中小学生睡眠时间和饮食与抑郁、焦虑及压力症状的关系

Associations of sleep duration and diet with depression, anxiety, and stress symptoms among primary and secondary school students

摘要

目的 探讨中小学生睡眠时间、饮食与抑郁、焦虑、压力症状的关系,为中小学生心理健康促进及干预提供参考依据。方法 2023年9—10月,采用分层整群随机抽样法对无锡市12 156名中小学生进行问卷调查,采用学生常见病和健康影响因素监测调查问卷相关条目评估中小学生的睡眠时间、饮食状况和抑郁、焦虑、压力症状。采用χ²检验进行组间比较,采用logistic回归模型分析睡眠时间和饮食与抑郁、焦虑、压力症状的独立和联合关联。结果 无锡市中小学生睡眠时间和健康饮食未达标率分别为68.8%(8 368/12 156)、91.4%(11 114/12 156),抑郁、焦虑、压力症状检出率分别为12.9%(1 574/12 156)、23.0%(2 797/12 156)、9.5%(1 152/12 156)。多因素logistic回归结果显示,睡眠时间未达标(OR=2.13、2.23、2.03)和健康饮食未达标(OR＝2.49、2.04、2.00)是存在抑郁、焦虑和压力症状的危险因素(P<0.05);饮食和睡眠时间与中小学生抑郁、焦虑症状存在交互效应,与两者均达标者相比,两者均未达标的中小学生其抑郁、焦虑、压力症状风险显著升高(OR＝10.87、6.83、3.06,P<0.05)。结论 无锡市中小学生睡眠时间、健康饮食和抑郁、焦虑、压力症状存在相关性。家庭、学校和社会应共同保障中小学生充足睡眠与健康饮食,以预防和减轻其心理问题。

Abstract

Objective To explore the association of sleep duration and diet with depression, anxiety and stress symptoms among primary and secondary school students, so as to provide reference for the promotion and intervention of mental health among primary and secondary school students. Methods A questionnaire survey was conducted by multi-stage cluster random sampling on 12 156 primary and secondary school students in Wuxi from September to October 2023.The entries of the questionnaire on monitoring of common diseases and health influencing factors of students were used to assess the sleep time, dietary status, and symptoms of depression, anxiety, and stress of primary and secondary school students.The χ² test was employed for between-group comparisons, and multivariate logistic regression models were utilised to analyze the independent and joint associations of sleep duration and diet with symptoms of depression, anxiety, and stress. Results The rates of inadequate sleep duration and unhealthy diet among students were 68.8% (8 368/12 156) and 91.4% (11 114/12 156), respectively.The detection rates of depression, anxiety, and stress symptoms were 12.9%(1 574/12 156), 23.0%(2 797/12 156) and 9.5%(1 152/12 156), respectively.Multivariate logistic regression analysis showed that inadequate sleep duration was positively associated with symptoms of depression, anxiety, and stress (OR=2.13, 2.23, 2.03, P<0.05), and an unhealthy diet was also positively associated with these symptoms (OR=2.49, 2.04, 2.00, P<0.05).An interaction effect between diet and sleep duration was observed for depression and anxiety symptoms.Compared with students who met both healthy diet and adequate sleep duration standards, those who failed to meet both had significantly higher risks of depression, anxiety, and stress symptoms (OR=10.87, 6.83, 3.06, P<0.05). Conclusions Inadequate sleep duration and unhealthy diet are significantly associated with depression, anxiety, and stress symptoms among primary and secondary school students in Wuxi.Families, schools, and society should work together to ensure sufficient sleep and healthy eating habits to prevent and alleviate mental health problems in students.

