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Article(id=1325533153703776901, tenantId=1146029695717560320, journalId=1256213402557890569, issueId=1325531848021140417, articleNumber=null, orderNo=null, doi=10.16835/j.cnki.1000-9817.2025320, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1751472000000, receivedDateStr=2025-07-03, revisedDate=1756828800000, revisedDateStr=2025-09-03, acceptedDate=null, acceptedDateStr=null, onlineDate=1793961331058, onlineDateStr=2026-11-06, pubDate=1764000000000, pubDateStr=2025-11-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793961331058, onlineIssueDateStr=2026-11-06, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793961331058, creator=13701087609, updateTime=1793961331058, updator=13701087609, issue=Issue{id=1325531848021140417, tenantId=1146029695717560320, journalId=1256213402557890569, year='2025', volume='46', issue='11', pageStart='1521', pageEnd='1672', issueExtLink='null', onlineDate='null', pubDate='1764000000000', pubDateStr='2025-11-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793961019759, creator='13701087609', updateTime=1793961019759, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=1640, endPage=1644, ext={EN=ArticleExt(id=1325533161878475398, articleId=1325533153703776901, tenantId=1146029695717560320, journalId=1256213402557890569, language=EN, title=Association of sleep and screen time with coexistence of screening myopia and depressive symptom among primary and secondary school students, columnId=1325500884406379444, journalTitle=Chinese Journal of School Health, columnName=Disease Control, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the prevalence of screening myopia and depressive symptom among primary and secondary school students in Xuzhou, and to explore the association of sleep and screen time on the coexistence of screening myopia and depressive symptom, so as to provide scientific references for developing intervention strategies to address the development of myopia and promote mental health in children and adolescents.

Methods

From September to October 2024, a stratified cluster random sampling method was used to select 6 605 students in grade 4 to 12 in 2 urban and 2 suburban districts in Xuzhou. The students' health condition and influencing factors questionnaire were used to assess students' basic information, sleep time, and screen time. The Center for Epidemiological Studies Depression Scale (CES-D) was used to assess primary and secondary school students' depressive symptom.Unaided distance visual acuity examination was conducted, and refractive assessment was performed using an automated refractometer without cycloplegic agents. The Chi-square test and multiple Logistic regression analysis were used to evaluate the association of sleep and screen time with the coexistence of screening myopia and depressive symptom.

Results

The detection rates of screening myopia, depressive symptom, and screening myopia and depressive symptoms co-morbidity among primary and secondary school students in Xuzhou were 60.35%, 4.45% and 18.61% respectively. Results from the multinomial Logistic regression analysis, using the healthy group as the reference and after adjusting for confounding factors, showed that students with insufficient sleep duration were more likely to have depressive symptom (OR=1.57, 95%CI=1.08-2.27) and the coexistence of screening myopia and depressive symptom (OR=1.85, 95%CI=1.45-2.36). Students with daily screen time≥2 h were more likely to have depressive symptom only (OR=1.41, 95%CI=1.04-1.93) and the coexistence of screening myopia and depressive symptom (OR=1.31, 95%CI=1.06-1.61). Further stratified analysis based on sufficient and insufficient sleep duration revealed that only in the insufficient sleep duration group, students with daily screen time≥2 h had an increased risk of depressive symptom only (OR=1.49, 95%CI=1.07-2.07) and the coexistence of screening positive myopia and depressive symptom (OR=1.40, 95%CI=1.11-1.77) (all P < 0.05).

Conclusions

Primary and secondary school students with insufficient sleep duration and daily screen time≥2 h have higher risks of depressive symptoms and the coexistence of screening myopia and depressive symptoms. It is recommended to ensure adequate sleep duration and limit screen time for children and adolescents.

