中国5省初中生视屏时间和饮食行为与抑郁症状的关联

doi:10.3969/j.issn.1674-8115.2024.03.008

上海交通大学学报（医学版） ›› 2024, Vol. 44 ›› Issue (3): 358-364.doi: 10.3969/j.issn.1674-8115.2024.03.008

• 论著 · 公共卫生 • 上一篇

中国5省初中生视屏时间和饮食行为与抑郁症状的关联

杨瑞君¹(), 吕书红², 刘志业³, 张新¹, 刘志浩⁴()

^1.四川省绵阳市第三人民医院/四川省精神卫生中心眼科，绵阳 621000
^2.中国健康教育中心健康促进部，北京 100011
^3.山东省聊城市第二人民医院健康管理科，聊城 252600
^4.江苏省疾病预防控制中心健康教育所，南京 210009

收稿日期:2023-09-21 接受日期:2024-01-04 出版日期:2024-03-28 发布日期:2024-04-29
通讯作者: 刘志浩 E-mail:806335880@qq.com;37894479@qq.com
作者简介:杨瑞君（1982—），女，副主任医师，硕士；电子信箱：806335880@qq.com。
基金资助:
国家卫生和计划生育委员会财政项目(1710908)

Relationship of screen time and dietary behaviors with depressive symptoms in junior high school students in five provinces in China

YANG Ruijun¹(), LÜ Shuhong², LIU Zhiye³, ZHANG Xin¹, LIU Zhihao⁴()

^1.Department of Ophthalmology, The Third Hospital of Mianyang, Sichuan Province/Sichuan Province Mental Health Center, Mianyang 621000, China
^2.Department of Health Promotion, Chinese Center for Health Education, Beijing 100011, China
^3.Department of Health Management, The Second People′s Hospital of Liaocheng, Shandong Province Liaocheng 252600, China
^4.Department of Health Education, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China

Received:2023-09-21 Accepted:2024-01-04 Online:2024-03-28 Published:2024-04-29
Contact: LIU Zhihao E-mail:806335880@qq.com;37894479@qq.com
Supported by:
Financial Project of National Health and Family Planning Commission(1710908)

摘要/Abstract

摘要：

目的·了解中国5省初中生视屏时间和饮食行为与抑郁症状的关联。方法·采用分层随机整群抽样方法，对中国东部地区的浙江、广东，中部地区的江西，西部地区的四川、贵州共5省1 067名初中生进行问卷调查，包括一般人口学特征、健康行为情况、饮食行为情况、抑郁情况。采用单因素分析比较不同人口学特征的初中生的抑郁症状报告率、每日视屏时间和饮食行为，采用Logistic回归分析每日视屏时间和饮食行为与抑郁症状的关联，并分析前两者的交互作用。结果·中国5省初中生抑郁症状报告率为12.9%，西部地区、非独生子女、每周零花钱超过100元、有过吸烟行为、有过饮酒行为、每日视屏时间≥2 h、有不健康饮食行为的初中生抑郁症状报告率较高，差异均有统计学意义（均P<0.05）。15.2%初中生每日视屏时间≥2 h；调整混杂因素后，与每日视屏时间<2 h组相比，≥2 h组抑郁症状报告率更高（OR=1.89，95%CI 1.22~2.95）。29.5%的初中生有不健康饮食行为；调整混杂因素后，与健康饮食行为组相比，不健康饮食行为组抑郁症状报告率更高（OR=2.16，95%CI 1.47~3.19）。6.4%的初中生每日视屏时间≥2 h且有不健康饮食行为；调整混杂因素后，这部分学生比每日视屏时间<2 h且饮食行为健康学生抑郁症状报告率更高（OR=4.26，95%CI 2.24~7.56）。调整混杂因素后，每日视屏时间与饮食行为的交互作用分析结果显示，两者存在相加交互作用，超额相对危险度（relative excess risk due to interaction，RERI）为1.21（95%CI 1.02~1.51），交互作用归因比（attributable proportion due to interaction，AP）为0.19（95%CI 0.13~0.31），交互作用指数（synergy index，S）为1.35（95%CI 1.12~1.69）。结论·视屏时间过长且有不健康饮食行为的中国初中生更容易出现抑郁症状，且两者对抑郁症状有相加交互作用。

关键词: 中学生, 视屏时间, 饮食行为, 抑郁症状

Abstract:

Objective ·To explore the relationship of screen time and dietary behaviors with depressive symptoms in junior high school students in 5 provinces in China. Methods ·A total of 1 067 junior high school students were selected from Zhejiang and Guangdong in the eastern region, Jiangxi in the central region, Sichuan and Guizhou in the western region of China by using stratified random cluster sampling method for a questionnaire survey, which included general demographic characteristics, health behaviors, diatery behaviors, and depressive symptoms. Univariate analysis was used to analyze the report rates of depressive symptoms, daily screen time and dietary behaviors of the students with variant demographic characteristics, and Logistic regression analysis was used to analyze the relationship of daily screen time and dietary behaviors with depressive symptoms and the interaction effects as well. Results ·The report rate of depressive symptoms was 12.9% in the junior high school students in 5 provinces. The students who were in the western region, were not only children, had a weekly allowance of over 100 yuan, had smoked or consumed alcohol, had daily screen time≥2 h, or had unhealthy dietary behaviors, had higher reporting rates of depressive symptoms (P<0.05). A total of 15.2% students had daily screen time≥2 h, who had a higher reporting rate of depressive symptoms than the others after the confounding factors being adjusted (OR=1.89, 95%CI 1.22?2.95). A total of 29.5% of students had unhealthy dietary behaviors, who had a higher reporting rate of depressive symptoms than the others after the confounding factors being adjusted (OR=2.16, 95%CI 1.47?3.19). A total of 6.4% of students had both daily screen time≥2 h and unhealthy dietary behaviors, who had a higher reporting rate of depressive symptoms than the students having daily screen time<2 h and healthy dietary behaviors after the confounding factors being adjusted (OR=4.26, 95%CI 2.24?7.56). After adjusting for the confounding factors, the analysis of the interaction between daily screen time and dietary behaviors showed an additive interaction with the relative excess risk due to interaction (RERI) of 1.21 (95%CI 1.02?1.51), the attributable proportion due to interaction (AP) of 0.19 (95%CI 0.13?0.31), and the synergy index (S) of 1.35 (95%CI 1.12?1.69). Conclusion ·The junior high school students with both long screen time and unhealthy dietary behaviors are more likely to suffer from depressive symptoms in China; long screen time and unhealthy dietary behaviors have an additive interactive effect on depressive symptoms.

Key words: middle school student, screen time, dietary behavior, depressive symptom

中图分类号:

R195.4

杨瑞君, 吕书红, 刘志业, 张新, 刘志浩. 中国5省初中生视屏时间和饮食行为与抑郁症状的关联[J]. 上海交通大学学报（医学版）, 2024, 44(3): 358-364.

YANG Ruijun, LÜ Shuhong, LIU Zhiye, ZHANG Xin, LIU Zhihao. Relationship of screen time and dietary behaviors with depressive symptoms in junior high school students in five provinces in China[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(3): 358-364.

图/表 3

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Factor	Sample size/n	Depressive symptoms/n(%)	χ² value	P value
Total	1 067	138 (12.9)
Area			18.177	0.000
East	406	34 (8.4)
Middle	283	34 (12.0)
West	378	70 (18.5)
Residence			2.469	0.116
Urban	422	63 (14.9)
Rural	645	75 (11.6)
Grade			0.008	0.930
7	252	33 (13.1)
8	815	105 (12.9)
Gender			0.426	0.514
Male	560	76 (13.6)
Female	507	62 (12.2)
Only child^①			4.291	0.038
Yes	319	31 (9.7)
No	737	106 (14.4)
Resident student^①			2.163	0.141
Yes	605	86 (14.2)
No	457	51 (11.2)
Weekly allowance^①			17.186	0.002
None	264	20 (7.6)
1‒10 yuan	209	20 (9.6)
11‒50 yuan	383	63 (16.4)
51‒100 yuan	156	24 (15.4)
>100 yuan	51	11 (21.6)
Smoking behavior^①			17.095	0.000
Yes	59	18 (30.5)
No	1 007	120 (11.9)
Drinking behavior^①			15.793	0.000
Yes	277	55 (19.9)
No	788	83 (10.5)
Daily screen time			18.783	0.000
<2 h	905	100 (11.1)
≥2 h	162	38 (23.5)
Healthy dietary behaviors			31.595	0.000
Yes	752	69 (9.2)
No	315	69 (21.9)
Daily exercise time			2.589	0.108
<1 h	428	64 (15.0)
≥1 h	639	74 (11.6)

Factor	Sample size/n	Depressive symptoms/n(%)	χ² value	P value
Total	1 067	138 (12.9)
Area			18.177	0.000
East	406	34 (8.4)
Middle	283	34 (12.0)
West	378	70 (18.5)
Residence			2.469	0.116
Urban	422	63 (14.9)
Rural	645	75 (11.6)
Grade			0.008	0.930
7	252	33 (13.1)
8	815	105 (12.9)
Gender			0.426	0.514
Male	560	76 (13.6)
Female	507	62 (12.2)
Only child^①			4.291	0.038
Yes	319	31 (9.7)
No	737	106 (14.4)
Resident student^①			2.163	0.141
Yes	605	86 (14.2)
No	457	51 (11.2)
Weekly allowance^①			17.186	0.002
None	264	20 (7.6)
1‒10 yuan	209	20 (9.6)
11‒50 yuan	383	63 (16.4)
51‒100 yuan	156	24 (15.4)
>100 yuan	51	11 (21.6)
Smoking behavior^①			17.095	0.000
Yes	59	18 (30.5)
No	1 007	120 (11.9)
Drinking behavior^①			15.793	0.000
Yes	277	55 (19.9)
No	788	83 (10.5)
Daily screen time			18.783	0.000
<2 h	905	100 (11.1)
≥2 h	162	38 (23.5)
Healthy dietary behaviors			31.595	0.000
Yes	752	69 (9.2)
No	315	69 (21.9)
Daily exercise time			2.589	0.108
<1 h	428	64 (15.0)
≥1 h	639	74 (11.6)

