Association between traditional bullying victimization and suicide-related psychological behaviors among adolescents and the moderating role of sleep quality
-
摘要:
目的 分析青少年遭受传统同伴欺凌与自杀相关心理行为的关联，并探讨青少年睡眠质量在该关联中的作用，为预防青少年自杀相关心理行为提供科学依据。 方法 2020年10月，采用分层随机整群抽样方法在安徽省宣城市、合肥市和淮北市共选取5 724名初中生，采用《Olweus欺凌受害问卷》《匹兹堡睡眠质量指数量表》和《自杀相关心理行为问卷》进行调查。使用χ2检验比较不同人口统计学特征间青少年遭受传统同伴欺凌和自杀相关心理行为的检出率，采用logistic回归分析模型分析遭受传统同伴欺凌与青少年自杀相关心理行为的关联，并通过分层回归探究青少年睡眠质量对上述关联的调节作用。 结果 多因素logistic回归分析模型分析结果显示，遭受传统同伴欺凌和睡眠质量与自杀意念(OR＝3.38，95% CI: 3.00~3.82)、自杀计划(OR＝3.44，95% CI: 2.99~3.96)、自杀准备(OR＝3.67，95%CI: 3.11~4.32)和自杀未遂(OR＝4.01，95% CI: 3.17~5.09)之间均呈正相关(均P＜0.001)。青少年较高的睡眠质量可以缓解遭受传统同伴欺凌与自杀意念(OR＝0.64，95% CI: 0.47~0.872)、自杀计划(OR＝0.50，95% CI: 0.37~0.68)、自杀准备(OR＝0.48，95% CI: 0.34~0.67)和自杀未遂(OR＝0.53，95% CI: 0.33~0.85)之间的关联(均P＜0.001)。 结论 青少年遭受传统同伴欺凌与自杀相关心理行为呈正相关，睡眠质量在遭受传统同伴欺凌与青少年自杀相关心理行为之间起调节作用。 Abstract:Objective To analyze the association between adolescents′ traditional peer victimization and suicide-related psychological behaviors, and explore the role of adolescents′ sleep quality in this association, so as to provide scientific basis for the prevention of adolescents′ suicide-related psychological behaviors. Methods In October 2020, a total of 5 724 middle school students in Xuancheng city, Hefei city and Huaibei city of Anhui province were selected by using a stratified random cluster sampling method. The Olweus bullying victimization questionnaire, Pittsburgh Sleep Quality Index scale and self-designed psychological behavior questionnaire were used. Chi-square test was used to compare the detection rates of traditional peer victimization and suicide-related psychological behaviors among adolescents with different demographic characteristics. Logistic regression was used to analyze the association between peer traditional bullying and suicide-related psychological behaviors, and the moderating role of sleep quality on the above association was explored by using logistic regression stratified by sleep disorders. Results Multivariate logistic regression analysis showed that peer victimization and sleep quality were positively correlated with four suicide-related psychological behaviors (OR=3.38-4.01, all P < 0.001). The sleep quality of adolescents had a moderating effect on the exposure to traditional peer victimization and four suicide-related psychological behaviors (OR=0.48-0.64, all P < 0.001). Conclusions There is a positive correlation between adolescents′ exposure to peer traditional victimization and suicide-related psychological behaviors, and sleep quality plays a moderating role between adolescents′ exposure to peer traditional victimization and suicide-related psychological behaviors. -
