流动儿童健康状况及其影响因素的结构方程模型研究
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摘要
目的
随着我国经济的发展，城市化进程的加速，未来几十年间都将是我国人口流动快速增长的时期。目前我国约有2000多万流动儿童，以户籍为基础的儿童福利政策，导致流动儿童很难享受到正常的城市公共卫生服务，对其健康发展造成影响。本研究以深圳为主要研究地区，将户籍地不属深圳的务工经商人员子女作为研究对象，分析了流动儿童体格发育、常见病、心理健康、行为问题等现状及特征；并分析了儿童心理健康状况的影响因素；建立结构方程，探讨了各因素对于儿童健康的影响及各因素之间的相互作用，为提高流动儿童健康状况提供科学、客观的策略。
方法
分层随机抽取深圳市宝安区3所学校1335名儿童为研究对象(男776名，女559名)，进行《学生心理健康诊断测验手册(MHT)》测试。839名(男463名，女376名)儿童进行儿童身体形态、功能指标及常见病等检查。12～16岁儿童824名(男459名，女365名)，用《Achenbach儿童行为量表》(家长问卷)调查儿童行为问题。416名儿童及家长用《父母教养方式评价量表(EMBU)》及《艾森克人格问卷(EPQ)》进行问卷调查。在此基础上建立结构方程模型分析家长对儿童心理的影响路径及作用的大小。使用Epidata3.0录入数据，SPSS16.0及SAS8.0进行统计分析。
结果
1流动儿童体格形态指标落后，营养不良患病率高，流动女童沙眼患病率高(p＜0.05)。
2流动儿童心理健康状况比常住儿童差(P＜0.05)，流动男、女童心理问题不同。
3流动儿童学校能力得分低(P＜0.05)，行为问题得分高(P＜0.05)，流动男、女童行为问题不同。
4 MHT问题组与正常组儿童人格不同(P＜0.05)，父母养育方式不同(P＜0.05)，家长人格无差异(P＞0.05)。不同的父母养育方式、儿童人格是儿童不同心理问题发生的危险或保护因素。母亲的过分干涉使儿童人格典型化。
6家长人格影响儿童心理健康，也影响其养育方式的选择，并直接和间接影响儿童人格(P＜0.10)。儿童内外向人格影响因素中：家长精神质人格＞家长神经质人格＞家长内外向人格＞家长理解、接纳—严厉、拒绝养育方式。儿童神经质人格影响因素：家长理解、接纳—严厉、拒绝养育方式＞家长神经质人格＞家长内外向人格＞家长过度干涉、保护养育方式。
结论
1、流动儿童体格发育的落后主要体现在形态指标：身高、体重落后及营养状况差，主要考虑环境因素影响。流动儿童营养不良、沙眼问题与考虑生活习惯、个人卫生有关。建议通过改善饮食习惯、加强锻炼、提高卫生保健意识，养成良好卫生习惯，提高流动儿童卫生服务水平来改善以上问题。
2、流动因素可能造成情绪问题、负面自我评价使流动儿童缺乏学习动力，影响学校能力。家庭环境较差对流动儿童行为问题产生不良影响。流动儿童需老师、家长给予鼓励、指导，同时需要社会要给予更多的关注和帮助。
3、家长人格可以直接对儿童生心理健康产生影响，也可以间接通过选择父母教养方式对儿童人格产生影响。因此，改善家长人格有助于提高流动儿童心理健康水平。
[ Objectives ]
With the developing of the economy, flouting population becomes a problem of our livies. Because of our country's base rule, the flouting population children can not get velue from the social medical servivers, that should bring a bad impaction on their health, including physical health and mental health. So we study the differences between floating population and resident population children's physical growth, the common diseases and the effecting factors on them, in order to looking for the key points and helping them. While child behavior problems are taken to a emphasis position today. Child behavior problems have effect on not only their physical development but also their socialization level, even can cause mental disease and bring bad impaction on the family relationship. To find the differences between resident and flouting population children's mental health status and the effecting factors on children's mental health can bring us the ideas to help children growing up healthly.
[Methods]
Stratified random sampling 1335 children and using MHT questionnaire manual tosurvey them. To check the physical growth and common diseases of 839 resident and flouting population children. Using CBCL questionnaires to investigate 824 flouting and resident population children, and comparing the results of the two groups. Using "Student Mental Health Test (MHT manual)" to screen the mental problems of 433 children, using "Eysenck Personality Questionnaire" to exam children and their parents, and using "Egma Minnen av Bardndosnauppforstran (EMBU) "to exam the children , conducting assessments, then analysing by SEM.
[Results]
1 The floating population children's heigth is significant lower than the resident population children's. The male floating population children's weight is significant lower than the resident population children's. The BMI of floating population children is significant lower than the resident population children's.
