Article(id=1325530110669111988, tenantId=1146029695717560320, journalId=1256213402557890569, issueId=1325530078536553117, articleNumber=null, orderNo=null, doi=10.16835/j.cnki.1000-9817.2025286, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1745856000000, receivedDateStr=2025-04-29, revisedDate=1748534400000, revisedDateStr=2025-05-30, acceptedDate=null, acceptedDateStr=null, onlineDate=1793960605541, onlineDateStr=2026-11-06, pubDate=1758729600000, pubDateStr=2025-09-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793960605541, onlineIssueDateStr=2026-11-06, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793960605541, creator=13701087609, updateTime=1793960605541, updator=13701087609, issue=Issue{id=1325530078536553117, tenantId=1146029695717560320, journalId=1256213402557890569, year='2025', volume='46', issue='9', pageStart='1217', pageEnd='1368', issueExtLink='null', onlineDate='null', pubDate='1758729600000', pubDateStr='2025-09-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793960597879, creator='13701087609', updateTime=1793960597879, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=1242, endPage=1245, ext={EN=ArticleExt(id=1325530110899798709, articleId=1325530110669111988, tenantId=1146029695717560320, journalId=1256213402557890569, language=EN, title=Longitudinal cross-lagged analysis of body mass index and weight stigma with depressive symptom in adolescents, columnId=1325530092633608953, journalTitle=Chinese Journal of School Health, columnName=Column on Child and Adolescent Mental Health Promotion, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the bidirectional associations among body mass index Z-scores (BMI Z-scores) and weight stigma with depressive symptoms in adolescents, thereby providing evidence for targeted intervention strategies.

Methods

A stratified cluster random sampling method was employed to select 18 301 adolescents aged 12-18 years from all 12 prefectures (103 counties) in the Inner Mongolia Autonomous Region, and two waves of longitudinal surveys were conducted in September 2023 (T1) and September 2024 (T2) among the adolescents. Weight stigma was assessed by using a self-developed questionnaire, depressive symptom was measured with the Center for Epidemiologic Studies Depression Scale (CES-D), and BMI Z-scores were calculated according to the World Health Organization standards. Pearson correlation analysis was used to examine associations among variables, and cross-lagged panel models were constructed to investigate the dynamic bidirectional relationships among the three variables.

Results

Adolescents' BMI Z-scores and weight stigma with depressive symptoms all exhibited autoregressive stability across the two time points (autoregressive paths, all P < 0.01). Cross-lagged model comparisons indicated that the bidirectional path model achieved the best fit (χ2=12.65, RMSEA=0.017, CFI=1.000; △χ2=193.39, P < 0.01), supporting dynamic bidirectional associations among the three variables. After adjusting for gender, age, subjective social status and only-child status, T1 BMI Z-scores among adolescents positively predicted T2 weight stigma (β=0.061), and T1 weight stigma positively predicted T2 depressive symptoms (β=0.608); in the reverse direction, T1 depressive symptoms predicted T2 weight stigma (β=0.003), and T1 weight stigma predicted T2 BMI Z-scores (β=0.081) (all P < 0.01).

Conclusions

There is a bidirectional cross-lagged relationship among adolescents' BMI Z-scores and weight stigma with depressive symptoms, suggesting that weight stigma may serve as a key psychological variable linking obesity and depressive symptoms. Greater attention should be paid to the potential threat of weight stigma to adolescents' mental health, with intervention strategies expanded from a solely physiological focus to encompass psychosocial dimensions.