, authors=Shuang ZHAI, Shenghao MIAO, Mengxing SHI, Yang ZHANG, Jiarui QI, Jiaan LI, Pei CHENG, Juan ZHANG*, authorsList=Shuang ZHAI, Shenghao MIAO, Mengxing SHI, Yang ZHANG, Jiarui QI, Jiaan LI, Pei CHENG, Juan ZHANG, authorCompany=null, correspAuthors=Juan ZHANG, 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=1325533166223774343, articleId=1325533153703776901, tenantId=1146029695717560320, journalId=1256213402557890569, language=CN, title=中小学生不同睡眠视屏时间与筛查性近视和抑郁症状共存的关联, columnId=1325500884628677558, journalTitle=中国学校卫生, columnName=疾病控制, runingTitle=null, highlight=null, articleAbstract=
目的

了解徐州市中小学生筛查性近视和抑郁症状现况，探讨睡眠时间和视屏时间与中小学生筛查性近视和抑郁症状共存的关联，为制定儿童青少年近视发生发展及促进心理健康的干预策略和措施提供科学参考。

方法

2024年9—10月，采用分层整群随机抽样方法，在徐州市2个城区和2个郊县中共抽取6 605名四至十二年级学生进行调查，采用学生健康状况及影响因素调查表调查中小学生基本信息、睡眠时间和视屏时间等，使用流调中心抑郁量表(CES-D)评估抑郁症状，采用裸眼远视力检查和非睫状肌麻痹状态下使用电脑验光仪进行屈光检测。采用χ2检验和多分类Logistic回归分析评估睡眠时间、视屏时间与中小学生筛查性近视和抑郁症状的关联。

结果

徐州市中小学生仅筛查性近视检出率为60.35%，仅抑郁症状的检出率为4.45%，筛查性近视和抑郁症状共存的检出率为18.61%。多分类Logistic回归分析结果显示，以健康组为参照，调整混杂因素后，睡眠时间不足的中小学生更易出现抑郁症状(OR=1.57，95%CI=1.08~2.27)和筛查性近视抑郁症状共存(OR=1.85，95%CI=1.45~2.36)，每天视屏时间≥2 h的中小学生更易出现抑郁症状(OR=1.41，95%CI=1.04~1.93)和筛查性近视抑郁症状共存(OR=1.31，95%CI=1.06~1.61)；进一步按睡眠时间充足和不足分层分析发现，仅在睡眠时间不足组中，每天视屏时间≥2 h的中小学生发生抑郁症状(OR=1.49，95%CI=1.07~2.07)、筛查性近视抑郁症状共存(OR=1.40，95%CI=1.11~1.77)的风险增加(P值均＜0.05)。

结论

睡眠时间不足且每天视屏时间≥2 h的中小学生抑郁症状以及筛查性近视和抑郁症状共存的发生风险更高，应保证儿童青少年充足的睡眠时长并限制视屏使用时长。

, authors=翟爽, 苗升浩, 时梦醒, 张洋, 祁家瑞, 李加安, 程佩, 张娟*, authorsList=翟爽, 苗升浩, 时梦醒, 张洋, 祁家瑞, 李加安, 程佩, 张娟, authorCompany=null, correspAuthors=张娟, authorNote=

翟爽(1997-)，女，江苏泗阳人，硕士，医师，主要研究方向为儿童青少年健康

, correspAuthorsNote=
张娟，E-mail:
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Invest Ophthalmol Vis Sci, 2020, 61(3): 37., articleTitle=null, refAbstract=null)], funds=[Fund(id=1325533237988315859, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325533153703776901, awardId=null, language=CN, fundingSource=徐州市科技创新项目重点研发计划(社会发展)(KC23226), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1325533168924906121, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325533153703776901, xref=null, ext=[AuthorCompanyExt(id=1325533169268839050, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325533153703776901, companyId=1325533168924906121, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Food Safety and School Health Department, Xuzhou Center for Disease Control and Prevention Affiliated to Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China), AuthorCompanyExt(id=1325533169562440331, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325533153703776901, companyId=1325533168924906121, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=徐州医科大学附属徐州市疾病预防控制中心食品安全与学校卫生科，江苏 221000)])], figs=[ArticleFig(id=1325533230807667404, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325533153703776901, language=EN, label=Tab.1, caption=

Comparison of detection rates of screening myopia and depressive symptom among primary and secondary school students with different groups