2 The flouting population children's malnutrition prevalence rate is significant higher than the resident population children's. The female flouting population children's trachoma prevalence rates is significant higher than the female resident population children's.
3 The male floating population children's scores on study anxiety, person anxiety, loneliness tendency, blaming oneself tendency , allergic tendency, physical symptoms and total anxiety are significant higher than the resident population children's( P <0.05).The female floating population children's scores on study anxiety, terror tendency and he total anxiety are significant higher than the resident population children's ( P <0.05).
4 The floating population children's school skills score and mental health status are significant lower than the resident population children's (P<0.05). The male floating population children and female floating population children have different mental problems. Different mental problems have different correlations with the Socio-economic situation of children's family.
5 The differences between the case group and control group children's personalities are significant (P <0.05). The differences between two group parents' personalities are not significant (P> 0.05).The differences of scores on peranting style between the case group and control group children are significant (P <0.05). Parenting style has effect on children's mental health and personality.
6 Personality of the parents has effect on children's mental health and parenting style, at the same time has effect on children's personality directly or indirectly. The order of parents' effects on E-personality of children is as follows: P-personality of parents > N-personality of parents > E-personality of parents> Understanding and accepting-strictive and refusing parenting style. E-personality of the parents negatively correlats with N-personality of the children, The order of parents' effects on N-personality of children is as follows: Understanding and accepting-strictive and refusing parenting style >N-personality of parents > E-personality of parents > Excessive interference and protection parenting style.
[ Conclutions ]
1 There is still a distance between floating population and the resident population children's physical development status and common diseases, we can improve their physical status through changing their environment, strengthening personal hygiene and providing higher level health services.
2 The floating population children's mental health is bad than the resident population children's, they need special intervention. Improving the family environment and giving more attention can perhaps improve the mental health of flouting population children. Different mental problems of children require targeting interventions.
3 Parenting style has a effect on children's personalities, at the same time, directly or indirectly has a effect on children's mental health. Parents' personality has effect on children's mental health and the parenting style, parents' personality and their parenting style have effects on children's personality. Improving children's mental health status needs improving parents' mental health status.
In summary, It is the first time that we study the relationship between children's physical and mental health through a across-the-board designed study in ShenZhen and from a perspection of Socio-economic situation. Taking the flouting population children as the hot piont and using SEM to canalysis the effecting factors on children mental status are a valuable work.
随着我国经济的发展，城市化进程的加速，未来几十年间都将是我国人口流动快速增长的时期。目前我国约有2000多万流动儿童，以户籍为基础的儿童福利政策，导致流动儿童很难享受到正常的城市公共卫生服务，对其健康发展造成影响。本研究以深圳为主要研究地区，将户籍地不属深圳的务工经商人员子女作为研究对象，分析了流动儿童体格发育、常见病、心理健康、行为问题等现状及特征；并分析了儿童心理健康状况的影响因素；建立结构方程，探讨了各因素对于儿童健康的影响及各因素之间的相互作用，为提高流动儿童健康状况提供科学、客观的策略。
方法
分层随机抽取深圳市宝安区3所学校1335名儿童为研究对象(男776名，女559名)，进行《学生心理健康诊断测验手册(MHT)》测试。839名(男463名，女376名)儿童进行儿童身体形态、功能指标及常见病等检查。12～16岁儿童824名(男459名，女365名)，用《Achenbach儿童行为量表》(家长问卷)调查儿童行为问题。416名儿童及家长用《父母教养方式评价量表(EMBU)》及《艾森克人格问卷(EPQ)》进行问卷调查。在此基础上建立结构方程模型分析家长对儿童心理的影响路径及作用的大小。使用Epidata3.0录入数据，SPSS16.0及SAS8.0进行统计分析。
结果
1流动儿童体格形态指标落后，营养不良患病率高，流动女童沙眼患病率高(p＜0.05)。
2流动儿童心理健康状况比常住儿童差(P＜0.05)，流动男、女童心理问题不同。
3流动儿童学校能力得分低(P＜0.05)，行为问题得分高(P＜0.05)，流动男、女童行为问题不同。
4 MHT问题组与正常组儿童人格不同(P＜0.05)，父母养育方式不同(P＜0.05)，家长人格无差异(P＞0.05)。不同的父母养育方式、儿童人格是儿童不同心理问题发生的危险或保护因素。母亲的过分干涉使儿童人格典型化。
6家长人格影响儿童心理健康，也影响其养育方式的选择，并直接和间接影响儿童人格(P＜0.10)。儿童内外向人格影响因素中：家长精神质人格＞家长神经质人格＞家长内外向人格＞家长理解、接纳—严厉、拒绝养育方式。儿童神经质人格影响因素：家长理解、接纳—严厉、拒绝养育方式＞家长神经质人格＞家长内外向人格＞家长过度干涉、保护养育方式。
结论
1、流动儿童体格发育的落后主要体现在形态指标：身高、体重落后及营养状况差，主要考虑环境因素影响。流动儿童营养不良、沙眼问题与考虑生活习惯、个人卫生有关。建议通过改善饮食习惯、加强锻炼、提高卫生保健意识，养成良好卫生习惯，提高流动儿童卫生服务水平来改善以上问题。
2、流动因素可能造成情绪问题、负面自我评价使流动儿童缺乏学习动力，影响学校能力。家庭环境较差对流动儿童行为问题产生不良影响。流动儿童需老师、家长给予鼓励、指导，同时需要社会要给予更多的关注和帮助。
3、家长人格可以直接对儿童生心理健康产生影响，也可以间接通过选择父母教养方式对儿童人格产生影响。因此，改善家长人格有助于提高流动儿童心理健康水平。
[ Objectives ]
