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.
Keywords:middle school student
;
screen time
;
dietary behavior
;
depressive symptom
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. Journal of Shanghai Jiao Tong University (Medical Science)[J], 2024, 44(3): 358-364 doi:10.3969/j.issn.1674-8115.2024.03.008
每日视屏时间:指调查对象回顾过去7 d每天看电子屏幕(包括手机、电脑、平板电脑、电视等)的时间,将7 d的时间相加求平均值,得到每日视屏时间。根据《中国儿童青少年身体活动指南》中的建议,6~17岁儿童青少年每日视屏时间应该限制在2 h以内,将每日视屏时间≥2 h定义为视屏时间过长[10]。健康饮食行为:根据《中国学龄儿童膳食指南》[11]和本次调查实际情况,将不喝含糖类饮料、不吃油炸类食品、每天吃1次以上的新鲜蔬菜、每天吃1次以上的新鲜水果、每天吃早饭定义为健康饮食行为。吸烟行为:指曾经吸过烟,即使是吸过一两口[12]。饮酒行为:指曾经喝过一杯酒,包括白酒、啤酒、葡萄酒等[13]。抑郁症状采用患者健康问卷(2条目)中文版(Chinese version of Patient Health Questionnaire,PHQ-2-C)进行评估,2个条目内容为“感到沮丧、抑郁或绝望”“做事情没有兴趣或乐趣”,每个条目计0~3分,2个条目相加计算总分,总分≥3分认为有抑郁症状[14]。PHQ-2-C量表在中学生中具有较好的稳定性和可靠性[14]。
应用SAS 9.4软件进行分析,采用χ2检验比较不同人口学特征学生的抑郁症状情况,采用Logistic回归分析视屏时间、饮食行为与抑郁症状的单独及联合作用。交互作用分析采用ANDERSSON等[15]的方法,计算相对超额危险度(relative excess risk due to interaction,RERI)、交互作用归因比(attributable proportion due to interaction,AP)、交互作用指数(synergy index,S)。检验水准α=0.05。
Tab 3 Logistic regression analysis between daily screen time or dietary behaviors and depressive symptoms in junior high school students in 5 provinces
Factor
Model 1
Model 2
Model 3
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
Note: No adjusted variables in model 1; the factors of region, only child, weekly allowance, smoking behavior, drinking behavior, and dietary behaviors were adjusted in model 2; the factors of region, only child, weekly allowance, smoking behavior, drinking behavior, and daily screen time were adjusted in model 3.
The manuscript was drafted and revised by YANG Ruijun and ZHANG Xin; data collection was completed by LIU Zhiye; study implementation was completed by LIU Zhiye and LÜ Shuhong; the study was designed by LÜ Shuhong and LIU Zhihao; the data were analyzed by LIU Zhihao. All the authors have read the last version of paper and consented for submission.
利益冲突声明
所有作者声明不存在利益冲突
COMPETING INTERESTS
All authors disclose no relevant conflict of interests.
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... 每日视屏时间:指调查对象回顾过去7 d每天看电子屏幕(包括手机、电脑、平板电脑、电视等)的时间,将7 d的时间相加求平均值,得到每日视屏时间.根据《中国儿童青少年身体活动指南》中的建议,6~17岁儿童青少年每日视屏时间应该限制在2 h以内,将每日视屏时间≥2 h定义为视屏时间过长[10].健康饮食行为:根据《中国学龄儿童膳食指南》[11]和本次调查实际情况,将不喝含糖类饮料、不吃油炸类食品、每天吃1次以上的新鲜蔬菜、每天吃1次以上的新鲜水果、每天吃早饭定义为健康饮食行为.吸烟行为:指曾经吸过烟,即使是吸过一两口[12].饮酒行为:指曾经喝过一杯酒,包括白酒、啤酒、葡萄酒等[13].抑郁症状采用患者健康问卷(2条目)中文版(Chinese version of Patient Health Questionnaire,PHQ-2-C)进行评估,2个条目内容为“感到沮丧、抑郁或绝望”“做事情没有兴趣或乐趣”,每个条目计0~3分,2个条目相加计算总分,总分≥3分认为有抑郁症状[14].PHQ-2-C量表在中学生中具有较好的稳定性和可靠性[14]. ...
