【作者】 唐芳；

【导师】 薛付忠； 覃萍；

【作者基本信息】 山东大学 ， 流行病与卫生统计学， 2015， 博士

【摘要】 自杀(suicide)是人类最重要的死因之一,是全世界共同关注的重大社会和公共卫生问题。近年来,青少年已经成为自杀的高危人群。据世界卫生组织数据显示,自杀已成为很多国家15岁-29岁人群的第二或第三位死因。我国目前正处于社会转型期,各种社会矛盾增多,竞争压力加大,当今的青少年在获得更多机会的同时,也承受着更大的压力。随着学习、就业和经济等压力的不断增大,部分学生出现了一系列严重的心理健康问题,尤其突出的是有自杀行为的大学生数量不断攀升。大学生自杀给家庭、社会和国家带来了极大的负面影响和严重的经济、社会负担。生命是不可逆的,正如首个“世界预防自杀日”的口号“自杀,一个都太多”。因此,探索大学生自杀行为的影响因素及其流行病学特征,为预防与干预大学生自杀提供科学依据,避免悲剧的发生,是目前一个亟待解决的重大课题。近年来,国内外学者对大学生自杀行为进行了深入广泛的科学研究和流行病学调查。但由于各国所调查的人群、调查方法等存在着差异,关于大学生自杀行为流行特点的报道也不尽相同。自杀是生理、心理和社会等诸多因素综合作用的结果,且各因素之间相互联系,相互影响。国内外学者对此也进行了大量的研究,试图从中找出自杀的规律及行之有效的预防和干预方法。然而,自杀的影响因素复杂多样,各研究的侧重点不同,致使有些研究结果存在分歧,甚至相互矛盾。因此,深入研究各影响因素间的相互联系以及对自杀行为的作用机制是需要进一步解决的关键问题。鉴于此,本研究从以下几方面进行了探讨：1、针对目前基于大样本的大学生自杀行为的研究较少,大学生自杀行为现状及其特点尚需进一步研究探讨。本研究采用分层随机抽样方法从湖北省武汉市6所部属院校随机抽取5972名大学生作为研究样本,调查研究其自杀行为的流行病学特征。2、针对以往研究中关于大学生社交网络、应对技能与自杀意念的研究尚不够系统和深入,从整体上探讨社交网络、应对技能与自杀意念的调控关系及影响路径的研究也较少。本研究在回归分析的基础上,进一步构建了大学生自杀意念的偏最小二乘路径模型,以便理解与认识大学生自杀意念及其影响因素间的关系,为大学生自杀意念的预防工作提供理论依据。3、鉴于以往有关负性生活事件和应对技能对大学生自杀行为的研究较少,而且多是针对单一指标或多个指标作为一个整体的联合作用,缺乏对应对技能、负性生活事件及自杀行为之间的交互网络关系的研究。本研究应用logistic回归分析探讨负性生活事件和应对技能与大学生自杀行为的关系,通过构建贝叶斯调控网络探索其中有相互作用和影响的指标,进而以图形和概率直观的描述各因素之间的调控关系,拟为预防和干预大学生自杀提供一定的理论依据和实证支持。本研究采用分层随机抽样方法,抽取了武汉市6所部属院校的5972名在校大学生作为研究样本,对大学生自杀行为的流行病学特征、社会网络和应对技能与大学生自杀意念的关系、负性生活事件和应对技能与大学生自杀行为的关系进行了系统分析,得出以下结论：1、大学生自杀行为的流行病学特征：大学生自杀行为的检出率处在一个较高的水平,大学生自杀意念检出率为16.39%,自杀未遂检出率为1.91%,最近一年自杀行为(自杀意念或自杀未遂)检出率为7.64%；以上检出率女性均高于男性。抑郁、焦虑、强迫、人际敏感等心理症状及考试不及格、失恋、与同学发生激烈冲突、经济拮据等负性生活事件在大学生中比较普遍,若缺乏成熟的应对技能和良好的社会支持,很容易发生自杀行为。研究结果进一步揭示了大学生自杀行为的分布特征及相关影响因素,为深入研究负性生活事件、应对技能、社交网络及心理因素与大学生自杀行为的关系提供了依据。2、社交网络、应对技能与大学生自杀意念的关系：自杀意念的产生是一个非常复杂的过程,受生理、心理、社会等诸多因素的影响,且各影响因素相互关联,有些甚至互为因果。本研究采用自杀行为问卷、社交网络问卷、应对技能量表及症状自评量表评估大学生的心理状况,应用logistic回归分析探讨社交网络、应对技能与大学生自杀意念的关系,并通过构建偏最小二乘路径模型从整体上探讨社交网络、应对技能与自杀意念的调控关系及影响路径。研究发现：(1)自杀意念与社交网络不健全密切相关,主要表现在学校中缺乏亲密朋友,无稳定的恋爱关系等方面。当年轻人遇到心理问题时更倾向于选择志同道合、有共同语言、能够相互理解的朋友或恋人的支持与帮助,这种从朋友或恋人中得到的安慰与支持可以帮助他们有效的处理一些不良的心理状态或压力性生活事件。因此,本研究建议,鼓励青年人(尤其是那些性格孤僻、习惯独处者)多参加集体活动,多与社会接触,可有效减少心理问题及自杀行为的发生。(2)成熟的应对策略可降低自杀意念的发生风险；总的看,多数积极应对策略为自杀意念的保护因素,多数消极应对策略为自杀意念的危险因素,但是,个别积极应对策略可能是自杀意念的危险因素,而个别的消极应对策略反而是自杀意念的保护因素。(3)本研究构建了社交网络、应对技能与大学生自杀意念的偏最小二乘路径模型,结果显示,社交网络、积极应对策略、消极应对策略对自杀意念既有直接效应,又可通过“心理症状”对自杀意念产生间接效应。在路径“积极应对→心理症状→自杀意念”中,直接效应的比重较大；而在路径“社交网络→心理症状→自杀意念”和“消极应对→心理症状→自杀意念”中,间接效应的比重较大。以上研究结果为自杀预防提供了重要的观点和全新的视角,提示在干预策略上,可以通过建立健全良好的社交网络、改善和提高大学生的应对技能等措施来避免或降低大学生自杀意念产生的可能性,这将对大学生自杀意念的预防和干预起到积极而深远的影响。3、负性生活事件、应对技能与大学生自杀行为的关系：青年人在大学生活中经常会面对人际冲突、学习压力、失恋等各种负性生活事件和压力,若缺乏成熟的应对策略,这些负性生活事件会成为大学生心理问题甚至是自杀行为的诱发因素。本研究采用自杀行为问卷、负性生活事件问卷、应对技能量表及症状自评量表评估大学生的心理状况,应用logistic回归分析探讨负性生活事件、应对技能与大学生最近一年的自杀行为的关联程度,并通过构建贝叶斯调控网络探索各因素之间的交互网络关系,研究发现：(1)负性生活事件与大学生自杀行为密切相关,近期有负性生活事件发生的个体更容易发生自杀行为。因此,学校相关部门应关注近期暴露于压力性生活事件的学生,并给予心理辅导,防止心理问题甚至自杀行为的发生。(2)成熟的应对方式有助于问题的解决和身心健康的维护,有助于预防心理问题甚至自杀行为的发生。本研究进一步证实积极应对策略是大学生自杀行为的保护因素。积极应对技能水平越高,自杀行为发生的风险越低。因此,在大学生群体中积极开展针对应对技能训练的培训项目,对于预防大学生自杀将起到积极的作用,特别是对近期经历过负性生活事件的大学生尤为重要。(3)本研究构建的负性生活事件、应对技能与大学生自杀行为的贝叶斯网络模型,证实了“性别”、“积极应对策略”、“考试不及格”、“与同学发生激烈冲突”和“自杀行为”这5个因素之间的交互网络关系；发现了与自杀行为相关的关键路径,即,大学生自杀行为发生概率最高的路径为“性别→积极应对→与同学发生激烈冲突→自杀行为”。该网路不仅能反映变量间的相互关系,而且可以从整体上观测负性生活事件和应对技能对自杀行为的作用大小。本研究为应对技能、负性生活事件与自杀行为的关系研究提供了一个新思路,为大学生自杀行为的个性化干预提供了新方法和新模式。更多还原

【Abstract】 Suicide is one of the leading causes of death among youth. It has become a major social and public health problem worldwide. According to the world health organization, suicide has become the second or the third cause of death in 15-29-year-olds in many countries. In the period of social transition of our country, the various social contradictions and competitive pressures increased. While getting more opportunities, today’s young people bear more pressure. Some students have kinds of serious mental health problems, especially suicidal behavior among college students. Suicidal behavior among college students brought great negative impact and serious economic and social burden on family, society and country. Life is irreversible, just like the slogan "One suicide is too many" of the first "world suicide prevention day". How to prevent college students from suicidal behavior and to early detect individuals at high risk of suicide are critically important.In recent years, a large number of studies on suicidal behavior