关键词

睡眠 / 饮食 / 抑郁 / 焦虑 / 压力

Key words

sleep / diet / depression / anxiety / stress

[1] McLeod GF, Horwood LJ, Fergusson DM.Adolescent depression, adult mental health and psychosocial outcomes at 30 and 35 years[J].Psychol Med, 2016, 46(7): 1401-1412.
[2] Palmer CA, Bower JL, Cho KW, et al.Sleep loss and emotion: A systematic review and meta-analysis of over 50 years of experimental research[J].Psychol Bull, 2024, 150(4): 440-463.
[3] Zhao J, Xu J, He Y, et al.Children and adolescents' sleep patterns and their associations with mental health during the COVID-19 pandemic in Shanghai, China[J].J Affect Disord, 2022, 301: 337-344.
[4] Ramon-Arbues E, Martinez Abadia B, Granada Lopez JM, et al.Eating behavior and relationships with stress, anxiety, depression and insomnia in university students[J].Nutr Hosp, 2019, 36(6): 1339-1345.
[5] 张娜, 朱文丽, 张曼, 等.《中国学龄儿童膳食指南(2022)》解读[J].中国学校卫生, 2022, 43(6): 805-808.
Zhang N, Zhu WL, Zhang M, et al.Interpretation on dietary guidelines for Chinese school-age children (2022)[J].Chin J Sch Health, 2022, 43(6): 805-808.(in Chinese)
[6] 张依航, 袁雯, 党佳佳, 等.内蒙古地区2021年中小学生近视与肥胖共患现状及生活方式的调节作用[J].中国学校卫生, 2023, 44 (9): 1299-1303.
Zhang YH, Yuan W, Dang JJ, et al.Co-morbidity of myopia and obesity and the moderating role of lifestyle among primary and secondary school students in Inner Mongolia Autonomous Region in 2021[J].Chin J Sch Health, 2023, 44 (9): 1299-1303.(in Chinese)
[7] 国家质量监督检验疫总局,中国国家标准化管理委员会.中小学生一日学习时间卫生要求: GB/T 17223-2012[S].北京:中国标准出版社,2013.
[8] 陈祉妍, 杨小冬, 李新影.流调中心抑郁量表在我国青少年中的试用[J].中国临床心理学杂志, 2009, 19(4): 443-445, 448.
Chen ZY, Yang XD, Li XY.Psychometric features of CES-D in Chinese adolescents[J].Chin J Clin Psychol, 2009, 19(4): 443-445, 448.(in Chinese)
[9] 赵芳芳, 赵瑞兰, 李莉, 等.中学生抑郁症状状况及其日常生活行为影响因素研究[J].中国健康教育, 2023, 39(9): 777-782.
Zhao FF, Zhao RL, Li L, et al.Study on depression symptoms and its influencing factors of daily living behaviors in middle school students[J].Chin J Health Educ, 2023, 39(9): 777-782.(in Chinese)
[10] Sun J, Liang K, Chi X, et al.Psychometric Properties of the Generalized Anxiety Disorder Scale-7 Item (GAD-7) in a large sample of Chinese adolescents[J].Healthcare (Basel), 2021, 9(12): 1709.
[11] Wang M, Mou X, Li T, et al.Association between comorbid anxiety and depression and health risk behaviors among Chinese adolescents: Cross-sectional questionnaire study[J].JMIR Public Health Surveill, 2023, 9: e46289.
[12] Lu S, Cheval B, Yu Q, et al.Associations of 24-hour movement behavior with depressive symptoms and anxiety in children: Cross-sectional findings from a chinese sample[J].Healthcare (Basel), 2021, 9(11).
[13] Lovibond PF, Lovibond SH.The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck depression and anxiety inventories[J].Behav Res Ther, 1995, 33(3): 335-343.
[14] Chen W, Peng K, Gao M, et al.Factor structure and measurement invariance of the Depression Anxiety Stress Scale (DASS-21) in Chinese left-behind and non-left-behind children: An exploratory structural equation modeling approach[J].BMC Public Health, 2024, 24(1): 1660.
[15] Yu L, Zhao J, Zhao T, et al.Multicenter analysis on the non-suicidal self-injury behaviors and related influencing factors-A case study of left-behind children in northeastern Sichuan[J].J Affect Disord, 2023, 320: 161-168.
[16] Antony MM, Bieling PJ, Cox BJ, et al.Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample[J].Psychol Assess, 1998, 10(2): 176-181.