, figureFileSmall=null, figureFileBig=null, tableContent=
组别选项人数筛查性近视和
抑郁症状共存		χ2值P值
性别男3 463532(15.36)90.99＜0.01
女3 142697(22.18)
学段小学1 994211(10.58)422.55＜0.01
初中2 049357(17.42)
高中2 562661(25.80)
曾吸烟否6 1901 085(17.53)118.99＜0.01
是415144(34.70)
曾饮酒否5 483865(15.78)218.48＜0.01
是1 122364(32.44)
中高强度体力活动是968142(14.67)26.76＜0.01
否5 6371 087(19.28)
户外活动充足1 987296(14.90)29.05＜0.01
不足4 618933(20.20)
健康饮食是39028(7.18)49.37＜0.01
否6 2151 201(19.32)
每天放学后写作业或＜24 575767(16.77)62.14＜0.01
读书时间/h≥22 030462(22.76)
每天视屏时间/h＜25 054845(16.72)64.96＜0.01
≥21 551384(24.76)
睡眠时间充足1 185127(10.72)71.14＜0.01
不足5 4201 102(20.33)
), ArticleFig(id=1325533231814300366, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325533153703776901, language=CN, label=表1, caption=

不同组别中小学生筛查性近视和抑郁症状共存检出率比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别选项人数筛查性近视和
抑郁症状共存		χ2值P值
性别男3 463532(15.36)90.99＜0.01
女3 142697(22.18)
学段小学1 994211(10.58)422.55＜0.01
初中2 049357(17.42)
高中2 562661(25.80)
曾吸烟否6 1901 085(17.53)118.99＜0.01
是415144(34.70)
曾饮酒否5 483865(15.78)218.48＜0.01
是1 122364(32.44)
中高强度体力活动是968142(14.67)26.76＜0.01
否5 6371 087(19.28)
户外活动充足1 987296(14.90)29.05＜0.01
不足4 618933(20.20)
健康饮食是39028(7.18)49.37＜0.01
否6 2151 201(19.32)
每天放学后写作业或＜24 575767(16.77)62.14＜0.01
读书时间/h≥22 030462(22.76)
每天视屏时间/h＜25 054845(16.72)64.96＜0.01
≥21 551384(24.76)
睡眠时间充足1 185127(10.72)71.14＜0.01
不足5 4201 102(20.33)
), ArticleFig(id=1325533232611218127, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325533153703776901, language=EN, label=Tab.2, caption=

Association of sleep duration and screen time with screening myopia and depressive symptoms among primary and secondary school students[OR(95%CI), n=6 605]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量选项模型1模型2
仅抑郁症状组仅筛查性近视组筛查性近视和抑郁症状共存组仅抑郁症状组仅筛查性近视组筛查性近视和抑郁症状共存组
睡眠时间充足1.001.001.001.001.001.00
不足1.80(1.25~2.59)**1.17(0.99~1.38)2.46(1.95~3.10)**1.57(1.08~2.27)*1.03(0.87~1.22)1.85(1.45~2.36)**
每天视屏时间/h＜21.001.001.001.001.001.00
≥21.75(1.30~2.36)**1.27(1.07~1.50)**2.02(1.67~2.46)**1.41(1.04~1.93)*1.01(0.84~1.21)1.31(1.06~1.61)*
), ArticleFig(id=1325533233525576400, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325533153703776901, language=CN, label=表2, caption=

睡眠和视屏时间与中小学生筛查性近视和抑郁症状共存的关联[OR值(95%CI)，n=6 605]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量选项模型1模型2
仅抑郁症状组仅筛查性近视组筛查性近视和抑郁症状共存组仅抑郁症状组仅筛查性近视组筛查性近视和抑郁症状共存组
睡眠时间充足1.001.001.001.001.001.00
不足1.80(1.25~2.59)**1.17(0.99~1.38)2.46(1.95~3.10)**1.57(1.08~2.27)*1.03(0.87~1.22)1.85(1.45~2.36)**
每天视屏时间/h＜21.001.001.001.001.001.00
≥21.75(1.30~2.36)**1.27(1.07~1.50)**2.02(1.67~2.46)**1.41(1.04~1.93)*1.01(0.84~1.21)1.31(1.06~1.61)*
), ArticleFig(id=1325533234590929617, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325533153703776901, language=EN, label=Tab.3, caption=