have been conducted. However, these results were inconsistent because of the different measurements, populations, regions, et al. Social, psychological, cultural and other factors could interact to lead a person to suicidal behavior. Previous researchers have tried to find rules of suicide and its effective prevention methods. However, the risk factors of suicide are complicate, and these studies also have different concerns. How to delve into these connections between all the factors and the mechanism of suicidal behavior is the major problem. Thus, this study aimed to assess the following aspects:1. Because of few studies for suicidal behavior based on large sample of population, in the present study,5972 students were randomly selected from 6 universities attached directly to the ministries of the P. R. China in Wuhan city to assess prevalence and distribution of suicidal behavior among university students.2. Available studies have delved into the individual effect of social network or of coping skills on suicide risk; rarely has any study attempted to investigate the interplay of these two factors and to moreover elucidate possible underlying mechanisms of these factors on suicidality. In the present study, we want to assess the relative importance of social contacts and coping skills on risk for suicidal ideation, and to probe their possible pathways of their effects in the context of personal psychopathology. Logistic regression was performed to estimate individual effect of social contacts and coping skills on risk for suicidal ideation. A partial least squares path model (PLSPM) was used to probe possible paths of their effects in the context of psychopathology.3. Previous studies have delved into the individual effect of stressful life events or of coping skills on suicide risk; rarely has any study attempted to investigate the combined interactive network effects of them. Therefore, in this study, we want to assess the impact of common life stressors and personal coping skills on risk for suicidal behavior. We also want to explore the mechanic role of coping skills on the relationship between life stressors and risk for suicidal behavior in this group of young people. Logistic regression analysis was performed to estimate the effect of stressful life events and coping skills on risk for suicidal behavior. Bayesian network was further adopted to probe their probabilistic relationship.5972 students, randomly selected from 6 universities in China, completed the questionnaire survey for the study. This study have assessed the influences of social contacts and coping skills on risk for suicidal ideation and stressful life events, coping skill on risk for suicidal behavior. The conclusions are as follows:1. Descriptive epidemiology for suicidal behavior:Of the 5972 students,16.39% reported the presence of suicidal ideation,1.91% reported the presence of suicidal attempt, including 7.64% reported the presence of suicidal behavior (attempt or ideation) within the past 12-month period. Female students reported higher presence of suicidal behavior than male students. Young people studying at universities often encounter various negative life events and stressors. Some students might not be able to reasonably analyze the importance and possible consequence of a perceived event, especially those with poor coping skills to handle the event or resolve the stress. Such instances, if occurred, would place them at risk to develop negative or depressive mood, leading to psychological problems and even suicidal behavior in serious cases. These findings further revealed the distribution of suicidal behavior in college students and influence factors, and provided evidence for assessing the relationships of stressful life events, coping skills, social network and psychological factors associated with suicidal behavior in university students.2. Influence of personal social network and coping skills on risk for suicidal ideation. While suicidal behavior of young people is often associated with psychosocial, cultural and environmental factors, personal social network and coping skill are of particular importance in this group