海南省医学大学生睡眠质量影响因素及干预研究
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摘要
[目的]了解海南省医学大学生睡眠质量的基本状况,研究睡眠质量的影响因素,并探讨团体辅导对医学大学生睡眠质量干预的效果。
[方法]采用整群随机抽样的方法从海南医学院一到五年级本科班的学生中,每年级各抽取一个班,共551人,其中男生254名,女生297名。用自制的睡眠质量影响因素调查表、PSQI、SCL-90和EPQ量表在2006年10月10日进行横断面调查。通过多元线性回归和通径分析方法来分析睡眠质量的影响因素及其作用大小。以抽取的551人为目标人群,从一、三、五三个年级的学生中各随机抽取50人(共150人),于2006年11月23日和2007年1月10日分别进行重复测量,通过混合效应线性模型分析方法来研究不同时间点睡眠质量的变化趋势,进一步探讨睡眠质量的影响因素。采用整群随机抽样的方法从一年级(排除先前参加研究的班级)的本科班中抽取一个班,共108人,进行睡眠质量的干预试验。用自制的睡眠质量影响因素调查表、PSQI和SCL-90量表进行筛查,对其中PSQI总分大于7分的21名学生进行一个月的团队辅导,分析团体辅导对睡眠质量干预的效果,符合正态分布的数据用配对t检验分析,否则用符号秩和检验方法。
[结果]被调查的551名学生的匹兹堡睡眠质量平均得分为5.74±2.78分,21.42%的学生睡眠质量较差,男生254名,女生297名,男女生睡眠质量差别无统计学意义(t=1.53,P=0.1256)。根据通径分析结果,“神经质”人格因素总作用最大,其总效应值为0.3575,其次为心理疾病倾向,其总效应值为0.2650,再次为迟睡频率,其总效应值为0.2351这三个因素是睡眠质量的主要影响因素。心理疾病倾向和宿舍环境是睡眠质量的直接影响因素。学习负担和应激事件是睡眠质量的诱发因素,但不起主要作用,人格因素、迟睡频率因素和年级因素直接和间接作用于中间变量对睡眠质量产生影响作用。用混合效应线性模型分析重复测量数据,结果显示睡眠质量随着时间的变化由学期初向期末推移呈先不变,后下降的趋势。不同年级间睡眠质量有差别(F=3.86,P=0.0232)。对睡眠质量有显著影响的因素为内外向(beta=-0.111,P=0.0013)和神经质(beta=0.0951,P=0.0031),心理疾病倾向(beta=0.0075,P=0.0023)、迟睡频率(beta=0.4280,P＜0.0001)、宿舍环境(beta=-0.2680,P=0.0043)和学习负担(beta=0.3905,P=0.0004)。团体辅导后睡眠质量好转率为80.95%,团体辅导前后睡眠质量差异有统计学意义(t=-8.72,P＜0.0001),干预后大学生睡眠质量显著提高。
[结论]对于大一的学生应进行心理教育,增加课外团体活动,让他们更快地融入到大学的生活模式中来。学习负担是客观存在因素,应激事件对睡眠质量的作用虽小却起到“扳机”作用,心理疾病倾向则是睡眠质量的直接作用因素,而人格是睡眠质量基础性因素,另外,大学生处在青春发育后期,仍是人格完善和可塑的时期,通过积极的心理咨询、心理疏导、团体辅导来调整不良行为和提高心理素质,是提高睡眠质量的有效途径,而良好的宿舍环境和规律作息是提高睡眠质量的保证。期末睡眠质量最差,心理干预悠关重要。
[Objective] To explore the baseline level of sleep quality in students of Hainan medical college, analyze the impact factors and evaluate the effect of group consulting intervention on sleep quality in medical students.
[Method] Using cluster sampling method, 551 students of 5 classes in Hainan medical college were selected from each of the 5 grades, and cross-sectional survey were conducted in October 10, 2006 with self-designed scale for sleep related factors and PSQI、SCL-90、EPQ scales. the impact factors and their effect on quality of sleep were analyzed using stepwise multiple regression and path analysis methods based on the cross-sectional data. We sampled 150 students from grade one、grade three and grade five, 50 each, from the original sample and conducted the same survey in November 23, 2007 and January 10, 2007. Then we evaluated the trends of sleep quality change in different time points using mixed effect linear model method based on repeat measurement data. On the same time, we also sample 108 students in grade one from department of preventive medicine, who did not participate the previous study, for the intervention study of sleep quality. They were investigated using the self-designed scale for sleep factors and PSQI、SCL-90、EPQ scales in December 15,2006, those who got an PSQI score more than 7(21 students) were intervened by group counseling for 30 days. Paired t-test or Signed-ranks test were used to evaluate the effect according to the data distribution.
