Article(id=1325530133825867957, tenantId=1146029695717560320, journalId=1256213402557890569, issueId=1325530078536553117, articleNumber=null, orderNo=null, doi=10.16835/j.cnki.1000-9817.2025227, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1746460800000, receivedDateStr=2025-05-06, revisedDate=1748361600000, revisedDateStr=2025-05-28, acceptedDate=null, acceptedDateStr=null, onlineDate=1793960611062, onlineDateStr=2026-11-06, pubDate=1758729600000, pubDateStr=2025-09-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793960611062, onlineIssueDateStr=2026-11-06, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793960611062, creator=13701087609, updateTime=1793960611062, 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=1246, endPage=1251, ext={EN=ArticleExt(id=1325530134073331894, articleId=1325530133825867957, tenantId=1146029695717560320, journalId=1256213402557890569, language=EN, title=Evolution and development of mental health policies for children and adolescents in China, columnId=1325530092633608953, journalTitle=Chinese Journal of School Health, columnName=Column on Child and Adolescent Mental Health Promotion, runingTitle=null, highlight=null, articleAbstract=
Objective

To systematically review the development and changes in mental health policies within the National Outline for Children's Development in China from 1992 to 2030, providing a reference basis for future formulation of mental health policies among children and adolescent in China.

Methods

Based on the four editions of the National Outline for Children's Development in China across different periods from 1992 to 2030, word frequency analysis was used to reveal shifts in policy priorities, and an internationally recognized framework for adolescent health policy analysis was applied to conduct a textual review.

Results

Word frequency analysis revealed that the term "psychological" appeared 6 times in the National Outline for Children's Development in China (2001-2010) but increased to 20 times in the National Outline for Children's Development in China (2021-2030) (abbreviated as the National Outline of 2021), while the term "health" rose from 4 times in the National Outline for Children's Development Plan in China in the 1990s to 68 times in the National Outline of 2021. The scope of mental health policy interventions expanded to encompass five key areas: health, safety, education, welfare and legal protection. Textual analysis highlighted that the policies of the National Outline for Children's Development in China were demand-driven, prioritized vulnerable groups and continuously broadened their coverage, emphasizing sustainability and appropriateness, and monitoring/evaluation mechanisms. By 2023, 42.3% of primary schools and 64.8% of secondary schools employed full-time mental health education teachers. However, the National Outline for Children's Development in China lacked direct evidence of children and adolescents participation in policy formulation, and publicly available mental health data disaggregated by age and gender remained limited.

Conclusion

Mental health policies of children and adolescents in China have evolved from nonexistence to gradual refinement, yet institutionalized channels for youth involvement in policy development and evaluation remain insufficient, and transparency in age- and gender-specific mental health data needs improvement.

, authors=Xiaoting GUO1, Juan YANG*, 2, Jiajia DANG1, Jiaxin LI1, Shan CAI1, Tianyu HUANG1, Ziyue SUN1, Yihang ZHANG1, Ruolan YANG1, Yi SONG*, 1, authorsList=Xiaoting GUO, Juan YANG, Jiajia DANG, Jiaxin LI, Shan CAI, Tianyu HUANG, Ziyue SUN, Yihang ZHANG, Ruolan YANG, Yi SONG, authorCompany=null, correspAuthors=Juan YANG, Yi SONG, 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=1325530135675556025, articleId=1325530133825867957, tenantId=1146029695717560320, journalId=1256213402557890569, language=CN, title=中国儿童青少年心理健康政策变迁与发展, 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

系统梳理1992—2030年《中国儿童发展纲要》中心理健康政策的发展与变化,为今后中国儿童青少年心理健康政策的制定提供参考依据。

方法

基于1992—2030年4个时期的《中国儿童发展纲要》,采用词频分析呈现各时期政策关注焦点的演变,并利用国际青少年健康政策分析框架进行文本分析。

结果

词频分析显示,“心理”一词频次从《中国儿童发展纲要(2001—2010)》的6次增至《中国儿童发展纲要(2021—2030)》(简称“2021纲要”)的20次,“健康”一词的频次从《九十年代中国儿童发展规划纲要》的4次增至2021纲要的68次,心理健康政策干预范围也扩展至健康、安全、教育、福利和法律保护五大领域。文本分析显示,《中国儿童发展纲要》政策特征显著,以需求为导向,关注弱势群体,不断扩展覆盖范围,纲要强调政策的可持续性与适当性,重视监测与评估。截至2023年,小学和中学配备专职心理健康教育教师的比例分别达42.3%和64.8%。但《中国儿童发展纲要》缺少儿童青少年参与心理健康政策制定的直接证据,分年龄、性别的心理健康监测数据公开性有限。

