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Article(id=1325536018027536430, tenantId=1146029695717560320, journalId=1256213402557890569, issueId=1325535161890398372, articleNumber=null, orderNo=null, doi=10.16835/j.cnki.1000-9817.2025372, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1753286400000, receivedDateStr=2025-07-24, revisedDate=1759939200000, revisedDateStr=2025-10-09, acceptedDate=null, acceptedDateStr=null, onlineDate=1793962013966, onlineDateStr=2026-11-06, pubDate=1766592000000, pubDateStr=2025-12-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793962013966, onlineIssueDateStr=2026-11-06, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793962013966, creator=13701087609, updateTime=1793962013966, updator=13701087609, issue=Issue{id=1325535161890398372, tenantId=1146029695717560320, journalId=1256213402557890569, year='2025', volume='46', issue='12', pageStart='1673', pageEnd='1824', issueExtLink='null', onlineDate='null', pubDate='1766592000000', pubDateStr='2025-12-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793961809846, creator='13701087609', updateTime=1793961809846, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=1765, endPage=1770, ext={EN=ArticleExt(id=1325536021441699889, articleId=1325536018027536430, tenantId=1146029695717560320, journalId=1256213402557890569, language=EN, title=Association of sleep quality with co-occurrence of non-suicidal self-injury behavior and depressive symptoms among junior high school students, columnId=1259565855189418448, journalTitle=Chinese Journal of School Health, columnName=Mental Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the association between various components of sleep quality and the co-occurrence of non-suicidal self-injury (NSSI) behaviors and depressive symptoms among junior high school students, so as to provide evidence for targeted prevention strategies of NSSI and depression.

Methods

From May to June 2024, a total of 5 008 junior high school students from 8 schools in 2 districts/counties of Chongqing were selected through a stratified cluster sampling method. The Pittsburgh Sleep Quality Index (PSQI), the Center for Epidemiological Studies Depression Scale (CES-D), and the Adolescent Non-suicidal Self-injury Assessment Questionnaire (ANSAQ) were used to assess sleep quality, depressive symptoms, and NSSI, respectively. Data were analyzed by using the Chi-square test, Bonferroni correction, and multivariate Logistic regression.

Results

Non-NSSI group and depressive symptoms group accounted for 68.11% among junior high school students, NSSI-only group accounted for 4.71%, only depressive symptoms group accounted for 14.94%, and co-occurrence of NSSI and depressive symptoms group accounted for 12.24%. The prevalence of the co-occurrence group was higher in girls (16.39%) than in boys (7.85%) (χ2=84.89, P < 0.01). After controlling for gender, grade, and boarding status etc., multivariate Logistic regression analysis revealed that five sleep components, including subjective sleep quality, sleep latency, sleep duration, sleep disturbances, and daytime dysfunction, were significantly and positively associated with the co-occurrence of NSSI and depressive symptoms (OR=1.30-3.86, all P < 0.05). The strength of association between these components and the co-occurrence group, in descending order, was: daytime dysfunction (OR=2.52), sleep disturbances (OR=2.36), subjective sleep quality (OR=1.76), sleep latency (OR=1.44), and sleep duration (OR=1.22) (all P < 0.01).

Conclusions

The co-occurrence of NSSI and depressive symptoms is prevalent among junior high school students, with girls being more significantly affected. Sleep disturbances and daytime dysfunction may represent particularly important risk factors. Targeted and prioritized intervention strategies addressing specific sleep components should be developed and implemented to reduce the co-occurrence of NSSI and depressive symptoms in junior high school students.

, authors=Siwei YANG, Zhouyan WANG, Gen CHEN, Xiaoke WAN, Xia LI, Chang PENG, Hong WANG*, authorsList=Siwei YANG, Zhouyan WANG, Gen CHEN, Xiaoke WAN, Xia LI, Chang PENG, Hong WANG, authorCompany=null, correspAuthors=Hong WANG, 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=1325536025174630451, articleId=1325536018027536430, tenantId=1146029695717560320, journalId=1256213402557890569, language=CN, title=睡眠质量与初中生非自杀性自伤行为和抑郁症状共存的关联, columnId=1259565858817491410, journalTitle=中国学校卫生, columnName=心理卫生, runingTitle=null, highlight=null, articleAbstract=
目的

探讨睡眠质量各成分与初中生非自杀性自伤(NSSI)行为和抑郁症状共存的关联，为NSSI行为和抑郁防控工作开展提供参考依据。

方法

2024年5—6月，采用分层整群抽样方法抽取重庆市2个区县8所初中5 008名学生进行调查，采用匹兹堡睡眠质量指数量表(PSQI)、流调中心用抑郁量表(CES-D)和青少年非自杀性自伤行为评定问卷(ANSAQ)评估初中生睡眠质量、抑郁症状和NSSI情况，采用χ2检验、Bonferroni法、多元Logistic回归对数据进行统计分析。

