医科大学生焦虑、抑郁及相关因素的1年纵向研究
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摘要
目的
描述医科大学生焦虑、抑郁情绪的流行现状及其纵向发展特征，并在此基础上进一步考察不同特征医学生亚群体（如不同年级、不同性别等）焦虑、抑郁的特点；考察环境因素以及医科大学生焦虑、抑郁情绪产生过程中的中介变量，如家庭功能、社会支持系统和负性生活事件等纵向发展特点及其与医学生焦虑、抑郁的关系，探讨影响医科大学生焦虑、抑郁发展的相关因素，为大学生心理健康的早期干预提供科学依据。
方法
选择安徽省三所医学院校中能随访到的10340名在校大学生作为研究对象。用自制的大学生心理健康状况与相关生活经历调查问卷（包括一般人口学特征、家庭因素、Beck焦虑量表、Beck抑郁量表、负性生活事件量表、家庭功能量表、生活质量量表和社会支持量表等）对目标人群进行纵向调查。首次测查完成后每隔半年进行一次追踪测查，总的纵向追踪时间为一年，追踪测查两次。追踪测查中所使用的调查问卷仍为第一次测查中所使用问卷。
焦虑、抑郁检出情况在单因素比较分析的基础上，分别以三次测查中焦虑和抑郁评分分级为因变量，以性别、年龄、年级、负性生活事件、家庭功能、社会支持、生活质量和家庭因素等为自变量，进行多元有序Logistic回归分析，探讨医科大学生焦虑、抑郁的影响因素。然后采用广义估计方程(GEEs)和多层线性模型(HLM)对医科大学生焦虑、抑郁的纵向追踪数据进行分析，进一步探讨社会支持、家庭功能、负性生活事件及生活质量与医科大学生焦虑、抑郁发展的关系。
采用EpiData3.1软件建立数据库，将所收集的资料经过核对、剔除不完整问卷后进行录入。应用SPSS17.0和HLM6.08软件对数据进行统计分析，单因素分析方法包括卡方检验(或Fisher’s确切概率法)、方差分析和秩相关，多因素分析有多元有序Logistic回归分析、广义估计方程(GEEs)和多层线性模型(HLM)。检验水准а=0.05。
结果
医科大学生焦虑、抑郁检出率：
各测查时点医科大学生焦虑的检出率分别为第一次测查（T1）：14.1%，第二次测查（T2）：14.3%和第三次测查（T3）：9.0%；抑郁的检出率分别为T1：16.8%，T2：14.7%和T3：10.3%。卡方检验结果显示，不同时点医科大学生焦虑、抑郁检出率有统计学差异。
不同群体医科大学生焦虑、抑郁特点：
三次测查中二年级医学生焦虑、抑郁检出率均高于一年级；女生焦虑检出率均高于男生；女生抑郁检出率在第一次测查、第二次测查中高于男生，第三次测查低于男生。
家庭因素与医科大学生焦虑、抑郁的关系
三次测查中家庭经济状况差的医科大学生焦虑和抑郁检出率均较高；第一次和第二次测查中家庭经济收入来源以家庭工资收入的医学生焦虑检出率最低；第一次测查家庭经济收入来源以家庭工资收入的医学生抑郁检出率最低；第二次测查非完整家庭医学生焦虑检出率高于完整家庭。
专业满意度与医科大学生焦虑、抑郁的关系：
不同专业满意度医学生焦虑、抑郁检出率差异均有统计学意义，且均以专业不满意者焦虑、抑郁检出率较高。
社会支持、家庭功能、负性生活事件和生活质量与医科大学生焦虑、抑郁的关系：
医科大学生社会支持、家庭功能和生活质量得分均与焦虑、抑郁评分呈显著负相关，社会支持越多，家庭功能和生活质量越好，焦虑、抑郁情绪越轻微；负性生活事件得分与焦虑、抑郁呈显著正相关，负性生活事件影响存在的严重程度越大，焦虑、抑郁情绪越严重。
医科大学生焦虑、抑郁相关因素的多元有序Logistic回归分析：
多元有序Logistic回归分析结果表明，生活质量、负性生活事件、家庭功能、社会支持（主观支持和支持利用度）等变量进入回归方程，提示：①主观感觉获得社会支持较少、生活质量和支持利用度差、以及家庭功能有障碍的医学生更易发生焦虑和抑郁情绪；②负性生活事件影响越严重的医学生更易发生焦虑和抑郁。
医科大学生焦虑、抑郁相关因素的广义估计方程和多层线性模型：
广义估计方程和多层线性模型统计结果显示，女性、二年级、专业不满意、社会支持（主观支持和支持利用度）、家庭功能、负性生活事件以及生活质量对医科大学生焦虑、抑郁情绪的预测显著。结论
医科大学生焦虑、抑郁情绪存在普遍，有较高的检出率。不同性别之间焦虑、抑郁状况有明显差异；二年级医学生焦虑、抑郁检出率较高；家庭经济状况差的医科大学生焦虑和抑郁检出率较高；所学专业不满意者焦虑、抑郁检出率较高。
社会支持、家庭功能、负性生活事件和生活质量等中介变量与医科大学生焦虑、抑郁的关系密切，社会支持中的主观支持和对支持的利用度是预测医科大学生焦虑、抑郁变化的重要因素，另外特别是负性生活事件对医学生焦虑、抑郁的影响更值得进一步关注。
应加强对大学生焦虑、抑郁问题的重视，通过多种方法预防焦虑、抑郁的发生，促进大学生健康成长。
Objectives
This study aims to assess the prevalence of psychological symptoms (anxiety,depression) and its longitudinal development among medical students; to examine thecharacteristics of anxiety and depression on different grades, gender, etc; to find thepossible relationships between psychological symptoms and related factors, such asfamily function, social support, negative life events and quality of life; to provideevidence for early intervention of mental health.
Methods
A sample of10340medical undergraduates from the First and Second grade amongthree medical universities of Anhui Province participated in the longitudinal study forone year, with an interval of6months. Data were collected by using a structuredquestionnaire, which included the Beck Depression Inventory, Beck Anxiety Inventory,Social Support Rating Scale, Life Events Scale, Quality of Life Scale, and FamilyAPGAR Index.
Multivariable ordinal logistic regression were employed to explore influentialfactors of anxiety and depression; the dependent variables were anxiety classificationand depression classification, respectively; the independent variables were negative lifeevents, family function, quality of life, social support, and the demographiccharacteristics, such as gender, age, grade, et al. Furthermore, generalized estimating equations (GEEs) and hierarchical linear modeling (HLM) were used to evaluate thecorrelation between psychological symptoms and related factors, such as familyfunction, social support, negative life events and quality of life.
We set up the quantitative database using EpiData3.1after checking and codingquestionnaires. The database was analyzed using SPSS17.0and HLM6.08.Chi-squared test (or Fisher’s exact test), one-way ANOVA, rank correlation,multivariable ordinal logistic regression analysis, GEEs and HLM were used foranalysis in the study. In all tests, the level of significance was set up at P<0.05.
Results
Prevalences of anxiety and depression:
16.8%,14.7%,10.3%of the medical students suffered from depression and14.1%,14.3%,9.0%from anxiety in the first, second and third investigation respectively.Results of Chi-squared test indicated that there were significant differences ofdepression and anxiety in different time point.
Characteristics of psychological symptoms on grade and gender:
Female students were more likely to have anxiety, the second-year students hadhigher levels of psychological symptoms than the first-year students in different timepoint. Female students were more likely to have depression in the first and secondinvestigation, while male students were more likely to have depression in the thirdinvestigation.
Relationship between psychological symptoms and family factors:
Poor household incomes were associated with more depression and anxiety. Medicalstudents from non-intact family were more likely to have anxiety in the second investigation.
Relationship between psychological symptoms and satisfaction of specialty:
Satisfaction of specialty was one of the predictors of depression and anxietysymptoms among the medical students. The students who were dissatisfied with theirspecialties were more likely to report depressed and anxious symptoms.
Relationships among depression, anxiety, family function, social support, negativelife events and quality of life:
Social support, family function and quality of life were significant negativelyassociated with depression and anxiety symptoms. Negative life events were significantpositively associated with depression and anxiety symptoms.
Multivariable ordinal logistic regression:
Multivariable ordinal logistic regression revealed that quality of life, negative lifeevents, social support, family function, etc entered regression equation. Students whohad severely negative life events, poor quality of life, less social support or familydysfunction were more vulnerable to anxiety and depression symptoms.
Generalized estimating equations and Hierarchical linear modeling:
Female, the second-year students, dissatisfaction of specialty, social support(objective support, utilizations of support), family function, negative life events, andquality of life were the significant predictors of depression and anxiety symptomsamong the medical students.
Conclusions
Depression and anxiety symptoms were relatively prevalent among medical studentsin Anhui Province, and multiple factors could affect depression and anxiety. There are significant differences of depression and anxiety in gender. The second-year studentshad higher levels of psychological symptoms. Poor household incomes were associatedwith more depression and anxiety. The students who were dissatisfied with theirspecialties were more likely to report depressed and anxious symptoms.
Depression and anxiety among medical students were significant associated withfamily function, social support, negative life events and quality of life. Supportive socialrelationships can play an important role in relieving the stresses and improving theirpsychological well-being among medical students. Negative life events possibly play animportant role in occurrence of anxiety and depression.
To promote the students’ healthy development, we should pay more attention topsychological symptoms, and carry out kinds of preventive measures to decrease theincidence of anxiety and depression symptoms.