结论

中国儿童青少年心理健康政策经历了从无到有、从起步到深化的转变,但儿童青少年直接参与政策制定与评估的制度化渠道仍显不足,分年龄、性别的心理健康数据公开性有限。

, authors=郭晓婷1, 杨娟*, 2, 党佳佳1, 李佳欣1, 蔡珊1, 黄天彧1, 孙子曰1, 张依航1, 杨若澜1, 宋逸*, 1, authorsList=郭晓婷, 杨娟, 党佳佳, 李佳欣, 蔡珊, 黄天彧, 孙子曰, 张依航, 杨若澜, 宋逸, authorCompany=null, correspAuthors=杨娟, 宋逸, authorNote=

郭晓婷(2003-),女,福建莆田人,在读本科,主要研究方向为儿童青少年心理健康

, correspAuthorsNote=
宋逸,E-mail:
杨娟,E-mail:
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郭晓婷(2003-),女,福建莆田人,在读本科,主要研究方向为儿童青少年心理健康

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中国儿童青少年心理健康政策变迁与发展
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郭晓婷 1 , 杨娟 *, 2 , 党佳佳 1 , 李佳欣 1 , 蔡珊 1 , 黄天彧 1 , 孙子曰 1 , 张依航 1 , 杨若澜 1 , 宋逸 *, 1
中国学校卫生 | 儿童青少年心理健康促进专栏 2025,46(9): 1246-1251
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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) : 1246 -1251
中国儿童青少年心理健康政策变迁与发展
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郭晓婷1, 杨娟*, 2 , 党佳佳1, 李佳欣1, 蔡珊1, 黄天彧1, 孙子曰1, 张依航1, 杨若澜1, 宋逸*, 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雄安新区公共卫生服务中心
通讯作者:
宋逸,E-mail:
杨娟,E-mail:
作者简介:

郭晓婷(2003-),女,福建莆田人,在读本科,主要研究方向为儿童青少年心理健康

Evolution and development of mental health policies for children and adolescents in China
Xiaoting GUO1, Juan YANG*, 2 , Jiajia DANG1, Jiaxin LI1, Shan CAI1, Tianyu HUANG1, Ziyue SUN1, Yihang ZHANG1, Ruolan YANG1, Yi SONG*, 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.1000-9817.2025227
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目的

系统梳理1992—2030年《中国儿童发展纲要》中心理健康政策的发展与变化,为今后中国儿童青少年心理健康政策的制定提供参考依据。

方法

基于1992—2030年4个时期的《中国儿童发展纲要》,采用词频分析呈现各时期政策关注焦点的演变,并利用国际青少年健康政策分析框架进行文本分析。

结果

词频分析显示,“心理”一词频次从《中国儿童发展纲要(2001—2010)》的6次增至《中国儿童发展纲要(2021—2030)》(简称“2021纲要”)的20次,“健康”一词的频次从《九十年代中国儿童发展规划纲要》的4次增至2021纲要的68次,心理健康政策干预范围也扩展至健康、安全、教育、福利和法律保护五大领域。文本分析显示,《中国儿童发展纲要》政策特征显著,以需求为导向,关注弱势群体,不断扩展覆盖范围,纲要强调政策的可持续性与适当性,重视监测与评估。截至2023年,小学和中学配备专职心理健康教育教师的比例分别达42.3%和64.8%。但《中国儿童发展纲要》缺少儿童青少年参与心理健康政策制定的直接证据,分年龄、性别的心理健康监测数据公开性有限。

结论

中国儿童青少年心理健康政策经历了从无到有、从起步到深化的转变,但儿童青少年直接参与政策制定与评估的制度化渠道仍显不足,分年龄、性别的心理健康数据公开性有限。

精神卫生  /  卫生政策  /  儿童  /  青少年
Objective

To systematically review the development and changes in mental health policies within the National Outline for Children's Development in China from 1992 to 2030, providing a reference basis for future formulation of mental health policies among children and adolescent in China.