1
... 每日视屏时间:指调查对象回顾过去7 d每天看电子屏幕(包括手机、电脑、平板电脑、电视等)的时间,将7 d的时间相加求平均值,得到每日视屏时间.根据《中国儿童青少年身体活动指南》中的建议,6~17岁儿童青少年每日视屏时间应该限制在2 h以内,将每日视屏时间≥2 h定义为视屏时间过长[10].健康饮食行为:根据《中国学龄儿童膳食指南》[11]和本次调查实际情况,将不喝含糖类饮料、不吃油炸类食品、每天吃1次以上的新鲜蔬菜、每天吃1次以上的新鲜水果、每天吃早饭定义为健康饮食行为.吸烟行为:指曾经吸过烟,即使是吸过一两口[12].饮酒行为:指曾经喝过一杯酒,包括白酒、啤酒、葡萄酒等[13].抑郁症状采用患者健康问卷(2条目)中文版(Chinese version of Patient Health Questionnaire,PHQ-2-C)进行评估,2个条目内容为“感到沮丧、抑郁或绝望”“做事情没有兴趣或乐趣”,每个条目计0~3分,2个条目相加计算总分,总分≥3分认为有抑郁症状[14].PHQ-2-C量表在中学生中具有较好的稳定性和可靠性[14]. ...
1
... 每日视屏时间:指调查对象回顾过去7 d每天看电子屏幕(包括手机、电脑、平板电脑、电视等)的时间,将7 d的时间相加求平均值,得到每日视屏时间.根据《中国儿童青少年身体活动指南》中的建议,6~17岁儿童青少年每日视屏时间应该限制在2 h以内,将每日视屏时间≥2 h定义为视屏时间过长[10].健康饮食行为:根据《中国学龄儿童膳食指南》[11]和本次调查实际情况,将不喝含糖类饮料、不吃油炸类食品、每天吃1次以上的新鲜蔬菜、每天吃1次以上的新鲜水果、每天吃早饭定义为健康饮食行为.吸烟行为:指曾经吸过烟,即使是吸过一两口[12].饮酒行为:指曾经喝过一杯酒,包括白酒、啤酒、葡萄酒等[13].抑郁症状采用患者健康问卷(2条目)中文版(Chinese version of Patient Health Questionnaire,PHQ-2-C)进行评估,2个条目内容为“感到沮丧、抑郁或绝望”“做事情没有兴趣或乐趣”,每个条目计0~3分,2个条目相加计算总分,总分≥3分认为有抑郁症状[14].PHQ-2-C量表在中学生中具有较好的稳定性和可靠性[14]. ...
1
... 每日视屏时间:指调查对象回顾过去7 d每天看电子屏幕(包括手机、电脑、平板电脑、电视等)的时间,将7 d的时间相加求平均值,得到每日视屏时间.根据《中国儿童青少年身体活动指南》中的建议,6~17岁儿童青少年每日视屏时间应该限制在2 h以内,将每日视屏时间≥2 h定义为视屏时间过长[10].健康饮食行为:根据《中国学龄儿童膳食指南》[11]和本次调查实际情况,将不喝含糖类饮料、不吃油炸类食品、每天吃1次以上的新鲜蔬菜、每天吃1次以上的新鲜水果、每天吃早饭定义为健康饮食行为.吸烟行为:指曾经吸过烟,即使是吸过一两口[12].饮酒行为:指曾经喝过一杯酒,包括白酒、啤酒、葡萄酒等[13].抑郁症状采用患者健康问卷(2条目)中文版(Chinese version of Patient Health Questionnaire,PHQ-2-C)进行评估,2个条目内容为“感到沮丧、抑郁或绝望”“做事情没有兴趣或乐趣”,每个条目计0~3分,2个条目相加计算总分,总分≥3分认为有抑郁症状[14].PHQ-2-C量表在中学生中具有较好的稳定性和可靠性[14]. ...
1
... 每日视屏时间:指调查对象回顾过去7 d每天看电子屏幕(包括手机、电脑、平板电脑、电视等)的时间,将7 d的时间相加求平均值,得到每日视屏时间.根据《中国儿童青少年身体活动指南》中的建议,6~17岁儿童青少年每日视屏时间应该限制在2 h以内,将每日视屏时间≥2 h定义为视屏时间过长[10].健康饮食行为:根据《中国学龄儿童膳食指南》[11]和本次调查实际情况,将不喝含糖类饮料、不吃油炸类食品、每天吃1次以上的新鲜蔬菜、每天吃1次以上的新鲜水果、每天吃早饭定义为健康饮食行为.吸烟行为:指曾经吸过烟,即使是吸过一两口[12].饮酒行为:指曾经喝过一杯酒,包括白酒、啤酒、葡萄酒等[13].抑郁症状采用患者健康问卷(2条目)中文版(Chinese version of Patient Health Questionnaire,PHQ-2-C)进行评估,2个条目内容为“感到沮丧、抑郁或绝望”“做事情没有兴趣或乐趣”,每个条目计0~3分,2个条目相加计算总分,总分≥3分认为有抑郁症状[14].PHQ-2-C量表在中学生中具有较好的稳定性和可靠性[14]. ...