Association of screen time with screening myopia and depressive symptoms for different sleep duration among primary and secondary school students[OR(95%CI)]

, figureFileSmall=null, figureFileBig=null, tableContent=
睡眠时间每天视屏时间/h模型1模型2
仅抑郁症状组仅筛查性近视组筛查性近视和抑郁症状共存组仅抑郁症状组仅筛查性近视组筛查性近视和抑郁症状共存组
充足＜21.001.001.001.001.001.00
(n=1 185)≥21.38(0.63~3.03)1.29(0.90~1.85)1.77(1.08~2.91)*1.08(0.47~2.48)0.96(0.66~1.41)1.01(0.59~1.74)
不足＜21.001.001.001.001.001.00
(n=5 420)≥21.83(1.33~2.53)**1.27(1.04~1.54)*2.08(1.68~2.58)**1.49(1.07~2.07)*1.03(0.84~1.26)1.40(1.11~1.77)**
), ArticleFig(id=1325533236348342994, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325533153703776901, language=CN, label=表3, caption=

不同睡眠时间下视屏时间与中小学生筛查性近视和抑郁症状共存的关联[OR值(95%CI)]

, figureFileSmall=null, figureFileBig=null, tableContent=
睡眠时间每天视屏时间/h模型1模型2
仅抑郁症状组仅筛查性近视组筛查性近视和抑郁症状共存组仅抑郁症状组仅筛查性近视组筛查性近视和抑郁症状共存组
充足＜21.001.001.001.001.001.00
(n=1 185)≥21.38(0.63~3.03)1.29(0.90~1.85)1.77(1.08~2.91)*1.08(0.47~2.48)0.96(0.66~1.41)1.01(0.59~1.74)
不足＜21.001.001.001.001.001.00
(n=5 420)≥21.83(1.33~2.53)**1.27(1.04~1.54)*2.08(1.68~2.58)**1.49(1.07~2.07)*1.03(0.84~1.26)1.40(1.11~1.77)**
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中小学生不同睡眠视屏时间与筛查性近视和抑郁症状共存的关联
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翟爽 , 苗升浩 , 时梦醒 , 张洋 , 祁家瑞 , 李加安 , 程佩 , 张娟 *
中国学校卫生 | 疾病控制 2025,46(11): 1640-1644
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中国学校卫生 |疾病控制 2025 , 46 (11) : 1640 -1644
中小学生不同睡眠视屏时间与筛查性近视和抑郁症状共存的关联
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翟爽, 苗升浩, 时梦醒, 张洋, 祁家瑞, 李加安, 程佩, 张娟*
作者信息
  • 徐州医科大学附属徐州市疾病预防控制中心食品安全与学校卫生科，江苏 221000
通讯作者:
张娟，E-mail:
作者简介:

翟爽(1997-)，女，江苏泗阳人，硕士，医师，主要研究方向为儿童青少年健康

Association of sleep and screen time with coexistence of screening myopia and depressive symptom among primary and secondary school students
Shuang ZHAI, Shenghao MIAO, Mengxing SHI, Yang ZHANG, Jiarui QI, Jiaan LI, Pei CHENG, Juan ZHANG*
Affiliations
  • Food Safety and School Health Department, Xuzhou Center for Disease Control and Prevention Affiliated to Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
出版时间: 2025-11-25 doi: 10.16835/j.cnki.1000-9817.2025320
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摘要
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目的

了解徐州市中小学生筛查性近视和抑郁症状现况，探讨睡眠时间和视屏时间与中小学生筛查性近视和抑郁症状共存的关联，为制定儿童青少年近视发生发展及促进心理健康的干预策略和措施提供科学参考。

方法

2024年9—10月，采用分层整群随机抽样方法，在徐州市2个城区和2个郊县中共抽取6 605名四至十二年级学生进行调查，采用学生健康状况及影响因素调查表调查中小学生基本信息、睡眠时间和视屏时间等，使用流调中心抑郁量表(CES-D)评估抑郁症状，采用裸眼远视力检查和非睫状肌麻痹状态下使用电脑验光仪进行屈光检测。采用χ2检验和多分类Logistic回归分析评估睡眠时间、视屏时间与中小学生筛查性近视和抑郁症状的关联。