Methods

Based on the four editions of the National Outline for Children's Development in China across different periods from 1992 to 2030, word frequency analysis was used to reveal shifts in policy priorities, and an internationally recognized framework for adolescent health policy analysis was applied to conduct a textual review.

Results

Word frequency analysis revealed that the term "psychological" appeared 6 times in the National Outline for Children's Development in China (2001-2010) but increased to 20 times in the National Outline for Children's Development in China (2021-2030) (abbreviated as the National Outline of 2021), while the term "health" rose from 4 times in the National Outline for Children's Development Plan in China in the 1990s to 68 times in the National Outline of 2021. The scope of mental health policy interventions expanded to encompass five key areas: health, safety, education, welfare and legal protection. Textual analysis highlighted that the policies of the National Outline for Children's Development in China were demand-driven, prioritized vulnerable groups and continuously broadened their coverage, emphasizing sustainability and appropriateness, and monitoring/evaluation mechanisms. By 2023, 42.3% of primary schools and 64.8% of secondary schools employed full-time mental health education teachers. However, the National Outline for Children's Development in China lacked direct evidence of children and adolescents participation in policy formulation, and publicly available mental health data disaggregated by age and gender remained limited.

Conclusion

Mental health policies of children and adolescents in China have evolved from nonexistence to gradual refinement, yet institutionalized channels for youth involvement in policy development and evaluation remain insufficient, and transparency in age- and gender-specific mental health data needs improvement.