描述医科大学生焦虑、抑郁情绪的流行现状及其纵向发展特征，并在此基础上进一步考察不同特征医学生亚群体（如不同年级、不同性别等）焦虑、抑郁的特点；考察环境因素以及医科大学生焦虑、抑郁情绪产生过程中的中介变量，如家庭功能、社会支持系统和负性生活事件等纵向发展特点及其与医学生焦虑、抑郁的关系，探讨影响医科大学生焦虑、抑郁发展的相关因素，为大学生心理健康的早期干预提供科学依据。
方法
选择安徽省三所医学院校中能随访到的10340名在校大学生作为研究对象。用自制的大学生心理健康状况与相关生活经历调查问卷（包括一般人口学特征、家庭因素、Beck焦虑量表、Beck抑郁量表、负性生活事件量表、家庭功能量表、生活质量量表和社会支持量表等）对目标人群进行纵向调查。首次测查完成后每隔半年进行一次追踪测查，总的纵向追踪时间为一年，追踪测查两次。追踪测查中所使用的调查问卷仍为第一次测查中所使用问卷。
焦虑、抑郁检出情况在单因素比较分析的基础上，分别以三次测查中焦虑和抑郁评分分级为因变量，以性别、年龄、年级、负性生活事件、家庭功能、社会支持、生活质量和家庭因素等为自变量，进行多元有序Logistic回归分析，探讨医科大学生焦虑、抑郁的影响因素。然后采用广义估计方程(GEEs)和多层线性模型(HLM)对医科大学生焦虑、抑郁的纵向追踪数据进行分析，进一步探讨社会支持、家庭功能、负性生活事件及生活质量与医科大学生焦虑、抑郁发展的关系。
采用EpiData3.1软件建立数据库，将所收集的资料经过核对、剔除不完整问卷后进行录入。应用SPSS17.0和HLM6.08软件对数据进行统计分析，单因素分析方法包括卡方检验(或Fisher’s确切概率法)、方差分析和秩相关，多因素分析有多元有序Logistic回归分析、广义估计方程(GEEs)和多层线性模型(HLM)。检验水准а=0.05。
结果
医科大学生焦虑、抑郁检出率：
各测查时点医科大学生焦虑的检出率分别为第一次测查（T1）：14.1%，第二次测查（T2）：14.3%和第三次测查（T3）：9.0%；抑郁的检出率分别为T1：16.8%，T2：14.7%和T3：10.3%。卡方检验结果显示，不同时点医科大学生焦虑、抑郁检出率有统计学差异。
不同群体医科大学生焦虑、抑郁特点：
三次测查中二年级医学生焦虑、抑郁检出率均高于一年级；女生焦虑检出率均高于男生；女生抑郁检出率在第一次测查、第二次测查中高于男生，第三次测查低于男生。
家庭因素与医科大学生焦虑、抑郁的关系
三次测查中家庭经济状况差的医科大学生焦虑和抑郁检出率均较高；第一次和第二次测查中家庭经济收入来源以家庭工资收入的医学生焦虑检出率最低；第一次测查家庭经济收入来源以家庭工资收入的医学生抑郁检出率最低；第二次测查非完整家庭医学生焦虑检出率高于完整家庭。
专业满意度与医科大学生焦虑、抑郁的关系：
不同专业满意度医学生焦虑、抑郁检出率差异均有统计学意义，且均以专业不满意者焦虑、抑郁检出率较高。
社会支持、家庭功能、负性生活事件和生活质量与医科大学生焦虑、抑郁的关系：
医科大学生社会支持、家庭功能和生活质量得分均与焦虑、抑郁评分呈显著负相关，社会支持越多，家庭功能和生活质量越好，焦虑、抑郁情绪越轻微；负性生活事件得分与焦虑、抑郁呈显著正相关，负性生活事件影响存在的严重程度越大，焦虑、抑郁情绪越严重。
医科大学生焦虑、抑郁相关因素的多元有序Logistic回归分析：
多元有序Logistic回归分析结果表明，生活质量、负性生活事件、家庭功能、社会支持（主观支持和支持利用度）等变量进入回归方程，提示：①主观感觉获得社会支持较少、生活质量和支持利用度差、以及家庭功能有障碍的医学生更易发生焦虑和抑郁情绪；②负性生活事件影响越严重的医学生更易发生焦虑和抑郁。
医科大学生焦虑、抑郁相关因素的广义估计方程和多层线性模型：
广义估计方程和多层线性模型统计结果显示，女性、二年级、专业不满意、社会支持（主观支持和支持利用度）、家庭功能、负性生活事件以及生活质量对医科大学生焦虑、抑郁情绪的预测显著。结论
医科大学生焦虑、抑郁情绪存在普遍，有较高的检出率。不同性别之间焦虑、抑郁状况有明显差异；二年级医学生焦虑、抑郁检出率较高；家庭经济状况差的医科大学生焦虑和抑郁检出率较高；所学专业不满意者焦虑、抑郁检出率较高。
社会支持、家庭功能、负性生活事件和生活质量等中介变量与医科大学生焦虑、抑郁的关系密切，社会支持中的主观支持和对支持的利用度是预测医科大学生焦虑、抑郁变化的重要因素，另外特别是负性生活事件对医学生焦虑、抑郁的影响更值得进一步关注。
应加强对大学生焦虑、抑郁问题的重视，通过多种方法预防焦虑、抑郁的发生，促进大学生健康成长。
Objectives
This study aims to assess the prevalence of psychological symptoms (anxiety,depression) and its longitudinal development among medical students; to examine thecharacteristics of anxiety and depression on different grades, gender, etc; to find thepossible relationships between psychological symptoms and related factors, such asfamily function, social support, negative life events and quality of life; to provideevidence for early intervention of mental health.
Methods
A sample of10340medical undergraduates from the First and Second grade amongthree medical universities of Anhui Province participated in the longitudinal study forone year, with an interval of6months. Data were collected by using a structuredquestionnaire, which included the Beck Depression Inventory, Beck Anxiety Inventory,Social Support Rating Scale, Life Events Scale, Quality of Life Scale, and FamilyAPGAR Index.
Multivariable ordinal logistic regression were employed to explore influentialfactors of anxiety and depression; the dependent variables were anxiety classificationand depression classification, respectively; the independent variables were negative lifeevents, family function, quality of life, social support, and the demographiccharacteristics, such as gender, age, grade, et al. Furthermore, generalized estimating equations (GEEs) and hierarchical linear modeling (HLM) were used to evaluate thecorrelation between psychological symptoms and related factors, such as familyfunction, social support, negative life events and quality of life.
We set up the quantitative database using EpiData3.1after checking and codingquestionnaires. The database was analyzed using SPSS17.0and HLM6.08.Chi-squared test (or Fisher’s exact test), one-way ANOVA, rank correlation,multivariable ordinal logistic regression analysis, GEEs and HLM were used foranalysis in the study. In all tests, the level of significance was set up at P<0.05.
Results
Prevalences of anxiety and depression:
16.8%,14.7%,10.3%of the medical students suffered from depression and14.1%,14.3%,9.0%from anxiety in the first, second and third investigation respectively.Results of Chi-squared test indicated that there were significant differences ofdepression and anxiety in different time point.
Characteristics of psychological symptoms on grade and gender:
Female students were more likely to have anxiety, the second-year students hadhigher levels of psychological symptoms than the first-year students in different timepoint. Female students were more likely to have depression in the first and secondinvestigation, while male students were more likely to have depression in the thirdinvestigation.
Relationship between psychological symptoms and family factors:
Poor household incomes were associated with more depression and anxiety. Medicalstudents from non-intact family were more likely to have anxiety in the second investigation.
Relationship between psychological symptoms and satisfaction of specialty:
Satisfaction of specialty was one of the predictors of depression and anxietysymptoms among the medical students. The students who were dissatisfied with theirspecialties were more likely to report depressed and anxious symptoms.
Relationships among depression, anxiety, family function, social support, negativelife events and quality of life:
Social support, family function and quality of life were significant negativelyassociated with depression and anxiety symptoms. Negative life events were significantpositively associated with depression and anxiety symptoms.
Multivariable ordinal logistic regression:
Multivariable ordinal logistic regression revealed that quality of life, negative lifeevents, social support, family function, etc entered regression equation. Students whohad severely negative life events, poor quality of life, less social support or familydysfunction were more vulnerable to anxiety and depression symptoms.
Generalized estimating equations and Hierarchical linear modeling:
Female, the second-year students, dissatisfaction of specialty, social support(objective support, utilizations of support), family function, negative life events, andquality of life were the significant predictors of depression and anxiety symptomsamong the medical students.
Conclusions
Depression and anxiety symptoms were relatively prevalent among medical studentsin Anhui Province, and multiple factors could affect depression and anxiety. There are significant differences of depression and anxiety in gender. The second-year studentshad higher levels of psychological symptoms. Poor household incomes were associatedwith more depression and anxiety. The students who were dissatisfied with theirspecialties were more likely to report depressed and anxious symptoms.
Depression and anxiety among medical students were significant associated withfamily function, social support, negative life events and quality of life. Supportive socialrelationships can play an important role in relieving the stresses and improving theirpsychological well-being among medical students. Negative life events possibly play animportant role in occurrence of anxiety and depression.
To promote the students’ healthy development, we should pay more attention topsychological symptoms, and carry out kinds of preventive measures to decrease theincidence of anxiety and depression symptoms.
引文
[1]姜乾金.医学心理学.第4版.北京:人民卫生出版社,2004.73.
[2]杨雪花.大学生心理健康状况及其研究进展.国外医学·社会医学分册,2000,17(2):65-68.
[3]肖圣龙.医学生心理咨询问题分析.中国健康心理学杂志,2007,15(2):122-123.
[4] Gomez EA, Gomez GE, Otto DA. Anxiety as a human emotion: some basicconceptual models. Nurs Forum,1984,21(1):38-42.
[5]魏义梅.大学生抑郁的心理社会机制及认知应对干预.吉林大学博士学位论文,2007.
[6] Holden C. Mental health. Global survey examines impact of depression. Science,2000,288(5463):39-40.
[7]费立鹏.中国的精神卫生问题—21世纪的挑战和选择.中国神经精神疾病杂志,2004，30(l):l-10.
[8] Peplau HE. Interpersonal Theory in Nursing Practice: Selected Works of HildegardE. Peplau. Springer Publishing Company,1989:270-326.
[9] Beck CK, Rawlins RP, Willams SR. Mental health-psychiatric nursing: A holisticlife-cycle approach (2nd ed.). St. Louis: The CV Mosbey,1988:33.
[10]朴松花,李春玉.焦虑的概念分析.吉林医学,2007,28(2):181-182.
[11] Angold A. Rutter M. Effects of age and pubertal status on depression in a largeclinical sample. Dev Psychopathol,1992,4:5-28.
[12]冯正直.中学生抑郁症状的社会信息加工方式研究.西南师范大学博士学位论文,2002.
[13]曾冬阳.护理本科新生的焦虑及相关因素的调查分析.山西医科大学硕士学位论文,2005.
[14]刘旬.焦虑问题的理论研究状况分析.菏泽医学专科学校学报,2006,18(4):79-83.
[15]李春波,吴文源,何康梅,等.焦虑症患者心理生理学反应研究.中国心理卫生杂志,2000,14(5):337-340.
[16]万黎,吴文源,李春波,等.焦虑症患者应激时情绪反应及脑功能状况.中国心理卫生杂志,2002,16(6):373-376.
[17] Davison GC, Neale JM. Abnormal Psychology. New York: John Wiley&Sons Inc.1998,14.
[18]黄希庭.人格心理学.台北:台湾中华书局,1998,129.
[19] Staats AW, Eifert GH. The paradigmatic behaviorism theory of emotion: Basis forunification. Clin Psychol Rev,1990,10(5):539–566.
[20] Eysenck MW.Trait anxiety and stress.In Fisher S and Reason J (Eds), Handbook ofLife1990.Stress, Cognition and Health.chichester:wiley.
[21]阳德华.大学生抑郁和焦虑研究.北京:科学出版社.2009.
[22] Nemeroff CB. The neurobiology of depression. Sci Am.1998,278(6):42-49.
[23] Takebayashi M, Kagaya A, Uchitomi Y, et al. Plasma dehydroepiandrosteronesulfate in unipolar major depression. Short communication. J Neural Transm,1998,105(4-5):537-542.
[24] Axelson DA, Doraiswamy PM, Boyko OB, et al. In vivo assessment of pituitaryvolume with magnetic resonance imaging and systematic stereology: relationship todexamethasone suppression test results in patients. Psychiatry Res,1992,44(1):63-70.
[25] Catalán R, Gallart JM, Castellanos JM, Galard R. Plasma corticotropin-releasingfactor in depressive disorders. Biol Psychiatry,1998,44(1):15-20.
[26] Whale R, Clifford EM, Bhagwagar Z, Cowen PJ. Decreased sensitivity of5-HT(1D) receptors in melancholic depression. Br J Psychiatry,2001,178:454-457.
[27] Maes M, Bosmans E, De Jongh R, Kenis G, Vandoolaeghe E, Neels H. Increasedserum IL-6and IL-1receptor antagonist concentrations in major depression andtreatment resistant depression. Cytokine,1997,9(11):853-858.
[28] Freud S. Mourning and melancholia. In JC Coyne (Ed.), Essential Papers onDepression. New York: New York University Press,1986,48-63.
[29] Rado S. The problem of Melancholia. Int J psychoanal,1928,9:420-438.
[30] Bibring E. The mechanism of depression, in Greenacre P (ed): Affective Disorders.New York, International Universities Press,1953.
[31] Coyne JC. Depression and the response of others. J Abnorm Psychol,1976,85(2):186-193.
[32] Monroe SM, Simons AD. Diathesis-stress theories in the context of life stressresearch: implications for the depressive disorders. Psychol Bull,1991,110(3):406-425.
[33] Abramson LY, Metalsky GI, Alloy LB. Hopelessness depression: a theory-basedsubtype of depression. Psychol Rev,1989,96(2):358-372.