, authors=Ziqi DONG1, Xinli SONG1, Wen YUAN2, Jing LI1, Tian YANG3, Xiuhong ZHANG3, Yi SONG1, Yanhui DONG*, 1, authorsList=Ziqi DONG, Xinli SONG, Wen YUAN, Jing LI, Tian YANG, Xiuhong ZHANG, Yi SONG, Yanhui DONG, authorCompany=null, correspAuthors=Yanhui DONG, 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=1325530111898043064, articleId=1325530110669111988, tenantId=1146029695717560320, journalId=1256213402557890569, language=CN, title=青少年体质量指数和体重污名化与抑郁症状纵向交叉滞后分析, columnId=1325530092839129851, journalTitle=中国学校卫生, columnName=儿童青少年心理健康促进专栏, runingTitle=null, highlight=null, articleAbstract=
目的

探讨青少年体质量指数(BMI)Z评分、体重污名化与抑郁症状之间的双向作用机制,为制定针对性的干预措施提供依据。

方法

采用分层整群随机抽样方法,于2023年9月(T1)和2024年9月(T2)从内蒙古自治区全部12个盟市(103个旗县区)抽取18 301名12~18岁青少年开展2次纵向调查。通过自编问卷评估体重污名化,采用流调中心抑郁量表(CES-D)测量抑郁症状,并依据世界卫生组织标准计算BMI Z评分。采用Pearson相关分析变量的相关性,构建交叉滞后面板模型考察三变量之间的动态双向关系。

结果

青少年BMI Z评分、体重污名化与抑郁症状在两个时间点之间均表现出自相关性(自回归路径P值均 < 0.01)。交叉滞后模型结果显示,双向路径模型拟合最佳(χ2=12.65,RMSEA=0.017,CFI=1.000;△χ2=193.39,P < 0.01),支持三变量之间的动态双向作用机制。调整性别、年龄、主观社会地位和是否为独生子女变量后,青少年T1 BMI Z评分正向预测T2体重污名化(β=0.061)、T1体重污名化正向预测T2抑郁症状(β=0.608);反向路径分析显示,青少年T1抑郁症状可预测T2体重污名化(β=0.003)、T1体重污名化可预测T2 BMI Z评分(β=0.081)(P值均 < 0.01)。

结论

青少年BMI Z评分、体重污名化与抑郁症状之间存在双向交叉滞后关系,体重污名化可能是连接肥胖与抑郁症状的关键变量。应重视体重污名化对青少年心理健康的潜在威胁,推动干预策略从生理指标延伸至社会心理层面。

, authors=董子奇1, 宋欣俐1, 袁雯2, 李晶1, 杨田3, 张秀红3, 宋逸1, 董彦会*, 1, authorsList=董子奇, 宋欣俐, 袁雯, 李晶, 杨田, 张秀红, 宋逸, 董彦会, authorCompany=null, correspAuthors=董彦会, authorNote=

董子奇(2001-),女,北京市人,在读硕士,主要研究方向为儿童青少年慢性病

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董彦会,E-mail:
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注:图中数值为β值; *P < 0.05,**P < 0.01。

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Comparison of BMI Z, weight stigma and depressive sy- mptoms scores among adolescents with different groups at T1(x ±s)

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组别人数统计值BMI Z体重污名化抑郁症状
性别
  男7 4610.69±1.440.15±0.4710.88±9.90
  女10 8400.42±1.190.19±0.5311.84±10.27
t值13.40-5.12-6.31
P值< 0.01< 0.01< 0.01
年龄/岁
  12~139 3910.63±1.310.14±0.4610.24±9.55
  14~154 6930.47±1.290.19±0.5412.21±10.55
  16~184 2170.38±1.290.21±0.5613.28±10.55
F值61.2026.52150.86
P值< 0.01< 0.01< 0.01
主观社会地位/分
  0~32 5790.51±1.310.22±0.5714.75±12.03
  4~612 6220.52±1.310.16±0.5011.05±9.63
  7~103 1000.58±1.290.17±0.5210.33±9.84
F值2.7713.69169.03
P值0.06< 0.01< 0.01
是否独生子女
  是7 1700.63±1.350.17±0.5211.07±10.18
  否11 1310.46±1.280.17±0.5011.69±10.10
t值8.280.65-4.03
P值< 0.010.51< 0.01
), ArticleFig(id=1325530115580642037, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325530110669111988, language=CN, label=表1, caption=

T1不同组别青少年BMI Z评分、体重污名化和抑郁症状评分比较(x ±s)