Mental health  /  Health policy  /  Child  /  Adolescent
郭晓婷, 杨娟, 党佳佳, 李佳欣, 蔡珊, 黄天彧, 孙子曰, 张依航, 杨若澜, 宋逸. 中国儿童青少年心理健康政策变迁与发展. 中国学校卫生, 2025 , 46 (9) : 1246 -1251 . DOI: 10.16835/j.cnki.1000-9817.2025227
Xiaoting GUO, Juan YANG, Jiajia DANG, Jiaxin LI, Shan CAI, Tianyu HUANG, Ziyue SUN, Yihang ZHANG, Ruolan YANG, Yi SONG. Evolution and development of mental health policies for children and adolescents in China[J]. Chinese Journal of School Health, 2025 , 46 (9) : 1246 -1251 . DOI: 10.16835/j.cnki.1000-9817.2025227
儿童青少年时期是心理健康的脆弱期[1],目前,精神障碍已成为中国儿童青少年致残的首要病因,其疾病负担呈现地域差异和低龄化现象[2-3],该群体心理政策的制定和实施是当前国家健康战略的重大需求[4]。自1992年起,中国每10年发布一次《中国儿童发展纲要》[5-8],该系列文件为儿童健康发展提供了重要的指导。然而,国内尚缺乏基于最新儿童青少年健康政策相关评估工具。2024年,Baird等[4]构建了青少年健康政策分析框架,为政策评估提供了新工具。该分析框架涵盖了政策制定、执行和监测评估的各个阶段,不仅可以有效指导青少年政策的制定,还可以作为一种评估工具,揭示政策实施全周期中影响效果的重要因素。基于该框架,本研究拟以1992—2030年的《中国儿童发展纲要》为基础,对儿童青少年心理政策进行深入分析,为今后相关政策的制定提供有益的参考与依据。
以《九十年代中国儿童发展规划纲要》[5](简称“90年代纲要”)、《中国儿童发展纲要(2001—2010)》[6](简称“2001纲要”)、《中国儿童发展纲要(2011—2020)》[7](简称“2011纲要”)和《中国儿童发展纲要(2021—2030)》[8](简称“2021纲要”)为基础进行政策文本分析。
该框架主要包括政策特征与成本、实施考量、参与式、包容性与覆盖范围、政策适当性、监测与评估6个维度31个指标[4],从政策的制定过程、政策的实施过程、参与主体的发展意愿、政策的普惠性、政策的发展能力、政策的监测评估对政策进行全面分析,有助于对政策作出全面科学的评价,并为未来政策的制定提供方向。
词频分析是通过统计文本中特定词汇出现的频率来揭示主题分布的研究方法[9]。利用Nvivo 12.0软件对4个时期的《中国儿童发展纲要》进行词频分析,将词汇条件设为具有最小长度值2,对自动生成的词频列表进行人工审核,去除纲要中“加强”“执行”等动词、“措施”“结构”等与研究无关的名词和没有意义的虚词后,分析词语出现频次、词频占比及词频排名,其中词频占比表示该词语出现次数占所有词语总出现次数的比例。运用青少年健康政策分析框架,结合Nvivo 12.0软件对4个时期《中国儿童发展纲要》进行词频统计,通过词云图呈现各时期政策关注焦点的演变,分析《中国儿童发展纲要》中心理健康政策的演变与发展。
词频统计结果显示,《中国儿童发展纲要》中与心理健康相关的主题词经历了从无到有的变化,随着词频增加,心理健康也逐渐从健康领域向安全、教育等多领域扩展。90年代纲要集中在解决儿童的生存问题,尚未将心理健康纳入政策视野,“健康”频数为4,词频占比0.29%;“身心”频数为2,词频占比0.14%。2001纲要新增“心理”等主题词,“心理”频数为6,词频占比0.31%;“健康”频数增加到19,词频占比增加到0.98%;“身心”频数增加到6,词频占比增加到0.31%。此后,纲要中的“健康”“身心”“心理”等词的频数不断增加,到2021纲要时“健康”频数增加到68,词频占比增加到1.07%;“心理”频数增加到20,词频占比增加到0.31%。值得注意的是,心理健康相关主题词词频的排名不断上升,90年代纲要“健康”排名为41,“身心”排名为73;2001纲要“健康”排名上升到13,“身心”排名上升到50,“心理”初次出现,排名为50;到2021纲要,“健康”排名上升到10,“心理”排名上升到42。此外,心理健康主题也在不断向更多领域扩展,从2001纲要中局限在健康领域,到2021纲要心理健康已经覆盖健康、安全、教育、福利、法律保护等五大领域,成为贯穿儿童发展全过程的战略性议题。
中国不同发展阶段儿童健康政策的制定、实施、监测与评估等与青少年健康政策分析框架所设置的维度与指标高度契合(图1),具体体现在政策特征与成本、实施考量、参与式、包容性与覆盖范围、政策适当性、监测与评估6个维度方面。