结果

徐州市中小学生仅筛查性近视检出率为60.35%，仅抑郁症状的检出率为4.45%，筛查性近视和抑郁症状共存的检出率为18.61%。多分类Logistic回归分析结果显示，以健康组为参照，调整混杂因素后，睡眠时间不足的中小学生更易出现抑郁症状(OR=1.57，95%CI=1.08~2.27)和筛查性近视抑郁症状共存(OR=1.85，95%CI=1.45~2.36)，每天视屏时间≥2 h的中小学生更易出现抑郁症状(OR=1.41，95%CI=1.04~1.93)和筛查性近视抑郁症状共存(OR=1.31，95%CI=1.06~1.61)；进一步按睡眠时间充足和不足分层分析发现，仅在睡眠时间不足组中，每天视屏时间≥2 h的中小学生发生抑郁症状(OR=1.49，95%CI=1.07~2.07)、筛查性近视抑郁症状共存(OR=1.40，95%CI=1.11~1.77)的风险增加(P值均＜0.05)。

结论

睡眠时间不足且每天视屏时间≥2 h的中小学生抑郁症状以及筛查性近视和抑郁症状共存的发生风险更高，应保证儿童青少年充足的睡眠时长并限制视屏使用时长。

睡眠  /  时间  /  注视  /  眼  /  近视  /  抑郁  /  共病现象  /  学生
Objective

To explore the prevalence of screening myopia and depressive symptom among primary and secondary school students in Xuzhou, and to explore the association of sleep and screen time on the coexistence of screening myopia and depressive symptom, so as to provide scientific references for developing intervention strategies to address the development of myopia and promote mental health in children and adolescents.

Methods

From September to October 2024, a stratified cluster random sampling method was used to select 6 605 students in grade 4 to 12 in 2 urban and 2 suburban districts in Xuzhou. The students' health condition and influencing factors questionnaire were used to assess students' basic information, sleep time, and screen time. The Center for Epidemiological Studies Depression Scale (CES-D) was used to assess primary and secondary school students' depressive symptom.Unaided distance visual acuity examination was conducted, and refractive assessment was performed using an automated refractometer without cycloplegic agents. The Chi-square test and multiple Logistic regression analysis were used to evaluate the association of sleep and screen time with the coexistence of screening myopia and depressive symptom.

Results

The detection rates of screening myopia, depressive symptom, and screening myopia and depressive symptoms co-morbidity among primary and secondary school students in Xuzhou were 60.35%, 4.45% and 18.61% respectively. Results from the multinomial Logistic regression analysis, using the healthy group as the reference and after adjusting for confounding factors, showed that students with insufficient sleep duration were more likely to have depressive symptom (OR=1.57, 95%CI=1.08-2.27) and the coexistence of screening myopia and depressive symptom (OR=1.85, 95%CI=1.45-2.36). Students with daily screen time≥2 h were more likely to have depressive symptom only (OR=1.41, 95%CI=1.04-1.93) and the coexistence of screening myopia and depressive symptom (OR=1.31, 95%CI=1.06-1.61). Further stratified analysis based on sufficient and insufficient sleep duration revealed that only in the insufficient sleep duration group, students with daily screen time≥2 h had an increased risk of depressive symptom only (OR=1.49, 95%CI=1.07-2.07) and the coexistence of screening positive myopia and depressive symptom (OR=1.40, 95%CI=1.11-1.77) (all P < 0.05).

Conclusions

Primary and secondary school students with insufficient sleep duration and daily screen time≥2 h have higher risks of depressive symptoms and the coexistence of screening myopia and depressive symptoms. It is recommended to ensure adequate sleep duration and limit screen time for children and adolescents.