of population. The present study found that:(1) Risk of suicidal ideation was highly associated with poor social network, reflected by fewer close friends and without a dating relationship. It is a known fact that for young people friends are an important source of support when needed. Young people are usually more willing to talk with friends, than family members, about their mental state and behavior without the concern of being judged. They are also more prone to share personal feelings and thoughts with their peer friends than with the families. The support and comfort attained from network friends could help them dealing with critical situation and stressors effectively and in a positive way. Efforts encouraging students, especially those who stay isolated, to be more active in social contacts and group activities may have a significant beneficial effect in suicide prevention and mental health care. (2) The influence of coping skills varied by coping styles adapted toward problems. A high score of skills on seeking guidance and support, problem solving as well as seeking alternative rewards was associated with a reduced risk of suicidal ideation; whereas a high score of acceptance or resignation, emotional discharge as well as logical analysis was associated with a significantly increased risk. (3) Modeling the data with PLSPM indicated that the avoidance coping skills conferred the most important dimensional variable in suicidal ideation prediction, followed by the approach coping skills and social network. In the pathways from social network to suicidal ideation, the indirect effect is slightly larger than the direct effect; from avoidance coping to suicidal ideation, the indirect effect contributes a larger proportion; but from approach coping to suicidal ideation, the direct effect accounts for a larger proportion. These findings provide valuable insights for strategies of suicide prevention. Programs targeting on expansion of social network and improvement of approach coping skills may have enduring effects on reducing suicidal ideation in this group of young people.3. The interplay of stressful life event and coping skills on risk for suicidal behavior. Evidence has shown that stressful life events, such as failure in exams, break-up of a love relationship, etc., are important contributors to suicidal behavior among young students.In this study, we used logistic regression analysis to estimate the effect of stressful life events and coping skills on risk for suicidal behavior. Bayesian network was further adopted to probe their probabilistic relationship. The present study found that:(1) Risk of suicidal behavior appears to be greater for individuals with than without stressful, negative or potentially traumatic life experiences in their histories. Therefore, students with recent exposure to life stressors should be on high priority in mental health programs and in strategies for suicide prevention and intervention in university settings. (2) The influence of coping skills varied according to the strategies adapted toward problems with a high score of approach coping skill significantly associated with a reduced risk of suicidal behavior. Hence, activities and training programs aiming to enhance personal approach coping skills is important in the efforts of suicide prevention in young people and would be particularly beneficiary to those recently exposed to negative life events and stress. (3) Bayesian network indicated the probability of suicidal behavior associated with specific life stressors was to a large extent conditional on coping skills. Our study demonstrates that the highest probability of suicidal behavior is the path "Gender→approach coping→have strong conflict with classmate→suicidal behavior". These results offer insights for our understanding of the role of coping skills on suicidal behavior in the young. The Bayesian network could probe the effect of important stressful life events and coping skills on suicidal behavior in qualitative aspect and quantitative aspect. This is a novel method and provides an mportant insight into individuation intervention for suicidal behaviors.更多还原