Guo Hongxiang, Yang Wenjie, Cao Ying, Li Jian, Siegrist Johannes
Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
School of Public Health, Zhengzhou University, Zhengzhou 450001, China.
Int J Environ Res Public Health. 2014 Jun 10;11(6):6085-98. doi: 10.3390/ijerph110606085.
Depression is a major mental health problem during adolescence. This study, using a sample of Chinese adolescents, examined the separate and combined effects of perceived school-related stress and of family socioeconomic status (SES) on the prevalence of depressive symptoms. A total of 1774 Chinese students from Grades 7-12 were recruited into our questionnaire survey. School-related stress was measured by the Effort-Reward Imbalance Questionnaire-School Version, family SES was assessed by a standardized question, and depressive symptoms were evaluated by the Center for Epidemiological Studies Depression Scale for Children. Multivariate logistic regression was applied, adjusting for age, gender, grade, smoking, alcohol drinking and physical activity. It was found that high school-related stress and low family SES were associated with elevated odds of depressive symptoms, respectively. The effect of school-related stress was particularly strong in low SES group. In adolescents with both high stress at school and low SES, the odds ratio was 9.18 (95% confidence interval = 6.53-12.89) compared to the reference group (low stress at school and high SES). A significant synergistic interaction effect was observed (synergy index = 2.28, 95% confidence interval = 1.56-3.32). The findings indicated that perceived school-related stress, in terms of effort-reward imbalance, was related to depressive symptoms in this sample of Chinese adolescents. The strong interaction with family SES suggests that health promoting efforts in school settings should be targeted specifically at these socially deprived groups.
抑郁症是青少年时期的一个主要心理健康问题。本研究以中国青少年为样本，考察了感知到的与学校相关的压力和家庭社会经济地位（SES）对抑郁症状患病率的单独影响和综合影响。共有1774名来自7至12年级的中国学生被纳入我们的问卷调查。与学校相关的压力通过《努力-回报失衡问卷-学校版》进行测量，家庭SES通过一个标准化问题进行评估，抑郁症状通过儿童流行病学研究中心抑郁量表进行评估。应用多因素逻辑回归分析，并对年龄、性别、年级、吸烟、饮酒和体育活动进行了校正。结果发现，与学校相关的高压力和低家庭SES分别与抑郁症状几率升高有关。在低SES组中，与学校相关的压力影响尤为强烈。在学校压力大且SES低的青少年中，与参照组（学校压力小且SES高）相比，优势比为9.18（95%置信区间=6.53-12.89）。观察到显著的协同交互作用效应（协同指数=2.28，95%置信区间=1.56-3.32）。研究结果表明，在这个中国青少年样本中，从努力-回报失衡角度来看，感知到的与学校相关的压力与抑郁症状有关。与家庭SES的强烈交互作用表明，在学校环境中促进健康的努力应特别针对这些社会弱势群体。