中国儿童发展纲要的政策特征显著,目标层次化、干预措施多元化,强调统一领导、职责划分明确、保障资金投入。纲要在目标和干预措施的制定上充分体现了政策的持续发展能力。目标由2001纲要提出的“促进儿童身心健康发展”到2011纲要的“提高儿童心理健康水平,降低儿童心理行为问题发生率和儿童精神疾病患病率”,再到2021纲要的“增强儿童心理健康服务能力,提升儿童心理健康水平”,不断提高儿童青少年心理健康目标地位[6-8]。在此基础上,不断完善儿童青少年心理健康干预措施,覆盖健康、安全、教育、福利、法律保护等5个领域,通过加强儿童心理健康服务,构建心理健康教育、咨询服务、评估治疗、危机干预和心理援助公共服务网络等为儿童青少年心理健康保驾护航。不同阶段制定的纲要始终由国务院妇女儿童工作委员会领导,各级妇女儿童工作委员会负责组织、协调、指导、督促,地方各级政府负责制定本级儿童发展规划,各级相关部门制定具体实施方案[5-8]。目标责任分解明确主要责任单位和工作职责,建立多部门协同机制[8]。心理健康工作在卫生健康、教育、民政、司法、公安、广电文旅等多个领域产生交叉影响,得到全社会的共同关注。《中国儿童发展纲要》强调加强经费投入,重点支持革命老区、民族地区、边疆地区、欠发达地区,动员社会力量多渠道筹集资源,保障儿童卫生服务的资金投入。2004年起,财政部、卫生部开展“中央补助地方重性精神疾病管理治疗项目”,保障精神卫生工作的专项经费投入[10],为精神障碍患者提供治疗康复服务。此外,中央财政近年来在精神卫生工作上投入累计106亿元,改扩建540余所医疗卫生机构,为600余所医疗卫生机构配置精神专科基本医疗设备[11],通过加强经费投入持续提升精神卫生医疗服务能力和精神障碍人员综合服务管理。
《中国儿童发展纲要》强调多主体协同联动,精准服务需求导向,构建起多维度联动的服务体系。2011纲要提出“政府主导、多部门合作”机制,2021年进一步明确各部门职责,通过卫生、教育、民政等多部门协作细化心理干预措施,并通过联动社会组织、社会工作者形成社区支持网络。《中国儿童发展纲要》不断深化专业化人才培育与技术支持,依托专业培训提升教师、家长及心理咨询人员的早期识别能力。《中国儿童发展纲要》注重响应儿童青少年实际需求,服务供给突出动态适配性,从早期聚焦基本生存保障转向心理健康需求下沉,按需增设学校心理咨询室,针对留守儿童等高风险群体制定精准干预方案[5-8]。政策制定过程融入公众,2020年国务院妇女儿童工作委员会在编制2021纲要时组织了网上征求意见活动,增强了2021纲要的科学性与适配性[8]。
《中国儿童发展纲要》的文本中未呈现参与式的相关内容,缺少儿童青少年参与心理健康政策制定的相关证据,但纲要中以其他相关语义体现了参与式,如“协同”“协作”“共同”“公众”“家庭”“学生”等,并且在纲要中逐渐增加该方面内容[5-8]。此外,2020年《中国儿童发展纲要》制定征集意见时曾提及“听取部门、专家和妇女儿童工作者意见建议,面向广大网民征求意见建议”,通过网上征求意见活动实现了公众参与。2021纲要也明确要进一步提高儿童参与的权利,鼓励和支持儿童参与家庭、社会和文化生活,在法规政策制定、学校社区工作中纳入儿童意见,组织开展社会实践及体验活动,畅通学生参与校务的渠道,加强儿童青少年参与的宣传培训,培养儿童参与的意识和能力,进一步落实儿童参与权[8]。
《中国儿童发展纲要》关注弱势群体,干预措施取得显著成效[12-14]。不同阶段纲要均采取多种措施以消除对女童的歧视,宣传性别平等观念,保障女童平等接受义务教育,对孤儿、事实无人抚养儿童、留守和困境儿童等弱势群体开展针对性干预服务,有效提高弱势群体心理健康服务的可及性。截至2023年底,全国建有儿童之家33.7万所[14]。儿童福利机构增加,更多儿童得到救助。家庭收养孤儿人数增加,孤儿身心更加健康[12-14]。心理健康教育的覆盖范围逐年扩大,2023年小学和中学配备专职心理健康教育教师学校比例分别为42.3%和64.8%,较2022年分别提高了9.1和6.2百分点,中学开展预防艾滋病教育和性教育相关课程和活动的学校比例为96.8%,2022年全年处置网上危害儿童的违法和不良信息462万条[12-14]。
《中国儿童发展纲要》始终立足儿童早期投资,多渠道筹资保障经费,强调对儿童早期发展的持续性投入。根据2011纲要终期统计监测报告:2020年全国学前教育毛入园率达85.2%,较2010年提高28.6百分点;全国共有幼儿园29.2万所,为2010年的1.9倍;全国共有幼儿园专任教师291.3万人,为2010年的2.5倍[15]。《中国儿童发展纲要》注重促进出生缺陷防治领域科技创新和成果转化。根据2023年《中国儿童发展纲要(2021—2030年)》统计监测报告,中国初步建立并不断完善覆盖儿童各阶段的出生缺陷防治体系:2023年,全国婚前医学检查率、孕前优生健康检查目标人群覆盖率分别为76.5%和96.9%,分别比2022年提高了1.7和5.1百分点;产前检查率和产前筛查率分别为98.2%和91.3%,分别提高0.3和2.6百分点;新生儿访视率为97.4%,提高0.7百分点[14]。成本方面,《中国儿童发展纲要》要求各地政府鼓励动员社会力量,多渠道筹集资金,并重点扶持革命老区、民族地区、边疆地区、欠发达地区,不断缩小城乡、不同区域因社会经济发展不平衡带来的区域差距,有力保障政策实施所需经费投入[5-8]。
