35)1.05(0.82~1.33)
≥20.64(0.41~1.00)1.66(1.08~2.57)*1.12(0.66~1.90)0.55(0.27~1.10)1.91(0.21~17.10)1.02(0.75~1.39)
中间型时型< 11.001.001.001.001.001.00
1~ < 21.35(1.11~1.64)**1.38(1.15~1.64)**1.17(0.85~1.62)1.34(1.08~1.65)**1.50(1.23~1.84)**1.35(1.18~1.54)**
≥22.18(1.68~2.82)**3.71(2.95~4.67)**0.60(0.29~1.27)3.21(2.43~4.23)**3.79(2.97~4.83)**2.94(2.48~3.48)**
夜晚型时型< 11.001.001.001.001.001.00
1~ < 21.20(0.76~1.88)3.44(2.21~5.35)**1.61(0.50~5.19)2.34(1.35~4.06)**2.18(1.45~3.28)**2.01(1.48~2.73)**
≥22.23(1.36~3.63)**7.87(4.90~12.65)**3.37(1.07~10.60)*4.36(2.41~7.89)**4.85(3.10~7.59)**4.18(3.01~5.81)**
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睡眠昼夜节律紊乱与中小学生抑郁焦虑症状共存的相关性
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叶盛 , 杨月 , 卢雪蕾 , 靳和玥 , 李俊同 , 刘辉 , 刘黎
中国学校卫生 | 心理卫生 2025,46(10): 1478-1483
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中国学校卫生 |心理卫生 2025 , 46 (10) : 1478 -1483
睡眠昼夜节律紊乱与中小学生抑郁焦虑症状共存的相关性
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叶盛, 杨月, 卢雪蕾, 靳和玥, 李俊同, 刘辉, 刘黎
作者信息
  • 江苏省南京市疾病预防控制中心学校卫生科，210003
作者简介:

叶盛(1993-)，男，安徽黄山人，硕士，主管医师，主要从事学生常见病防制工作

Association of sleep and circadian rhythm disruption with co-occurring depressive and anxiety symptoms among primary and secondary school students
Sheng YE, Yue YANG, Xuelei LU, Heyue JIN, Juntong LI, Hui LIU, Li LIU
Affiliations
  • Section of School Health, Nanjing Municipal Center for Disease Control and Prevention, Nanjing 210003, Jiangsu Province, China
出版时间: 2025-10-25 doi: 10.16835/j.cnki.1000-9817.2025287
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摘要
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目的

探讨睡眠昼夜节律紊乱指标(睡眠时型、时长和社会时差)与中小学生抑郁焦虑症状共存的关系，为促进中小学生心理健康提供参考依据。

方法

2023年10月，基于分层整群随机抽样方法选取南京市15 944名中小学生为研究对象，其睡眠时型、抑郁焦虑症状共存情况通过清晨与夜晚型问卷、流调中心抑郁量表和广泛性焦虑障碍量表进行调查。采用χ2检验进行率的组间比较，应用Logistic回归模型分析睡眠时型、时长和社会时差与中小学生抑郁焦虑症状共存的关联。

结果

南京市中小学生抑郁焦虑症状共存检出率为16.9%。调整协变量后，Logistic回归模型结果显示，夜晚型睡眠时型(OR=6.55，95%CI=5.59~7.68)、睡眠不足(OR=3.05，95%CI=2.60~3.59)和社会时差≥2 h(OR=2.09，95%CI=1.85~2.37)与中小学生抑郁焦虑症状共存独立相关(P值均 < 0.05)，独立相关性在性别、学段亚组中始终稳健。同时经历夜晚型睡眠时型和睡眠不足(OR=7.54，95%CI=3.55~16.01)、夜晚型睡眠时型和社会时差≥2 h(OR=4.18，95%CI=3.01~5.81)与抑郁焦虑症状共存风险增加相关(P值均 < 0.05)。女生组、高中生组的夜晚型睡眠时型且睡眠不足、社会时差≥2 h呈现出对抑郁焦虑症状共存更高的联合效应[OR值(95%CI)分别为8.46(3.25~22.04)，15.90(3.66~69.08)；7.87(4.90~12.65)，4.85(3.10~7.59)，P值均 < 0.05]。

结论

夜晚型睡眠时型、睡眠不足和社会时差≥2 h可能是抑郁焦虑症状共存的风险因素。关注多个睡眠风险因素的共存可能有助于减缓中小学生情绪障碍的发生。

睡眠  /  昼夜节律  /  焦虑  /  抑郁  /  回归分析  /  学生
Objective

To investigate the association of sleep and circadian rhythm disruption indicators (including chronotype, sleep duration, and social jetlag) with co-occurring depressive and anxiety symptoms among primary and secondary school students, so as to provide a reference for promoting their mental health.