[17] Borjigen A, Huang C, Liu M, et al.Status and factors of menstrual knowledge, attitudes, behaviors and their correlation with psychological stress in adolescent girls[J].J Pediatr Adolesc Gynecol, 2019, 32(6): 584-589.
[18] Shi J, Wang X, Wu Q, et al.The joint association of physical activity and sedentary behavior with health-related quality of life among children and adolescents in Mainland China[J].Front Public Health, 2022, 10: 1003358.
[19] Zhong CC, Li Z, Chen M, et al.Unhealthy dietary behaviors and associated factors among adolescents: A territory-wide study[J].BMC Public Health, 2026, 26(1): 1370.
[20] 张威, 蔡洋洋, 李秀玲, 等.贵州省三地区初中生饮食行为调查研究[J].中国健康教育, 2020, 36(9): 788-792.
Zhang W, Cai YY, Li XL, et al.Analysis on the prevalence of eating behaviors among middle school students in 3 districts of Guizhou Province[J].Chin J Health Educ, 2020, 36(9): 788-792.(in Chinese)
[21] 李俊同, 刘辉, 叶盛, 等.南京市中小学生生活方式与近视和抑郁症状共患的关系[J].中国学校卫生, 2024, 45(5): 630-634.
Li JT, Liu H, Ye S, et al.Relationship between lifestyle and the comorbidity of myopia and depressive symptoms among primary and secondary school students in Nanjing[J].Chin J Sch Health, 2024, 45(5): 630-634.(in Chinese)
[22] 赵栋, 邹艳, 苏丹婷, 等.浙江省西部公办学校初中生营养知信行现状[J].卫生研究, 2020, 49(4): 659-662.
[23] Della Corte K, Fife J, Gardner A, et al.World trends in sugar-sweetened beverage and dietary sugar intakes in children and adolescents: A systematic review[J].Nutr Rev, 2021, 79(3): 274-288.
[24] Chen Z, Ren S, He R, et al.Prevalence and associated factors of depressive and anxiety symptoms among Chinese secondary school students[J].BMC Psychiatry, 2023, 23(1): 580.
[25] 苏华倩, 王凯, 永忠甜, 等.中学生睡眠和饮食节律紊乱联合暴露与抑郁症状的关联性[J].中华疾病控制杂志, 2025, 29(1): 89-107.
Su HQ, Wang K, Yong ZT, et al.Association of sleep and dietary rhythm disorders on the development of depressive symptoms in secondary school students[J].Chin J Dis Control Prev, 2025, 29(1): 89-107.(in Chinese)
[26] Guedes LG, Abreu Gde A, Rodrigues DF, et al.Comparison between self-reported sleep duration and actigraphy among adolescents: Gender differences[J].Rev Bras Epidemiol, 2016, 19(2): 339-347.
[27] 张矗, 常树丽, 管新艳, 等.深圳市宝安区小学生睡眠健康与不良行为习惯的关联性分析[J].实用预防医学, 2017, 24 (7): 848-851.
Zhang C, Chang SL, Guan XY, et al.An analysis of the correlation between sleep health and unhealthy behavioral habits among primary school students in Bao'an District, Shenzhen[J].Pract Prev Med, 2017, 24 (7): 848-851.(in Chinese)
[28] Xu WQ, Tan WY, Li XL, et al.Prevalence and correlates of depressive and anxiety symptoms among adults in Guangdong Province of China: A population-based study[J].J Affect Disord, 2022, 308: 535-544.
[29] Gong WJ, Fong DY, Wang MP, et al.Skipping breakfast and eating breakfast away from home were prospectively associated with emotional and behavioral problems in 115 217 Chinese adolescents[J].J Epidemiol, 2022, 32(12): 551-558.
[30] 牟春英, 张田香, 郑有礼, 等.心理压力与摄食偏好及摄取率的相关性分析: 高考压力对学生不同味觉食物偏好及摄取率的影响[J].中国医学伦理学, 2014, 27(5): 720-722.
[31] Wang X, Arafa A, Liu K, et al.Combined healthy lifestyle and depressive symptoms: A meta-analysis of observational studies[J].J Affect Disord, 2021, 289: 144-150.
[32] Bourke M, Wang HFW, McNaughton SA, et al.Clusters of healthy lifestyle behaviours are associated with symptoms of depression, anxiety, and psychological distress: A systematic review and meta-analysis of observational studies[J].Clin Psychol Rev, 2025, 118: 102585.

基金资助

无锡市医学重点学科项目(LCZX2021006);无锡市卫健委青年科研基金项目(Q202461);无锡市妇幼健康科研基金项目(FYKY202406)