Prevalence of post-traumatic stress disorder and analysis of influencing factors among left-behind middle school students
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摘要:
目的 了解留守中学生创伤后应激障碍(post-traumatic stress disorder, PTSD)的流行情况及其影响因素, 为保护留守中学生心理健康状况提供科学依据。 方法 2021年9月―2023年6月采用多阶段整群抽样的方法, 选取留守儿童较多的6个省份中10~18岁留守中学生作为研究对象。通过问卷调查收集一般情况、创伤性事件和PTSD发生情况。采用χ2检验、t检验分析不同特征留守中学生PTSD的发生情况, 采用logistic回归分析模型分析PTSD的影响因素。 结果 8 878名留守中学生中, 4 496人(50.6%)有过创伤经历, 965人有PTSD症状, PTSD总体发生率为10.9%, 创伤群体发生率为21.5%。在创伤群体中, 经历过在外面被暴打、被骂或者被伤害事件的PTSD发生率最高(42.6%), 从创伤类型来看, 经历其他类型的PTSD发生率最高(18.1%); 从创伤数量来看, 经历数量越多, PTSD的发生率越高。多因素分析结果显示, 女性(OR=1.49, 95% CI: 1.28~1.73)、家庭氛围一般(OR=1.33, 95% CI: 1.09~1.62)或差(OR=2.77, 95% CI: 2.04~3.75)、看护人不固定(OR=1.26, 95% CI: 1.05~1.52)、主要教养方式为责骂(OR=1.51, 95% CI: 1.23~1.86)、溺爱(OR=1.30, 95% CI: 1.01~1.66)、体罚(OR=1.52, 95% CI: 1.10~2.19)或不管不问(OR=2.56, 95% CI: 1.66~3.94)是PTSD的危险因素。与看护人关系一般或亲近、经济条件中等、学校附近治安好是PTSD的保护因素(均P < 0.05)。相较于经历1件创伤性事件, 经历≥7件创伤性事件的PTSD风险增加8.72倍(OR=8.72, 95% CI: 5.52~13.80)。相较于只经历事故/伤害类型的创伤性事件, 只经历其他或多种类型创伤性事件的PTSD风险都会增加。 结论 留守中学生群体发生PTSD风险较大, 尤其是有创伤经历的群体, 其心理健康状况亟待关注, 应及时采取针对性的措施进行预防和干预。 Abstract:Objective This study examines the prevalence of Post-Traumatic Stress Disorder (PTSD) and its influencing factors among left-behind middle school students, providing a scientific basis for mental health interventions. Methods From September 2021 to June 2023, a multi-stage cluster sampling method was used to select left-behind middle school students aged 10-18 from six provinces with a significant population of left-behind children for mental health interventions. A questionnaire collected data on demographics, traumatic experiences, and PTSD. The prevalence of PTSD was analyzed using chi-square tests and t-tests, while logistic regression identified the influencing factors. Results Among the 8 878 left-behind middle school students, 4 496 (50.6%) reported experiencing trauma, and 965 exhibited PTSD symptoms, resulting in an overall PTSD prevalence rate of 10.9% and a prevalence rate of 21.5% among those who had experienced trauma. The highest PTSD prevalence (42.6%) was found in students who reported being physically assaulted, threatened, or severely harmed in their town. Students who experienced "other" types of trauma had the highest PTSD prevalence at 18.1%. The prevalence of PTSD increased with the number of traumatic events experienced. Multivariate analysis identified several risk factors for PTSD, including female gender (OR=1.49, 95% CI: 1.28-1.73), moderate (OR=1.33, 95% CI: 1.09-1.62) or poor family environments (OR=2.77, 95% CI: 2.04-3.75), unstable caregivers (OR=1.26, 95% CI: 1.05-1.52), and certain parenting styles such as reprimanding (OR=1.51, 95% CI: 1.23-1.86), spoiling (OR=1.30, 95% CI: 1.01-1.66), corporal punishment (OR=1.52, 95% CI: 1.10-2.19), or neglect (OR=2.56, 95% CI: 1.66-3.94). Protective factors included having a close or average relationship with caregivers, moderate economic conditions, and good security near the school (all P < 0.05). Additionally, the risk of PTSD was 8.72 times higher for those who experienced more than 7 traumatic events compared to those who experienced only one. Students who experienced trauma categorized as "other" or multiple types had a higher risk of PTSD than those who only faced "accidents or injuries". Conclusions Left-behind middle school students exhibit a high risk of PTSD, particularly those with traumatic experiences, highlighting the urgent need for targeted mental health interventions and preventive measures. -