结果

初中生中无NSSI和抑郁症状组占比为68.11%，仅NSSI组占4.71%，仅抑郁症状组占14.94%，共存组占12.24%；女生NSSI和抑郁症状共存检出率(16.39%)高于男生(7.85%)(χ2=84.89，P＜0.01)。多元Logistic回归结果显示，控制性别、年级、住校等变量后，主观睡眠质量、入睡时间、睡眠持续时间、睡眠障碍、日间功能障碍5个成分得分与初中生NSSI和抑郁症状共存的发生均呈正向关联(OR=1.30~3.86，P值均＜0.05)；5个成分与共存组的关联强度由高到低依次是日间功能障碍(OR=2.52)、睡眠障碍(OR=2.36)、主观睡眠质量(OR=1.76)、入睡时间(OR=1.44)、睡眠持续时间(OR=1.22)(P值均＜0.01)。

结论

初中生NSSI和抑郁症状共存现象普遍且女生更为突出；睡眠障碍与日间功能障碍可能是更重要的风险因素。应针对不同睡眠成分制定并实施优先、精准的防控策略，以减少初中生NSSI和抑郁症状共存的发生。

, authors=杨思维, 王周艳, 陈根, 万小可, 李霞, 彭畅, 王宏*, authorsList=杨思维, 王周艳, 陈根, 万小可, 李霞, 彭畅, 王宏, authorCompany=null, correspAuthors=王宏, authorNote=

杨思维(1999-)，女，四川珙县人，在读硕士，主要研究方向为儿童青少年卫生与健康

, correspAuthorsNote=
王宏，E-mail:
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(in Chinese), articleTitle=null, refAbstract=null)], funds=[Fund(id=1325536064089383021, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325536018027536430, awardId=null, language=CN, fundingSource=教育部人文社会科学研究规划基金项目(22YJA840010)；国家自然科学基金青年项目(82404288)；重庆市博士后研究项目特别资助项目(2024CQBSHTB2032)；重庆市学校卫生协会健康学校研究项目(WXD2024008), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1325536027762516020, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325536018027536430, xref=null, ext=[AuthorCompanyExt(id=1325536028072894517, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325536018027536430, companyId=1325536027762516020, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=College of Public Health, Chongqing Medical University/Center for Medical and Social Development Research, Chongqing 400016, China), AuthorCompanyExt(id=1325536028093866038, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325536018027536430, companyId=1325536027762516020, 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=1325536057110061159, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325536018027536430, language=EN, label=Tab.1, caption=

Comparison of NSSI and depressive symptom status with different groups among junior high school students

, figureFileSmall=null, figureFileBig=null, tableContent=
组别选项人数无NSSI和抑郁症状组仅NSSI组仅抑郁症状组共存组χ2值P值
性别男2 4331 804(74.15)127(5.22)311(12.78)191(7.85)117.09＜0.01
女2 5751 607(62.41)109(4.23)437(16.97)422(16.39)
年级初一1 539975(63.35)94(6.11)227(14.75)243(15.80)40.93＜0.01
初二1 7691 238(69.98)79(4.47)260(14.70)192(10.85)
初三1 7001 198(70.47)63(3.71)261(15.35)178(10.47)
家庭居住地农村1 250837(66.96)55(4.40)207(16.56)151(12.08)4.880.56
乡镇1 9401 327(68.40)88(4.54)288(14.85)237(12.22)
城市1 8181 247(68.59)93(5.12)253(13.92)225(12.38)
住校是2 2771 508(66.23)99(4.35)390(17.13)280(12.30)16.79＜0.01
否2 7311 903(69.68)137(5.02)358(13.11)333(12.19)
父亲受教育程度小学及以下804535(66.54)31(3.86)132(16.42)106(13.18)9.290.41
初中2 5001 691(67.64)121(4.84)390(15.60)298(11.92)
高中或中专1 217853(70.09)57(4.68)161(13.23)146(12.00)
大专及以上487332(68.17)27(5.54)65(13.35)63(12.94)
母亲受教育程度小学及以下924621(67.21)46(4.98)140(15.15)117(12.66)4.480.88
初中2 5781 736(67.34)123(4.77)402(15.59)317(12.30)
高中或中专1 123788(70.17)48(4.27)154(13.71)133(11.84)
大专及以上383266(69.45)19(4.96)52(13.58)46(12.01)
自评家庭经济收入高1 106828(74.86)49(4.43)119(10.76)110(9.95)132.02＜0.01
中等3 3622 321(69.04)159(4.73)498(14.81)384(11.42)
低540262(48.52)28(5.19)131(24.26)119(22.04)
自评学习成绩好1 4131 036(73.32)69(4.88)180(12.74)128(9.06)82.48＜0.01
中等1 7721 256(70.88)79(4.46)262(14.79)175(9.88)
差1 8231 119(61.38)88(4.83)306(16.79)310(17.00)
自评学习压力小604498(82.45)32(5.30)48(7.95)26(4.30)431.72＜0.01
适度2 7742 097(75.59)130(4.69)315(11.36)232(8.36)
大1 630816(50.06)74(4.54)385(23.62)355(21.78)
亲密朋友数量/个0~21 530846(55.29)57(3.73)336(21.96)291(19.02)233.49＜0.01
3~52 1151 503(71.06)109(5.15)286(13.52)217(10.26)
≥61 3631 062(77.92)70(5.14)126(9.24)105(7.70)
吸烟是582263(45.19)63(10.82)109(18.73)147(25.26)200.51＜0.01
否4 4263 148(71.13)173(3.91)639(14.44)466(10.53)
饮酒是1 613866(53.69)115(7.13)294(18.23)338(20.95)267.03＜0.01
否3 3952 545(74.96)121(3.56)454(13.37)275(8.10)
), ArticleFig(id=1325536057512714344, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325536018027536430, language=CN, label=表1, caption=