[Result] The mean of PSQI score was 5.74±2.78, 21.42% of subjects in this study had problem in sleep. No statistically significant difference was found between different genders. Path analysis showed that among all factors we explored, the personality of "nervousness" play the most important role in the sleep quality of medical students with an effect value of 0.3575, " mental disorder disposition" and " frequency of sleep delay " were main factors subsequently with effect value of 0.2650 and 0.2351, respectively. "mental disorder disposition" and "dormitory's environment" were direct impact factors of sleep quality, while study burden and stress were inducement factors, but did not played main role. Personality, "frequency of sleep delay "and grade factors can affect sleep quality both by direct influence and intermediate impact. Repeat measurement analysis with mixed effect linear method showed a stable level of sleep quality in the first half of term followed by a decrease in the later term. Sleep quality were different between grades(F=3.86, P=0.0232). the main impact factors to sleep quality were personality dimension of "extraversion" (beta =-0.111, P=0.0013) and nervousness (beta =0.0951, P=0.0031), mental disorder disposition (beta =0.0075, P=0.0023)、frequency of sleep delay (beta =0.4280, P<0.0001), dormitory's environment (beta =-0.2680, P=0.0043) and study burden(beta =0.3905, P=0. 0004). There were significant difference between pre-evaluation and post-evaluation of sleep quality after group counseling intervention (t=-8.72,P<0.0001) , most students (80.95%) got better sleep quality.
[Conclusion] The sleep quality of medical students is worthy of worrying about, especially for the grade 1 students. Psychological Consulting and group activities should be strengthened to help the students to fit into college life effectively. Based on the results that study burden was an objective factor, stress does a small effect but acting as a trigger, mental disorder disposition was the direct factor, personality was the bases factor to sleep quality, and the fact that college students are on the stage of personality construct and thus impressionable, we conclude that psychological consulting、psychology induction、group counseling、should be effective method to improve the sleep quality by personality trait adjustment and psycho-quality improvement. At the same time, good environment in dormitory and regular bedtime and rising time can also help. It was obviously that sleep quality in end-of-term stage was worst, so intervention in the period is more important.
[方法]采用整群随机抽样的方法从海南医学院一到五年级本科班的学生中,每年级各抽取一个班,共551人,其中男生254名,女生297名。用自制的睡眠质量影响因素调查表、PSQI、SCL-90和EPQ量表在2006年10月10日进行横断面调查。通过多元线性回归和通径分析方法来分析睡眠质量的影响因素及其作用大小。以抽取的551人为目标人群,从一、三、五三个年级的学生中各随机抽取50人(共150人),于2006年11月23日和2007年1月10日分别进行重复测量,通过混合效应线性模型分析方法来研究不同时间点睡眠质量的变化趋势,进一步探讨睡眠质量的影响因素。采用整群随机抽样的方法从一年级(排除先前参加研究的班级)的本科班中抽取一个班,共108人,进行睡眠质量的干预试验。用自制的睡眠质量影响因素调查表、PSQI和SCL-90量表进行筛查,对其中PSQI总分大于7分的21名学生进行一个月的团队辅导,分析团体辅导对睡眠质量干预的效果,符合正态分布的数据用配对t检验分析,否则用符号秩和检验方法。
[结果]被调查的551名学生的匹兹堡睡眠质量平均得分为5.74±2.78分,21.42%的学生睡眠质量较差,男生254名,女生297名,男女生睡眠质量差别无统计学意义(t=1.53,P=0.1256)。根据通径分析结果,“神经质”人格因素总作用最大,其总效应值为0.3575,其次为心理疾病倾向,其总效应值为0.2650,再次为迟睡频率,其总效应值为0.2351这三个因素是睡眠质量的主要影响因素。心理疾病倾向和宿舍环境是睡眠质量的直接影响因素。学习负担和应激事件是睡眠质量的诱发因素,但不起主要作用,人格因素、迟睡频率因素和年级因素直接和间接作用于中间变量对睡眠质量产生影响作用。用混合效应线性模型分析重复测量数据,结果显示睡眠质量随着时间的变化由学期初向期末推移呈先不变,后下降的趋势。不同年级间睡眠质量有差别(F=3.86,P=0.0232)。对睡眠质量有显著影响的因素为内外向(beta=-0.111,P=0.0013)和神经质(beta=0.0951,P=0.0031),心理疾病倾向(beta=0.0075,P=0.0023)、迟睡频率(beta=0.4280,P＜0.0001)、宿舍环境(beta=-0.2680,P=0.0043)和学习负担(beta=0.3905,P=0.0004)。团体辅导后睡眠质量好转率为80.95%,团体辅导前后睡眠质量差异有统计学意义(t=-8.72,P＜0.0001),干预后大学生睡眠质量显著提高。
[结论]对于大一的学生应进行心理教育,增加课外团体活动,让他们更快地融入到大学的生活模式中来。学习负担是客观存在因素,应激事件对睡眠质量的作用虽小却起到“扳机”作用,心理疾病倾向则是睡眠质量的直接作用因素,而人格是睡眠质量基础性因素,另外,大学生处在青春发育后期,仍是人格完善和可塑的时期,通过积极的心理咨询、心理疏导、团体辅导来调整不良行为和提高心理素质,是提高睡眠质量的有效途径,而良好的宿舍环境和规律作息是提高睡眠质量的保证。期末睡眠质量最差,心理干预悠关重要。
[Objective] To explore the baseline level of sleep quality in students of Hainan medical college, analyze the impact factors and evaluate the effect of group consulting intervention on sleep quality in medical students.
