本文選題：不確定心理壓力 + 自我傷害行為�。� 參考：《浙江大學(xué)》2015年博士論文

【摘要】：研究背景 近幾十年,自我傷害這一現(xiàn)象引起了國(guó)內(nèi)外學(xué)者的廣泛關(guān)注。2002年世界衛(wèi)生組織的報(bào)告指出自我傷害是全球15-44歲人群的第4位死亡原因和第6位疾病和殘疾原因,已經(jīng)成為一個(gè)嚴(yán)重的社會(huì)和公共衛(wèi)生問(wèn)題。青少年和年輕成人的自我傷害現(xiàn)象非常普遍,是自傷研究的重點(diǎn)對(duì)象。中國(guó)大學(xué)生自傷發(fā)生率高達(dá)11-34%。自傷不僅給大學(xué)生帶來(lái)生理上的痛苦,還會(huì)影響其情緒功能、人際關(guān)系及工作學(xué)業(yè)表現(xiàn),甚至還會(huì)增加自殺風(fēng)險(xiǎn),危及生命。作為剛進(jìn)入高校到即將畢業(yè)走向社會(huì)的大學(xué)生,恰處在成年初期階段,他們面臨著人生重要的轉(zhuǎn)型期,因周圍環(huán)境發(fā)生巨大變化和自身心智還未完全成熟,可能會(huì)給他們帶來(lái)不適應(yīng)感,從而產(chǎn)生一系列的心理壓力問(wèn)題。國(guó)內(nèi)外研究表明,當(dāng)人們無(wú)法有效地面對(duì)壓力時(shí),就可能會(huì)導(dǎo)致自我傷害行為的發(fā)生。不確定性是重要的心理壓力來(lái)源之一,但學(xué)術(shù)界目前對(duì)于不確定心理壓力,以及不確定心理壓力對(duì)自我傷害的影響這一領(lǐng)域缺乏系統(tǒng)的研究。 研究目的 本研究重點(diǎn)在于了解國(guó)內(nèi)醫(yī)學(xué)生的自我傷害現(xiàn)狀及其心理、社會(huì)影響因素的情況。為了更好地了解不確定心理壓力對(duì)醫(yī)學(xué)生自傷行為的的影響,本研究從心理壓力理論和社會(huì)資本理論視角出發(fā),基于已有文獻(xiàn)整理的基礎(chǔ)上,構(gòu)建自傷相關(guān)的不確定心理壓力-社會(huì)資本模型,并對(duì)模型進(jìn)行檢驗(yàn)和修正,進(jìn)而為公共衛(wèi)生政策制定者和教育工作者提供科學(xué)的研究證據(jù),改進(jìn)以人群為基礎(chǔ)的傷害控制與預(yù)防項(xiàng)目的設(shè)計(jì)、實(shí)施以及評(píng)價(jià),最終促進(jìn)大學(xué)生的心理健康。 研究方法 本研究是一次大樣本量的橫斷面調(diào)查,主要采用多階段分層隨機(jī)抽樣方法來(lái)采集數(shù)據(jù)。按照地理分布和經(jīng)濟(jì)水平等因素最終選擇14個(gè)省份的22所高校作為調(diào)查點(diǎn)。調(diào)查對(duì)象為臨床、護(hù)理或公衛(wèi)等醫(yī)學(xué)相關(guān)專業(yè)的大學(xué)本科生,樣本量為4446人。本研究采用自編的自傷測(cè)量問(wèn)卷評(píng)估被試者在過(guò)去一年中故意自我傷害的情況；采用由浙江大學(xué)楊廷忠教授編制的《社會(huì)壓力刺激事件量表》修改而來(lái)的心理壓力測(cè)量問(wèn)卷來(lái)評(píng)估被試者對(duì)不同類型壓力源的壓力感知情況；采用楊廷忠教授等人編制的《社會(huì)資本測(cè)量問(wèn)卷》評(píng)估醫(yī)學(xué)生的社會(huì)資本情況。運(yùn)用SPSS18.0. SAS9.3以及Amos17.0等軟件對(duì)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析。應(yīng)用克隆巴哈系數(shù)和探索性因子分析方法檢驗(yàn)心理壓力量表和社會(huì)資本量表的信效度。采用單因素卡方檢驗(yàn)、多元Logistic回歸方法分析自傷的影響因素。運(yùn)用結(jié)構(gòu)方程模型,驗(yàn)證自傷的不確定心理壓力-社會(huì)資本模型。 研究結(jié)果 本研究結(jié)果主要包括以下幾點(diǎn)內(nèi)容： 1)在過(guò)去一年內(nèi)醫(yī)學(xué)生故意自我傷害行為總檢出率為9.56%,男生自傷率(11.51%)高于女生(8.71%),且有統(tǒng)計(jì)學(xué)差異(χ2=8.48,P0.01)。最常用的自傷方式為“刮傷”、“割傷”、“捏掐傷”。年齡(χ2=26.63,P0.01)、年級(jí)(χ2=30.24,P0.01)、專業(yè)(χ2=28.13,P0.01)、家庭年人均收入(χ2=11.10,P0.05)與自傷存在統(tǒng)計(jì)學(xué)差異。民族、父母親職業(yè)、家庭所在地、學(xué)生月消費(fèi)水平與自傷不相關(guān)。年齡低的學(xué)生自傷發(fā)生率高,大學(xué)一年級(jí)的學(xué)生自傷率最高,護(hù)理學(xué)專業(yè)學(xué)生的自傷發(fā)生率高于公共衛(wèi)生和臨床醫(yī)學(xué)專業(yè)的學(xué)生,家庭人均年收入在4萬(wàn)以上的學(xué)生自傷率較低。 2)自傷的多元Logistic回歸全模型結(jié)果顯示,不確定心理壓力(OR=1.734,P0.01)、社會(huì)網(wǎng)絡(luò)(OR=1.352,P0.01)、認(rèn)知社會(huì)資本(OR=1.902,P0.01)、社會(huì)參與(OR=1.328,P0.01)對(duì)自傷行為有統(tǒng)計(jì)學(xué)意義；學(xué)習(xí)、家庭、人際關(guān)系壓力在該模型中對(duì)自傷沒(méi)有顯著性差異。不確定心理壓力越大,社會(huì)資本越少,越容易發(fā)生自傷行為。 3)結(jié)構(gòu)方程模型分析結(jié)果顯示,不確定心理壓力對(duì)自傷的標(biāo)化路徑系數(shù)為0.068；認(rèn)知社會(huì)資本對(duì)自傷行為的直接標(biāo)化系數(shù)為-0.121,間接標(biāo)化路徑系數(shù)為-0.051,兩者合計(jì)為-0.172；社會(huì)網(wǎng)絡(luò)對(duì)自傷行為的直接標(biāo)化系數(shù)為-0.059,間接標(biāo)化路徑系數(shù)為-0.007,兩者合計(jì)為-0.066；社會(huì)參與對(duì)自傷行為的間接標(biāo)化路徑系數(shù)為0.017。 研究結(jié)論 本研究構(gòu)建并驗(yàn)證了自我傷害的不確定心理壓力-社會(huì)資本理論模型,證實(shí)心理壓力對(duì)醫(yī)學(xué)生自我傷害有影響,尤其是不確定心理壓力,較學(xué)習(xí)、家庭、人際關(guān)系壓力對(duì)自傷的作用更為顯著,是自傷特異的預(yù)測(cè)因素之一。同時(shí)本研究還發(fā)現(xiàn)社會(huì)資本對(duì)醫(yī)學(xué)生自我傷害存在直接和間接的作用。社會(huì)資本在不確定心理壓力與自我傷害的關(guān)系中發(fā)揮中介調(diào)節(jié)作用,其中認(rèn)知社會(huì)資本、社會(huì)網(wǎng)絡(luò)通過(guò)影響不確定心理壓力間接作用于自我傷害行為,且認(rèn)知社會(huì)資本對(duì)自傷的影響最為突出。此外,年齡/年級(jí)、性別、專業(yè)、家庭年收入均對(duì)醫(yī)學(xué)生自傷有影響。本研究開(kāi)拓了不確定心理壓力的研究領(lǐng)域,為相關(guān)政策制定者和后續(xù)醫(yī)學(xué)生自傷干預(yù)項(xiàng)目的設(shè)計(jì)、實(shí)施和評(píng)價(jià)提供了前期的理論基礎(chǔ)和科學(xué)的實(shí)證依據(jù)。
[Abstract]:Research background