不同组别初中生非自杀性自伤和抑郁症状检出分布比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别选项人数无NSSI和抑郁症状组仅NSSI组仅抑郁症状组共存组χ2值P值
性别男2 4331 804(74.15)127(5.22)311(12.78)191(7.85)117.09＜0.01
女2 5751 607(62.41)109(4.23)437(16.97)422(16.39)
年级初一1 539975(63.35)94(6.11)227(14.75)243(15.80)40.93＜0.01
初二1 7691 238(69.98)79(4.47)260(14.70)192(10.85)
初三1 7001 198(70.47)63(3.71)261(15.35)178(10.47)
家庭居住地农村1 250837(66.96)55(4.40)207(16.56)151(12.08)4.880.56
乡镇1 9401 327(68.40)88(4.54)288(14.85)237(12.22)
城市1 8181 247(68.59)93(5.12)253(13.92)225(12.38)
住校是2 2771 508(66.23)99(4.35)390(17.13)280(12.30)16.79＜0.01
否2 7311 903(69.68)137(5.02)358(13.11)333(12.19)
父亲受教育程度小学及以下804535(66.54)31(3.86)132(16.42)106(13.18)9.290.41
初中2 5001 691(67.64)121(4.84)390(15.60)298(11.92)
高中或中专1 217853(70.09)57(4.68)161(13.23)146(12.00)
大专及以上487332(68.17)27(5.54)65(13.35)63(12.94)
母亲受教育程度小学及以下924621(67.21)46(4.98)140(15.15)117(12.66)4.480.88
初中2 5781 736(67.34)123(4.77)402(15.59)317(12.30)
高中或中专1 123788(70.17)48(4.27)154(13.71)133(11.84)
大专及以上383266(69.45)19(4.96)52(13.58)46(12.01)
自评家庭经济收入高1 106828(74.86)49(4.43)119(10.76)110(9.95)132.02＜0.01
中等3 3622 321(69.04)159(4.73)498(14.81)384(11.42)
低540262(48.52)28(5.19)131(24.26)119(22.04)
自评学习成绩好1 4131 036(73.32)69(4.88)180(12.74)128(9.06)82.48＜0.01
中等1 7721 256(70.88)79(4.46)262(14.79)175(9.88)
差1 8231 119(61.38)88(4.83)306(16.79)310(17.00)
自评学习压力小604498(82.45)32(5.30)48(7.95)26(4.30)431.72＜0.01
适度2 7742 097(75.59)130(4.69)315(11.36)232(8.36)
大1 630816(50.06)74(4.54)385(23.62)355(21.78)
亲密朋友数量/个0~21 530846(55.29)57(3.73)336(21.96)291(19.02)233.49＜0.01
3~52 1151 503(71.06)109(5.15)286(13.52)217(10.26)
≥61 3631 062(77.92)70(5.14)126(9.24)105(7.70)
吸烟是582263(45.19)63(10.82)109(18.73)147(25.26)200.51＜0.01
否4 4263 148(71.13)173(3.91)639(14.44)466(10.53)
饮酒是1 613866(53.69)115(7.13)294(18.23)338(20.95)267.03＜0.01
否3 3952 545(74.96)121(3.56)454(13.37)275(8.10)
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Multiple Logistic regression analysis of sleep quality components for NSSI and depressive symptoms among junior high school students (n=5 008)