Methods

In October 2023, a total of 15 944 primary and secondary school students were recruited from Nanjing, using a stratified cluster random sampling method. The Morning and Evening Questionnaire-5, Center for Epidemiological Studies Depression, and Generalized Anxiety Disorder-7 were used for the survey. Chi-square test was employed for intergroup comparisons, and Logistic regression model was applied to analyze the independent and joint effects of sleep-related factors on comorbid symptoms of depressive and anxiety among primary and middle school students.

Results

The prevalence of co-occurring depressive and anxiety symptoms among primary and secondary school students in Nanjing was 16.9%. After adjusting for covariates, Logistic regression analysis revealed significant independent associations between evening chronotype (OR=6.55, 95%CI=5.59-7.68), insufficient sleep duration (OR=3.05, 95%CI=2.60-3.59), and social jetlag ≥2 h (OR=2.09, 95%CI=1.85-2.37) with comorbid symptoms of depressive and anxiety among students (all P < 0.05). Concurrent of evening chronotype and insufficient sleep (OR=7.54, 95%CI=3.55-16.01), as well as evening chronotype and social jetlag ≥2 h (OR=4.18, 95%CI=3.01-5.81), were associated with an increased risk of co-occurring depressive and anxiety symptoms (both P < 0.05). In the female and high school student subgroups, the combination of evening chronotype and insufficient sleep or social jetlag ≥2 h showed stronger joint effects on co-occurring depressive and anxiety symptoms [OR(95%CI)=8.46(3.25-22.04) and 15.90(3.66-69.08); 7.87(4.90-12.65) and 4.85(3.10-7.59), respectively; all P < 0.05].

Conclusions

Evening chronotype, insufficient sleep, and social jetlag≥2 h may serve as risk factors for comorbid symptoms of depressive and anxiety in school-aged populations. Paying attention to the coexistence of multiple sleep-related risk factors may help mitigate the occurrence of emotional disorders in this demographic.