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组别人数统计值BMI Z体重污名化抑郁症状
性别
  男7 4610.69±1.440.15±0.4710.88±9.90
  女10 8400.42±1.190.19±0.5311.84±10.27
t值13.40-5.12-6.31
P值< 0.01< 0.01< 0.01
年龄/岁
  12~139 3910.63±1.310.14±0.4610.24±9.55
  14~154 6930.47±1.290.19±0.5412.21±10.55
  16~184 2170.38±1.290.21±0.5613.28±10.55
F值61.2026.52150.86
P值< 0.01< 0.01< 0.01
主观社会地位/分
  0~32 5790.51±1.310.22±0.5714.75±12.03
  4~612 6220.52±1.310.16±0.5011.05±9.63
  7~103 1000.58±1.290.17±0.5210.33±9.84
F值2.7713.69169.03
P值0.06< 0.01< 0.01
是否独生子女
  是7 1700.63±1.350.17±0.5211.07±10.18
  否11 1310.46±1.280.17±0.5011.69±10.10
t值8.280.65-4.03
P值< 0.010.51< 0.01
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青少年体质量指数和体重污名化与抑郁症状纵向交叉滞后分析
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董子奇 1 , 宋欣俐 1 , 袁雯 2 , 李晶 1 , 杨田 3 , 张秀红 3 , 宋逸 1 , 董彦会 *, 1
中国学校卫生 | 儿童青少年心理健康促进专栏 2025,46(9): 1242-1245
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中国学校卫生 |儿童青少年心理健康促进专栏 2025 , 46 (9) : 1242 -1245
青少年体质量指数和体重污名化与抑郁症状纵向交叉滞后分析
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董子奇1, 宋欣俐1, 袁雯2, 李晶1, 杨田3, 张秀红3, 宋逸1, 董彦会*, 1
作者信息
  • 1北京大学公共卫生学院/北京大学儿童青少年卫生研究所,北京 100191
  • 2华中师范大学心理学院
  • 3内蒙古自治区疾病预防控制中心学校卫生科
通讯作者:
董彦会,E-mail:
作者简介:

董子奇(2001-),女,北京市人,在读硕士,主要研究方向为儿童青少年慢性病

Longitudinal cross-lagged analysis of body mass index and weight stigma with depressive symptom in adolescents
Ziqi DONG1, Xinli SONG1, Wen YUAN2, Jing LI1, Tian YANG3, Xiuhong ZHANG3, Yi SONG1, Yanhui DONG*, 1
Affiliations
  • 1School of Public Health/Institute of Child and Adolescent Health, Peking University, Beijing 100191, China
出版时间: 2025-09-25 doi: 10.16835/j.cnki.1000-9817.2025286
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目的

探讨青少年体质量指数(BMI)Z评分、体重污名化与抑郁症状之间的双向作用机制,为制定针对性的干预措施提供依据。

方法

采用分层整群随机抽样方法,于2023年9月(T1)和2024年9月(T2)从内蒙古自治区全部12个盟市(103个旗县区)抽取18 301名12~18岁青少年开展2次纵向调查。通过自编问卷评估体重污名化,采用流调中心抑郁量表(CES-D)测量抑郁症状,并依据世界卫生组织标准计算BMI Z评分。采用Pearson相关分析变量的相关性,构建交叉滞后面板模型考察三变量之间的动态双向关系。

结果

青少年BMI Z评分、体重污名化与抑郁症状在两个时间点之间均表现出自相关性(自回归路径P值均 < 0.01)。交叉滞后模型结果显示,双向路径模型拟合最佳(χ2=12.65,RMSEA=0.017,CFI=1.000;△χ2=193.39,P < 0.01),支持三变量之间的动态双向作用机制。调整性别、年龄、主观社会地位和是否为独生子女变量后,青少年T1 BMI Z评分正向预测T2体重污名化(β=0.061)、T1体重污名化正向预测T2抑郁症状(β=0.608);反向路径分析显示,青少年T1抑郁症状可预测T2体重污名化(β=0.003)、T1体重污名化可预测T2 BMI Z评分(β=0.081)(P值均 < 0.01)。