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自变量仅NSSI组仅抑郁症状组共存组
β值OR值(95%CI)β值OR值(95%CI)β值OR值(95%CI)
主观睡眠质量0.351.42 (1.11~1.82)**0.651.91 (1.62~2.25)**0.812.24 (1.84~2.72)**
入睡时间0.231.26 (1.05~1.51)*0.161.17 (1.04~1.32)**0.371.45 (1.26~1.67)**
睡眠持续时间0.191.21 (0.95~1.54)0.231.26 (1.07~1.47)**0.271.30 (1.09~1.56)**
睡眠效率-0.260.77 (0.35~1.68)-0.030.97 (0.61~1.54)0.411.50 (0.98~2.29)
睡眠障碍0.661.93 (1.47~2.53)**0.661.94 (1.61~2.33)**1.353.86 (3.11~4.79)**
催眠药物0.121.13 (0.63~2.01)-0.090.92 (0.60~1.40)0.331.39 (0.94~2.05)
日间功能障碍0.311.36 (1.15~1.61)**0.762.15 (1.91~2.41)**0.932.53 (2.18~2.94)**
), ArticleFig(id=1325536059890884714, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325536018027536430, language=CN, label=表2, caption=

初中生睡眠质量各成分与非自杀性自伤和抑郁症状关联的多元Logistic回归分析(n=5 008)

, figureFileSmall=null, figureFileBig=null, tableContent=
自变量仅NSSI组仅抑郁症状组共存组
β值OR值(95%CI)β值OR值(95%CI)β值OR值(95%CI)
主观睡眠质量0.351.42 (1.11~1.82)**0.651.91 (1.62~2.25)**0.812.24 (1.84~2.72)**
入睡时间0.231.26 (1.05~1.51)*0.161.17 (1.04~1.32)**0.371.45 (1.26~1.67)**
睡眠持续时间0.191.21 (0.95~1.54)0.231.26 (1.07~1.47)**0.271.30 (1.09~1.56)**
睡眠效率-0.260.77 (0.35~1.68)-0.030.97 (0.61~1.54)0.411.50 (0.98~2.29)
睡眠障碍0.661.93 (1.47~2.53)**0.661.94 (1.61~2.33)**1.353.86 (3.11~4.79)**
催眠药物0.121.13 (0.63~2.01)-0.090.92 (0.60~1.40)0.331.39 (0.94~2.05)
日间功能障碍0.311.36 (1.15~1.61)**0.762.15 (1.91~2.41)**0.932.53 (2.18~2.94)**
), ArticleFig(id=1325536060314509419, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325536018027536430, language=EN, label=Tab.3, caption=

Multiple Logistic regression analysis of standardized scores of sleep quality components for NSSI and depressive symptoms among junior high school students (n=5 008)

, figureFileSmall=null, figureFileBig=null, tableContent=
自变量仅NSSI组仅抑郁症状组共存组
β值OR值(95%CI)β值OR值(95%CI)β值OR值(95%CI)
主观睡眠质量0.251.29 (1.08~1.53)**0.451.56 (1.39~1.75)**0.561.76 (1.54~2.01)**
入睡时间0.181.20 (1.03~1.40)*0.131.14 (1.03~1.26)**0.371.44 (1.28~1.63)**
睡眠持续时间0.111.11 (0.96~1.29)0.141.15 (1.04~1.26)**0.201.22 (1.10~1.35)**
睡眠障碍0.421.52 (1.28~1.80)**0.411.51 (1.34~1.69)**0.862.36 (2.07~2.70)**
日间功能障碍0.311.36 (1.15~1.60)**0.762.14 (1.90~2.40)**0.922.52 (2.17~2.92)**
), ArticleFig(id=1325536061996425324, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325536018027536430, language=CN, label=表3, caption=

初中生睡眠质量各成分标准化得分与非自杀性自伤和抑郁症状关联的多元Logistic回归分析(n=5 008)