Sleep  /  Time  /  Fixation  /  ocular  /  Myopia  /  Depression  /  Comorbidity  /  Students
翟爽, 苗升浩, 时梦醒, 张洋, 祁家瑞, 李加安, 程佩, 张娟. 中小学生不同睡眠视屏时间与筛查性近视和抑郁症状共存的关联. 中国学校卫生, 2025 , 46 (11) : 1640 -1644 . DOI: 10.16835/j.cnki.1000-9817.2025320
Shuang ZHAI, Shenghao MIAO, Mengxing SHI, Yang ZHANG, Jiarui QI, Jiaan LI, Pei CHENG, Juan ZHANG. Association of sleep and screen time with coexistence of screening myopia and depressive symptom among primary and secondary school students[J]. Chinese Journal of School Health, 2025 , 46 (11) : 1640 -1644 . DOI: 10.16835/j.cnki.1000-9817.2025320
正文
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我国儿童青少年近视流行率居世界前位，且逐年攀升，形势严峻；近视不仅影响儿童青少年日常学习和生活质量，还会增加未来患白内障、黄斑病变和视网膜脱落等疾病的风险，已成为重要的公共卫生问题[1-2]。青春期是儿童青少年近视快速发展的重要阶段，并且这一时期也是其生理和心理快速发展和变化的阶段，较易出现心理健康问题[3]。研究证实，近视的儿童青少年更容易出现抑郁等心理健康问题，若不积极进行干预，不仅影响其身体健康、人际关系、学业等，还会增加成年后疾病风险和负担，降低生活质量[4-5]。有研究表明，儿童青少年睡眠质量下降与近视和抑郁风险增加相关[6-8]。一项系统综述表明，儿童青少年过多的视屏时间更易出现心理健康问题[9]。视屏行为和睡眠问题可能是改变儿童青少年筛查性近视和抑郁症状的共同影响因素，因此，本研究旨在探讨睡眠时间和视屏时间的联合暴露与中小学生筛查性近视及抑郁症状的关联，为制定预防儿童青少年筛查性近视发生发展及促进心理健康的干预策略提供科学参考。
1　对象与方法
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1.1　对象
于2024年9—10月，采用分层整群随机抽样方法在徐州市2个城区和2个郊县中抽取四至十二年级中小学生，每个城区采用直接抽选法选取2所小学、2所初中、2所普通高中和1所职业高中，每个郊县采用直接抽选法选取2所小学、2所初中和2所普通高中，以班级为单位，每所学校各个年级采用直接抽选法抽取1~2个班级的全部学生，保证每个年级不少于80名学生参与调查，其中一至三年级小学生不参与问卷调查；排除不同意参与或患有眼部疾病者，最终发放问卷6 785份，剔除数据不全者，回收有效问卷6 605份，有效率97.35%。其中男生3 463名，女生3 142名，平均年龄(13.94±2.72)岁。调查前已取得所有家长和学生知情同意。研究已通过徐州市疾病预防控制中心伦理委员会的审查(批号：ZYSH20230147)。
1.2　方法
1.2.1　问卷调查
采用2024年江苏省学生常见病和健康影响因素监测与干预工作手册中的学生健康状况及影响因素调查表(小学版)和(中学版)进行调查[10]，调查对象在学校机房完成电子问卷，调查内容包括一般人口学特征(性别、学段等)、吸烟饮酒情况、体力活动强度、户外活动时长、饮食相关行为、放学后做作业或读书写字时间、视屏行为时长和睡眠时长等。
1.2.2　视力检查
按照中小学生屈光不正筛查规范(WS/T 663—2020)的要求[11]进行视力检查，由专业眼科医师对中小学生进行裸眼远视力检查，在学生非睫状肌麻痹状态下使用电脑验光仪进行屈光检查，当双眼任意一只眼裸眼远视力＜5.0且等效球镜度数＜-0.50 D时，判定为筛查性近视。
1.2.3　判定标准