结论

青少年BMI Z评分、体重污名化与抑郁症状之间存在双向交叉滞后关系,体重污名化可能是连接肥胖与抑郁症状的关键变量。应重视体重污名化对青少年心理健康的潜在威胁,推动干预策略从生理指标延伸至社会心理层面。

人体质量指数  /  抑郁  /  精神卫生  /  交叉滞后分析  /  青少年
Objective

To explore the bidirectional associations among body mass index Z-scores (BMI Z-scores) and weight stigma with depressive symptoms in adolescents, thereby providing evidence for targeted intervention strategies.

Methods

A stratified cluster random sampling method was employed to select 18 301 adolescents aged 12-18 years from all 12 prefectures (103 counties) in the Inner Mongolia Autonomous Region, and two waves of longitudinal surveys were conducted in September 2023 (T1) and September 2024 (T2) among the adolescents. Weight stigma was assessed by using a self-developed questionnaire, depressive symptom was measured with the Center for Epidemiologic Studies Depression Scale (CES-D), and BMI Z-scores were calculated according to the World Health Organization standards. Pearson correlation analysis was used to examine associations among variables, and cross-lagged panel models were constructed to investigate the dynamic bidirectional relationships among the three variables.

Results

Adolescents' BMI Z-scores and weight stigma with depressive symptoms all exhibited autoregressive stability across the two time points (autoregressive paths, all P < 0.01). Cross-lagged model comparisons indicated that the bidirectional path model achieved the best fit (χ2=12.65, RMSEA=0.017, CFI=1.000; △χ2=193.39, P < 0.01), supporting dynamic bidirectional associations among the three variables. After adjusting for gender, age, subjective social status and only-child status, T1 BMI Z-scores among adolescents positively predicted T2 weight stigma (β=0.061), and T1 weight stigma positively predicted T2 depressive symptoms (β=0.608); in the reverse direction, T1 depressive symptoms predicted T2 weight stigma (β=0.003), and T1 weight stigma predicted T2 BMI Z-scores (β=0.081) (all P < 0.01).

Conclusions

There is a bidirectional cross-lagged relationship among adolescents' BMI Z-scores and weight stigma with depressive symptoms, suggesting that weight stigma may serve as a key psychological variable linking obesity and depressive symptoms. Greater attention should be paid to the potential threat of weight stigma to adolescents' mental health, with intervention strategies expanded from a solely physiological focus to encompass psychosocial dimensions.