, figureFileSmall=null, figureFileBig=null, tableContent=
自变量仅NSSI组仅抑郁症状组共存组
β值OR值(95%CI)β值OR值(95%CI)β值OR值(95%CI)
主观睡眠质量0.251.29 (1.08~1.53)**0.451.56 (1.39~1.75)**0.561.76 (1.54~2.01)**
入睡时间0.181.20 (1.03~1.40)*0.131.14 (1.03~1.26)**0.371.44 (1.28~1.63)**
睡眠持续时间0.111.11 (0.96~1.29)0.141.15 (1.04~1.26)**0.201.22 (1.10~1.35)**
睡眠障碍0.421.52 (1.28~1.80)**0.411.51 (1.34~1.69)**0.862.36 (2.07~2.70)**
日间功能障碍0.311.36 (1.15~1.60)**0.762.14 (1.90~2.40)**0.922.52 (2.17~2.92)**
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睡眠质量与初中生非自杀性自伤行为和抑郁症状共存的关联
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杨思维 , 王周艳 , 陈根 , 万小可 , 李霞 , 彭畅 , 王宏 *
中国学校卫生 | 心理卫生 2025,46(12): 1765-1770
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中国学校卫生 |心理卫生 2025 , 46 (12) : 1765 -1770
睡眠质量与初中生非自杀性自伤行为和抑郁症状共存的关联
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杨思维, 王周艳, 陈根, 万小可, 李霞, 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:
王宏，E-mail:
作者简介:

杨思维(1999-)，女，四川珙县人，在读硕士，主要研究方向为儿童青少年卫生与健康

Association of sleep quality with co-occurrence of non-suicidal self-injury behavior and depressive symptoms among junior high school students
Siwei YANG, Zhouyan WANG, Gen CHEN, Xiaoke WAN, Xia LI, Chang PENG, Hong WANG*
Affiliations
  • College of Public Health, Chongqing Medical University/Center for Medical and Social Development Research, Chongqing 400016, China
出版时间: 2025-12-25 doi: 10.16835/j.cnki.1000-9817.2025372
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摘要
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目的

探讨睡眠质量各成分与初中生非自杀性自伤(NSSI)行为和抑郁症状共存的关联，为NSSI行为和抑郁防控工作开展提供参考依据。

方法

2024年5—6月，采用分层整群抽样方法抽取重庆市2个区县8所初中5 008名学生进行调查，采用匹兹堡睡眠质量指数量表(PSQI)、流调中心用抑郁量表(CES-D)和青少年非自杀性自伤行为评定问卷(ANSAQ)评估初中生睡眠质量、抑郁症状和NSSI情况，采用χ2检验、Bonferroni法、多元Logistic回归对数据进行统计分析。

结果

初中生中无NSSI和抑郁症状组占比为68.11%，仅NSSI组占4.71%，仅抑郁症状组占14.94%，共存组占12.24%；女生NSSI和抑郁症状共存检出率(16.39%)高于男生(7.85%)(χ2=84.89，P＜0.01)。多元Logistic回归结果显示，控制性别、年级、住校等变量后，主观睡眠质量、入睡时间、睡眠持续时间、睡眠障碍、日间功能障碍5个成分得分与初中生NSSI和抑郁症状共存的发生均呈正向关联(OR=1.30~3.86，P值均＜0.05)；5个成分与共存组的关联强度由高到低依次是日间功能障碍(OR=2.52)、睡眠障碍(OR=2.36)、主观睡眠质量(OR=1.76)、入睡时间(OR=1.44)、睡眠持续时间(OR=1.22)(P值均＜0.01)。

结论

初中生NSSI和抑郁症状共存现象普遍且女生更为突出；睡眠障碍与日间功能障碍可能是更重要的风险因素。应针对不同睡眠成分制定并实施优先、精准的防控策略，以减少初中生NSSI和抑郁症状共存的发生。

睡眠  /  自我伤害行为  /  抑郁  /  精神卫生  /  回归分析  /  学生
Objective

To explore the association between various components of sleep quality and the co-occurrence of non-suicidal self-injury (NSSI) behaviors and depressive symptoms among junior high school students, so as to provide evidence for targeted prevention strategies of NSSI and depression.

Methods

From May to June 2024, a total of 5 008 junior high school students from 8 schools in 2 districts/counties of Chongqing were selected through a stratified cluster sampling method. The Pittsburgh Sleep Quality Index (PSQI), the Center for Epidemiological Studies Depression Scale (CES-D), and the Adolescent Non-suicidal Self-injury Assessment Questionnaire (ANSAQ) were used to assess sleep quality, depressive symptoms, and NSSI, respectively. Data were analyzed by using the Chi-square test, Bonferroni correction, and multivariate Logistic regression.

Results

Non-NSSI group and depressive symptoms group accounted for 68.11% among junior high school students, NSSI-only group accounted for 4.71%, only depressive symptoms group accounted for 14.94%, and co-occurrence of NSSI and depressive symptoms group accounted for 12.24%. The prevalence of the co-occurrence group was higher in girls (16.39%) than in boys (7.85%) (χ2=84.89, P < 0.01). After controlling for gender, grade, and boarding status etc., multivariate Logistic regression analysis revealed that five sleep components, including subjective sleep quality, sleep latency, sleep duration, sleep disturbances, and daytime dysfunction, were significantly and positively associated with the co-occurrence of NSSI and depressive symptoms (OR=1.30-3.86, all P < 0.05). The strength of association between these components and the co-occurrence group, in descending order, was: daytime dysfunction (OR=2.52), sleep disturbances (OR=2.36), subjective sleep quality (OR=1.76), sleep latency (OR=1.44), and sleep duration (OR=1.22) (all P < 0.01).