Sleep  /  Circadian rhythm  /  Anxiety  /  Depression  /  Regression analysis  /  Students
叶盛, 杨月, 卢雪蕾, 靳和玥, 李俊同, 刘辉, 刘黎. 睡眠昼夜节律紊乱与中小学生抑郁焦虑症状共存的相关性. 中国学校卫生, 2025 , 46 (10) : 1478 -1483 . DOI: 10.16835/j.cnki.1000-9817.2025287
Sheng YE, Yue YANG, Xuelei LU, Heyue JIN, Juntong LI, Hui LIU, Li LIU. Association of sleep and circadian rhythm disruption with co-occurring depressive and anxiety symptoms among primary and secondary school students[J]. Chinese Journal of School Health, 2025 , 46 (10) : 1478 -1483 . DOI: 10.16835/j.cnki.1000-9817.2025287
正文
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青少年时期是心理、情感和认知快速发展的关键阶段，容易引发心理健康问题[1]。抑郁和焦虑是青少年群体患病率较高的2种情绪障碍，因存在相近行为特征和致病因素，二者常表现为症状共存模式[2]。抑郁青少年中15%~75%存有焦虑，焦虑青少年中10%~15%存有抑郁[3]。一项全国性研究显示，我国青少年抑郁焦虑症状共存的检出率为31.6%[4]。抑郁焦虑症状共存可能导致青少年学业表现差、人际关系不佳、认知功能损害甚至自杀风险增加[5]，进而加重成年期疾病负担。
睡眠问题是青少年群体另一重大健康隐患。与童年期相比，青春期进程中发生内源性昼夜节律延迟，睡眠时型向“夜晚型”转变[6]；同时叠加社交时间和夜间人工光源等外源性因素影响，导致青少年入睡时间推迟，睡眠不足和社会时差现象日趋流行[7-8]。越来越多研究显示，睡眠时型、时长和社会时差等睡眠昼夜节律紊乱(sleep and circadian rhythm disruption, SCRD)指标与抑郁、焦虑等情绪障碍密切相关[9-11]。本研究在中小学生群体中开展流行病学调查，旨在了解SCRD指标、抑郁焦虑症状共存的流行现状，探讨不同SCRD指标对抑郁焦虑症状共存的独立和联合效应，以期从睡眠角度提供改善中小学生心理健康的理论依据。
1　对象与方法
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1.1　对象
2023年10月，采用分层整群随机抽样方法，以城区/郊县分层，在南京市各城区分别选取2所小学、2所初中和2所普通高中，各郊县分别选取2所小学、2所初中和1所普通高中。在小学四至六年级、初中和高中一至三年级，每个年级采用直接抽选法选取1~2个班级，整班学生纳入研究，各年级至少监测80名学生。剔除关键变量信息缺失的样本后，最终共纳入15 944名中小学生，其中男生8 226名，女生7 718名；小学生5 766名，初中生5 832名，高中生4 346名；平均年龄(13.35±2.55)岁。本研究已通过南京市疾病预防控制中心伦理委员会审查(批号：PJ2023-A001-12)，所有研究对象均知情同意。
1.2　方法
1.2.1　基本情况
使用问卷收集学生基本情况数据，主要包括性别、年级和学段、所在地区、吸烟史、饮酒史、近一周中高强度活动天数等。该问卷来源于《全国学生常见病和健康影响因素监测与干预工作方案》[12](以下简称“工作方案”)，由学生本人填写。中高强度活动通过“过去7 d每天至少60 min及以上中高强度运动(指让你气喘吁吁或者心跳加快的运动。如跑步、搬重物、篮球、游泳等)的天数”来反映，并将研究对象分为7和<7 d两组[12]。参照工作方案，使用身高体重仪规范测量学生身高和体重，并计算体质量指数(body mass index, BMI)，BMI=体重(kg)/[身高(m)]2，依据《学龄儿童青少年超重与肥胖筛查》(WS/T 586—2018)[13]判定学生超重与肥胖情况。
1.2.2　SCRD指标
睡眠时型通过清晨与夜晚型问卷(Morning and Evening Questionnaire-5, MEQ-5)[9]评估。问卷由Horne等[14]编制，用于描述睡眠的时间分型或相位偏好。MEQ-5由5个条目构成，其中3个条目反向计5~1分，1个条目正向计1~4分，1个条目反向计6，4，2，0分；总分范围为4~25分。根据总分将研究对象分为“夜晚型”(晚睡晚起，4~11分)、“中间型”(时间倾向具有灵活性，12~17分)和“清晨型”(早睡早起，18~25分)3类[9]。本研究中该量表Cronbach α系数为0.80。