With the developing of the economy, flouting population becomes a problem of our livies. Because of our country's base rule, the flouting population children can not get velue from the social medical servivers, that should bring a bad impaction on their health, including physical health and mental health. So we study the differences between floating population and resident population children's physical growth, the common diseases and the effecting factors on them, in order to looking for the key points and helping them. While child behavior problems are taken to a emphasis position today. Child behavior problems have effect on not only their physical development but also their socialization level, even can cause mental disease and bring bad impaction on the family relationship. To find the differences between resident and flouting population children's mental health status and the effecting factors on children's mental health can bring us the ideas to help children growing up healthly.
[Methods]
Stratified random sampling 1335 children and using MHT questionnaire manual tosurvey them. To check the physical growth and common diseases of 839 resident and flouting population children. Using CBCL questionnaires to investigate 824 flouting and resident population children, and comparing the results of the two groups. Using "Student Mental Health Test (MHT manual)" to screen the mental problems of 433 children, using "Eysenck Personality Questionnaire" to exam children and their parents, and using "Egma Minnen av Bardndosnauppforstran (EMBU) "to exam the children , conducting assessments, then analysing by SEM.
[Results]
1 The floating population children's heigth is significant lower than the resident population children's. The male floating population children's weight is significant lower than the resident population children's. The BMI of floating population children is significant lower than the resident population children's.
2 The flouting population children's malnutrition prevalence rate is significant higher than the resident population children's. The female flouting population children's trachoma prevalence rates is significant higher than the female resident population children's.
3 The male floating population children's scores on study anxiety, person anxiety, loneliness tendency, blaming oneself tendency , allergic tendency, physical symptoms and total anxiety are significant higher than the resident population children's( P <0.05).The female floating population children's scores on study anxiety, terror tendency and he total anxiety are significant higher than the resident population children's ( P <0.05).
4 The floating population children's school skills score and mental health status are significant lower than the resident population children's (P<0.05). The male floating population children and female floating population children have different mental problems. Different mental problems have different correlations with the Socio-economic situation of children's family.
5 The differences between the case group and control group children's personalities are significant (P <0.05). The differences between two group parents' personalities are not significant (P> 0.05).The differences of scores on peranting style between the case group and control group children are significant (P <0.05). Parenting style has effect on children's mental health and personality.
6 Personality of the parents has effect on children's mental health and parenting style, at the same time has effect on children's personality directly or indirectly. The order of parents' effects on E-personality of children is as follows: P-personality of parents > N-personality of parents > E-personality of parents> Understanding and accepting-strictive and refusing parenting style. E-personality of the parents negatively correlats with N-personality of the children, The order of parents' effects on N-personality of children is as follows: Understanding and accepting-strictive and refusing parenting style >N-personality of parents > E-personality of parents > Excessive interference and protection parenting style.
[ Conclutions ]
1 There is still a distance between floating population and the resident population children's physical development status and common diseases, we can improve their physical status through changing their environment, strengthening personal hygiene and providing higher level health services.
2 The floating population children's mental health is bad than the resident population children's, they need special intervention. Improving the family environment and giving more attention can perhaps improve the mental health of flouting population children. Different mental problems of children require targeting interventions.
3 Parenting style has a effect on children's personalities, at the same time, directly or indirectly has a effect on children's mental health. Parents' personality has effect on children's mental health and the parenting style, parents' personality and their parenting style have effects on children's personality. Improving children's mental health status needs improving parents' mental health status.
In summary, It is the first time that we study the relationship between children's physical and mental health through a across-the-board designed study in ShenZhen and from a perspection of Socio-economic situation. Taking the flouting population children as the hot piont and using SEM to canalysis the effecting factors on children mental status are a valuable work.
引文
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