Conclusions

The co-occurrence of NSSI and depressive symptoms is prevalent among junior high school students, with girls being more significantly affected. Sleep disturbances and daytime dysfunction may represent particularly important risk factors. Targeted and prioritized intervention strategies addressing specific sleep components should be developed and implemented to reduce the co-occurrence of NSSI and depressive symptoms in junior high school students.

Sleep  /  Self-injurious behavior  /  Depression  /  Mental health  /  Regression analysis  /  Students
杨思维, 王周艳, 陈根, 万小可, 李霞, 彭畅, 王宏. 睡眠质量与初中生非自杀性自伤行为和抑郁症状共存的关联. 中国学校卫生, 2025 , 46 (12) : 1765 -1770 . DOI: 10.16835/j.cnki.1000-9817.2025372
Siwei YANG, Zhouyan WANG, Gen CHEN, Xiaoke WAN, Xia LI, Chang PENG, Hong WANG. Association of sleep quality with co-occurrence of non-suicidal self-injury behavior and depressive symptoms among junior high school students[J]. Chinese Journal of School Health, 2025 , 46 (12) : 1765 -1770 . DOI: 10.16835/j.cnki.1000-9817.2025372
正文
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非自杀性自伤(non-suicidal self-injury, NSSI)行为是指在没有自杀意图的情况下，故意、反复、直接破坏身体组织，造成轻度或中度损伤的行为[1-3]，通常首次发生于青春期早期[4]。抑郁症状表现为情绪低落、快感缺失或兴趣减退[5]。在有抑郁症状的青少年群体中，NSSI常作为一种负面情绪调节方式[6]，被用于减少痛苦，释放负面情绪[1]。越来越多的研究表明NSSI和抑郁症状具有共存性，针对中国青少年的研究显示，68.67%的抑郁症状青少年存在NSSI[7]，49.70%的NSSI青少年存在抑郁症状[8]。相较于单一NSSI或抑郁症状，两者共存可能导致更严重的后果，如自杀风险显著增高[9]。因此，关注NSSI与抑郁症状共存现象，探讨共存的影响因素对于制定针对性的预防和干预计划具有重要意义。
睡眠质量作为NSSI与抑郁症状共存潜在影响因素值得重点关注。尽管既往研究已明确睡眠质量差会增加NSSI[7, 10-11]、抑郁症状[12-14]单独发生的风险，但其与风险更高的共存现象的研究仍不足。此外，睡眠质量包括主观睡眠质量、睡眠障碍及日间功能障碍等多个成分[15]，不同成分对共存的效应尚不明确，最具干预价值的核心睡眠成分也待探索。本研究通过探讨重庆市初中生睡眠质量各成分与NSSI和抑郁症状共存的关联，明确核心睡眠成分，为NSSI与抑郁症状共存防控工作开展提供参考依据。
1　对象与方法
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1.1　对象
2024年5—6月，采用分层整群抽样方法，从重庆市经济发展水平较高与较低的片区中各抽取1个区(县)，每个区(县)各抽取4所初中(城乡各2所)，共8所学校，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的全部在校生进行问卷调查。共发放问卷5 143份，回收问卷5 143份，删除缺失、无效数据后，有效问卷5 008份，有效回收率为97.38%。其中男生2 433名(48.58%)，女生2 575名(51.42%)；平均年龄(13.86±0.95)岁。本研究经重庆医科大学伦理委员会批准(批号：2023028)，参与调查的学生均知情同意。
1.2　调查方法
1.2.1　自编一般情况问卷
内容包括家庭居住地、年级、性别、住校情况、父/母亲受教育程度、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。(1)亲密朋友指与调查对象关系紧密且能提供切实支持与帮助的朋友，亲密朋友数量通过问题“你有多少个关系密切且可以得到支持和帮助的朋友？”来调查亲密朋友数量[16]，选项包括：0，1~2，3~5，≥6个。在进行数据分析时，由于选择0个的学生较少，将其与1~2个合并为0~2个，最终将亲密朋友数量划分为3分类变量：0~2，3~5，≥6个；(2)吸烟通过问题“你是否曾尝试过吸烟，即使只吸过一口、两口？”调查[17]；(3)饮酒通过问题“你是否喝过一杯酒(一杯酒的量相当于半瓶/1听啤酒，一小盅白酒，一玻璃杯葡萄酒或黄酒)？”调查[18]。