表 1 青少年遭受传统同伴欺凌和自杀相关心理行为的不同人口统计学特征及检出率比较
Table 1. Detection rates of traditional peer victimization and suicide among adolescents with general demographic characteristics
变量Variable 人数
Number of people遭受传统同伴欺凌①
Traditional bullying ①自杀相关心理行为 ① Suicide psychological behaviors ① 自杀意念
Suicidal ideation自杀计划
Suicidal plan自杀准备
Suicidal preparation自杀未遂
Suicidal attempt性别Gender 男Male 3 006 959(31.9) 894(29.7) 425(14.1) 273(9.1) 111(3.7) 女Female 2 718 711(26.2) 1 275(46.9) 661(24.3) 442(16.3) 206(7.6) χ2值value 22.791 178.784 96.240 67.320 41.213 P值value ＜0.001 ＜0.001 ＜0.001 ＜0.001 ＜0.001 独生子女Only child 是Yes 1 942 601(30.9) 719(37.0) 328(16.9) 235(12.1) 111(5.7) 否No 3 782 1 069(28.3) 1 450(38.3) 758(20.0) 480(12.7) 206(5.4) χ2值value 4.467 0.944 8.295 0.410 0.177 P值value 0.035 0.331 0.004 0.522 0.674 自评家庭经济Self-perceived family economic status 中等以下Below middle 499 223(44.7) 259(51.9) 148(29.7) 93(18.6) 50(10.0) 中等Middle 4 277 1 200(28.1) 1 612(37.7) 794(18.6) 523(12.2) 225(5.3) 中等以上Above middle 948 247(26.1) 298(31.4) 144(15.2) 99(10.4) 42(4.4) χ2值value 65.179 58.499 46.358 24.525 22.014 P值value ＜0.001 ＜0.001 ＜0.001 ＜0.001 ＜0.001 母亲教育程度Mother′s education level 小学及以下Primary and below 1 245 419(33.7) 523(42.0) 266(21.4) 185(14.9) 91(7.3) 初中Junior middle 2 640 740(28.0) 994(37.7) 487(18.4) 308(11.7) 130(4.9) 高中及以上Senior middle and above 1 839 511(27.8) 652(35.5) 333(18.1) 222(12.1) 96(5.2) χ2值value 15.480 13.672 6.006 8.326 9.722 P值value ＜0.001 0.004 0.050 0.016 0.008 父亲教育程度Father′s education level 小学及以下Primary and below 746 250(33.5) 326(43.7) 172(23.1) 114(15.3) 53(7.1) 初中Junior middle 2 674 777(29.1) 1 021(38.2) 510(19.1) 328(12.3) 145(5.4) 高中及以上Senior middle and above 2 304 643(27.9) 822(35.7) 404(17.5) 273(11.8) 119(5.2) χ2值value 8.599 15.591 11.209 6.307 4.181 P值value 0.014 ＜0.001 0.004 0.043 0.124 合计Total 5 724 1 670(29.2) 2169(37.9) 1 086(19.0) 715(12.5) 317(5.5) 注：①以人数(占比/%)表示。
Note: ① Number of people(proportion/%).
下载: 导出CSV
表 2 青少年遭受传统同伴欺凌和睡眠质量与自杀相关心理行为关联的logistic回归分析
Table 2. Logistic regression analysis of traditional peer victimization and sleep quality with suicide behaviors among adolescents
因变量
Dependent variable自变量
Independent variable单因素分析Single factor analysis 多因素分析Multifactor analysis OR值value (95% CI) P值value OR值value (95% CI) P值value 自杀意念Suicidal ideation 遭受传统同伴欺凌Traditional peer victimization 3.13(2.78~3.52) ＜0.001 3.38(3.00~3.82) ＜0.001 睡眠质量Sleep quality 4.38(3.79~5.06) ＜0.001 4.06(3.50~4.70) ＜0.001 自杀计划Suicidal plan 遭受传统同伴欺凌Traditional peer victimization 3.26(2.84~3.73) ＜0.001 3.44 (2.99~3.96) ＜0.001 睡眠质量Sleep quality 4.38(3.77~5.08) ＜0.001 4.04(3.45~4.70) ＜0.001 自杀准备Suicidal preparation 遭受传统同伴欺凌Traditional peer victimization 3.50(2.98~4.10) ＜0.001 3.67(3.11~4.32) ＜0.001 睡眠质量Sleep quality 5.60(4.74~6.63) ＜0.001 5.17(4.36~6.13) ＜0.001 自杀未遂Suicidal attempt 遭受传统同伴欺凌Traditional peer victimization 3.91(3.10~4.94) ＜0.001 4.01(3.17~5.09) ＜0.001 睡眠质量Sleep quality 6.59(5.23~8.33) ＜0.001 5.93(4.68~7.51) ＜0.001