[34]张光健,钱铭怡.社会关系问题解决能力缺陷与抑郁症的关系.中国临床心理学杂志,1998,6(4):254-256.
[35]丁树荣,石晶,徐宏斌,等.医学生焦虑状况及影响因素调查研究.临床荟萃,2007,22(19):1404-1405.
[36]魏俊彪.医学生焦虑和抑郁及相关因素研究.新乡医学院学报,2006,23(6):550-552.
[37]金喆,翟德春,潘秀丹,等.医科大学生抑郁和焦虑情绪调查.中国校医,2006,20(6):599-600.
[38]翟德春,潘秀丹,韩素玲,牟均,周旭松.医学生抑郁、焦虑症状的流行学特征及相关因素分析.中国学校卫生,2006,27(3):217-219.
[39] Vontver L, Irby D, Rakestraw P, et al. The effects of two methods of pelvicexamination instruction on student performance and anxiety. J Med Educ,1980,55(9):778–785.
[40] Knight RG, Waal-Manning HJ, Spears GF. Some norms and reliability data for theState–Trait Anxiety Inventory and the Zung Self-Rating Depression scale. Br J ClinPsychology,1983,22(Pt4):245–249.
[41] Mehanna Z, Richa S. Prevalence of anxiety and depressive disorders in medicalstudents. Transversal study in medical students in the Saint-Joseph University of Beirut.Encephale,2006,32(6Pt1):976-982.
[42] Inam SN, Saqib A, Alam E. Prevalence of anxiety and depression among medicalstudents of private university. J Pak Med Assoc,2003,53(2):44-47.
[43] Jadoon NA, Yaqoob R, Raza A, Shehzad MA, Zeshan SC. Anxiety and depressionamong medical students: a cross-sectional study. J Pak Med Assoc,2010,60(8):699-702.
[44] Lloyd C, Gartrell NK. Psychiatric symptoms in medical students. ComprPsychiatry,1984,25(6):552–565.
[45] Hojat M, Glaser K, Xu G, Veloski JJ, Christian EB. Gender comparisons ofmedical students’ psychosocial profiles. Med Educ,1999,33(5):342–349.
[46] Vitaliano PP, Maiuro RD, Russo J, et al. Medical student distress: a longitudinalstudy. J Nerv Ment Dis,1989,177(2):70–76.
[47]李迎春,胡传来,陶兴永,等.医学生焦虑、抑郁与个性特征的关系研究.中国学校卫生,2005,26(2):107-108.
[48]余跃生,高丽,何萍.不同行为类型医学生焦虑、抑郁情绪及其影响因素研究.黔南民族医专学报,2004,17(4):229-231.
[49] Jiang N, Sato T, Hara T,et al. Correlations between trait anxiety, personality andfatigue: study based on the Temperament and Character Inventory. J Psychosom Res,2003,55(6):493-500.
[50] Bunevicius A, Katkute A, Bunevicius R. Symptoms of anxiety and depression inmedical students and in humanities students: relationship with big-five personalitydimensions and vulnerability to stress. Int J Soc Psychiatry,2008,54(6):494-501.
[51] Moos RH, Moos BS. Family Environment Scale: Manual. Palo Alto, CA:Consulting Psychologists Press,1981.
[52] Sen S, Kranzler HR, Krystal JH, et al. A prospective cohort study investigatingfactors associated with depression during medical internship. Arch Gen Psychiatry,2010,67(6):557-565.
[53]王艳芳,杨翠华,潘集阳.广州地区某重点高校医学生焦虑状况的调查.中国健康心理学杂志,2006,14(2):220-221.
[54]王锋生,孙业桓,钮娟娟,蔡标,龚磊,孙丽娜.家庭环境因素对医科大学生焦虑影响的研究.中华流行病学杂志2010,31(4):475-476.
[55]王基鸿,林潇萍,王小丹.医学生心理健康和家庭环境的相关分析.临床医学工程,2011,18(3):461-462.
[56] Slotkin J, Forehand R, Fauber R, McCombs A, Long N. Parent-completed andadolescent-completed CDIs: relationship to adolescent social and cognitive functioning.J Abnorm Child Psychol,1988,16(2):207-217.
[57] Jacobsen RH, Lahey BB, Strauss CC. Correlates of depressed mood in normalchildren. J Abnorm Child Psychol,1983,11(1):29-39.
[58] Calvo MG, Carreiras M. Selective influence of test anxiety on reading processes.Br J Psychol,1993,84(Pt3):375-388.
[59]阳德华.师生、同伴关系与初中生焦虑的探讨.中国心理卫生杂志,2001,15(2):78-80.
[60]阳德华.初中生抑郁情绪与学校因素的相关性研究.中国临床心理学杂志,2002,10(1):33-35.
[61]左川,曾静,黄慧,邱红渝,王一平,易智慧.医学生心理健康状况及影响因素分析.现代预防医学,2008,35(6):1118-1120.
[62] Rabkin JG, Struening EL. Live events, stress, and illness. Science,1976,194(4269):1013-1020.
[63] Vadher A, Ndetei DM. Life events and depression in a Kenyan setting. Br JPsychiatry,1981,139:134-137.
[64] Khan MS, Mahmood S, Badshah A,et al. Prevalence of depression, anxiety andtheir associated factors among medical students in Karachi, Pakistan. J Pak Med Assoc,2006,56(12):583-586.
[65] Aktekin M, Karaman T, Senol YY, Erdem S, Erengin H, Akaydin M. Anxiety,depression and stressful life events among medical students: a prospective study inAntalya, Turkey. Med Educ,2001,35(1):12-17.
[66] Rab F, Mamdou R, Nasir S. Rates of depression and anxiety among female medicalstudents in Pakistan. East Mediterr Health J,2008,14(1):126-133.
[67]李松英,温迺.医学院学生焦虑、抑郁、孤独及相关因素探讨.浙江预防医学,2006,18(8):13-15.
[68] Holmes TH, Rahe RH. The Social Readjustment Rating Scale. J Psychosom Res,1967,11(2):213-218.
[69]肖水源.《社会支持评定量表》的理论基础与研究应用.临床精神医学杂志,1994,4(2):98-100.
[70] Cohen S, Hoberman HM. Positive events and social support as buffers of lifechange stress. J Appl Soc Psychol,1983,13:99-125.
[71] Moak ZB, Agrawal A. The association between perceived interpersonal socialsupport and physical and mental health: Results from the National EpidemiologicalSurvey on Alcohol and Related Conditions. J Public Health (Oxf),2010,32(2):191-201.
[72] Jeong Y, Kim JY, Ryu JS, Lee KE, Ha EH, Park H. The associations betweensocial support, health-related behaviors, socioeconomic status and depression in medicalstudents. Epidemiol Health.2010,32:e2010009.
[73] Ball S, Bax A. Self-care in medical education: effectiveness of health-habitsinterventions for first-year medical students. Acad Med,2002,77:911–917.
[74]檀立,程淑英,王淑娟,陈桂芝,金英爱.SARS期间医学生心理健康状况与社会支持相关性研究.华北煤炭医学院学报,2005,7(2):144-145.
[75] Bronfenbrenner U. The ecology of human development. Cambridge, MA: HarvardUniversity Press,1979.
[76]许敏兰,张洪波,许娟,等.安徽省有焦虑症状大学生的社会人口特征及社会心理分析.中国心理卫生杂志,2006,20(8):510-512.
[77]王君,张洪波,王莉娜,等.安徽省大学生抑郁症状与人格特征和家庭环境的关系.中国学校卫生,2009,30(1):32-33.
[78]汪向东，王希林，马弘.心理卫生评定量表手册（增订版）.北京：中国心理卫生杂志社出版发行，1999:251-253.
[79] Beck AT, Steer RA. Beck Anxiety Inventory Manual. San Antonio, TX: ThePsychological Corporation Harcourt Brace Jovanovich, Inc.,1990.
[80]郑健荣,黄炽荣,黄洁晶,等.贝克焦虑量表的心理测量学特性、常模分数及因子结构的研究.中国临床心理学杂志,2002,10(1):4-6.
[81]汪向东，王希林，马弘.心理卫生评定量表手册（增订版）.北京：中国心理卫生杂志社出版发行，1999:191-194.
[82] Beck A, Steer R, Garbin M. Psychometric properties of the Beck DepressionInventory: Twenty-five years of evaluation. Clin Psychol Rev,1988,8(1):77-100.
[83] Shek DT. Reliability and factorial structure of the Chinese version of the BeckDepression Inventory. J Clin Psychol,1990,46(1):35-43.
[84] Zheng YP, Lin KM. Comparison of the Chinese Depression Inventory andtheChinese version of the Beck Depression Inventory. Acta Psychiatr Scand,1991,84(6):531-536.
[85] Zheng YP, Wei LA, Goa LG, Zhang GC, Wong CG. Applicability of the ChineseBeck Depression Inventory. Compr Psychiatry,1988,29(5):484-489.
[86] Smilkstein G. The family APGAR: A proposal for a family function test and its useby physicians. J Fam Pract,1978,6:1231-1239.
[87] Smilkstein G, Ashworth C, Montano D. Validity and reliability of the familyAPGAR as a test of family function. J Fam Pract,1982,15:303-311.
[88]吕繁,曾光,刘松暖,钟天伦,詹志强.家庭关怀度指数问卷测量脑血管病病人家庭功能的信度和效度研究.中国公共卫生,1999,15(11):987-988.
[89]李献云，费立鹏，及惠郁，等.乡村严重自杀未遂者的特征.中国神经精神疾病杂志，2005,31(4):272-277.
[90]汪向东，王希林，马弘.心理卫生评定量表手册（增订版）.北京：中国心理卫生杂志社出版发行，1999:127-131.
[91] Roh MS, Jeon HJ, Kim H, Han SK, Hahm BJ. The prevalence and impact ofdepression among medical students: a nationwide cross-sectional study in South Korea.Acad Med,2010,85(8):1384-1390.
[92]张雷，雷劈，郭伯良.多层线性模型应用.北京:教育科学出版社.2003.
[93]刘红云，张雷.追踪数据分析方法及其应用.北京:教育科学出版社.2005.
[94] Derogatis LR, Rickels K, Rock AF. The SCL-90and the MMPI: a step in thevalidation of a new self-report scale. Br J Psychiatry,1976,128:280–289.
[95] Zung WW. A rating instrument for anxiety disorders. Psychosomatics,1971,12(6):371-379.
[96] Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol,1959,32(1):50-55.
[97] Zung WW, Richards CB, Short MJ. Self-rating depression scale in an outpatientclinic: further validation of the SDS. Arch Gen Psychiatry,1965,13(6):508–515.
[98] Radloff LS. The CES-D Scale: a self report depressive scale for research in thegeneral population. Appl Psychol Meas,1977,1:385-401.
[99] Weissman MM, Sholomskas D, Pottenger M, Prusoff BA, Locke BZ. Assessingdepressive symptoms in five psychiatric populations: a validation study. Am JEpidemiol,1977,106(3):203-214.
[100] Schulberg HC, Saul M, McClelland M, Ganguli M, ChristyW, Frank R. Assessingdepression in primary medical and psychiatric practices. Arch Gen Psychiatry,1985,42(12):1164–1170.
[101] Li Z, Hicks MH. The CES-D in Chinese American women: construct validity,diagnostic validity for major depression, and cultural response bias. Psychiatry Res,2010,175(3):227-232.
[102] Hamilton M. Development of a rating scale for primary depressive illness. Br JSoc Clin Psychol,1967,6(4):278-296.
[103]边水玲,牛亚兰,郭建,等.医科大学生中焦虑流行状况的调查.中国健康心理学杂志,2007,15(9):795-796.
[104]冀伟.308名医学生心理健康水平调查.中国健康心理学杂志.2007，15(8):734-735.