1.2.2　匹兹堡睡眠质量指数(Pittsburgh Sleep Quality Index，PSQI)量表
由美国匹兹堡大学精神科医生Buysse等[19]编制，本研究采用刘贤臣等[20]译制的中文版评估研究对象近1个月的睡眠质量。该量表由18个自评条目构成，分为主观睡眠质量、入睡时间、睡眠持续时间、睡眠效率、睡眠障碍、催眠药物及日间功能障碍7个成分，每个成分得分范围为0~3分，得分越高代表该方面睡眠问题更严重；总分范围为0~21分，总分越高代表睡眠问题越严重。PSQI量表在青少年群体中显示出良好的信度和效度[21]，本研究中该量表Cronbach α系数为0.70。
1.2.3　流调中心用抑郁量表(Center for Epidemiological Studies Depression Scale, CES-D)
由Radloff等[22]编制，用于评估研究对象最近1周的抑郁症状。量表由20个条目构成，每个条目采用4级评分(0=很少，1=有时，2=偶尔，3=大部分时间)，其中条目4，8，12和16采用反向计分，量表总分范围为0~60分[23]。得分越高表明抑郁症状越严重，若CES-D得分≥20分，则判定存在抑郁症状。CES-D量表在青少年群体中显示出良好的信度和效度[23]，本研究中该量表Cronbach α系数为0.88。
1.2.4　青少年非自杀性自伤行为评定问卷(Adolescent Non-suicidal Self-injury Assessment Questionnaire, ANSAQ)
由万宇辉等[24]编制，采用ANSAQ中“行为问卷”部分询问调查对象过去12个月是否出现过不以自杀为目的的自我伤害行为，包括“故意掐伤自己”“烧伤或烫伤”等12个问题，题目选项包括0，1，2，3，4，≥5次。根据《精神障碍诊断与统计手册(第5版)》[25]的标准，若研究对象出现上述行为累计≥5次则判定存在NSSI行为。本研究中该问卷的Cronbach α系数为0.90。
1.3　质量控制
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。现场调查时，在调查学校的配合下，以班级为单位开展调查，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，对问卷录入人员进行统一培训，删除缺失、无效问卷后再进行数据分析。
1.4　统计学分析
采用EpiData 3.1软件建立数据库，IBM SPSS 26.0软件进行统计分析。本研究根据NSSI和抑郁症状的发生情况将研究对象划分为4组：无NSSI和抑郁症状组(同时无抑郁症状和NSSI)、仅NSSI组(仅有NSSI无抑郁症状)、仅抑郁症状组(仅有抑郁症状无NSSI)、共存组(同时有抑郁症状和NSSI)。计数资料采用例数(n)和百分比(%)进行描述；计量资料采用Kolmogorov-Smirnov检验进行正态性检验，年龄符合正态分布用(x±s)描述。采用χ2检验对不同特征初中生的NSSI和抑郁症状发生情况进行组间比较。采用Bonferroni法进行两两比较，检验水准α=0.05/k(k为两两比较的总次数)。采用多元Logistic回归分析睡眠质量各成分与NSSI和抑郁症状发生情况的关联。以P＜0.05为有统计学意义。
2　结果
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2.1　不同组别初中生NSSI和抑郁症状检出情况比较
初中生NSSI检出率为16.95%(849名)，抑郁症状检出率为27.18%(1 361名)。无NSSI和抑郁症状组、仅NSSI组、仅抑郁症状组、共存组占比分别为68.11%(3 411名)、4.71%(236名)、14.94%(748名)、12.24%(613名)。女生NSSI和抑郁症状共存检出率(16.39%)高于男生(7.85%)(χ2=84.89，P＜0.01)；不同年级初中生NSSI和抑郁症状检出率差异有统计学意义(χ2=40.93，P＜0.01)。Bonferroni法校正结果显示，初一学生NSSI和抑郁症状共存检出率(15.79%)高于初二(10.85%)和初三学生(10.47%)(P值均＜0.016 7)。不同性别、住校、自评家庭经济收入、自评学习成绩、自评学习压力、亲密朋友数量及是否吸烟、饮酒初中生NSSI和抑郁症状检出率差异均有统计学意义(P值均＜0.01)。见表1。
2.2　初中生睡眠质量各成分与NSSI和抑郁症状检出的关联
以NSSI和抑郁症状检出情况(1=无NSSI和抑郁症状组，2=仅NSSI组，3=仅抑郁症状组，4=共存组)为因变量，以主观睡眠质量、入睡时间、睡眠持续时间、睡眠效率、睡眠障碍、催眠药物、日间功能障碍得分为自变量，控制单因素分析有统计学意义的变量后进行多元Logistic回归分析。结果显示，主观睡眠质量、入睡时间、睡眠持续时间、睡眠障碍、日间功能障碍5个成分得分与初中生NSSI和抑郁症状共存均呈正向关联(OR=1.30~3.86，P值均＜0.05)。见表2。