下载: 导出CSV
表 3 青少年在不同睡眠质量中遭受传统同伴欺凌与自杀相关心理行为关联的logistic回归分析
Table 3. Logistic regression analysis of traditional peer victimization and suicide-related behaviors among adolescents stratified by sleep disorders
睡眠障碍Sleep disorder 自变量Independent variable 因变量Dependent variable OR值value (95% CI) P值value 无No 遭受传统同伴欺凌Traditional peer victimization 自杀意念Suicidal ideation 2.24(1.69~3.00) ＜0.001 自杀计划Suicidal plan 1.81(1.39~2.34) ＜0.001 自杀准备Suicidal preparation 1.86(1.42~2.44) ＜0.001 自杀未遂Suicidal attempt 2.21(1.56~3.12) ＜0.001 有Yes 遭受传统同伴欺凌Traditional peer victimization 自杀意念Suicidal ideation 3.15(2.74~3.64) ＜0.001 自杀计划Suicidal plan 3.56(2.99~4.25) ＜0.001 自杀准备Suicidal preparation 3.88(3.12~4.83) ＜0.001 自杀未遂Suicidal attempt 3.95(2.80~5.56) ＜0.001 注：模型调整了性别、独生子女、自评家庭经济和父母受教育程度。
Note: the model adjusted for gender, only child, self-rated family economy and parental education.
下载: 导出CSV
表 4 青少年睡眠质量在遭受传统同伴欺凌与自杀心理行为中的调节效应
Table 4. Moderating effects of sleep quality in traditional peer victimization and adolescent suicide-related behaviors
因变量Dependent variable 自变量Independent variable 模型1 Model 1 模型2 Model 2 模型3 Model 3 自杀意念Suicidal ideation 遭受传统同伴欺凌Traditional peer victimization 3.38(3.00~3.82) ① 2.94(2.59~3.34) ① 3.22(2.80~3.72) ① 睡眠质量Sleep quality 3.42(2.94~3.99) ① 4.07(3.35~4.94) ① 交互项Interaction term 0.64(0.47~0.87) ① 自杀计划Suicidal plan 遭受传统同伴欺凌Traditional peer victimization 3.44 (2.99~3.96) ① 2.89(2.50~3.35) ① 3.59(3.01~4.27) ① 睡眠质量Sleep quality 3.37(2.85~3.91) ① 4.65(3.76~5.76) ① 交互项Interaction term 0.50(0.37~0.68) ① 自杀准备Suicidal preparation 遭受传统同伴欺凌Traditional peer victimization 3.67(3.11~4.32) ① 2.93(2.45~3.46) ① 3.88(3.12~4.82) ① 睡眠质量Sleep quality 4.24(3.56~5.06) ① 6.19(4.84~7.92) ① 交互项Interaction term 0.48(0.34~0.67) ① 自杀未遂Suicidal attempt 遭受传统同伴欺凌Traditional peer victimization 4.01(3.17~5.09) ① 2.97(2.33~3.80) ① 4.05(2.89~5.70) ① 睡眠质量Sleep quality 4.70(3.68~6.00) ① 6.73(4.68~9.68) ① 交互项Interaction term 0.53(0.33~0.85) ① 注：模型1在调整性别、独生子女、自评家庭经济和父母受教育程度的基础上，添加了遭受传统同伴欺凌；模型2在模型1的基础上添加了睡眠质量；模型3在模型2的基础上添加了遭受传统同伴欺凌与睡眠质量的交互项。
① P＜0.001。
Note: model 1 added traditional peer victimization after adjusting for gender, only child, self-rated family economy and parents′ education level; Model 2 added sleep quality on the basis of model 1; Model 3 added the interaction between exposure to traditional peer bullying and sleep quality on the basis of Model 2.
