【作者】 吴丹；

【导师】 杨廷忠；

【作者基本信息】 浙江大学 ， 精神病与精神卫生学， 2015， 博士

【摘要】 研究背景近几十年,自我伤害这一现象引起了国内外学者的广泛关注。2002年世界卫生组织的报告指出自我伤害是全球15-44岁人群的第4位死亡原因和第6位疾病和残疾原因,已经成为一个严重的社会和公共卫生问题。青少年和年轻成人的自我伤害现象非常普遍,是自伤研究的重点对象。中国大学生自伤发生率高达11-34%。自伤不仅给大学生带来生理上的痛苦,还会影响其情绪功能、人际关系及工作学业表现,甚至还会增加自杀风险,危及生命。作为刚进入高校到即将毕业走向社会的大学生,恰处在成年初期阶段,他们面临着人生重要的转型期,因周围环境发生巨大变化和自身心智还未完全成熟,可能会给他们带来不适应感,从而产生一系列的心理压力问题。国内外研究表明,当人们无法有效地面对压力时,就可能会导致自我伤害行为的发生。不确定性是重要的心理压力来源之一,但学术界目前对于不确定心理压力,以及不确定心理压力对自我伤害的影响这一领域缺乏系统的研究。研究目的本研究重点在于了解国内医学生的自我伤害现状及其心理、社会影响因素的情况。为了更好地了解不确定心理压力对医学生自伤行为的的影响,本研究从心理压力理论和社会资本理论视角出发,基于已有文献整理的基础上,构建自伤相关的不确定心理压力-社会资本模型,并对模型进行检验和修正,进而为公共卫生政策制定者和教育工作者提供科学的研究证据,改进以人群为基础的伤害控制与预防项目的设计、实施以及评价,最终促进大学生的心理健康。研究方法本研究是一次大样本量的横断面调查,主要采用多阶段分层随机抽样方法来采集数据。按照地理分布和经济水平等因素最终选择14个省份的22所高校作为调查点。调查对象为临床、护理或公卫等医学相关专业的大学本科生,样本量为4446人。本研究采用自编的自伤测量问卷评估被试者在过去一年中故意自我伤害的情况；采用由浙江大学杨廷忠教授编制的《社会压力刺激事件量表》修改而来的心理压力测量问卷来评估被试者对不同类型压力源的压力感知情况；采用杨廷忠教授等人编制的《社会资本测量问卷》评估医学生的社会资本情况。运用SPSS18.0. SAS9.3以及Amos17.0等软件对数据进行统计分析。应用克隆巴哈系数和探索性因子分析方法检验心理压力量表和社会资本量表的信效度。采用单因素卡方检验、多元Logistic回归方法分析自伤的影响因素。运用结构方程模型,验证自伤的不确定心理压力-社会资本模型。研究结果本研究结果主要包括以下几点内容：1)在过去一年内医学生故意自我伤害行为总检出率为9.56%,男生自伤率(11.51%)高于女生(8.71%),且有统计学差异(χ2=8.48,P<0.01)。最常用的自伤方式为“刮伤”、“割伤”、“捏掐伤”。年龄(χ2=26.63,P<0.01)、年级(χ2=30.24,P<0.01)、专业(χ2=28.13,P<0.01)、家庭年人均收入(χ2=11.10,P<0.05)与自伤存在统计学差异。民族、父母亲职业、家庭所在地、学生月消费水平与自伤不相关。年龄低的学生自伤发生率高,大学一年级的学生自伤率最高,护理学专业学生的自伤发生率高于公共卫生和临床医学专业的学生,家庭人均年收入在4万以上的学生自伤率较低。2)自伤的多元Logistic回归全模型结果显示,不确定心理压力(OR=1.734,P<0.01)、社会网络(OR=1.352,P<0.01)、认知社会资本(OR=1.902,P<0.01)、社会参与(OR=1.328,P<0.01)对自伤行为有统计学意义；学习、家庭、人际关系压力在该模型中对自伤没有显著性差异。不确定心理压力越大,社会资本越少,越容易发生自伤行为。3)结构方程模型分析结果显示,不确定心理压力对自伤的标化路径系数为0.068；认知社会资本对自伤行为的直接标化系数为-0.121,间接标化路径系数为-0.051,两者合计为-0.172；社会网络对自伤行为的直接标化系数为-0.059,间接标化路径系数为-0.007,两者合计为-0.066；社会参与对自伤行为的间接标化路径系数为0.017。研究结论本研究构建并验证了自我伤害的不确定心理压力-社会资本理论模型,证实心理压力对医学生自我伤害有影响,尤其是不确定心理压力,较学习、家庭、人际关系压力对自伤的作用更为显著,是自伤特异的预测因素之一。同时本研究还发现社会资本对医学生自我伤害存在直接和间接的作用。社会资本在不确定心理压力与自我伤害的关系中发挥中介调节作用,其中认知社会资本、社会网络通过影响不确定心理压力间接作用于自我伤害行为,且认知社会资本对自伤的影响最为突出。此外,年龄/年级、性别、专业、家庭年收入均对医学生自伤有影响。本研究开拓了不确定心理压力的研究领域,为相关政策制定者和后续医学生自伤干预项目的设计、实施和评价提供了前期的理论基础和科学的实证依据。更多还原