[105]王梦龙,黄旭,黄娟,等.中山大学医学生个性特征与抑郁关系研究.中国学校卫生,2003,24(5):458-459.
[106]尚玉秀,严淑珍,朱凤萍.医学生自杀意念与抑郁的现况调查及影响因素分析.现代预防医学,2009,36(16):3092-3094.
[107]周榕,杨翠华,潘集阳.广州地区重点医科大学生抑郁状况及相关因素调查分析.神经疾病与精神卫生,2003,3(5):367-368.
[108]王黎恩,王极盛.医科大学生的生活事件与焦虑.中国临床康复,2006,10(6):20-23.
[109]孙萍.高职大专学生焦虑状况调查与思考.现代医药卫生,2005,21(24):3384-3385.
[110]张泽武,吴赤蓬,刘国宁,范存欣,王惠苏.广州市医科大学生抑郁状况及影响因素分析.中国学校卫生,2006,27(1):51-52.
[111] Dyrbye LN, Thomas MR, Shanafelt TD. Systematic review of depression, anxiety,and other indicators of psychological distress among U.S. and Canadian medicalstudents. Acad Med,2006,81(4):354-373.
[112]陈祎平.关于海南大学专业调整与建设的思考.海南大学学报社会科学版,1999,17(3):17-21,33.
[113]杨爱莲,王铁英,马慧琴.高等护理专业学生心理状况调查及分析.天津医科大学学报,2000,6(2):158-159.
[114]吴敏,时松和,杨翠萍.父母文化程度、职业、期望值及教育方式等因素对大学生心理健康水平的影响.郑州大学学报·医学版,2007,42(6):1184-1187.
[115]姚齐和,赵传昌.独生子女与非独生子女心理健康状况比较研究.健康心理学杂志,1998,6(4):427-429.
[116]叶玉清,张劲松.家庭结构缺陷对青少年心理成长的影响.中国青年研究,2006(7):74-77.
[117] Franks P, Campbell TL, Shields CG. Social relationships and health: the relativeroles of family functioning and social support. Soc Sci Med,1992,34(7):779-788.
[118]杨德森，主编.基础精神医学.长沙:湖南科学技术出版社，1994,193-260.
[119]卢晓红，李凌江，李昌琦，等.应激对中枢神经系统即刻早期基因表达及轴的调节作用研究.中国心理卫生杂志，2000,14(1):10-13.
[120]王卫华,卢祖洵.生命质量研究的现状与趋势.医学与社会,2005,18(7):8-10.
[121]张云.大学生生活质量、应对方式及其关系的研究.安徽师范大学硕士学位论文,2006.
[122]张国忠,毛宗福,毕勇毅.大学生生活质量问题试探.当代青年研究,2001,(4):33-34.
[123]张国忠,毛宗福,毕勇毅,郭毅. l134名医科大学生生活质量状况研究.中国学校卫生,2003,24(3):248-249.
[124] Klemenc-Ketis Z, Kersnik J, Eder K, Colaric D. Factors associated withhealth-related quality of life among university students. Srp Arh Celok Lek,2011,139(3-4):197-202.
[125] Liang KY, Zeger SL. Longitudinal data analysis using generalized linear models.Biometrika,1986,73(l):13-22.
[126] Zeger SL, Liang KY. Longitudinal data analysis for discrete and continuousoutcomes. Biometrics,1986,42(1):121-130.
[127]盖笑松,张向葵.多层线性模型在纵向研究中的运用.心理科学,2005,28(2):429-431.
[128]刘红云,孟庆茂.教育和心理研究中的多层线性模型.心理科学进展,2002,10(2):213-219.
[1] Saslow G. Psychiatric problems of medical students. J Medl Educ,1956,31(1):27-33.
[2] Adewuya AO, Ola BA, Aloba OO, Mapayi BM, Oginni OO. Depression amongstNigerian university students. Prevalence and sociodemographic correlates. SocPsychiatry Psychiatr Epidemiol,2006,41(8):674-678.
[3] Chan DW. Depressive symptoms and depressed mood among Chinese medicalstudents in Hong Kong. Compr Psychiatry,1991,32(2):170-180.
[4] Guthrie EA, Black D, Shaw CM, Hamilton J, Creed FH, Tomenson B. Embarkingupon a medical career: psychological morbidity in first year medical students. MedEduc,1995,29(5):337-341.
[5] Miller PM, Surtees PG. Psychological symptoms and their course in first-yearmedical students as assessed by the Interval General Health Questionnaire (I-GHQ). BrJ Psychiatry,1991,159:199-207.
[6] Dahlin M, Joneborg N, Runeson B. Stress and depression among medical students: across-sectional study. Med Educ,2005,39(6):594-604.
[7] Jeong Y, Kim JY, Ryu JS, Lee KE, Ha EH, Park H. The associations between socialsupport, health-related behaviors, socioeconomic status and depression in medicalstudents. Epidemiol Health.2010,32:e2010009.
[8]肖圣龙.医学生心理咨询问题分析.中国健康心理学杂志,2007,15(2):122-123.
[9] Gomez EA, Gomez GE, Otto DA. Anxiety as a human emotion: some basicconceptual models. Nurs Forum,1984,21(1):38-42.
[10]魏义梅.大学生抑郁的心理社会机制及认知应对干预.吉林大学博士学位论文,2007.
[11] Holden C. Mental health. Global survey examines impact of depression. Science,2000,288(5463):39-40.
[12]费立鹏.中国的精神卫生问题—21世纪的挑战和选择.中国神经精神疾病杂志,2004,30(l):l-10.
[13] Peplau HE. Interpersonal Theory in Nursing Practice: Selected Works of HildegardE. Peplau. Springer Publishing Company,1989:270-326.
[14] Beck CK, Rawlins RP, Willams SR. Mental health-psychiatric nursing: A holisticlife-cycle approach (2nd ed.). St. Louis: The CV Mosbey,1988:33.
[15]朴松花,李春玉.焦虑的概念分析.吉林医学,2007,28(2):181-182.
[16] Angold A. Rutter M. Effects of age and pubertal status on depression in a largeclinical sample. Dev Psychopathol,1992,4:5-28.
[17]冯正直.中学生抑郁症状的社会信息加工方式研究.西南师范大学博士学位论文,2002.
[18] Derogatis LR, Rickels K, Rock AF. The SCL-90and the MMPI: a step in thevalidation of a new self-report scale. Br J Psychiatry,1976,128:280–289.
[19] Zung WW. A rating instrument for anxiety disorders. Psychosomatics,1971,12(6):371-379.
[20] Beck AT, Steer RA. Beck Anxiety Inventory Manual. San Antonio: ThePsychological Corporation Harcourt Brace Jovanovich, Inc,1990.
[21] Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol,1959,32(1):50-55.
[22] Knight RG, Waal-Manning HJ, Spears GF. Some norms and reliability data for theState–Trait Anxiety Inventory and the Zung Self-Rating Depression scale. Br J ClinPsychology,1983,22(Pt4):245–249.
[23] Zung WW, Richards CB, Short MJ. Self-rating depression scale in an outpatientclinic: further validation of the SDS. Arch Gen Psychiatry,1965,13(6):508–515.
[24] Beck A, Steer R, Garbin M. Psychometric properties of the Beck DepressionInventory: twenty-five years of evaluation. Clin Psychol Rev,1988,8:77–100.
[25] Radloff LS. The CES-D Scale: a self report depressive scale for research in thegeneral population. Appl Psychol Meas,1977,1:385-401.
[26] Thomas JL, Jones GN, Scarinci IC, Mehan DJ, Brantley PJ. The utility of theCES-D as a depression screening measure among low-income women attendingprimary care clinics. The Center for Epidemiologic Studies-Depression. Int J PsychiatryMed,2001,31(1):25-40.
[27] Schulberg HC, Saul M, McClelland M, Ganguli M, Christy W, Frank R. Assessingdepression in primary medical and psychiatric practices. Arch Gen Psychiatry,1985,42(12):1164–1170.
[28] Li Z, Hicks MH. The CES-D in Chinese American women: construct validity,diagnostic validity for major depression, and cultural response bias. Psychiatry Res,2010,175(3):227-232.
[29] Hamilton M. Development of a rating scale for primary depressive illness. Br J SocClin Psychol,1967,6(4):278-296.
[30]汪向东,王希林,马弘.心理卫生评定量表手册(增订版).北京:中国心理卫生杂志社,1999.
[31]张作记.行为医学量表手册.中国行为医学科学编辑部,2001.
[32]冀伟.308名医学生心理健康水平调查.中国健康心理学杂志.2007,15(8):734-735.
[33]边永玲,牛亚兰,郭建,等.医科大学生中焦虑流行状况的调查.中国健康心理学杂志,2007,15(9):795-796.
[34]王黎恩,王极盛.医科大学生的生活事件与焦虑.中国临床康复,2006,10(6):20-23.
[35]孙萍.高职大专学生焦虑状况调查与思考.现代医药卫生,2005,21(24):3384-3385.
[36]许敏兰,张洪波,许娟,等.安徽省有焦虑症状大学生的社会人口特征及社会心理分析.中国心理卫生杂志,2006,20(8):510-512.
[37]丁树荣,石晶,徐宏斌,等.医学生焦虑状况及影响因素调查研究.临床荟萃,2007,22(19):1404-1405.
[38]金喆,翟德春,潘秀丹,等.医科大学生抑郁和焦虑情绪调查.中国校医,2006,20(6):599-600.
[39] Vontver L, Irby D, Rakestraw P, et al. The effects of two methods of pelvicexamination instruction on student performance and anxiety. J Med Educ,1980,55(9):778–785.
[40] Knight RG, Waal-Manning HJ, Spears GF. Some norms and reliability data for theState–Trait Anxiety Inventory and the Zung Self-Rating Depression scale. Br J ClinPsychology,1983,22(Pt4):245–249.
[41] Mehanna Z, Richa S. Prevalence of anxiety and depressive disorders in medicalstudents. Transversal study in medical students in the Saint-Joseph University of Beirut.Encephale,2006,32(6Pt1):976-982.
[42] Inam SN, Saqib A, Alam E. Prevalence of anxiety and depression among medicalstudents of private university. J Pak Med Assoc,2003,53(2):44-47.
[43] Lloyd C, Gartrell NK. Psychiatric symptoms in medical students. ComprPsychiatry,1984,25(6):552-565.
[44] Hojat M, Glaser K, Xu G, et al. Gender comparisons of medical students’psychosocial profiles. Med Educ,1999,33(5):342–349.
[45] Vitaliano PP, Maiuro RD, Russo J, et al. Medical student distress: a longitudinalstudy. J Nerv Ment Dis,1989,177(2):70–76.
[46] Achenbach TM. The derivation of taxonomic constructs: A necessary stage in thedevelopment of developmental psychology. In: Cicchetti D, Toth SL, editors. RochesterSymposium on Developmental Psychopathology, Vol.3: Models and Integrations.Rochester, NY: University of Rochester Press;1991.
[47] Dyrbye LN, Thomas MR, Shanafelt TD. Systematic review of depression, anxiety,and other indicators of psychological distress among U.S. and Canadian medicalstudents. Acad Med,2006,81(4):354-373.
[48] Barrett J, Hurst MW, DiScala C, Rose RM. Prevalence of depression over a12-month period in a nonpatient population. Arch Gen Psychiatry,1978,35(6):741-744.
[49] Sherry S, Notman MT, Nadelson CC, Kanter F, Salt P. Anxiety, depression, andmenstrual symptoms among freshman medical students. J Clin Psychiatry,1988,49(12):490-493.
[50] Buchman BP, Sallis JF, Criqui MH, Dimsdale JE, Kaplan RM. Physical activity,physical fitness, and psychological characteristics of medical students. J Psychosom Res,1991,35(2-3):197-208.