① P＜0.001.
下载: 导出CSV
-
[1] United Nations Children's Fund. The state of the world's children 2021: on my mind-promoting, protecting and caring for children's mental health[M]. New York: United Nations Children's Fund, 2021: 38-40. [2] Nock MK, Borges G, Bromet EJ, et al. Cross-national prevalence and risk factors for suicidal ideation, plans and attempts[J]. Br J Psychiatry, 2008, 192(2): 98-105. DOI: 10.1192/bjp.bp.107.040113. [3] Tang JJ, Yu YZ, Wilcox HC, et al. Global risks of suicidal behaviours and being bullied and their association in adolescents: school-based health survey in 83 countries[J]. EClinicalMedicine, 2020, 19: 100253. DOI: 10.1016/j.eclinm.2019.100253. [4] Glenn CR, Kleiman EM, Kellerman J, et al. Annual research review: a meta-analytic review of worldwide suicide rates in adolescents[J]. J Child Psychol Psychiatry, 2020, 61(3): 294-308. DOI: 10.1111/jcpp.13106. [5] Wagner B, Hofmann L, Grafiadeli R. The relationship between guilt, depression, prolonged grief, and posttraumatic stress symptoms after suicide bereavement[J]. J Clin Psychol, 2021, 77(11): 2545-2558. DOI: 10.1002/jclp.23192. [6] Benatov J, Brunstein Klomek A, Chen-Gal S. Bullying perpetration and victimization associations to suicide behavior: a longitudinal study[J]. Eur Child Adolesc Psychiatry, 2022, 31(9): 1353-1360. DOI: 10.1007/s00787-021-01776-9. [7] Gini G, Espelage DL. Peer victimization, cyberbullying, and suicide risk in children and adolescents[J]. JAMA, 2014, 312(5): 545-546. DOI: 10.1001/jama.2014.3212. [8] Cáceda R, Kim DJ, Carbajal JM, et al. The experience of pain is strongly associated with poor sleep quality and increased risk for suicide[J]. Arch Suicide Res, 2022, 26(3): 1572-1586. DOI: 10.1080/13811118.2021.1939208. [9] Zhou Y, Guo L, Lu CY, et al. Bullying as a risk for poor sleep quality among high school students in China[J]. PLoS One, 2015, 10(3): e0121602. DOI: 10.1371/journal.pone.0121602. [10] He Y, Chen SS, Xie GD, et al. Bidirectional associations among school bullying, depressive symptoms and sleep problems in adolescents: a cross-lagged longitudinal approach[J]. J Affect Disord, 2022, 298(Pt A): 590-598. DOI: 10.1016/j.jad.2021.11.038. [11] Wang GF, Jiang L, Wang LH, et al. Examining childhood maltreatment and school bullying among adolescents: a cross-sectional study from Anhui Province in China[J]. J Interpers Violence, 2016, 34(5): 980-999. DOI: 10.1177/0886260516647000. [12] Buysse DJ, Reynolds CF 3rd, Monk TH, et al. The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research[J]. Psychiatry Res, 1989, 28(2): 193-213. DOI: 10.1016/0165-1781(89)90047-4. [13] Tsai PS, Wang SY, Wang MY, et al. Psychometric evaluation of the Chinese version of the Pittsburgh sleep quality index (CPSQI) in primary insomnia and control subjects[J]. Qual Life Res, 2005, 14(8): 1943-1952. DOI: 10.1007/s11136-005-4346-x. [14] Wang GF, Han AZ, Zhang GB, et al. Sensitive periods for the effect of bullying victimization on suicidal behaviors among university students in China: the roles of timing and chronicity[J]. J Affect Disord, 2020, 268: 12-19. DOI: 10.1016/j.jad.2020.02.049. [15] Yuan MY, Li YH, Chang JJ, et al. Vitamin D and suicidality: a Chinese early adolescent cohort and Mendelian randomization study[J]. Epidemiol Psychiatr Sci, 2023, 32: e52. DOI: 10.1017/S2045796023000665. [16] 吴芃, 夏娟, 唐富荣, 等. 