【Abstract】 BackgroundDeliberate self-harm (DSH) has received significant attention in recent decades. The WHO report on violence and health demonstrated that self-inflicted injuries are the fourth leading cause of death and the sixth leading cause of ill-health and disability. The phenomenon of DSH among adolescent and young adult populations is very common and has increased widespread concern by domestic and international researchers. The prevalence of DSH for Chinese university and college students is about11%-34%. DSH not only brings the physical pain, but also influences affect function, interpersonal relationship, and academic performance. Repeated deliberate self-harm even increased the risk of suicide. DSH becomes a major public health and social issue among young adults. The transition to college often involves significant stress associated with adjusting to a new social environment, physical separation from parents, and alterations in social support networks. Previous studies have indicated that a need for DSH when individuals are confronted with stressful conditions or have difficulty in coping with stress. The individual who self-harms oneself is associated with high stress. Uncertainty is one of the major stressors. However, there is a lack of systematic studies on uncertainty stress, and the association between uncertainty stress and DSH. It is urgent to address this important area of research.ObjectivesThis study aims to explore the current condition of deliberate self-harm among medical college students in China, and to identify the risk factors of DSH at the psychosocial perspective. The current study focuses on understanding the effect of uncertainty stress on DSH among medical students, in comparison with study stress, family stress, and interpersonal stress. Based on stress coping theory and social capital theory, the uncertainty stress-social capital model for DSH is developed and amended. This study is to provide the scientific research evidence for public health policy makers and educators, to improve the population-based injury intervention projects’design, implementation, and evaluation, and finally to improve the mental health among college students.MethodsA cross-sectional survey with a multi-staged stratified randomize sampling method was conducted. According to the geographical location and economic development status,22medical universities were randomly selected for this study. The participants consisted of4,446undergraduate students majoring in clinical medicine, nursing, public health, and/or other medical-related areas. The demographic characteristics of the medical students were collected. Perceived stress from different life pressures including study, family, interpersonal relationship, and uncertainty were assessed. The situation about students’social capital containing cognitive social capital, structural social capital (social participation and social network) were also assessed. The SPSS18.0, SAS9.3and Amos17.0were applied to analyze the data. Cronbach’s alpha coefficient and exploratory factor analysis were used to examine the reliability and validity of the self-designed questionnaire of stress and social capital. Chi-square test and multiple logistic regression models were applied to analyse the influence factors of DSH. The structural equation model was used to examine the network relationship among social capital, uncertainty stress, and DSH.Results1) The rate of DSH of medical college students was9.56%in the past12months. The DSH rate in male students (11.51%) is significantly higher than female students (8.71%). The most common self-harm actions were scratching, cutting, and pinching. Age (x2=26.63, p<0.01), gender (%2=30.24, p<0.01), major (x2=28.13, p<0.01), annual household income (X2=11.10, p<0.05) were statistically associated with DSH. While there was no significant difference among the factors of race, parent occupation, family location, and student’s consumption level. The DSH rate declined with the increased age of the participants of this study. Freshman students had the highest DSH rate. Students who majored in nursing and other medical-related areas had higher DSH rate than that of public health students and clinical medical students. Student participants whose annual household income of more than40,000RMB reported lower DSH rates.2) The results from multiple Logistic regression full model showed that uncertainty stress (OR=1.734, p＜O.Ol), social network (OR=1.352, p＜O.Ol), cognitive social capital (OR=1.352, p<0.01), social participation (OR=1.352, p<0.01) have significant effect on DSH while stress from study, family, interpersonal relationship have no statistically difference on DSH. The students, who perceived larger uncertainty stress or possessed less social capital, have a higher risk for occurrence of DSH.3) Structural equation model demonstrated that the correlation from uncertainty stress to DSH is0.068. The total correlation from cognitive social capital to DSH is-0.172including direct path (r=-0.121, p＜O.Ol) and indirect path(r=-0.051, pO.Ol). The total correlation from social network to DSH is-0.066including direct path (r=-0.059, p<0.01) and indirect path(r=-0.007, p<0.01). The indirectly standard effect between social participation and DSH is0.017and social participation is not directly correlated with DSH.Conclusion:Age, grade, gender, major and annual household income are the influence factors for deliberate self-harm behaviors of medical college students. We should pay more attention on the DSH phenomenon among lower-grade, male, poor, and nursing students. Mental stress was confirmed to influence the DSH behavior. Uncertainty stress is a unique factor for prediction of DSH, and has larger impact on DSH compared with other three stressors. Social capital has a significant effect on DSH as well, especially cognitive social capital. Meanwhile, social capital could indirectly influence DSH through affecting uncertainty stress. It is recommended that DSH intervention study should target on uncertainty stress management and social capital accumulation.更多还原