通过4个条目调查睡眠时长和社会时差，包括“周一至周五学习日晚上入睡时间”“周一至周五学习日早晨起床时间”“周末期间晚上入睡时间”“周末期间早晨起床时间”。根据学习日和周末的夜间睡眠时长(夜间睡眠时长=起床时间-入睡时间)，加权计算学生的平均夜间睡眠时长[平均夜间睡眠时长=(学习日夜间睡眠时长×5+周末夜间睡眠时长×2)/7]，并按照“小学生10 h、初中生9 h、高中生8 h”每日睡眠时长推荐量[15]将平均夜间睡眠时长转化为二分类指标纳入分析(充足，不足)。基于学习日睡眠中点和周末睡眠中点计算社会时差，睡眠中点=起床时间-夜间睡眠时长/2，社会时差=|周末睡眠中点-学习日睡眠中点|[8]。参照既往研究，本研究将社会时差分为3组，即 < 1，1~<2，≥2 h[16-17]。
1.2.3　抑郁焦虑症状共存
使用流调中心抑郁量表(Center for Epidemiological Studies Depression, CES-D)[18]调查近一周抑郁症状。量表共20个条目，采用4级分制，其中第4、8、12、16题反向计分，其余题目均对“没有或偶尔”“有时”“时常或一半时间”“多数时间或持续”正向计0~3分。量表得分范围为0~60分，分数越高提示抑郁程度越高，总分≥16分界定为有抑郁症状[18]。本研究中该量表Cronbach α系数为0.88。使用广泛性焦虑障碍量表(Generalized Anxiety Disorder-7，GAD-7)[4]调查近一周焦虑症状。量表共7个条目，各条目均对“从来没有”“偶尔几天有”“经常有”“几乎天天有”正向计0~3分，得分范围为0~21分，分数越高提示焦虑程度越高；将总分≥5界定为有焦虑症状[4]。本研究中该量表Cronbach α系数为0.94。经CES-D和GAD-7评估，同时检出抑郁症状和焦虑症状者被界定为抑郁焦虑症状共存。
1.3　质量控制
调查前由统一培训的调查员向学生说明调查目的和注意事项。身高体重仪每日由专业医务人员校正后使用。学生在学校机房使用江苏省统一的线上系统填写问卷，问卷系统设有多项逻辑校验，如时间填空设有逻辑范围，填写值超出所设范围会有提示。问卷调查现场配备班主任和调查员，前者负责维护现场秩序，确保每名学生独立作答；后者负责解答学生在问卷填写过程中的相关问题。每日调查结束后由质控人员在管理后台审核问卷。
1.4　统计学分析
使用SPSS 26.0软件进行统计分析。计数资料用频数和构成比描述，采用χ2检验比较不同组别中小学生的抑郁焦虑症状共存分布。以抑郁焦虑症状共存为因变量(否=0，是=1)，分别以SCRD指标为自变量，调整年龄、性别、学段、吸烟史、饮酒史和中高强度活动情况，采用多因素Logistic回归模型分析中小学生不同SCRD指标与抑郁焦虑症状共存的独立关联，并以睡眠时型分层，分析睡眠时型与睡眠时长、睡眠时型与社会时差不同类别组合间的联合效应。由于SCRD指标与情绪障碍的关联性可能存在性别和学段差异，因此需要进一步分性别、学段对上述独立及联合效应进行亚组分析。检验水准α=0.05。
2　结果
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2.1　中小学生抑郁焦虑症状共存情况
南京市中小学生抑郁症状检出率为22.0%(3 500/15 944)，焦虑症状检出率为26.2%(4 181/15 944)，有2 690名(16.9%)中小学生检出抑郁焦虑症状共存。不同学段、性别、吸烟史、饮酒史、中高强度活动情况的中小学生抑郁焦虑症状共存检出率差异均有统计学意义(P值均 < 0.05)。见表1。
2.2　SCRD指标和抑郁焦虑症状共存的单因素分析
中小学生夜晚型睡眠时型、睡眠不足、社会时差为1~ < 02和≥2 h的检出率分别为7.0%(1 113名)，80.3%(12 810名)，39.5%(6 304名)和13.5%(2 148名)，SCRD指标在女生、高中生中检出率较高(P值均 < 00.05)。全体学生、分性别和学段样本不同SCRD指标的抑郁焦虑症状共存检出率差异均有统计学意义(P值均 < 0.05)。见表2~3。
2.3　SCRD指标和中小学生抑郁焦虑症状共存的多因素Logistic回归分析
调整协变量后，回归分析结果显示，中间型睡眠时型(OR=2.98)、夜晚型睡眠时型(OR=6.55)、睡眠不足(OR=3.05)、社会时差≥2 h(OR=2.09)与中小学生抑郁焦虑症状共存独立相关(P值均 < 00.01)。亚组分析表明，上述独立相关性在不同性别、学段样本中依旧稳健，且女生SCRD指标的独立效应高于男生；小学生中夜晚型睡眠时型和睡眠不足的独立效应较高，高中生中社会时差≥2 h的独立效应较高。见表4。
2.4　基于睡眠时型的分层分析
睡眠时型与睡眠时长、社会时差联合效应的性别、学段亚组分层分析显示，相较清晨型、中间型，夜晚型时型且睡眠不足与抑郁焦虑症状共存的关联性最强(OR=7.54)，且该关联性在女生(OR=8.46)和高中生(OR=15.90)中更高(P值均 < 00.05)。见表5。夜晚型时型且社会时差≥2 h也呈现更强的联合效应(OR=4.18)，此关联性在女生(OR=7.87)和高中生(OR=4.85)中更高。见表6。