进一步将主观睡眠质量、入睡时间、睡眠持续时间、睡眠障碍、日间功能障碍5个成分得分标准化处理后进行多元Logistic回归分析，结果显示，5个成分与共存组的关联强度由高到低依次是日间功能障碍(OR=2.52)、睡眠障碍(OR=2.36)、主观睡眠质量(OR=1.76)、入睡时间(OR=1.44)、睡眠持续时间(OR=1.22)(P值均＜0.01)。见表3。
3　讨论
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重庆市初中生NSSI与抑郁症状共存的检出率为12.24%，与既往研究[9]一致，提示共存现象较为普遍。关于NSSI与抑郁症状共存机制主要有两种观点：一是NSSI作为非适应性情绪调节策略，被存在抑郁症状的青少年用于缓解负面情绪[6, 26-28]；二是青少年参与NSSI时，因愤怒、羞愧或自控力有限，可能引发抑郁症状[6, 28]。这种相互影响的动态关系是两者共存的原因。本研究中女生共存组发生率(16.39%)高于男生(7.85%)。可能是因为一方面女生抑郁症状发生率高于男生；另一方面女生更倾向将NSSI作为情绪调节的方式，而男生依赖于其他方式进行情绪调节[29-30]。
研究结果显示，不同睡眠成分对NSSI和抑郁症状共存的效应有统计学意义。主观睡眠质量、入睡时间、睡眠持续时间、睡眠障碍、日间功能障碍会增加两者共存的风险，提示睡眠质量对心理健康问题影响巨大。睡眠问题可能造成个体认知能量匮乏[31]，从而出现情绪调节困难，当抑郁症状等负面情绪积压突破个体耐受力时，冲动性上升，NSSI行为可能成为缓解痛苦的应对策略，出现NSSI行为与抑郁症状共存现象。若睡眠质量问题进一步发展为临床诊断的睡眠障碍，可能会引发更为严重的精神障碍。一项关于青春期和成年早期睡眠障碍与主要精神障碍首次发作的Meta分析指出，睡眠问题会增加精神障碍首次发作的风险，且不同睡眠问题类型对应的风险存在差异[32]。
进一步分析结果显示，相较于其他睡眠成分，睡眠障碍、日间功能障碍与NSSI和抑郁症状共存的关联更强。提示对于存在睡眠障碍和日间功能障碍的学生，需早期筛查NSSI与抑郁症状；对于已经存在共存现象的学生，可以将提高睡眠质量作为干预措施，优先改善睡眠障碍及日间功能障碍。相较于直接针对NSSI或抑郁症状的心理干预，以改善睡眠为目标的干预措施更易被学生接受。一项随机对照试验的Meta分析结果也显示，睡眠与心理健康问题有因果联系[33]，无论心理问题的严重程度如何，改善睡眠对心理健康问题均有益处。因此，学校可以构建并实施睡眠卫生计划，提升学生整体睡眠质量，降低NSSI行为和抑郁症状的发生率。
本研究存在一定局限性：首先，样本仅覆盖重庆市，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，未来研究可利用客观测量方法进行评估，如采用多导睡眠图[34]监测睡眠，减少回忆偏倚；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进一步验证睡眠质量与非自杀性自伤行为和抑郁症状共存的因果关联。
基金
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  • 教育部人文社会科学研究规划基金项目(22YJA840010)；国家自然科学基金青年项目(82404288)；重庆市博士后研究项目特别资助项目(2024CQBSHTB2032)；重庆市学校卫生协会健康学校研究项目(WXD2024008)
文献
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2025年第46卷第12期
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doi: 10.16835/j.cnki.1000-9817.2025372
  • 接收时间：2025-07-24
  • 首发时间：2026-11-06
  • 出版时间：2025-12-25
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  • 收稿日期：2025-07-24
  • 修回日期：2025-10-09
基金
教育部人文社会科学研究规划基金项目(22YJA840010)；国家自然科学基金青年项目(82404288)；重庆市博士后研究项目特别资助项目(2024CQBSHTB2032)；重庆市学校卫生协会健康学校研究项目(WXD2024008)
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

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王宏，E-mail:
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
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
栓菌属 Trametes 5 2.39
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