Body mass index  /  Depression  /  Mental health  /  Cross-lagged analysis  /  Adolescent
董子奇, 宋欣俐, 袁雯, 李晶, 杨田, 张秀红, 宋逸, 董彦会. 青少年体质量指数和体重污名化与抑郁症状纵向交叉滞后分析. 中国学校卫生, 2025 , 46 (9) : 1242 -1245 . DOI: 10.16835/j.cnki.1000-9817.2025286
Ziqi DONG, Xinli SONG, Wen YUAN, Jing LI, Tian YANG, Xiuhong ZHANG, Yi SONG, Yanhui DONG. Longitudinal cross-lagged analysis of body mass index and weight stigma with depressive symptom in adolescents[J]. Chinese Journal of School Health, 2025 , 46 (9) : 1242 -1245 . DOI: 10.16835/j.cnki.1000-9817.2025286
儿童青少年超重肥胖问题日益严重。在过去30年间,全球儿童青少年的超重肥胖率已增长超过一倍,成为重要的公共卫生问题[1]。超重肥胖不仅与个体生理健康风险密切相关,同时也带来了显著的社会心理负担。体重污名化是指由于个体体重超重肥胖而遭受社会性贬损和诋毁的现象,通常表现为对超重或肥胖人群赋予负面的刻板印象,如懒惰、缺乏自律性和健康管理的动机缺失等[2]。污名化不仅无法有效促进体重管理,反而加剧相关的健康风险[3-4]。被污名化的个体通常表现出自我效能感降低、逃避运动和医疗保健、情绪性进食增加等不健康行为,从而进入体重增加的恶性循环[5-7]。青少年时期的污名化经历与抑郁、焦虑、自尊心降低和社交孤立等心理与社会问题显著相关[8]。同时,抑郁作为青少年常见的心理健康问题,亦可能通过负性情绪体验和社交回避进一步影响健康行为,增加青少年超重与肥胖的风险[9]。因此,本研究采用纵向交叉滞后设计,探讨青少年体质量指数(body mass index, BMI)Z评分、体重污名化与抑郁症状之间的双向预测机制,深入理解三者间的动态关系,为制定针对性的干预措施提供支持。
2023年9月(T1)和2024年9月(T2),采用分层整群随机抽样法,在内蒙古自治区12个盟市(103个旗县区)抽取样本。按区域划分为城区和郊县,采取直接抽选法从每个城区抽取2所初中、2所普通高中、1所职业高中,在每个郊县抽取2所初中、1所高中; 再按照年级分层,在每个年级抽取≥2个班级,以整班为单位纳入所有学生作为调查对象,确保每个年级的样本量不少于80人。纳入标准:(1)年龄12~18岁; (2)能够配合完成2次问卷调查和身体测量; (3)本人和监护人同意参与并签署知情同意书。排除标准:(1)体格检查记录不完整或数值可疑; (2)问卷关键变量缺失或逻辑异常。最终纳入18 301份有效样本。其中男生7 461名(40.8%),女生10 840名(59.2%); 平均年龄(13.92±1.58)岁。参与调查青少年均由本人或家长签署知情同意书,研究通过内蒙古自治区疾病预防控制中心伦理委员会审批(批号:202309271)。
通过问卷调查青少年年龄、性别、是否为独生子女、主观社会地位。主观社会地位采用麦克阿瑟主观社会地位量表[10]测评,该量表为10级阶梯式量表,最底层赋值为1,最顶层赋值为10,形成1~10的定距变量,数值越大表示主观社会地位越高。
身高、体重由经过严格培训并经考核合格的儿童保健人员使用机械式身高计和电子体重计进行测量,数据分别精确至0.1 cm和0.1 kg。BMI=体重(kg)/ [身高(m)]2。本研究采用世界卫生组织(World Health Organization,WHO)5~19岁儿童青少年生长参考标准,依据受试者的年龄(月龄)和性别,使用WHO AnthroPlus软件包计算BMI Z评分[11]。
参考既有体重污名化研究中测量工具嘲笑感知量表(Perception of Teasing Scale,POTS)[12]中的核心维度,结合中国青少年群体特点进行了简化与本土化编制。量表包括因体重较重/肥胖而被排挤(如不被允许参与集体活动)、被他人取笑或起绰号、遭受负面刻板印象(如被认为懒惰、不自律等)3个条目。每题选项选择“是”计1分,“否”计0分,总分0~3分,得分越高表示体重污名化经历越多。为评估该量表的信度,考虑到项目为有序分类变量,采用有序α系数(Ordinal α)评估内部一致性,T1和T2时的Ordinal α分别为0.88和0.87,内部一致性良好。在效度方面,效标关联分析结果显示,体重污名化总分与BMI Z评分、抑郁症状评分均呈正相关(P值均 < 0.01),表明该量表在反映青少年体重相关社会评价及其心理状态方面具有良好的效标效度。