3　讨论
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本研究结果显示，南京市中小学生抑郁焦虑症状共存检出率为16.9%，检出率随学段升高而上升，女生检出率高于男生，与既往研究报道基本一致[4]。孤独感增加、学业压力增大、激素水平变化等因素可能介导了以上差异[19]。本研究中，南京市中小学生夜晚型睡眠时型、睡眠不足和社会时差≥2 h检出率分别为7.0%，80.3%和13.5%。重庆市初、高中学生夜晚型睡眠时型的报告率为20%[20]；《中国国民心理健康发展报告(2019—2020)》[7]显示，我国中小学生睡眠不足现象严重，95.5%的小学生、90.8%的初中生和84.1%的高中生报告睡眠不足；国内一项覆盖10万余名中小学生的横断面研究发现，社会时差≥2 h的报告率为17.8%[16]。本研究与上述研究报道结果不同，可能与样本量、研究对象人口学背景等因素差异有关，但均表明睡眠问题在中小学生中存在一定程度的流行，需引起重视。
本研究结果显示，夜晚型睡眠时型、睡眠不足和社会时差与中小学生抑郁焦虑症状共存独立相关，且这种独立相关性在不同性别和学段亚组中依旧稳健，进一步印证了现有相关研究报告结果[9, 21-22]。在此基础上，本研究还发现SCRD指标对中小学生抑郁焦虑症状共存存在联合效应，即多个SCRD指标的共存可能比单个指标影响更大。一项对俄罗斯10~20岁青少年开展的横断面研究发现，季节性情感障碍的女生同时表现出较晚的睡眠时型和较大的社会时差[23]。Qu等[9]在大学生群体中发现，夜晚型睡眠时型且社会时差≥2 h、夜晚型睡眠时型且睡眠不足(≤8 h)均与抑郁症状有更高强度的关联。生物钟基因可能驱动了这种联合效应。有研究表明，调节昼夜节律的基因座在恐惧焦虑和行为防御反应相关基因中过度表达，提示昼夜节律紊乱可能通过行为抑制通路促进负性情绪的产生[24]。此外，昼夜节律发生异常改变可引起皮质认知控制降低，大脑奖赏环路活动增强，青少年对冲动和奖赏寻求行为的易感性进一步增加，最终导致或加重负性情绪[25]。因此，关注SCRD指标的共存情况可能是心理卫生问题防控的有效路径。
本研究中SCRD指标与抑郁焦虑症状共存的关联强度在女生中较高。美国“脆弱家庭与儿童福利”研究结果显示，仅在女生表现出学习日夜晚睡眠时长与抑郁症状得分呈负相关，社会时差与抑郁症状得分呈正相关[26]。Tamura等[17]对1 493名日本初中生调查发现，调整年龄后，女生社会时差≥2 h与抑郁症状的关联性高于男生；进一步调整协变量后，仅在女生中存在关联性。提示女生的心理健康可能更容易受到睡眠和昼夜节律紊乱问题的影响。这种性别差异可能源于男生和女生在睡眠特征、心理行为等方面的不同[26]。另外，本研究中SCRD指标的独立效应在不同学段中存在差异，但均在高中阶段呈现出更高的联合效应。鉴于高中阶段青少年有着更低的心理健康水平且可能面临更大的社会压力[27]，睡眠问题对高中生心理健康的影响应得到持续关注。
本研究存在以下局限性：SCRD指标等关键变量信息均通过问卷调查获取，可能受到报告偏倚和回忆偏倚的影响。研究采用横断面设计，限制了SCRD指标和抑郁焦虑症状共存之间的因果关系推断。未来需更多纵向研究探讨中小学生SCRD指标长期变化与心理健康的关联。
基金
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  • 南京医科大学科技发展基金项目(NMUB20230279)；南京市疾控中心青年人才科研培育团队项目(NPY2304)
文献
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2025年第46卷第10期
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doi: 10.16835/j.cnki.1000-9817.2025287
  • 接收时间：2025-05-12
  • 首发时间：2026-11-06
  • 出版时间：2025-10-25
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  • 收稿日期：2025-05-12
  • 修回日期：2025-07-23
基金
南京医科大学科技发展基金项目(NMUB20230279)；南京市疾控中心青年人才科研培育团队项目(NPY2304)
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    江苏省南京市疾病预防控制中心学校卫生科，210003
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