中国农村地区留守儿童女性看护人抑郁的影响因素研究
Analysis of the Influencing Factors for Depression of Female Caregivers of Left-behind Children in Rural Area in China
摘要
背景 我国农村绝大多数留守儿童看护人为儿童的母亲和祖母，儿童看护人的心理健康是儿童早期发展的重要影响因素之一，目前缺少对留守儿童母亲和祖母抑郁影响因素的研究和比较。目的 研究中国农村地区留守儿童看护人中母亲和祖母抑郁的影响因素。方法 本研究数据来自联合国儿童基金会 2018 年 4—7 月开展的“农村留守儿童健康与发展促进项目”家访干预项目的基线调查。采用多阶段分层抽样方法，在 5 个省的 5 个贫困县内各选取1~2 个乡镇作为项目乡镇。平山县项目乡镇的所有村纳入调查，其他项目乡镇的村根据 3 岁以下儿童的数量进行分层，每层内随机抽取 3 个村作为干预村。在同县具有相似 3 岁以下儿童数量、经济水平以及与县城距离的村中匹配对照村。最终 27 个镇的 113 个村庄纳入基线调查，选取 3 岁以下留守儿童的母亲或祖母为研究对象。采用问卷收集留守儿童及其主要看护人的资料，并使用 Zung 氏抑郁自评量表（ZSDS）评估看护人的抑郁情况。采用多因素 Logistic 回归分析探讨留守儿童主要看护人抑郁的影响因素。结果 本研究共纳入 728 名调查对象，其中 282 名为儿童母亲，446 名为祖母。728 名调查对象抑郁检出率为 32.8%（239/728），留守儿童母亲和祖母的抑郁检出率分别为 29.8%（84/282）和 34.8%（155/446）。留守儿童母亲和祖母的抑郁检出率比较，差异无统计学意义（P>0.05）。多因素 Logistic 回归分析结果显示，儿童年龄为 1~ 岁（OR=2.041，95%CI=1.065~3.913）、2~3 岁（OR=2.128，95%CI=1.023~4.425），有看护压力（OR=4.043，95%CI=2.152~7.594）是留守儿童母亲发生抑郁的危险因素（P<0.05），与外出父亲平均每次联系时长≥ 10 min（OR=0.396，95%CI=0.175~0.898）是留守儿童母亲发生抑郁的保护因素（P<0.05）。儿童为女性（OR=0.506，95%CI=0.331~0.772）是留守儿童祖母发生抑郁的保护因素（P<0.05），看护人年龄≥ 60 岁（OR=1.879，95%CI=1.082~3.261）、健康状况影响看护（OR=2.402，95%CI=1.364~4.231）、母亲外出务工累计时长占儿童年龄比例高（OR=2.468，95%CI=1.059~5.751）是留守儿童祖母发生抑郁的危险因素（P<0.05）。结论 中国农村地区留守儿童女性看护人抑郁发生率高，儿童母亲和祖母作为绝大多数留守儿童的主要看护人，具有不同的抑郁影响因素。儿童年龄较大、看护压力大为母亲抑郁危险因素，与儿童父亲交流较多为母亲抑郁保护因素，高年龄、自评健康状况影响看护以及儿童母亲外出时间较长为祖母抑郁危险因素，看护女童为祖母抑郁保护因素。
Abstract
BackgroundThe majority of caregivers of left-behind children in rural China are their mothers and grandmothers. The mental health of children's caregivers is one of the significant factors affecting the early development of children. Currentlythere is a lack of research and comparison on the factors influencing depression among mothers and grandmothers of left-behind children in rural China. ObjectiveTo investigate the determinants of depression among female caregivers of left#2;behind children in rural China. MethodsData were collected from the baseline survey of the Home Visit Intervention Evaluation segment of the Health and Development Promotion Program for Left-behind Childrenconducted by UNICEF from April to July in 2018. The villages were selected through multi-stage stratified sampling. 1 or 2 towns were chosen as program towns in each of the 5 impoverished counties in 5 provinces. Villages in program towns were stratified by number of under-3-year-old children except Pingshanwhere all villages from the program town were included. Three villages were randomly selected in each stratum as intervention villagesmatched with control villages of similar number of under-3-year-old childrensocioeconomic status and the distance from county. Ultimately 113 villages in 27 towns were included in the survey. This study focused on the mothers and grandmothers of left-behind children under 3. Questionnaire was used to collect the data of left-behind children under 3 years old and their main caregivers participating in the surveyand Zung Self-rating Depression ScaleZSDS was used to assess the depression status of caregivers. Logistic regression was used to analyze the determinants of depression in the main caregivers of left-behind children. ResultsA total of 728 subjects were included in this studyincluding 282 mothers and 446 grandmothers. The overall incidence of depressive symptoms was 32.8%239/728. The prevalence of depression among mothers and grandmothers of left-behind children was 29.8%84/282and 34.8%115/446respectivelywith no statistical significance between two groupsP>0.05. Multivariate analysis revealed that for motherscaring for 1~-year-old childrenOR=2.041 95%CI=1.065-3.9132~3-year-old childrenOR=2.12895%CI=1.023-4.425and experiencing caregiving stress OR=4.04395% CI=2.152-7.594 were risk factors for depressionP<0.05. A mean communication time 10 minutes per time with absent fathersOR=0.39695%CI=0.175-0.898was a protective factor against maternal depressionP<0.05. For grandmotherslooking after girls rather than boysOR=0.50695%CI=0.331-0.772 was a protective factor for depression P<0.05. Converselybeing 60 years or olderOR=1.87995%CI=1.082-3.261self-rated health status affecting caregivingOR=2.40295%CI=1.364-4.231 and children's mothers cumulative longer absence from homeOR=2.468 95%CI=1.059-5.751 were the risk factors for depressionP<0.05. ConclusionThe incidence of depression among female caregivers of left-behind children in rural China is high. Mothers and grandmothersas the primary caregivers of most left-behind childrenexperience different factors affecting depression. Older childrenhigh caregiving stress are risk factors for maternal depressionwhereas greater communication with the children's fathers is protective factor for maternal depression. Grandmothers face a higher risk of depression when advanced ageself-report health status affacts caregivingand children's mothers are absent from home for extended periodwhile caring for a granddaughter is a protective factor against grandmother's depression.关键词
抑郁/看护人/留守儿童/农村留守女性/影响因素分析引用本文复制引用
夏玉雯,石慧峰,李梦诗,王晓莉,张敬旭.中国农村地区留守儿童女性看护人抑郁的影响因素研究[EB/OL].(2024-08-28)[2026-04-04].https://chinaxiv.org/abs/202408.00258.学科分类
医药卫生理论/医学研究方法/预防医学
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