通过询问“你是否吸过烟，即使只吸过一两口？”评估中小学生曾吸烟情况，询问“你是否喝过一整杯酒？(相当于一听啤酒、一小盅白酒、一杯葡萄酒或黄酒)”评估中小学生曾饮酒情况[10]。中高强度体力活动定义为过去7 d每天至少进行60 min心跳加快或者气喘吁吁的运动[12]。健康饮食定义为过去7 d里每天都吃早餐、从不吃油炸食物、从不喝含糖饮料、每天至少吃1次新鲜水果(不包括水果罐头)、每天至少吃2种蔬菜(生熟均算)[13]。每天放学后做作业或读书时间≥2 h为课后作业时间过长[13]。睡眠时长充足为小学生、初中生和高中生每天睡眠时长分别≥10，9和8 h，户外活动充足为每天户外活动时间≥2 h[14]。每天视屏行为时间≥2 h为视屏时间过长[15]。
使用流调中心抑郁量表(Center for Epidemiological Studies Depression Scale，CES-D)调查中小学生抑郁症状情况，共有20个条目，除第4，8，12，16题为反向计分外，其他题采用正向计分，回答采用4级分制(正向计分：“没有或偶尔”=0至“多数时间或持续”=3；反向计分：“多数时间或持续”=0至“没有或偶尔”=3)，得分范围为0~60分，分数越高表示抑郁症状程度越高。按照总分＜16分为无抑郁症状，≥16分为有抑郁症状进行划分[16]；该量表的Cronbach α系数为0.86，KMO值为0.95，信效度较好。不存在抑郁症状和筛查性近视者为健康组，存在抑郁症状且无筛查性近视者为仅抑郁症状组，存在筛查性近视且无抑郁症状者为仅筛查性近视组，同时存在筛查性近视和抑郁症状者界定为筛查性近视和抑郁症状共存组。
1.3　质量控制
现场调查员统一进行技能培训和考核，熟练掌握检测方法，对专业机构及人员资质进行审核，视力检查由眼科医师、眼视光相关专业知识的技师、护士或学校卫生领域专业人员组成。学生在学校机房进行现场电子问卷填写，问卷设有多项逻辑校验，需依次作答每个题目，数字填空题设有取值范围。填写问卷前调查员统一向学生说明调查目的和注意事项，问卷填写过程中调查员及时解答疑问，同时选取5%的学生进行现场视力检查复核，确保监测质量。
1.4　统计学分析
采用SPSS 24.0软件分析数据，分类变量使用频数和率描述，采用χ2检验比较不同人口统计学特征中小学生筛查性近视和抑郁症状共存的检出率，使用多分类Logistic回归模型评估睡眠时间、视屏时间与中小学生筛查性近视和抑郁症状的关联；再进一步按睡眠时间是否充足分层分析视屏时间与中小学生筛查性近视和抑郁症状共存的关联。双侧检验水准α=0.05。
2　结果
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2.1　不同组别中小学生筛查性近视和抑郁症状及共存检出率
中小学生仅筛查性近视的检出率为60.35%(3 986名)，仅抑郁症状的检出率为4.45%(294名)，筛查性近视和抑郁症状共存的检出率为18.61%(1 229名)。不同性别、学段、户外活动、放学后写作业或读书时间、睡眠时间、视屏时间及是否曾吸烟、饮酒、中高强度体力活动、健康饮食的中小学生筛查性近视和抑郁症状共存检出率差异均有统计学意义(P值均＜0.01)。见表1。
2.2　睡眠和视屏时间与中小学生筛查性近视和抑郁症状共存的关联
多分类Logistic回归分析结果显示，睡眠时间不足的中小学生更易出现抑郁症状(OR=1.80)、筛查性近视和抑郁症状共存(OR=2.46)，每天视屏时间≥2 h的中小学生更易出现抑郁症状(OR=1.75)、筛查性近视(OR=1.27)、筛查性近视和抑郁症状共存(OR=2.02)(P值均＜0.01)。进一步调整性别、学段、曾吸烟、曾饮酒、体力活动、户外活动、健康饮食、放学后写作业或读书时间等协变量后，睡眠时间不足的中小学生出现抑郁症状(OR=1.57)及筛查性近视和抑郁症状共存(OR=1.85)的可能性更高，每天视屏时间≥2 h的中小学生更易出现抑郁症状(OR=1.41)及筛查性近视和抑郁症状共存(OR=1.31)(P值均＜0.05)。见表2。
2.3　不同睡眠时间下视屏时间与中小学生筛查性近视和抑郁症状共存的关联
按睡眠时间充足和不足进行分层，在调整性别、学段、曾吸烟、曾饮酒、体力活动、户外活动、健康饮食、放学后做作业或读书时间等协变量后，仅在睡眠时间不足组中，中小学生每天视屏时间≥2 h与抑郁症状(OR=1.49)及筛查性近视和抑郁症状共存(OR=1.40)的发生风险增加有关(P值均＜0.05)。见表3。