《中国儿童发展纲要》重视监管,逐步构建数据库,定期开展监测与评估。2001纲要的监测统计指标体系中加入了“提供多种形式儿童心理健康咨询指导及不良心理矫正服务工作评估”这一监测指标,但并未明确具体的量化指标,主要通过“工作评估”形式监测其实施情况,并且缺少监测评估的具体证据;2021年起纲要统计监测报告新增“小学、中学配备专职心理健康教育教师的学校比例”指标[12, 16],在一定程度上填补了中国儿童心理健康统计监测指标的空白。国务院妇女儿童工作委员会不断加强监测评估制度建设,对纲要实施情况进行年度监测、中期评估和终期评估;通过评估掌握纲要实施进展和儿童发展状况,目标任务完成情况,评判纲要策略措施的实施效果,总结经验做法,找出突出问题,预测发展趋势,并提出对策建议[12-17]。
中国儿童青少年心理健康政策经历了从无到有,从初步提出到深入实施的过程,相关干预措施也逐渐具体化、系统化。这些变化反映了中国在儿童发展领域的不断进步和深化,对儿童全面发展需求有了更深入的认识。儿童青少年心理健康政策越来越注重跨部门合作及专业人员的培训,并加强与青少年群体的联系,共同促进儿童青少年心理健康。《中国儿童发展纲要》高度重视公平性和包容性,关注弱势群体,多部门联合、强化开展心理健康专项行动,为增进儿童青少年健康福祉、共建共享健康中国奠定重要基础。随着《中国儿童发展纲要》相关措施的落实,儿童青少年心理健康工作体系得到进一步健全与完善。持续开展监测与评估,使全社会更加关注儿童青少年的身心健康,学生健康体检和体质监测制度不断完善,儿童青少年心理行为发育监测得以加强,儿童青少年心理行为发育健康知识大力普及,有效促进了儿童青少年身心健康发展[17]。
此外,在《中国儿童发展纲要》的基础上,中国多部门联合制定儿童青少年心理健康相关方案,使儿童青少年心理健康相关目标和策略措施得到进一步的补充与完善。2019年国家卫生健康委等十二部门联合制定《健康中国行动——儿童青少年心理健康行动方案(2019—2022年)》[18],基本建成有利于儿童青少年心理健康的社会环境,形成学校、社区、家庭、媒体、医疗卫生机构等联动的心理健康服务模式,落实儿童青少年心理行为问题和精神障碍的预防干预措施,加强重点人群心理疏导。2021年教育部发布《关于加强学生心理健康管理工作的通知》[19],明确中小学及高校心理健康教育专职教师配比数量、心理健康教育培训力度、建立中小学心理辅导室、保障心理健康教育工作基础经费等方面要求。2023年教育部等十七部门联合印发《全面加强和改进新时代学生心理健康工作专项行动计划(2023—2025年)》[20],标志着加强学生心理健康工作上升为国家战略,摆在更加突出、更加重要的位置,并且首次提出“五育并举促进心理健康”理念(以德育心、以智慧心、以体强心、以美润心、以劳健心),为学校开展学生心理健康教育提供了方向和思路。
与中国儿童心理健康政策发展相对应的是,世界各国都在不同程度上关注未成年人心理健康问题。澳大利亚通过政策引领,整合学校、家庭和社会资源,为儿童青少年提供多元化的心理健康支持,同时借助信息化手段促进心理健康服务的普及,以便捷的方式满足儿童青少年的心理健康需求[21]。澳大利亚于2006年开发的headspace中心模型被认为是青少年心理健康保健领域的一种创新和最佳实践[22],主要包括青少年参与、家庭和朋友参与、社区意识、强化可及性、早期干预、适当护理、循证实践、4个核心流、服务整合、支持性过渡等10个服务组件,以及国家网络、领导机构治理、合作机构、多学科工作团队、混合资金、监测和评估等6个支持组件[22],旨在通过打破青少年和新兴成年人面临的服务获取障碍,早期干预12~25岁群体的心理健康问题发展。经充分考虑文化、社会经济和医疗保健系统等方面差异,进行全面的适配性论证和本土化改造,通过政府、专业人员和社会各界的共同努力,headspace模型有望在中国成功应用,为更多青少年提供及时、有效的心理健康支持。如在文化方面,需要更加努力消除社会对心理健康问题的污名化,鼓励家庭、社区等支持儿童青少年寻求心理帮助;在服务模式方面,考虑中国区域广阔,且不同地区经济水平和服务能力差异较大,可灵活调整服务提供模式,以覆盖更多儿童青少年,提高心理健康服务的可及性;在能力建设方面,培训足够多的心理健康专业人员,包括心理学家、咨询师和社会工作者,并提高基层医疗人员识别和处理儿童青少年心理健康问题的能力;在政策制定方面,更加注重儿童青少年的参与,以确保真正以青少年为中心,满足其需求和偏好。