[51] Weissman MM, Sholomskas D, Pottenger M, Prusoff BA, Locke BZ. Assessingdepressive symptoms in five psychiatric populations: a validation study. Am JEpidemiol,1977,106(3):203-214.
[52] Lloyd C, Miller PM. The relationship of parental style to depression andself-esteem in adulthood. J Nerv Ment Dis,1997,185(11):655-663.
[53] Hendryx MS, Haviland MG, Shaw DG. Dimensions of alexithymia and theirrelationships to anxiety and depression. J Pers Assess,1991,56(2):227-237.
[54] Vitaliano PP, Maiuro RD, Russo J, Mitchell ES, Carr JE, Van Citters RL. Abiopsychosocial model of medical student distress. J Behav Med,1988,11(4):311-331.
[55] Ball S, Bax A. Self-care in medical education: effectiveness of health-habitsinterventions for first-year medical students. Acad Med,2002,77(9):911–917.
[56] Clark DC, Zeldow PB. Vicissitudes of depressed mood during four years ofmedical school. JAMA,1988,260(17):2521-2528
[57] Rosal MC, Ockene IS, Ockene JK, Barrett SV, Ma Y, Hebert JR. A longitudinalstudy of students’ depression at one medical school. Acad Med,1997,72(6):542-546.
[58] Zoccolillo M, Murphy GE, Wetzel RD. Depression among medical students. JAffect Disord,1986,11(1):91-96.
[59] Richman JA, Flaherty JA. Gender differences in medical student distress:contributions of prior socialization and current role-related stress. Soc Sci Med,1990,30(7):777-787.
[60] Pyskoty CE, Richman JA, Flaherty JA. Psychosocial assets and mental health ofminority medical students. Acad Med,1990,65(9):581-585.
[61] Whitehouse WG, Dinges DF, Orne EC, et al. Psychosocial and immune effects ofself-hypnosis training for stress management throughout the first semester of medicalschool. Psychosom Med,1996,58(3):249-263.
[62] Lloyd C, Gartrell NK. Sex differences in medical student mental health. Am JPsychiatry,1981,138(10):1346-1351.
[63] Jadoon NA, Yaqoob R, Raza A, Shehzad MA, Zeshan SC. Anxiety and depressionamong medical students: a cross-sectional study. J Pak Med Assoc,2010,60(8):699-702.
[64] Roh MS, Jeon HJ, Kim H, Han SK, Hahm BJ. The prevalence and impact ofdepression among medical students: a nationwide cross-sectional study in South Korea.Acad Med,2010,85(8):1384-1390.
[65]尚玉秀,严淑珍,朱凤萍.医学生自杀意念与抑郁的现况调查及影响因素分析.现代预防医学,2009,36(16):3092-3094.
[66]周榕,杨翠华,潘集阳.广州地区重点医科大学生抑郁状况及相关因素调查分析.神经疾病与精神卫生,2003,3(5):367-368.
[67]张泽武,吴赤蓬,刘国宁,范存欣,王惠苏.广州市医科大学生抑郁状况及影响因素分析.中国学校卫生,2006,27(1):51-52.
[68]王梦龙,黄旭,黄娟,等.中山大学医学生个性特征与抑郁关系研究.中国学校卫生,2003,24(5):458-459.
[69]魏俊彪.医学生焦虑和抑郁及相关因素研究.新乡医学院学报,2006,23(6):550-552.
[70]翟德春,潘秀丹,韩素玲,牟均,周旭松.医学生抑郁、焦虑症状的流行学特征及相关因素分析.中国学校卫生,2006,27(3):217-219.
[71]李迎春,胡传来,陶兴永,等.医学生焦虑、抑郁与个性特征的关系研究.中国学校卫生,2005,26(2):107-108.
[72]余跃生,高丽,何萍.不同行为类型医学生焦虑、抑郁情绪及其影响因素研究.黔南民族医专学报,2004,17(4):229-231.
[73] Jiang N, Sato T, Hara T,et al. Correlations between trait anxiety, personality andfatigue: study based on the Temperament and Character Inventory. J Psychosom Res,2003,55(6):493-500.
[74] Bunevicius A, Katkute A, Bunevicius R. Symptoms of anxiety and depression inmedical students and in humanities students: relationship with big-five personalitydimensions and vulnerability to stress. Int J Soc Psychiatry,2008,54(6):494-501.
[75] Moos RH, Moos BS. Family Environment Scale: Manual. Palo Alto, CA:Consulting Psychologists Press,1981.
[76] Sen S, Kranzler HR, Krystal JH, et al. A prospective cohort study investigatingfactors associated with depression during medical internship. Arch Gen Psychiatry,2010,67(6):557-565.
[77]王艳芳,杨翠华,潘集阳.广州地区某重点高校医学生焦虑状况的调查.中国健康心理学杂志,2006,14(2):220-221.
[78]王锋生,孙业桓,钮娟娟,蔡标,龚磊,孙丽娜.家庭环境因素对医科大学生焦虑影响的研究.中华流行病学杂志2010,(4):475-476.
[79]王基鸿,林潇萍,王小丹.医学生心理健康和家庭环境的相关分析.临床医学工程,2011,18(3):461-462.
[80] Slotkin J, Forehand R, Fauber R, McCombs A, Long N. Parent-completed andadolescent-completed CDIs: relationship to adolescent social and cognitive functioning.J Abnorm Child Psychol,1988,16(2):207-217.
[81] Jacobsen RH, Lahey BB, Strauss CC. Correlates of depressed mood in normalchildren. J Abnorm Child Psychol,1983,11(1):29-39.
[82] Calvo MG, Carreiras M. Selective influence of test anxiety on reading processes.Br J Psychol,1993,84(Pt3):375-388.
[83]阳德华.师生、同伴关系与初中生焦虑的探讨.中国心理卫生杂志,2001,15(2):78-80.
[84]阳德华.初中生抑郁情绪与学校因素的相关性研究.中国临床心理学杂志,2002,10(1):33-35.
[85]左川,曾静,黄慧,邱红渝,王一平,易智慧.医学生心理健康状况及影响因素分析.现代预防医学,2008,35(6):1118-1120.
[86] Rabkin JG, Struening EL. Live events, stress, and illness. Science,1976,194(4269):1013-1020.
[87] Vadher A, Ndetei DM. Life events and depression in a Kenyan setting. Br JPsychiatry,1981,139:134-137.
[88] Khan MS, Mahmood S, Badshah A,et al. Prevalence of depression, anxiety andtheir associated factors among medical students in Karachi, Pakistan. J Pak Med Assoc,2006,56(12):583-586.
[89] Aktekin M, Karaman T, Senol YY, Erdem S, Erengin H, Akaydin M. Anxiety,depression and stressful life events among medical students: a prospective study inAntalya, Turkey. Med Educ,2001,35(1):12-17.
[90] Rab F, Mamdou R, Nasir S. Rates of depression and anxiety among female medicalstudents in Pakistan. East Mediterr Health J,2008,14(1):126-133.
[91]李松英,温迺.医学院学生焦虑、抑郁、孤独及相关因素探讨.浙江预防医学,2006,18(8):13-15.
[92] Holmes TH, Rahe RH. The Social Readjustment Rating Scale. J Psychosom Res,1967,11(2):213-218.
[93]肖水源.《社会支持评定量表》的理论基础与研究应用.临床精神医学杂志,1994,4(2):98-100.
[94] Cohen S, Hoberman HM. Positive events and social support as buffers of lifechange stress. J Appl Soc Psychol,1983,13:99-125.
[95] Moak ZB, Agrawal A. The association between perceived interpersonal socialsupport and physical and mental health: Results from the National EpidemiologicalSurvey on Alcohol and Related Conditions. J Public Health (Oxf),2010,32(2):191-201.
[96]檀立,程淑英,王淑娟,陈桂芝,金英爱.SARS期间医学生心理健康状况与社会支持相关性研究.华北煤炭医学院学报,2005,7(2):144-145.
[97] Zuardi AW, Prota FD, Del-Ben CM. Reduction of the anxiety of medical studentsafter curricular reform. Rev Bras Psiquiatr.2008,30(2):136-138.
[98] Finkelstein C, Brownstein A, Scott C,et al. Anxiety and stress reduction in medicaleducation: an intervention. Med Educ,2007,41(3):258-264.
[99] Velayudhan A, Gayatridevi S, Bhattacharjee RR. Efficacy of behavioralintervention in reducing anxiety and depression among medical students. Ind PsychiatryJ,2010,19(1):41-46.
[100]吴汉荣,卢珊,蒙衡.《健康心理学》课程对医科大学生心理健康的影响.医学与社会,2007,20(1):38-40.
[101]张殿君,赫英娟,耿艳萌.应用团体生涯辅导技术对医学生心理素质的干预性调查研究.牡丹江医学院学报,2007,28(4):74-76.
[102] Rosenzweig S, Reibel DK, Greeson JM, et al.Mindfulness-based stress reductionlowers psychological distress in medical students. Teach Learn Med,2003,15(2):88–92.
[103] Warnecke E, Quinn S, Ogden K, Towle N, Nelson MR. A randomised controlledtrial of the effects of mindfulness practice on medical student stress levels. Med Educ,2011,45(4):381-388. doi:10.1111/j.1365-2923.2010.03877.x.
[104] Lee J, Graham AV. Students' perception of medical school stress and theirevaluation of a wellness elective. Med Educ,2001,35(7):652–659.
[105] Simard AA, Henry M. Impact of a short yoga intervention on medical students'health: a pilot study. Med Teach,2009,31(10):950-952.
[2]杨雪花.大学生心理健康状况及其研究进展.国外医学·社会医学分册,2000,17(2):65-68.
[3]肖圣龙.医学生心理咨询问题分析.中国健康心理学杂志,2007,15(2):122-123.
[4] Gomez EA, Gomez GE, Otto DA. Anxiety as a human emotion: some basicconceptual models. Nurs Forum,1984,21(1):38-42.
[5]魏义梅.大学生抑郁的心理社会机制及认知应对干预.吉林大学博士学位论文,2007.
[6] Holden C. Mental health. Global survey examines impact of depression. Science,2000,288(5463):39-40.
[7]费立鹏.中国的精神卫生问题—21世纪的挑战和选择.中国神经精神疾病杂志,2004，30(l):l-10.
[8] Peplau HE. Interpersonal Theory in Nursing Practice: Selected Works of HildegardE. Peplau. Springer Publishing Company,1989:270-326.
[9] Beck CK, Rawlins RP, Willams SR. Mental health-psychiatric nursing: A holisticlife-cycle approach (2nd ed.). St. Louis: The CV Mosbey,1988:33.
[10]朴松花,李春玉.焦虑的概念分析.吉林医学,2007,28(2):181-182.
[11] Angold A. Rutter M. Effects of age and pubertal status on depression in a largeclinical sample. Dev Psychopathol,1992,4:5-28.
[12]冯正直.中学生抑郁症状的社会信息加工方式研究.西南师范大学博士学位论文,2002.
[13]曾冬阳.护理本科新生的焦虑及相关因素的调查分析.山西医科大学硕士学位论文,2005.
[14]刘旬.焦虑问题的理论研究状况分析.菏泽医学专科学校学报,2006,18(4):79-83.
[15]李春波,吴文源,何康梅,等.焦虑症患者心理生理学反应研究.中国心理卫生杂志,2000,14(5):337-340.
[16]万黎,吴文源,李春波,等.焦虑症患者应激时情绪反应及脑功能状况.中国心理卫生杂志,2002,16(6):373-376.
[17] Davison GC, Neale JM. Abnormal Psychology. New York: John Wiley&Sons Inc.1998,14.
[18]黄希庭.人格心理学.台北:台湾中华书局,1998,129.
[19] Staats AW, Eifert GH. The paradigmatic behaviorism theory of emotion: Basis forunification. Clin Psychol Rev,1990,10(5):539–566.
