不确定心理压力对医学生自我伤害影响的社会资本模式研究

发布时间：2018-05-13 00:07

本文选题：不确定心理压力 + 自我伤害行为　；参考：《浙江大学》2015年博士论文

【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,P0.01)。最常用的自伤方式为“刮伤”、“割伤”、“捏掐伤”。年龄(χ2=26.63,P0.01)、年级(χ2=30.24,P0.01)、专业(χ2=28.13,P0.01)、家庭年人均收入(χ2=11.10,P0.05)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,P0.01)、社会网络(OR=1.352,P0.01)、认知社会资本(OR=1.902,P0.01)、社会参与(OR=1.328,P0.01)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。
[Abstract]:Research background
The phenomenon of self injury in recent decades has caused widespread concern at home and abroad by scholars at home and abroad for.2002, the WHO report pointed out that self injury is the fourth cause of death and sixth causes of disease and disability in the world's 15-44 year old population, and has become a serious social and public health problem. Adolescent and young adults' self injury. The prevalence of injury is very common, and it is the focus of self injury research. The incidence of self injury in Chinese college students is up to 11-34%. self injury, which not only brings physical pain to college students, but also affects their emotional function, interpersonal relationship and work performance, even increase the risk of suicide and endanger life. College students are in the early stage of adulthood. They are facing an important transition period of life. Because of the great changes in the environment and their lack of full maturity, they may bring them a sense of inadaptability and produce a series of psychological stress problems. It can lead to the occurrence of self injurious behavior. Uncertainty is one of the important sources of psychological stress, but there is a lack of systematic research in the academic field on the uncertainty of psychological stress and the effect of uncertainty on the impact of psychological stress on self injury.
research objective
The focus of this study is to understand the status of self injury of medical students and their psychological and social factors. In order to better understand the influence of psychological stress on the self injury behavior of medical students, this study is based on the theory of psychological pressure and social capital theory, based on the existing literature, and constructs a self injury phase. The indeterminate psychological pressure - the social capital model and the model are tested and amended to provide scientific research evidence for public health policy makers and educators to improve the design, implementation and evaluation of the crowd based injury control and prevention projects, and ultimately to promote the mental health of college students.
research method
This study is a cross-sectional survey with large sample size, mainly using multi stage stratified random sampling to collect data. According to the geographical distribution and economic level, the final selection of 22 colleges and universities in 14 provinces is selected as the investigation point. The subjects of the survey are clinical, nursing or public health and other medical related undergraduates, with a sample size of 4446 People. In this study, self-made self injury questionnaire was used to evaluate the subjects' intentional self injury during the past year. The psychological stress survey questionnaire, which was compiled by Professor Yang Tingzhong of Zhejiang University, was used to evaluate the stress perception of different types of stressors. The social capital survey of medical students was evaluated by the "social capital survey questionnaire" compiled by Professor Yang Tingzhong and others. The data were analyzed by SPSS18.0. SAS9.3 and Amos17.0 software. The reliability and validity of the psychological pressure scale and social capital scale were tested by using the clone Baja coefficient and exploratory factor analysis method. The multivariate Logistic regression method was used to analyze the influencing factors of self injury. The structural equation model was used to verify the uncertain psychological pressure social capital model of self injury.
Research results
The results of this study mainly include the following points:
1) the total detection rate of intentional self injury behavior of medical students in the past year was 9.56%, and the rate of self injury for boys (11.51%) was higher than that of girls (8.71%), and there were statistical differences (x 2=8.48, P0.01). The most commonly used ways of self injury were "scratch", "cut", "pinch and pinch". Age (chi 2=26.63, P0.01), grade (chi square, P0.01), specialty (chi 2=28.13, P0.01), home The annual per capita income (chi 2=11.10, P0.05) and self injury were statistically different. Ethnic, parental occupation, home location, and students' monthly consumption level were not related to self injury. The incidence of self injury was high in students with low age, the highest rate of self injury in the freshmen and the incidence of self injury in nursing students was higher than that of public health and clinical medicine. Students with a per capita annual income of more than 40 thousand have low self injury rate.
2) the results of the multiple Logistic regression model of self injury showed that the uncertainty of psychological stress (OR=1.734, P0.01), social network (OR=1.352, P0.01), cognitive social capital (OR=1.902, P0.01), social participation (OR=1.328, P0.01) had statistical significance for self injury behavior, and there was no significant difference between learning, family and interpersonal stress on self injury in the model. The greater the uncertainty psychological pressure and the less social capital, the more likely to be self injurious behavior.
3) the result of structural equation model analysis shows that the normalized path coefficient of self injury is 0.068, the direct scaling coefficient of cognitive social capital to self injury behavior is -0.121, the indirect scaling path coefficient is -0.051, and the combination of the two is -0.172; the direct scaling coefficient of the social network for self injury is -0.059 and the indirect standardization path. The coefficient is -0.007, the total is -0.066; the indirect normalized path coefficient of social participation on self injury is 0.017.
research conclusion
This study constructs and validates the uncertain psychological stress of self injury - social capital theory model, which confirms that psychological stress has an impact on the self injury of medical students, especially the uncertainty of psychological stress. The effect of learning, family and interpersonal stress on self injury is more significant, and is one of the predictors of self injury. Social capital has a direct and indirect effect on the self injury of medical students. Social capital plays an intermediary role in the relationship between the uncertainty of psychological stress and self injury, in which social capital is cognitively affected by the influence of uncertain psychological pressure on the behavior of self injury and the influence of social capital on self injury. In addition, age / grade, gender, specialty and family income all affect the self injury of medical students. This research opens up the research field of uncertain psychological pressure, and provides the theoretical basis and scientific evidence for the design, implementation and evaluation of the relevant policy makers and follow-up medical students' self injury intervention projects.

【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：G444

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