[Method] Using cluster sampling method, 551 students of 5 classes in Hainan medical college were selected from each of the 5 grades, and cross-sectional survey were conducted in October 10, 2006 with self-designed scale for sleep related factors and PSQI、SCL-90、EPQ scales. the impact factors and their effect on quality of sleep were analyzed using stepwise multiple regression and path analysis methods based on the cross-sectional data. We sampled 150 students from grade one、grade three and grade five, 50 each, from the original sample and conducted the same survey in November 23, 2007 and January 10, 2007. Then we evaluated the trends of sleep quality change in different time points using mixed effect linear model method based on repeat measurement data. On the same time, we also sample 108 students in grade one from department of preventive medicine, who did not participate the previous study, for the intervention study of sleep quality. They were investigated using the self-designed scale for sleep factors and PSQI、SCL-90、EPQ scales in December 15,2006, those who got an PSQI score more than 7(21 students) were intervened by group counseling for 30 days. Paired t-test or Signed-ranks test were used to evaluate the effect according to the data distribution.
[Result] The mean of PSQI score was 5.74±2.78, 21.42% of subjects in this study had problem in sleep. No statistically significant difference was found between different genders. Path analysis showed that among all factors we explored, the personality of "nervousness" play the most important role in the sleep quality of medical students with an effect value of 0.3575, " mental disorder disposition" and " frequency of sleep delay " were main factors subsequently with effect value of 0.2650 and 0.2351, respectively. "mental disorder disposition" and "dormitory's environment" were direct impact factors of sleep quality, while study burden and stress were inducement factors, but did not played main role. Personality, "frequency of sleep delay "and grade factors can affect sleep quality both by direct influence and intermediate impact. Repeat measurement analysis with mixed effect linear method showed a stable level of sleep quality in the first half of term followed by a decrease in the later term. Sleep quality were different between grades(F=3.86, P=0.0232). the main impact factors to sleep quality were personality dimension of "extraversion" (beta =-0.111, P=0.0013) and nervousness (beta =0.0951, P=0.0031), mental disorder disposition (beta =0.0075, P=0.0023)、frequency of sleep delay (beta =0.4280, P<0.0001), dormitory's environment (beta =-0.2680, P=0.0043) and study burden(beta =0.3905, P=0. 0004). There were significant difference between pre-evaluation and post-evaluation of sleep quality after group counseling intervention (t=-8.72,P<0.0001) , most students (80.95%) got better sleep quality.
[Conclusion] The sleep quality of medical students is worthy of worrying about, especially for the grade 1 students. Psychological Consulting and group activities should be strengthened to help the students to fit into college life effectively. Based on the results that study burden was an objective factor, stress does a small effect but acting as a trigger, mental disorder disposition was the direct factor, personality was the bases factor to sleep quality, and the fact that college students are on the stage of personality construct and thus impressionable, we conclude that psychological consulting、psychology induction、group counseling、should be effective method to improve the sleep quality by personality trait adjustment and psycho-quality improvement. At the same time, good environment in dormitory and regular bedtime and rising time can also help. It was obviously that sleep quality in end-of-term stage was worst, so intervention in the period is more important.
引文
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