表 1 留守中学生基本情况
Table 1. Demographic characteristics of 8 878 left-behind middle school students: number and percentage of age, gender, school type, home location, parent′s education level, form of parental absence, parents′ relationship status, family atmosphere, caregivers maintenance, main parenting style, relationship with caregiver, economic conditions, academic achievement, security around the school
特征 留守中学生人数(n=8 878) 百分比/% 特征 留守中学生人数(n=8 878) 百分比/% 年龄/岁① 15.5±1.6 家庭氛围 性别 好 5 703 64.2 男性 4 139 46.6 一般 2 744 30.9 女性 4 739 53.4 差 431 4.9 调查学校 看护人是否固定 初中 2 812 31.7 固定 7 490 84.4 高中 3 094 34.8 不固定 1 388 15.6 中等职业学校 2 972 33.5 主要教养方式 家庭所在地 说理 5 862 66.0 农村 5 567 62.7 责骂 1 057 11.9 城镇 3 311 37.3 溺爱 798 9.0 父亲文化水平 体罚 296 3.3 小学及以下 1 984 22.3 不管不问 173 2.0 初中 5 154 58.1 其他 692 7.8 高中或中专 1 474 16.6 与看护人关系 大专及以上 266 3.0 疏远 119 1.4 母亲文化水平 一般 1 352 15.2 小学及以下 3 075 34.6 亲近 7 407 83.4 初中 4 515 50.9 经济条件 高中或中专 1 072 12.1 困难 1 816 20.5 大专及以上 216 2.4 中等 6 792 76.5 留守类型 富裕 270 3.0 父亲外出 2 594 29.2 学习成绩 母亲外出 494 5.6 好 1 079 12.1 双亲外出 5 790 65.2 一般 5 876 66.2 父母感情状况 差 1 923 21.7 好 5 785 65.2 学校附近治安 一般 2 272 25.6 差 209 2.3 差 821 9.2 一般 2 742 30.9 好 5 927 66.8 注：①以x±s表示。 
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表 2 经历不同类别和数量创伤性事件留守中学生的创伤后应激障碍发生率
Table 2. Prevalence of post-traumatic stress disorder in 8 878 left-behind middle school students based on exposure to different types and numbers of traumatic events in the overall and trauma-exposed populations
变量 创伤人数(n=8 878)① 创伤后应激障碍人数 创伤后应激障碍发生率/% 变量 创伤人数(n=8 878)① 创伤后应激障碍人数 创伤后应激障碍发生率/% 总体 创伤群体 总体 创伤群体 任意创伤性事件 4 496(50.6) 965 10.9 21.5 经历创伤性事件类型 经历创伤性事件类型 听说你爱的人的伤亡情况 654(7.4) 212 2.4 32.4 事故和伤害 469(5.3) 41 0.5 8.7 其他事件 182(2.1) 33 0.4 18.1 地震 66(0.7) 20 0.2 30.3 其他令人害怕的事情 1 241(14.0) 466 5.2 37.6 自然灾害 857(9.7) 200 2.3 23.3 任意2类 1 480(16.7) 322 3.6 21.8 严重的事故 459(5.2) 126 1.4 27.5 任意3类 782(8.8) 290 3.3 37.1 痛苦的医疗 891(10.0) 254 2.9 28.5 任意4类 243(2.7) 128 1.4 52.7 人际创伤 291(3.3) 39 0.4 13.4 经历创伤性事件数量/件 遭受家庭暴力 1 520(17.1) 446 5.0 29.3 1 1 673(18.8) 179 2.0 10.7 遭受过性骚扰 262(3.0) 100 1.1 38.2 2 1 219(13.7) 202 2.3 16.6 在外面遭受暴力 537(6.0) 229 2.6 42.6 3 709(8.0) 192 2.2 27.1 社交网络和目睹事件 1 049(11.8) 112 1.3 10.7 4 419(4.7) 145 1.6 34.6 在外面目睹暴力 1 853(20.9) 482 5.4 26.0 5 243(2.7) 122 1.4 50.2 看见过死人 1 217(13.7) 306 3.4 25.1 6 135(1.5) 67 0.8 49.6 目睹家庭暴力 1 131(12.7) 350 3.9 30.9 ≥7 98(1.1) 58 0.7 59.2 注：①以人数(占比/%)表示。
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表 3 有创伤经历的留守中学生创伤后应激障碍影响因素分析
Table 3. Analysis of factors influencing post-traumatic stress disorder in 4 496 left-behind middle school students who have experienced trauma