Factor	Sample size/n	Daily screen time≥2 h/n(%)	χ² value	P value	Unhealthy dietary behaviors/n(%)	χ² value	P value
Total	1 067	162 (15.2)			315 (29.5)
Area			18.551	0.000		90.119	0.000
East	406	40 (9.9)			63 (15.5)
Middle	283	43 (15.2)			77 (27.2)
West	378	79 (20.9)			175 (46.3)
Residence			5.201	0.023		27.806	0.000
Urban	422	51 (12.1)			163 (38.6)
Rural	645	111 (17.2)			152 (23.6)
Grade			5.116	0.024		1.089	0.297
7	252	27 (10.7)			81 (32.1)
8	815	135 (16.6)			234 (28.7)
Gender			2.905	0.088		0.969	0.325
Male	560	95 (17.0)			158 (28.2)
Female	507	67 (13.2)			157 (31.0)
Only child^①			0.310	0.578		19.389	0.000
Yes	319	51 (16.0)			64 (20.1)
No	737	108 (14.7)			247 (33.5)
Resident student^①			0.665	0.415		22.238	0.000
Yes	605	87 (14.4)			213 (35.2)
No	457	74 (16.2)			100 (21.9)
Weekly allowance^①			7.631	0.106		32.124	0.000
None	264	36 (13.6)			57 (21.6)
1‒10 yuan	209	28 (13.4)			41 (19.6)
11‒50 yuan	383	53 (13.8)			142 (37.1)
51‒100 yuan	156	34 (21.8)			57 (36.5)
>100 yuan	51	10 (19.6)			15 (29.4)
Smoking behavior^①			17.207	0.000		20.882	0.000
Yes	59	20 (33.9)			33 (55.9)
No	1 007	141 (14.0)			282 (28.0)
Drinking behavior^①			27.976	0.000		16.271	0.000
Yes	277	69 (24.9)			108 (39.0)
No	788	92 (11.7)			206 (26.1)
Daily exercise time			2.464	0.117		28.004	0.000
<1 h	428	74 (17.3)			165 (38.6)
≥1 h	639	88 (13.8)			150 (23.5)

Factor	Sample size/n	Daily screen time≥2 h/n(%)	χ² value	P value	Unhealthy dietary behaviors/n(%)	χ² value	P value
Total	1 067	162 (15.2)			315 (29.5)
Area			18.551	0.000		90.119	0.000
East	406	40 (9.9)			63 (15.5)
Middle	283	43 (15.2)			77 (27.2)
West	378	79 (20.9)			175 (46.3)
Residence			5.201	0.023		27.806	0.000
Urban	422	51 (12.1)			163 (38.6)
Rural	645	111 (17.2)			152 (23.6)
Grade			5.116	0.024		1.089	0.297
7	252	27 (10.7)			81 (32.1)
8	815	135 (16.6)			234 (28.7)
Gender			2.905	0.088		0.969	0.325
Male	560	95 (17.0)			158 (28.2)
Female	507	67 (13.2)			157 (31.0)
Only child^①			0.310	0.578		19.389	0.000
Yes	319	51 (16.0)			64 (20.1)
No	737	108 (14.7)			247 (33.5)
Resident student^①			0.665	0.415		22.238	0.000
Yes	605	87 (14.4)			213 (35.2)
No	457	74 (16.2)			100 (21.9)
Weekly allowance^①			7.631	0.106		32.124	0.000
None	264	36 (13.6)			57 (21.6)
1‒10 yuan	209	28 (13.4)			41 (19.6)
11‒50 yuan	383	53 (13.8)			142 (37.1)
51‒100 yuan	156	34 (21.8)			57 (36.5)
>100 yuan	51	10 (19.6)			15 (29.4)
Smoking behavior^①			17.207	0.000		20.882	0.000
Yes	59	20 (33.9)			33 (55.9)
No	1 007	141 (14.0)			282 (28.0)
Drinking behavior^①			27.976	0.000		16.271	0.000
Yes	277	69 (24.9)			108 (39.0)
No	788	92 (11.7)			206 (26.1)
Daily exercise time			2.464	0.117		28.004	0.000
<1 h	428	74 (17.3)			165 (38.6)
≥1 h	639	88 (13.8)			150 (23.5)

Factor	Model 1		Model 2		Model 3
Factor	OR (95%CI)	P value	OR (95%CI)	P value	OR (95%CI)	P value
Daily screen time
<2 h	1.00		1.00
≥2 h	2.47 (1.62‒3.75)	0.000	1.89 (1.22‒2.95)	0.005
Healthy dietary behaviors
Yes	1.00				1.00
No	2.78 (1.93‒4.01)	0.000			2.16 (1.47‒3.19)	0.000

中国5省初中生视屏时间和饮食行为与抑郁症状的关联

Relationship of screen time and dietary behaviors with depressive symptoms in junior high school students in five provinces in China

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