3　讨论
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本次调查结果显示，徐州市中小学生筛查性近视和抑郁症状共存的检出率为18.61%，与李俊同等[13]调查南京市中小学生的检出率(18.11%)相似。女生筛查性近视和抑郁症状共存的检出率高于男生，与其他研究结果一致[17-18]，可能是与男生相比，女生近距离用眼时间长、户外活动较少、青春期时更为敏感、容易受外界压力刺激等有关[19-20]。高中学段的筛查性近视和抑郁症状共存检出率最高，可能与该学段学业任务繁重、学业压力大、视屏时间长等密切相关[9]。每天放学后写作业或读书时间≥2 h的中小学生筛查性近视和抑郁症状共存检出率更高，可能是由于过长的课后作业时间会增加中小学生近距离用眼和久坐时间、压缩户外活动时间、加重课业负担等有关[21]。
本研究发现，中小学生睡眠时间不充足、每天视屏时间≥2 h是抑郁症状、筛查性近视和抑郁症状共存的风险因素，与既往研究结果一致[13, 22-23]。系统综述阐明，儿童青少年同时满足每天视屏时间＜2 h和睡眠时间充足的推荐标准，与良好心理健康存在正相关[24]。广州市一项调查结果显示，高中生视屏时间和睡眠时间与抑郁症状相关，视屏时间可以通过睡眠时间介导抑郁症状风险增加[25]。中小学生正处于身心快速发展阶段，行为具有较强的可塑性，应倡导儿童青少年避免长时间的视屏行为，保证充足的睡眠，养成良好睡眠和视屏习惯，对其预防筛查性近视和抑郁症状共存发生发展尤为重要。
本研究结果显示每天视屏时间≥2 h与中小学生抑郁症状、筛查性近视和抑郁症状共存呈正向关联，仅在睡眠不足组中有统计学意义。有研究表明，儿童睡眠时间减少对调节情绪和思维的神经递质水平有负面影响，从而增加抑郁等心理健康问题的风险[26]。青少年对数字媒体具有高度敏感性，过度数字媒体使用易导致视屏时间增长，进而可能会影响情绪加工过程相关脑区的活动，从而导致情绪敏感度提高[27]。睡眠时间不足还会导致昼夜节律紊乱，进而影响控制眼球正视化进程的调节机制，从而导致近视风险增加[28]。应保证中小学生每天充足的睡眠，减少视屏时间，关注儿童青少年睡眠时间不足和视屏时间长的联合暴露，从而预防筛查性近视和抑郁症状共存的发生发展，为精准指导儿童青少年筛查性近视和抑郁症状共存防控措施提供科学依据。
本研究还存在一定的局限性：首先，横断面调查无法确定睡眠时间、视屏时间与筛查性近视和抑郁症状共存的因果关系，未来还需要深入的临床和实验研究进一步探讨视屏时间和睡眠时间与筛查性近视和抑郁症状共存的确切机制。其次，以自我报告的形式获取睡眠时间、视屏行为时间和体力活动强度等数据，可能无法避免回忆偏倚，未来可以引入更客观的监测方法，如多导睡眠监测、可穿戴设备加速度传感器等。
基金
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  • 徐州市科技创新项目重点研发计划(社会发展)(KC23226)
文献
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2025年第46卷第11期
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doi: 10.16835/j.cnki.1000-9817.2025320
  • 接收时间：2025-07-03
  • 首发时间：2026-11-06
  • 出版时间：2025-11-25
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  • 收稿日期：2025-07-03
  • 修回日期：2025-09-03
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徐州市科技创新项目重点研发计划(社会发展)(KC23226)
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    徐州医科大学附属徐州市疾病预防控制中心食品安全与学校卫生科，江苏 221000

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