特征 合计(n=4 496) 创伤后应激障碍① 单因素分析 多因素分析 t/χ2值 P值 OR值(95% CI) P值 年龄/岁 15.4±1.4 15.6±1.4 -0.514 0.607 性别 24.558 < 0.001 男 2 200 404(18.4) 1.00 女 2 296 561(24.4) 1.49(1.28~1.73) < 0.001 调查学校 2.970 0.227 初中 1 297 267(20.6) 高中 1 719 392(22.8) 中等职业学校 1 480 306(20.7) 家庭所在地 0.788 0.375 农村 2 716 571(21.0) 城镇 1 780 394(22.1) 父亲文化水平 6.322 0.097 小学及以下 1 014 242(23.9) 初中 2 577 523(20.3) 高中或中专 753 163(21.6) 大专及以上 152 37(24.3) 母亲文化水平 5.333 0.149 小学及以下 1 596 334(20.9) 初中 2 245 472(21.0) 高中或中专 533 124(23.3) 大专及以上 122 35(28.7) 留守类型 1.246 0.536 父亲外出 1 288 273(21.2) 母亲外出 254 48(18.9) 双亲外出 2 954 644(21.8) 父母感情状况 95.641 < 0.001 好 2 605 442(17.0) 1.00 一般 1 343 334(24.9) 1.07(0.88~1.31) 0.503 差 548 189(34.5) 1.26(0.97~1.64) 0.087 家庭氛围 174.951 < 0.001 好 2 483 397(16.0) 1.00 一般 1 668 410(24.6) 1.33(1.09~1.62) 0.005 差 345 158(45.8) 2.77(2.04~3.75) < 0.001 看护人是否固定 20.378 < 0.001 固定 3 697 746(20.2) 1.00 不固定 799 219(27.4) 1.26(1.05~1.52) 0.014 主要教养方式 104.498 < 0.001 说理 2 648 459(17.3) 1.00 责骂 727 220(30.3) 1.51(1.23~1.86) < 0.001 溺爱 453 102(22.5) 1.30(1.01~1.66) 0.042 体罚 225 66(29.3) 1.52(1.10~2.19) 0.011 不管不问 100 46(46.0) 2.56(1.66~3.94) < 0.001 其他 343 72(21.0) 1.07(0.80~1.43) 0.644 与看护人关系 74.594 < 0.001 疏远 84 44(52.4) 1.00 一般 840 230(27.4) 0.42(0.26~0.68) < 0.001 亲近 3 572 691(19.3) 0.38(0.24~0.61) < 0.001 经济条件 36.795 < 0.001 困难 1 055 297(28.2) 1.00 中等 3 293 637(19.3) 0.72(0.61~0.85) < 0.001 富裕 148 31(20.9) 0.93(0.60~1.44) 0.749 学习成绩 16.054 < 0.001 好 518 100(19.3) 1.00 一般 2 844 574(20.2) 1.05(0.82~1.35) 0.692 差 1 134 291(25.7) 1.24(0.95~1.63) 0.113 学校附近治安 34.420 < 0.001 差 138 39(28.3) 1.00 一般 1 649 423(25.7) 0.89(0.59~1.33) 0.561 好 2 709 503(18.6) 0.61(0.41~0.91) 0.016 注：①以人数(占比/%)或x±s表示。
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表 4 有创伤经历的留守中学生创伤后应激障碍发生率与创伤数量和类型的关系
Table 4. Association between post-traumatic stress disorder prevalence and different types and numbers of trauma in 4 496 left-behind middle school students
变量 模型1 模型2 模型3 OR值(95% CI) P值 OR值(95% CI) P值 OR值(95% CI) P值 经历创伤性事件数量/件 1 1.00 1.00 1.00 2 1.66(1.34~2.06) < 0.001 1.72(1.38~2.14) < 0.001 1.56(1.25~1.95) < 0.001 3 3.10(2.47~3.89) < 0.001 3.28(2.61~4.12) < 0.001 2.86(2.26~3.61) < 0.001 4 4.42(3.43~5.70) < 0.001 4.65(3.60~6.00) < 0.001 3.74(2.87~4.88) < 0.001 5 8.42(6.26~11.31) < 0.001 8.97(6.65~12.10) < 0.001 6.98(5.13~9.52) < 0.001 6 8.22(5.67~11.92) < 0.001 8.84(6.08~12.87) < 0.001 6.76(4.57~9.98) < 0.001 ≥7 12.10(7.86~18.64) < 0.001 13.75(8.88~21.30) < 0.001 8.72(5.52~13.80) < 0.001 经历创伤性事件类型 事故/伤害 1.00 1.00 1.00 人际创伤 1.62(1.02~2.57) 0.043 1.62(1.02~2.59) 0.042 1.32(0.82~2.13) 0.252 社交网络和目睹事件 1.25(0.86~1.82) 0.248 1.24(0.85~1.81) 0.261 1.13(0.77~1.66) 0.524 其他事件 2.31(1.41~3.79) 0.001 2.17(1.32~3.57) 0.002 1.92(1.16~3.18) 0.012 任意2类 2.90(2.06~4.09) < 0.001 2.97(2.10~4.19) < 0.001 2.39(1.68~3.39) < 0.001 任意3类 6.15(4.33~8.75) < 0.001 6.39(4.49~9.10) < 0.001 4.73(3.30~6.79) < 0.001 任意4类 11.62(7.73~17.47) < 0.001 12.16(8.07~18.32) < 0.001 8.16(5.32~12.38) < 0.001 注：模型1未添加控制变量。模型2在模型1的基础上, 加入性别和年龄为控制变量。模型3在模型2的基础上, 加入父母感情状况、家庭氛围、看护人是否固定、主要教养方式、与看护人关系、经济条件、学习成绩、学校附近治安等因素为控制变量。
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