上海市金山区青少年受欺凌状况及与心理行为问题的关联[J]. 中国学校卫生, 2019, 40(4): 608-611. DOI: 10.16835/j.cnki.1000-9817.2019.04.036.Wu P, Xia J, Tang FR, et al. Bullying status of teenagers in Jinshan District of Shanghai and its relationship with psychological and behavioral problems[J]. Chin J Sch Health, 2019, 40(4): 608-611. DOI: 10.16835/j.cnki.1000-9817.2019.04.036. [17] 史高岩, 刘金同, 张燕, 等. 受欺负初中学生身心健康状况及相关因素分析[J]. 中国学校卫生, 2011, 32(4): 404-406. DOI: 10.16835/j.cnki.1000-9817.2011.04.010.Shi GY, Liu JT, Zhang Y, et al. Psychosomatic status and related factors of bullied students in junior high schools[J]. Chin J Sch Health, 2011, 32(4): 404-406. DOI: 10.16835/j.cnki.1000-9817.2011.04.010. [18] 唐寒梅, 杨丽霞, 傅树坚, 等. 江西中学生校园欺凌与自杀相关行为的关联分析[J]. 中国学校卫生, 2018, 39(1): 60-63. DOI: 10.16835/j.cnki.1000-9817.2018.01.018.Tang HM, Yang LX, Fu SJ, et al. Relationship between bullying and suicide-related behaviors among middle school students[J]. Chin J Sch Health, 2018, 39(1): 60-63. DOI: 10.16835/j.cnki.1000-9817.2018.01.018. [19] 陈婷, 范奕, 张子华, 等. 江西省中学生校园受欺凌行为与抑郁的相关性[J]. 中国学校卫生, 2020, 41(4): 600-603. DOI: 10.16835/j.cnki.1000-9817.2020.04.032.Chen T, Fan Y, Zhang ZH, et al. Correlation between bullying behavior and depression of middle school students in Jiangxi Province[J]. Chin J Sch Health, 2020, 41(4): 600-603. DOI: 10.16835/j.cnki.1000-9817.2020.04.032. [20] Sangalang CC, Tran AGTT, Ayers SL, et al. Bullying among urban Mexican-heritage youth: exploring risk for substance use by status as a bully, victim, and bully-victim[J]. Child Youth Serv Rev, 2016, 61: 216-221. DOI: 10.1016/j.childyouth.2015.12.019. [21] Moreno-Mansilla S, Ricarte JJ, Barry TJ. The role of transdiagnostic variables within gender differences in adolescents' self reports of suicidal ideation and suicide attempts[J]. Psicothema, 2022, 34(2): 209-216. DOI: 10.7334/psicothema2021.327. [22] Zygo M, Pawⱡowska B, Potembska E, et al. Prevalence and selected risk factors of suicidal ideation, suicidal tendencies and suicide attempts in young people aged 13-19 years[J]. Ann Agric Environ Med, 2019, 26(2): 329-336. DOI: 10.26444/aaem/93817. [23] Swearer SM, Hymel S. Understanding the psychology of bullying: moving toward a social-ecological diathesis-stress model[J]. Am Psychol, 2015, 70(4): 344-353. DOI: 10.1037/a0038929. [24] Nollet M, Wisden W, Franks NP. Sleep deprivation and stress: a reciprocal relationship[J]. Interface Focus, 2020, 10(3): 20190092. DOI: 10.1098/rsfs.2019.0092. [25] Carballo JJ, Llorente C, Kehrmann L, et al. Psychosocial risk factors for suicidality in children and adolescents[J]. Eur Child Adolesc Psychiatry, 2020, 29(6): 759-776. DOI: 10.1007/s00787-018-01270-9. -