[20] Eysenck MW.Trait anxiety and stress.In Fisher S and Reason J (Eds), Handbook ofLife1990.Stress, Cognition and Health.chichester:wiley.
[21]阳德华.大学生抑郁和焦虑研究.北京:科学出版社.2009.
[22] Nemeroff CB. The neurobiology of depression. Sci Am.1998,278(6):42-49.
[23] Takebayashi M, Kagaya A, Uchitomi Y, et al. Plasma dehydroepiandrosteronesulfate in unipolar major depression. Short communication. J Neural Transm,1998,105(4-5):537-542.
[24] Axelson DA, Doraiswamy PM, Boyko OB, et al. In vivo assessment of pituitaryvolume with magnetic resonance imaging and systematic stereology: relationship todexamethasone suppression test results in patients. Psychiatry Res,1992,44(1):63-70.
[25] Catalán R, Gallart JM, Castellanos JM, Galard R. Plasma corticotropin-releasingfactor in depressive disorders. Biol Psychiatry,1998,44(1):15-20.
[26] Whale R, Clifford EM, Bhagwagar Z, Cowen PJ. Decreased sensitivity of5-HT(1D) receptors in melancholic depression. Br J Psychiatry,2001,178:454-457.
[27] Maes M, Bosmans E, De Jongh R, Kenis G, Vandoolaeghe E, Neels H. Increasedserum IL-6and IL-1receptor antagonist concentrations in major depression andtreatment resistant depression. Cytokine,1997,9(11):853-858.
[28] Freud S. Mourning and melancholia. In JC Coyne (Ed.), Essential Papers onDepression. New York: New York University Press,1986,48-63.
[29] Rado S. The problem of Melancholia. Int J psychoanal,1928,9:420-438.
[30] Bibring E. The mechanism of depression, in Greenacre P (ed): Affective Disorders.New York, International Universities Press,1953.
[31] Coyne JC. Depression and the response of others. J Abnorm Psychol,1976,85(2):186-193.
[32] Monroe SM, Simons AD. Diathesis-stress theories in the context of life stressresearch: implications for the depressive disorders. Psychol Bull,1991,110(3):406-425.
[33] Abramson LY, Metalsky GI, Alloy LB. Hopelessness depression: a theory-basedsubtype of depression. Psychol Rev,1989,96(2):358-372.
[34]张光健,钱铭怡.社会关系问题解决能力缺陷与抑郁症的关系.中国临床心理学杂志,1998,6(4):254-256.
[35]丁树荣,石晶,徐宏斌,等.医学生焦虑状况及影响因素调查研究.临床荟萃,2007,22(19):1404-1405.
[36]魏俊彪.医学生焦虑和抑郁及相关因素研究.新乡医学院学报,2006,23(6):550-552.
[37]金喆,翟德春,潘秀丹,等.医科大学生抑郁和焦虑情绪调查.中国校医,2006,20(6):599-600.
[38]翟德春,潘秀丹,韩素玲,牟均,周旭松.医学生抑郁、焦虑症状的流行学特征及相关因素分析.中国学校卫生,2006,27(3):217-219.
[39] Vontver L, Irby D, Rakestraw P, et al. The effects of two methods of pelvicexamination instruction on student performance and anxiety. J Med Educ,1980,55(9):778–785.
[40] Knight RG, Waal-Manning HJ, Spears GF. Some norms and reliability data for theState–Trait Anxiety Inventory and the Zung Self-Rating Depression scale. Br J ClinPsychology,1983,22(Pt4):245–249.
[41] Mehanna Z, Richa S. Prevalence of anxiety and depressive disorders in medicalstudents. Transversal study in medical students in the Saint-Joseph University of Beirut.Encephale,2006,32(6Pt1):976-982.
[42] Inam SN, Saqib A, Alam E. Prevalence of anxiety and depression among medicalstudents of private university. J Pak Med Assoc,2003,53(2):44-47.
[43] Jadoon NA, Yaqoob R, Raza A, Shehzad MA, Zeshan SC. Anxiety and depressionamong medical students: a cross-sectional study. J Pak Med Assoc,2010,60(8):699-702.
[44] Lloyd C, Gartrell NK. Psychiatric symptoms in medical students. ComprPsychiatry,1984,25(6):552–565.
[45] Hojat M, Glaser K, Xu G, Veloski JJ, Christian EB. Gender comparisons ofmedical students’ psychosocial profiles. Med Educ,1999,33(5):342–349.
[46] Vitaliano PP, Maiuro RD, Russo J, et al. Medical student distress: a longitudinalstudy. J Nerv Ment Dis,1989,177(2):70–76.
[47]李迎春,胡传来,陶兴永,等.医学生焦虑、抑郁与个性特征的关系研究.中国学校卫生,2005,26(2):107-108.
[48]余跃生,高丽,何萍.不同行为类型医学生焦虑、抑郁情绪及其影响因素研究.黔南民族医专学报,2004,17(4):229-231.
[49] Jiang N, Sato T, Hara T,et al. Correlations between trait anxiety, personality andfatigue: study based on the Temperament and Character Inventory. J Psychosom Res,2003,55(6):493-500.
[50] Bunevicius A, Katkute A, Bunevicius R. Symptoms of anxiety and depression inmedical students and in humanities students: relationship with big-five personalitydimensions and vulnerability to stress. Int J Soc Psychiatry,2008,54(6):494-501.
[51] Moos RH, Moos BS. Family Environment Scale: Manual. Palo Alto, CA:Consulting Psychologists Press,1981.
[52] Sen S, Kranzler HR, Krystal JH, et al. A prospective cohort study investigatingfactors associated with depression during medical internship. Arch Gen Psychiatry,2010,67(6):557-565.
[53]王艳芳,杨翠华,潘集阳.广州地区某重点高校医学生焦虑状况的调查.中国健康心理学杂志,2006,14(2):220-221.
[54]王锋生,孙业桓,钮娟娟,蔡标,龚磊,孙丽娜.家庭环境因素对医科大学生焦虑影响的研究.中华流行病学杂志2010,31(4):475-476.
[55]王基鸿,林潇萍,王小丹.医学生心理健康和家庭环境的相关分析.临床医学工程,2011,18(3):461-462.
[56] Slotkin J, Forehand R, Fauber R, McCombs A, Long N. Parent-completed andadolescent-completed CDIs: relationship to adolescent social and cognitive functioning.J Abnorm Child Psychol,1988,16(2):207-217.
[57] Jacobsen RH, Lahey BB, Strauss CC. Correlates of depressed mood in normalchildren. J Abnorm Child Psychol,1983,11(1):29-39.
[58] Calvo MG, Carreiras M. Selective influence of test anxiety on reading processes.Br J Psychol,1993,84(Pt3):375-388.
[59]阳德华.师生、同伴关系与初中生焦虑的探讨.中国心理卫生杂志,2001,15(2):78-80.
[60]阳德华.初中生抑郁情绪与学校因素的相关性研究.中国临床心理学杂志,2002,10(1):33-35.
[61]左川,曾静,黄慧,邱红渝,王一平,易智慧.医学生心理健康状况及影响因素分析.现代预防医学,2008,35(6):1118-1120.
[62] Rabkin JG, Struening EL. Live events, stress, and illness. Science,1976,194(4269):1013-1020.
[63] Vadher A, Ndetei DM. Life events and depression in a Kenyan setting. Br JPsychiatry,1981,139:134-137.
[64] Khan MS, Mahmood S, Badshah A,et al. Prevalence of depression, anxiety andtheir associated factors among medical students in Karachi, Pakistan. J Pak Med Assoc,2006,56(12):583-586.
[65] Aktekin M, Karaman T, Senol YY, Erdem S, Erengin H, Akaydin M. Anxiety,depression and stressful life events among medical students: a prospective study inAntalya, Turkey. Med Educ,2001,35(1):12-17.
[66] Rab F, Mamdou R, Nasir S. Rates of depression and anxiety among female medicalstudents in Pakistan. East Mediterr Health J,2008,14(1):126-133.
[67]李松英,温迺.医学院学生焦虑、抑郁、孤独及相关因素探讨.浙江预防医学,2006,18(8):13-15.
[68] Holmes TH, Rahe RH. The Social Readjustment Rating Scale. J Psychosom Res,1967,11(2):213-218.
[69]肖水源.《社会支持评定量表》的理论基础与研究应用.临床精神医学杂志,1994,4(2):98-100.
[70] Cohen S, Hoberman HM. Positive events and social support as buffers of lifechange stress. J Appl Soc Psychol,1983,13:99-125.
[71] Moak ZB, Agrawal A. The association between perceived interpersonal socialsupport and physical and mental health: Results from the National EpidemiologicalSurvey on Alcohol and Related Conditions. J Public Health (Oxf),2010,32(2):191-201.
[72] Jeong Y, Kim JY, Ryu JS, Lee KE, Ha EH, Park H. The associations betweensocial support, health-related behaviors, socioeconomic status and depression in medicalstudents. Epidemiol Health.2010,32:e2010009.
[73] Ball S, Bax A. Self-care in medical education: effectiveness of health-habitsinterventions for first-year medical students. Acad Med,2002,77:911–917.
[74]檀立,程淑英,王淑娟,陈桂芝,金英爱.SARS期间医学生心理健康状况与社会支持相关性研究.华北煤炭医学院学报,2005,7(2):144-145.
[75] Bronfenbrenner U. The ecology of human development. Cambridge, MA: HarvardUniversity Press,1979.
[76]许敏兰,张洪波,许娟,等.安徽省有焦虑症状大学生的社会人口特征及社会心理分析.中国心理卫生杂志,2006,20(8):510-512.
[77]王君,张洪波,王莉娜,等.安徽省大学生抑郁症状与人格特征和家庭环境的关系.中国学校卫生,2009,30(1):32-33.
[78]汪向东，王希林，马弘.心理卫生评定量表手册（增订版）.北京：中国心理卫生杂志社出版发行，1999:251-253.
[79] Beck AT, Steer RA. Beck Anxiety Inventory Manual. San Antonio, TX: ThePsychological Corporation Harcourt Brace Jovanovich, Inc.,1990.
[80]郑健荣,黄炽荣,黄洁晶,等.贝克焦虑量表的心理测量学特性、常模分数及因子结构的研究.中国临床心理学杂志,2002,10(1):4-6.
[81]汪向东，王希林，马弘.心理卫生评定量表手册（增订版）.北京：中国心理卫生杂志社出版发行，1999:191-194.
[82] Beck A, Steer R, Garbin M. Psychometric properties of the Beck DepressionInventory: Twenty-five years of evaluation. Clin Psychol Rev,1988,8(1):77-100.
[83] Shek DT. Reliability and factorial structure of the Chinese version of the BeckDepression Inventory. J Clin Psychol,1990,46(1):35-43.
[84] Zheng YP, Lin KM. Comparison of the Chinese Depression Inventory andtheChinese version of the Beck Depression Inventory. Acta Psychiatr Scand,1991,84(6):531-536.
[85] Zheng YP, Wei LA, Goa LG, Zhang GC, Wong CG. Applicability of the ChineseBeck Depression Inventory. Compr Psychiatry,1988,29(5):484-489.
[86] Smilkstein G. The family APGAR: A proposal for a family function test and its useby physicians. J Fam Pract,1978,6:1231-1239.
[87] Smilkstein G, Ashworth C, Montano D. Validity and reliability of the familyAPGAR as a test of family function. J Fam Pract,1982,15:303-311.
[88]吕繁,曾光,刘松暖,钟天伦,詹志强.家庭关怀度指数问卷测量脑血管病病人家庭功能的信度和效度研究.中国公共卫生,1999,15(11):987-988.
[89]李献云，费立鹏，及惠郁，等.乡村严重自杀未遂者的特征.中国神经精神疾病杂志，2005,31(4):272-277.