1
... 每日视屏时间:指调查对象回顾过去7 d每天看电子屏幕(包括手机、电脑、平板电脑、电视等)的时间,将7 d的时间相加求平均值,得到每日视屏时间.根据《中国儿童青少年身体活动指南》中的建议,6~17岁儿童青少年每日视屏时间应该限制在2 h以内,将每日视屏时间≥2 h定义为视屏时间过长[10].健康饮食行为:根据《中国学龄儿童膳食指南》[11]和本次调查实际情况,将不喝含糖类饮料、不吃油炸类食品、每天吃1次以上的新鲜蔬菜、每天吃1次以上的新鲜水果、每天吃早饭定义为健康饮食行为.吸烟行为:指曾经吸过烟,即使是吸过一两口[12].饮酒行为:指曾经喝过一杯酒,包括白酒、啤酒、葡萄酒等[13].抑郁症状采用患者健康问卷(2条目)中文版(Chinese version of Patient Health Questionnaire,PHQ-2-C)进行评估,2个条目内容为“感到沮丧、抑郁或绝望”“做事情没有兴趣或乐趣”,每个条目计0~3分,2个条目相加计算总分,总分≥3分认为有抑郁症状[14].PHQ-2-C量表在中学生中具有较好的稳定性和可靠性[14]. ...
1
... 每日视屏时间:指调查对象回顾过去7 d每天看电子屏幕(包括手机、电脑、平板电脑、电视等)的时间,将7 d的时间相加求平均值,得到每日视屏时间.根据《中国儿童青少年身体活动指南》中的建议,6~17岁儿童青少年每日视屏时间应该限制在2 h以内,将每日视屏时间≥2 h定义为视屏时间过长[10].健康饮食行为:根据《中国学龄儿童膳食指南》[11]和本次调查实际情况,将不喝含糖类饮料、不吃油炸类食品、每天吃1次以上的新鲜蔬菜、每天吃1次以上的新鲜水果、每天吃早饭定义为健康饮食行为.吸烟行为:指曾经吸过烟,即使是吸过一两口[12].饮酒行为:指曾经喝过一杯酒,包括白酒、啤酒、葡萄酒等[13].抑郁症状采用患者健康问卷(2条目)中文版(Chinese version of Patient Health Questionnaire,PHQ-2-C)进行评估,2个条目内容为“感到沮丧、抑郁或绝望”“做事情没有兴趣或乐趣”,每个条目计0~3分,2个条目相加计算总分,总分≥3分认为有抑郁症状[14].PHQ-2-C量表在中学生中具有较好的稳定性和可靠性[14]. ...
2
... 每日视屏时间:指调查对象回顾过去7 d每天看电子屏幕(包括手机、电脑、平板电脑、电视等)的时间,将7 d的时间相加求平均值,得到每日视屏时间.根据《中国儿童青少年身体活动指南》中的建议,6~17岁儿童青少年每日视屏时间应该限制在2 h以内,将每日视屏时间≥2 h定义为视屏时间过长[10].健康饮食行为:根据《中国学龄儿童膳食指南》[11]和本次调查实际情况,将不喝含糖类饮料、不吃油炸类食品、每天吃1次以上的新鲜蔬菜、每天吃1次以上的新鲜水果、每天吃早饭定义为健康饮食行为.吸烟行为:指曾经吸过烟,即使是吸过一两口[12].饮酒行为:指曾经喝过一杯酒,包括白酒、啤酒、葡萄酒等[13].抑郁症状采用患者健康问卷(2条目)中文版(Chinese version of Patient Health Questionnaire,PHQ-2-C)进行评估,2个条目内容为“感到沮丧、抑郁或绝望”“做事情没有兴趣或乐趣”,每个条目计0~3分,2个条目相加计算总分,总分≥3分认为有抑郁症状[14].PHQ-2-C量表在中学生中具有较好的稳定性和可靠性[14]. ...
... [14]. ...
1
... 应用SAS 9.4软件进行分析,采用χ2检验比较不同人口学特征学生的抑郁症状情况,采用Logistic回归分析视屏时间、饮食行为与抑郁症状的单独及联合作用.交互作用分析采用ANDERSSON等[15]的方法,计算相对超额危险度(relative excess risk due to interaction,RERI)、交互作用归因比(attributable proportion due to interaction,AP)、交互作用指数(synergy index,S).检验水准α=0.05. ...