既往研究显示,政策实施过程中无法满足弱势青少年(如失能或残疾青少年)需求可能会导致青少年干预或政策未能达到预期效果[23]。《中国儿童发展纲要》中儿童心理健康发展相关目标、干预措施越来越完善的同时,青少年参与到监测与评估中的直接证据欠缺,尤其是缺少直接使用参与式表述的词汇,而且缺少分年龄、性别开展心理健康监测的公开可及性数据资源。自2001年,儿童参与已被写入纲要中,但并未明确具体程序标准,儿童青少年的参与无法得到制度保障,或许是实践过程中儿童青少年参与缺失的原因之一[6-8]。
心理健康服务的利用情况也面临严峻挑战。基于中国精神卫生调查的横断面调查显示,在1 007名抑郁障碍患者中仅有9.5%接受了心理健康服务,且女性治疗率高于男性、东部地区高于西部地区、城市高于农村,而其中接受充分治疗的比例仅有0.5%[24]。治疗延迟现象尤为突出,研究显示,在接受治疗的精神障碍患者中,半数以上经历了首次治疗延迟[25]。心理健康资源短缺与地区分布差异是影响治疗的重要因素,截至2020年底,中国每10万人口精神科医师数仅为3.55名,且西部地区单位土地面积上的精神卫生资源低于东中部地区,基层服务能力薄弱[24, 26-28]。公众对心理健康的认知不足与污名化态度常常会导致延迟治疗,进一步加剧服务利用障碍[25-26, 29]。一项研究显示,中国国民心理健康素养水平整体偏低,可能导致无法早期识别精神障碍,而70%的被调查者对心理/精神疾病患者存在污名态度,这会使患者倾向选择自我调节或求助于非专业渠道,延误治疗时机[30]。
为提升政策实效性,建议构建“需求-供给-评估”三位一体的儿童青少年心理健康治理体系。在政策制定阶段,通过匿名问卷等方式预调查儿童青少年的真实心理诉求,实现需求导向;增加心理健康资金投入,加强心理健康服务人才培训,开展心理健康教育,提高公众的心理健康认知水平,依托人工智能技术动态调配资源,覆盖服务不足的地区和高风险人群,提高心理健康服务的可及性;定期开展心理健康服务满意度调查,将“服务满意度”等指标纳入地方政府绩效考核框架;同时进一步构建并完善分性别、年龄、地域的多维度心理健康数据库,整合校园筛查、医疗记录及社区服务数据,增强政策评估的精准性,并为政策效果评价提供高质量循证依据[31-32]。
此外,需强化技术赋能,构建心理健康智能化监测平台[33]。(1)首先,通过使用可穿戴设备监测学生生理、行为和社交媒体活动等数据,对学生进行多源多模态数据智能融合分析,构建学生个人心理健康档案。(2)其次,利用传感器网络和人工智能算法,对学生的心率、睡眠和活动量等生理和情绪数据进行实时监测和分析,或与专业机构合作,使用专业心理筛查量表,及时识别其情绪状态。对学生心理健康进行风险预测,如通过分析学生的社交媒体数据,识别其是否存在自杀倾向。(3)最后,根据学生的心理健康状况,提供个性化的干预建议和服务。如为其推荐合适的心理咨询师、心理健康课程等;同时,在网络上提供心理热线电话、心理咨询服务等,便于学生和家长及时寻求心理帮助。
本研究也存在一定的局限性:政策文本分析主要基于《中国儿童发展纲要》,未系统梳理相关灰色文献,可能无法充分反映政策执行的实际情况与实践特征;此外,政策文本分析需要进行一定的主观判断,分析结果可能存在一定的判断偏差。未来可以结合地方性实施政策和多源数据进一步深化分析。
  • 科技部重点研发课题项目(2024YFC2707901)
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2025年第46卷第9期
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doi: 10.16835/j.cnki.1000-9817.2025227
  • 接收时间:2025-05-06
  • 首发时间:2026-11-06
  • 出版时间:2025-09-25
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  • 收稿日期:2025-05-06
  • 修回日期:2025-05-28
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科技部重点研发课题项目(2024YFC2707901)
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雄安新区公共卫生服务中心

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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
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