[90]汪向东，王希林，马弘.心理卫生评定量表手册（增订版）.北京：中国心理卫生杂志社出版发行，1999:127-131.
[91] Roh MS, Jeon HJ, Kim H, Han SK, Hahm BJ. The prevalence and impact ofdepression among medical students: a nationwide cross-sectional study in South Korea.Acad Med,2010,85(8):1384-1390.
[92]张雷，雷劈，郭伯良.多层线性模型应用.北京:教育科学出版社.2003.
[93]刘红云，张雷.追踪数据分析方法及其应用.北京:教育科学出版社.2005.
[94] Derogatis LR, Rickels K, Rock AF. The SCL-90and the MMPI: a step in thevalidation of a new self-report scale. Br J Psychiatry,1976,128:280–289.
[95] Zung WW. A rating instrument for anxiety disorders. Psychosomatics,1971,12(6):371-379.
[96] Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol,1959,32(1):50-55.
[97] Zung WW, Richards CB, Short MJ. Self-rating depression scale in an outpatientclinic: further validation of the SDS. Arch Gen Psychiatry,1965,13(6):508–515.
[98] Radloff LS. The CES-D Scale: a self report depressive scale for research in thegeneral population. Appl Psychol Meas,1977,1:385-401.
[99] Weissman MM, Sholomskas D, Pottenger M, Prusoff BA, Locke BZ. Assessingdepressive symptoms in five psychiatric populations: a validation study. Am JEpidemiol,1977,106(3):203-214.
[100] Schulberg HC, Saul M, McClelland M, Ganguli M, ChristyW, Frank R. Assessingdepression in primary medical and psychiatric practices. Arch Gen Psychiatry,1985,42(12):1164–1170.
[101] Li Z, Hicks MH. The CES-D in Chinese American women: construct validity,diagnostic validity for major depression, and cultural response bias. Psychiatry Res,2010,175(3):227-232.
[102] Hamilton M. Development of a rating scale for primary depressive illness. Br JSoc Clin Psychol,1967,6(4):278-296.
[103]边水玲,牛亚兰,郭建,等.医科大学生中焦虑流行状况的调查.中国健康心理学杂志,2007,15(9):795-796.
[104]冀伟.308名医学生心理健康水平调查.中国健康心理学杂志.2007，15(8):734-735.
[105]王梦龙,黄旭,黄娟,等.中山大学医学生个性特征与抑郁关系研究.中国学校卫生,2003,24(5):458-459.
[106]尚玉秀,严淑珍,朱凤萍.医学生自杀意念与抑郁的现况调查及影响因素分析.现代预防医学,2009,36(16):3092-3094.
[107]周榕,杨翠华,潘集阳.广州地区重点医科大学生抑郁状况及相关因素调查分析.神经疾病与精神卫生,2003,3(5):367-368.
[108]王黎恩,王极盛.医科大学生的生活事件与焦虑.中国临床康复,2006,10(6):20-23.
[109]孙萍.高职大专学生焦虑状况调查与思考.现代医药卫生,2005,21(24):3384-3385.
[110]张泽武,吴赤蓬,刘国宁,范存欣,王惠苏.广州市医科大学生抑郁状况及影响因素分析.中国学校卫生,2006,27(1):51-52.
[111] Dyrbye LN, Thomas MR, Shanafelt TD. Systematic review of depression, anxiety,and other indicators of psychological distress among U.S. and Canadian medicalstudents. Acad Med,2006,81(4):354-373.
[112]陈祎平.关于海南大学专业调整与建设的思考.海南大学学报社会科学版,1999,17(3):17-21,33.
[113]杨爱莲,王铁英,马慧琴.高等护理专业学生心理状况调查及分析.天津医科大学学报,2000,6(2):158-159.
[114]吴敏,时松和,杨翠萍.父母文化程度、职业、期望值及教育方式等因素对大学生心理健康水平的影响.郑州大学学报·医学版,2007,42(6):1184-1187.
[115]姚齐和,赵传昌.独生子女与非独生子女心理健康状况比较研究.健康心理学杂志,1998,6(4):427-429.
[116]叶玉清,张劲松.家庭结构缺陷对青少年心理成长的影响.中国青年研究,2006(7):74-77.
[117] Franks P, Campbell TL, Shields CG. Social relationships and health: the relativeroles of family functioning and social support. Soc Sci Med,1992,34(7):779-788.
[118]杨德森，主编.基础精神医学.长沙:湖南科学技术出版社，1994,193-260.
[119]卢晓红，李凌江，李昌琦，等.应激对中枢神经系统即刻早期基因表达及轴的调节作用研究.中国心理卫生杂志，2000,14(1):10-13.
[120]王卫华,卢祖洵.生命质量研究的现状与趋势.医学与社会,2005,18(7):8-10.
[121]张云.大学生生活质量、应对方式及其关系的研究.安徽师范大学硕士学位论文,2006.
[122]张国忠,毛宗福,毕勇毅.大学生生活质量问题试探.当代青年研究,2001,(4):33-34.
[123]张国忠,毛宗福,毕勇毅,郭毅. l134名医科大学生生活质量状况研究.中国学校卫生,2003,24(3):248-249.
[124] Klemenc-Ketis Z, Kersnik J, Eder K, Colaric D. Factors associated withhealth-related quality of life among university students. Srp Arh Celok Lek,2011,139(3-4):197-202.
[125] Liang KY, Zeger SL. Longitudinal data analysis using generalized linear models.Biometrika,1986,73(l):13-22.
[126] Zeger SL, Liang KY. Longitudinal data analysis for discrete and continuousoutcomes. Biometrics,1986,42(1):121-130.
[127]盖笑松,张向葵.多层线性模型在纵向研究中的运用.心理科学,2005,28(2):429-431.
[128]刘红云,孟庆茂.教育和心理研究中的多层线性模型.心理科学进展,2002,10(2):213-219.
[1] Saslow G. Psychiatric problems of medical students. J Medl Educ,1956,31(1):27-33.
[2] Adewuya AO, Ola BA, Aloba OO, Mapayi BM, Oginni OO. Depression amongstNigerian university students. Prevalence and sociodemographic correlates. SocPsychiatry Psychiatr Epidemiol,2006,41(8):674-678.
[3] Chan DW. Depressive symptoms and depressed mood among Chinese medicalstudents in Hong Kong. Compr Psychiatry,1991,32(2):170-180.
[4] Guthrie EA, Black D, Shaw CM, Hamilton J, Creed FH, Tomenson B. Embarkingupon a medical career: psychological morbidity in first year medical students. MedEduc,1995,29(5):337-341.
[5] Miller PM, Surtees PG. Psychological symptoms and their course in first-yearmedical students as assessed by the Interval General Health Questionnaire (I-GHQ). BrJ Psychiatry,1991,159:199-207.
[6] Dahlin M, Joneborg N, Runeson B. Stress and depression among medical students: across-sectional study. Med Educ,2005,39(6):594-604.
[7] Jeong Y, Kim JY, Ryu JS, Lee KE, Ha EH, Park H. The associations between socialsupport, health-related behaviors, socioeconomic status and depression in medicalstudents. Epidemiol Health.2010,32:e2010009.
[8]肖圣龙.医学生心理咨询问题分析.中国健康心理学杂志,2007,15(2):122-123.
[9] Gomez EA, Gomez GE, Otto DA. Anxiety as a human emotion: some basicconceptual models. Nurs Forum,1984,21(1):38-42.
[10]魏义梅.大学生抑郁的心理社会机制及认知应对干预.吉林大学博士学位论文,2007.
[11] Holden C. Mental health. Global survey examines impact of depression. Science,2000,288(5463):39-40.
[12]费立鹏.中国的精神卫生问题—21世纪的挑战和选择.中国神经精神疾病杂志,2004,30(l):l-10.
[13] Peplau HE. Interpersonal Theory in Nursing Practice: Selected Works of HildegardE. Peplau. Springer Publishing Company,1989:270-326.
[14] Beck CK, Rawlins RP, Willams SR. Mental health-psychiatric nursing: A holisticlife-cycle approach (2nd ed.). St. Louis: The CV Mosbey,1988:33.
[15]朴松花,李春玉.焦虑的概念分析.吉林医学,2007,28(2):181-182.
[16] Angold A. Rutter M. Effects of age and pubertal status on depression in a largeclinical sample. Dev Psychopathol,1992,4:5-28.
[17]冯正直.中学生抑郁症状的社会信息加工方式研究.西南师范大学博士学位论文,2002.
[18] Derogatis LR, Rickels K, Rock AF. The SCL-90and the MMPI: a step in thevalidation of a new self-report scale. Br J Psychiatry,1976,128:280–289.
[19] Zung WW. A rating instrument for anxiety disorders. Psychosomatics,1971,12(6):371-379.
[20] Beck AT, Steer RA. Beck Anxiety Inventory Manual. San Antonio: ThePsychological Corporation Harcourt Brace Jovanovich, Inc,1990.
[21] Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol,1959,32(1):50-55.
[22] Knight RG, Waal-Manning HJ, Spears GF. Some norms and reliability data for theState–Trait Anxiety Inventory and the Zung Self-Rating Depression scale. Br J ClinPsychology,1983,22(Pt4):245–249.
[23] Zung WW, Richards CB, Short MJ. Self-rating depression scale in an outpatientclinic: further validation of the SDS. Arch Gen Psychiatry,1965,13(6):508–515.
[24] Beck A, Steer R, Garbin M. Psychometric properties of the Beck DepressionInventory: twenty-five years of evaluation. Clin Psychol Rev,1988,8:77–100.
[25] Radloff LS. The CES-D Scale: a self report depressive scale for research in thegeneral population. Appl Psychol Meas,1977,1:385-401.
[26] Thomas JL, Jones GN, Scarinci IC, Mehan DJ, Brantley PJ. The utility of theCES-D as a depression screening measure among low-income women attendingprimary care clinics. The Center for Epidemiologic Studies-Depression. Int J PsychiatryMed,2001,31(1):25-40.
[27] Schulberg HC, Saul M, McClelland M, Ganguli M, Christy W, Frank R. Assessingdepression in primary medical and psychiatric practices. Arch Gen Psychiatry,1985,42(12):1164–1170.
[28] Li Z, Hicks MH. The CES-D in Chinese American women: construct validity,diagnostic validity for major depression, and cultural response bias. Psychiatry Res,2010,175(3):227-232.
[29] Hamilton M. Development of a rating scale for primary depressive illness. Br J SocClin Psychol,1967,6(4):278-296.
[30]汪向东,王希林,马弘.心理卫生评定量表手册(增订版).北京:中国心理卫生杂志社,1999.
[31]张作记.行为医学量表手册.中国行为医学科学编辑部,2001.
[32]冀伟.308名医学生心理健康水平调查.中国健康心理学杂志.2007,15(8):734-735.
[33]边永玲,牛亚兰,郭建,等.医科大学生中焦虑流行状况的调查.中国健康心理学杂志,2007,15(9):795-796.
[34]王黎恩,王极盛.医科大学生的生活事件与焦虑.中国临床康复,2006,10(6):20-23.
[35]孙萍.高职大专学生焦虑状况调查与思考.现代医药卫生,2005,21(24):3384-3385.
[36]许敏兰,张洪波,许娟,等.安徽省有焦虑症状大学生的社会人口特征及社会心理分析.中国心理卫生杂志,2006,20(8):510-512.
[37]丁树荣,石晶,徐宏斌,等.医学生焦虑状况及影响因素调查研究.临床荟萃,2007,22(19):1404-1405.
[38]金喆,翟德春,潘秀丹,等.医科大学生抑郁和焦虑情绪调查.中国校医,2006,20(6):599-600.
[39] Vontver L, Irby D, Rakestraw P, et al. The effects of two methods of pelvicexamination instruction on student performance and anxiety. J Med Educ,1980,55(9):778–785.