采用流调中心抑郁量表(Center for Epidemiologic Studies Depression Scale,CES-D)评估[13],共包含20个条目,其中4个项目为反向计分。该量表采用Likert 4点计分方式,“0”表示偶尔或无(< 1 d),“1”表示有时(1~2 d),“2”表示时常或一半时间(3~4 d),“3”表示多数时间或持续(5~7 d)。对反向计分项目进行反转处理后,计算全部条目的总分。量表总分范围为0~60分,得分越高表示受试者经历的抑郁症状越严重。本研究中,该量表在T1和T2的Cronbach α系数分别为0.83,0.88。验证性因素分析结果表明,T1时近似误差均方根(root mean square error of approximation,RMSEA)=0.07(< 0.08),比较拟合指数(comparative fit index,CFI)=0.85,Tucker-Lewis指数(tucker-lewis index,TLI)=0.83,标准化均方根残差(standardized root mean square residual,SRMR)=0.07;T2时RMSEA=0.07(< 0.08),CFI=0.86,TLI=0.84,SRMR=0.07,在不同时间点上具有结构稳定性。
所有参与监测的工作人员均接受严格培训和考核,配备合规仪器设备,熟练掌握相关检测方法,确保数据采集、管理和使用规范统一。此外抽取5%的学生进行现场复核,提升过程监管的严谨性和指导效果。
采用EpiData 3.1软件双录入建立数据库,使用R 4.4.3软件对数据进行统计分析。首先对样本的基线特征进行描述统计,采用(x ±s)描述,采用独立样本t检验比较BMI Z评分、体重污名化评分及抑郁症状评分在二分类人口学变量(性别、是否为独生子女)方面的差异; 采用单因素方差分析对多分类变量(年龄、主观社会地位)进行组间比较。此外,计算各变量在不同时间点的平均值、标准差与偏度、峰度以评估正态性,体重污名化评分和抑郁症状评分存在一定程度的偏态分布,但鉴于样本量较大,根据中心极限定理可视为近似正态分布,采用Pearson相关分析检验主要变量间的同步与跨时间相关性。为进一步探讨BMI Z评分、体重污名化与抑郁症状之间的纵向关系,构建交叉滞后模型。先后建立3个嵌套模型,模型1(基础模型)仅包含变量自回归路径及同时点相关,作为基准模型控制变量本身的时间稳定性; 模型2(前向模型)在模型1基础上引入BMI Z评分→体重污名化→抑郁症状的单向交叉路径,模型3(双向模型)在模型2基础上引入一组从抑郁症状出发的路径(抑郁症状→体重污名化→BMI Z评分),以评估双向路径。所有模型均采用结构方程建模框架完成,基于最大似然估计方法进行参数估计。模型拟合优度评价指标包括RMSEA、SRMR、CFI和TLI,参考常规拟合标准,RMSEA < 0.08、SRMR < 0.08、CFI和TLI>0.90表示模型拟合较好。嵌套模型之间通过卡方差值检验(△χ2)评估路径增加是否带来显著拟合提升。最后,在模型3的基础上构建协变量调整模型,将性别、年龄、主观社会地位及是否为独生子女纳入作为协变量,以提高模型估计的稳健性与解释效度。双侧检验水准α=0.05。
12~18岁青少年T1时BMI Z评分、体重污名化和抑郁症状评分分别为(0.53±1.31)(0.17±0.51)(11.45±10.13)分,男生BMI Z评分高于女生,但体重污名化和抑郁症状评分均低于女生,差异均有统计学意义(P值均 < 0.01)。不同年龄组青少年BMI Z评分、体重污名化和抑郁症状评分差异均有统计学意义,不同主观社会地位青少年体重污名化和抑郁症状评分差异均有统计学意义; 独生子女的BMI Z评分高于非独生子女,抑郁症状评分低于非独生子女,差异均有统计学意义(P值均 < 0.01)。见表1。
T2时青少年BMI Z评分、体重污名化、抑郁症状评分分别为(0.48±1.27)(0.15±0.47)(12.19±11.5)分。青少年BMI Z评分、体重污名化及抑郁症状评分在2个时间点之间均有自相关性(r值分别为0.88,0.48,0.51,P值均 < 0.01)。在横截面层面,青少年BMI Z评分与同期体重污名化评分均呈正相关(T1:r=0.32,T2:r=0.30),体重污名化与抑郁症状评分也均呈正相关(T1:r=0.26,T2:r=0.26)(P值均 < 0.01)。在纵向层面,T1青少年的BMI Z评分与T2青少年的体重污名化评分呈正相关(r=0.29),T1体重污名化评分与T2抑郁症状评分亦呈正相关(r=0.16)(P值均 < 0.01)。
结果显示,模型1拟合指数表现一般(χ2=810.67,df=6, RMSEA=0.085, CFI=0.981)。模型2拟合提升(Δχ2=604.63,P < 0.01),表明新增路径能够解释跨时变化。模型3提升了模型拟合(χ2=12.65, RMSEA=0.017,CFI=1.000;Δχ2=193.39, P < 0.01)。总体看模型3展现出最佳拟合效果,支持变量间存在双向交叉滞后关系。基于模型3,以性别、年龄、主观社会地位与是否独生子女为协变量,构建协变量调整模型(图1),结果显示,T1青少年的BMI Z评分可正向预测T2的体重污名化(β=0.061),T1青少年的体重污名化进一步预测T2的抑郁症状(β=0.608)(P值均 < 0.01)。在反向路径中,T1青少年的抑郁症状可正向预测T2的体重污名化(β=0.003),T1青少年的体重污名化也正向预测T2的BMI Z评分(β=0.081)(P值均 < 0.01)。
本研究基于大样本纵向数据,采用交叉滞后模型,探讨了青少年BMI Z评分、体重污名化与抑郁症状的动态关系,发现三者表现出有统计学意义的时间稳定性,BMI Z评分可通过体重污名化间接预测后续抑郁症状水平,抑郁症状亦可通过增强污名化体验进一步影响个体BMI Z评分,提示三者存在双向动态机制。具体而言,T1较高的BMI Z评分可正向预测T2的体重污名化,支持高BMI个体更易遭受负面评价并内化为污名感知的观点[14-15]。体重污名化作为一种社会心理压力源,易导致自我认同受损和情绪低落,为后续抑郁症状的发生提供精神基础[16-17]。进一步分析发现,T1体重污名化正向预测T2的抑郁症状,提示高BMI青少年可能因感知更多体重负面评价而更易发展为情绪困扰。此外,T1抑郁症状可通过T2体重污名化影响T2时BMI Z评分,表明初始心理状态不仅是体重问题的结果,也可能成为前因。抑郁症状个体往往更敏感于社会评价,易内化负性体验并发展不良健康行为,进而促成体重增加[18]。
结果提示,BMI、体重污名化与抑郁症状之间可能构成一种双向循环。既往研究支持抑郁症状与肥胖之间存在双向关联[19]。既往荟萃分析显示,抑郁症状青少年肥胖的风险增加了70%,而肥胖青少年患抑郁症的风险增加了40%[9]。Tomiyama[20]提出的“循环肥胖/体重污名”模型指出,体重污名作为慢性社会压力源,可通过诱发个体的皮质醇水平升高和负性情绪体验,促发进食失调、运动回避等不良行为反应,进而导致体重进一步上升。本研究在该模型基础上,进一步揭示体重、体重污名化与抑郁症状的动态交互。
协变量分析显示,女生BMI Z评分虽然较低,但体重污名化和抑郁症状水平更高,反映性别社会角色对体型期待及自我评价的影响[21]。主观社会地位较低者亦显示出更高的体重污名化与抑郁症状水平[22],提示未来干预应注重群体差异。
本研究也存在一定局限性:自评量表可能引发社会期望偏差、观测时点有限,且部分潜在变量未能纳入模型。未来研究可延长随访周期并完善协变量控制,进一步提升因果推断力和解释效度。
  • “十四五”国家重点研发计划项目(2024YFC3308300)
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2025年第46卷第9期
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doi: 10.16835/j.cnki.1000-9817.2025286
  • 接收时间:2025-04-29
  • 首发时间:2026-11-06
  • 出版时间:2025-09-25
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  • 收稿日期:2025-04-29
  • 修回日期:2025-05-30
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“十四五”国家重点研发计划项目(2024YFC3308300)
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    1北京大学公共卫生学院/北京大学儿童青少年卫生研究所,北京 100191
    2华中师范大学心理学院
    3内蒙古自治区疾病预防控制中心学校卫生科

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