[40] Knight RG, Waal-Manning HJ, Spears GF. Some norms and reliability data for theState–Trait Anxiety Inventory and the Zung Self-Rating Depression scale. Br J ClinPsychology,1983,22(Pt4):245–249.
[41] Mehanna Z, Richa S. Prevalence of anxiety and depressive disorders in medicalstudents. Transversal study in medical students in the Saint-Joseph University of Beirut.Encephale,2006,32(6Pt1):976-982.
[42] Inam SN, Saqib A, Alam E. Prevalence of anxiety and depression among medicalstudents of private university. J Pak Med Assoc,2003,53(2):44-47.
[43] Lloyd C, Gartrell NK. Psychiatric symptoms in medical students. ComprPsychiatry,1984,25(6):552-565.
[44] Hojat M, Glaser K, Xu G, et al. Gender comparisons of medical students’psychosocial profiles. Med Educ,1999,33(5):342–349.
[45] Vitaliano PP, Maiuro RD, Russo J, et al. Medical student distress: a longitudinalstudy. J Nerv Ment Dis,1989,177(2):70–76.
[46] Achenbach TM. The derivation of taxonomic constructs: A necessary stage in thedevelopment of developmental psychology. In: Cicchetti D, Toth SL, editors. RochesterSymposium on Developmental Psychopathology, Vol.3: Models and Integrations.Rochester, NY: University of Rochester Press;1991.
[47] Dyrbye LN, Thomas MR, Shanafelt TD. Systematic review of depression, anxiety,and other indicators of psychological distress among U.S. and Canadian medicalstudents. Acad Med,2006,81(4):354-373.
[48] Barrett J, Hurst MW, DiScala C, Rose RM. Prevalence of depression over a12-month period in a nonpatient population. Arch Gen Psychiatry,1978,35(6):741-744.
[49] Sherry S, Notman MT, Nadelson CC, Kanter F, Salt P. Anxiety, depression, andmenstrual symptoms among freshman medical students. J Clin Psychiatry,1988,49(12):490-493.
[50] Buchman BP, Sallis JF, Criqui MH, Dimsdale JE, Kaplan RM. Physical activity,physical fitness, and psychological characteristics of medical students. J Psychosom Res,1991,35(2-3):197-208.
[51] Weissman MM, Sholomskas D, Pottenger M, Prusoff BA, Locke BZ. Assessingdepressive symptoms in five psychiatric populations: a validation study. Am JEpidemiol,1977,106(3):203-214.
[52] Lloyd C, Miller PM. The relationship of parental style to depression andself-esteem in adulthood. J Nerv Ment Dis,1997,185(11):655-663.
[53] Hendryx MS, Haviland MG, Shaw DG. Dimensions of alexithymia and theirrelationships to anxiety and depression. J Pers Assess,1991,56(2):227-237.
[54] Vitaliano PP, Maiuro RD, Russo J, Mitchell ES, Carr JE, Van Citters RL. Abiopsychosocial model of medical student distress. J Behav Med,1988,11(4):311-331.
[55] Ball S, Bax A. Self-care in medical education: effectiveness of health-habitsinterventions for first-year medical students. Acad Med,2002,77(9):911–917.
[56] Clark DC, Zeldow PB. Vicissitudes of depressed mood during four years ofmedical school. JAMA,1988,260(17):2521-2528
[57] Rosal MC, Ockene IS, Ockene JK, Barrett SV, Ma Y, Hebert JR. A longitudinalstudy of students’ depression at one medical school. Acad Med,1997,72(6):542-546.
[58] Zoccolillo M, Murphy GE, Wetzel RD. Depression among medical students. JAffect Disord,1986,11(1):91-96.
[59] Richman JA, Flaherty JA. Gender differences in medical student distress:contributions of prior socialization and current role-related stress. Soc Sci Med,1990,30(7):777-787.
[60] Pyskoty CE, Richman JA, Flaherty JA. Psychosocial assets and mental health ofminority medical students. Acad Med,1990,65(9):581-585.
[61] Whitehouse WG, Dinges DF, Orne EC, et al. Psychosocial and immune effects ofself-hypnosis training for stress management throughout the first semester of medicalschool. Psychosom Med,1996,58(3):249-263.
[62] Lloyd C, Gartrell NK. Sex differences in medical student mental health. Am JPsychiatry,1981,138(10):1346-1351.
[63] Jadoon NA, Yaqoob R, Raza A, Shehzad MA, Zeshan SC. Anxiety and depressionamong medical students: a cross-sectional study. J Pak Med Assoc,2010,60(8):699-702.
[64] Roh MS, Jeon HJ, Kim H, Han SK, Hahm BJ. The prevalence and impact ofdepression among medical students: a nationwide cross-sectional study in South Korea.Acad Med,2010,85(8):1384-1390.
[65]尚玉秀,严淑珍,朱凤萍.医学生自杀意念与抑郁的现况调查及影响因素分析.现代预防医学,2009,36(16):3092-3094.
[66]周榕,杨翠华,潘集阳.广州地区重点医科大学生抑郁状况及相关因素调查分析.神经疾病与精神卫生,2003,3(5):367-368.
[67]张泽武,吴赤蓬,刘国宁,范存欣,王惠苏.广州市医科大学生抑郁状况及影响因素分析.中国学校卫生,2006,27(1):51-52.
[68]王梦龙,黄旭,黄娟,等.中山大学医学生个性特征与抑郁关系研究.中国学校卫生,2003,24(5):458-459.
[69]魏俊彪.医学生焦虑和抑郁及相关因素研究.新乡医学院学报,2006,23(6):550-552.
[70]翟德春,潘秀丹,韩素玲,牟均,周旭松.医学生抑郁、焦虑症状的流行学特征及相关因素分析.中国学校卫生,2006,27(3):217-219.
[71]李迎春,胡传来,陶兴永,等.医学生焦虑、抑郁与个性特征的关系研究.中国学校卫生,2005,26(2):107-108.
[72]余跃生,高丽,何萍.不同行为类型医学生焦虑、抑郁情绪及其影响因素研究.黔南民族医专学报,2004,17(4):229-231.
[73] Jiang N, Sato T, Hara T,et al. Correlations between trait anxiety, personality andfatigue: study based on the Temperament and Character Inventory. J Psychosom Res,2003,55(6):493-500.
[74] Bunevicius A, Katkute A, Bunevicius R. Symptoms of anxiety and depression inmedical students and in humanities students: relationship with big-five personalitydimensions and vulnerability to stress. Int J Soc Psychiatry,2008,54(6):494-501.
[75] Moos RH, Moos BS. Family Environment Scale: Manual. Palo Alto, CA:Consulting Psychologists Press,1981.
[76] Sen S, Kranzler HR, Krystal JH, et al. A prospective cohort study investigatingfactors associated with depression during medical internship. Arch Gen Psychiatry,2010,67(6):557-565.
[77]王艳芳,杨翠华,潘集阳.广州地区某重点高校医学生焦虑状况的调查.中国健康心理学杂志,2006,14(2):220-221.
[78]王锋生,孙业桓,钮娟娟,蔡标,龚磊,孙丽娜.家庭环境因素对医科大学生焦虑影响的研究.中华流行病学杂志2010,(4):475-476.
[79]王基鸿,林潇萍,王小丹.医学生心理健康和家庭环境的相关分析.临床医学工程,2011,18(3):461-462.
[80] Slotkin J, Forehand R, Fauber R, McCombs A, Long N. Parent-completed andadolescent-completed CDIs: relationship to adolescent social and cognitive functioning.J Abnorm Child Psychol,1988,16(2):207-217.
[81] Jacobsen RH, Lahey BB, Strauss CC. Correlates of depressed mood in normalchildren. J Abnorm Child Psychol,1983,11(1):29-39.
[82] Calvo MG, Carreiras M. Selective influence of test anxiety on reading processes.Br J Psychol,1993,84(Pt3):375-388.
[83]阳德华.师生、同伴关系与初中生焦虑的探讨.中国心理卫生杂志,2001,15(2):78-80.
[84]阳德华.初中生抑郁情绪与学校因素的相关性研究.中国临床心理学杂志,2002,10(1):33-35.
[85]左川,曾静,黄慧,邱红渝,王一平,易智慧.医学生心理健康状况及影响因素分析.现代预防医学,2008,35(6):1118-1120.
[86] Rabkin JG, Struening EL. Live events, stress, and illness. Science,1976,194(4269):1013-1020.
[87] Vadher A, Ndetei DM. Life events and depression in a Kenyan setting. Br JPsychiatry,1981,139:134-137.
[88] Khan MS, Mahmood S, Badshah A,et al. Prevalence of depression, anxiety andtheir associated factors among medical students in Karachi, Pakistan. J Pak Med Assoc,2006,56(12):583-586.
[89] Aktekin M, Karaman T, Senol YY, Erdem S, Erengin H, Akaydin M. Anxiety,depression and stressful life events among medical students: a prospective study inAntalya, Turkey. Med Educ,2001,35(1):12-17.
[90] Rab F, Mamdou R, Nasir S. Rates of depression and anxiety among female medicalstudents in Pakistan. East Mediterr Health J,2008,14(1):126-133.
[91]李松英,温迺.医学院学生焦虑、抑郁、孤独及相关因素探讨.浙江预防医学,2006,18(8):13-15.
[92] Holmes TH, Rahe RH. The Social Readjustment Rating Scale. J Psychosom Res,1967,11(2):213-218.
[93]肖水源.《社会支持评定量表》的理论基础与研究应用.临床精神医学杂志,1994,4(2):98-100.
[94] Cohen S, Hoberman HM. Positive events and social support as buffers of lifechange stress. J Appl Soc Psychol,1983,13:99-125.
[95] Moak ZB, Agrawal A. The association between perceived interpersonal socialsupport and physical and mental health: Results from the National EpidemiologicalSurvey on Alcohol and Related Conditions. J Public Health (Oxf),2010,32(2):191-201.
[96]檀立,程淑英,王淑娟,陈桂芝,金英爱.SARS期间医学生心理健康状况与社会支持相关性研究.华北煤炭医学院学报,2005,7(2):144-145.
[97] Zuardi AW, Prota FD, Del-Ben CM. Reduction of the anxiety of medical studentsafter curricular reform. Rev Bras Psiquiatr.2008,30(2):136-138.
[98] Finkelstein C, Brownstein A, Scott C,et al. Anxiety and stress reduction in medicaleducation: an intervention. Med Educ,2007,41(3):258-264.
[99] Velayudhan A, Gayatridevi S, Bhattacharjee RR. Efficacy of behavioralintervention in reducing anxiety and depression among medical students. Ind PsychiatryJ,2010,19(1):41-46.
[100]吴汉荣,卢珊,蒙衡.《健康心理学》课程对医科大学生心理健康的影响.医学与社会,2007,20(1):38-40.
[101]张殿君,赫英娟,耿艳萌.应用团体生涯辅导技术对医学生心理素质的干预性调查研究.牡丹江医学院学报,2007,28(4):74-76.
[102] Rosenzweig S, Reibel DK, Greeson JM, et al.Mindfulness-based stress reductionlowers psychological distress in medical students. Teach Learn Med,2003,15(2):88–92.
[103] Warnecke E, Quinn S, Ogden K, Towle N, Nelson MR. A randomised controlledtrial of the effects of mindfulness practice on medical student stress levels. Med Educ,2011,45(4):381-388. doi:10.1111/j.1365-2923.2010.03877.x.
[104] Lee J, Graham AV. Students' perception of medical school stress and theirevaluation of a wellness elective. Med Educ,2001,35(7):652–659.
[105] Simard AA, Henry M. Impact of a short yoga intervention on medical students'health: a pilot study. Med Teach,2009,31(10):950-952.