The phenomenon of self injury in recent decades has caused widespread concern at home and abroad by scholars at home and abroad for.2002, the WHO report pointed out that self injury is the fourth cause of death and sixth causes of disease and disability in the world's 15-44 year old population, and has become a serious social and public health problem. Adolescent and young adults' self injury. The prevalence of injury is very common, and it is the focus of self injury research. The incidence of self injury in Chinese college students is up to 11-34%. self injury, which not only brings physical pain to college students, but also affects their emotional function, interpersonal relationship and work performance, even increase the risk of suicide and endanger life. College students are in the early stage of adulthood. They are facing an important transition period of life. Because of the great changes in the environment and their lack of full maturity, they may bring them a sense of inadaptability and produce a series of psychological stress problems. It can lead to the occurrence of self injurious behavior. Uncertainty is one of the important sources of psychological stress, but there is a lack of systematic research in the academic field on the uncertainty of psychological stress and the effect of uncertainty on the impact of psychological stress on self injury.
research objective
The focus of this study is to understand the status of self injury of medical students and their psychological and social factors. In order to better understand the influence of psychological stress on the self injury behavior of medical students, this study is based on the theory of psychological pressure and social capital theory, based on the existing literature, and constructs a self injury phase. The indeterminate psychological pressure - the social capital model and the model are tested and amended to provide scientific research evidence for public health policy makers and educators to improve the design, implementation and evaluation of the crowd based injury control and prevention projects, and ultimately to promote the mental health of college students.
research method
This study is a cross-sectional survey with large sample size, mainly using multi stage stratified random sampling to collect data. According to the geographical distribution and economic level, the final selection of 22 colleges and universities in 14 provinces is selected as the investigation point. The subjects of the survey are clinical, nursing or public health and other medical related undergraduates, with a sample size of 4446 People. In this study, self-made self injury questionnaire was used to evaluate the subjects' intentional self injury during the past year. The psychological stress survey questionnaire, which was compiled by Professor Yang Tingzhong of Zhejiang University, was used to evaluate the stress perception of different types of stressors. The social capital survey of medical students was evaluated by the "social capital survey questionnaire" compiled by Professor Yang Tingzhong and others. The data were analyzed by SPSS18.0. SAS9.3 and Amos17.0 software. The reliability and validity of the psychological pressure scale and social capital scale were tested by using the clone Baja coefficient and exploratory factor analysis method. The multivariate Logistic regression method was used to analyze the influencing factors of self injury. The structural equation model was used to verify the uncertain psychological pressure social capital model of self injury.
Research results
The results of this study mainly include the following points:
1) the total detection rate of intentional self injury behavior of medical students in the past year was 9.56%, and the rate of self injury for boys (11.51%) was higher than that of girls (8.71%), and there were statistical differences (x 2=8.48, P0.01). The most commonly used ways of self injury were "scratch", "cut", "pinch and pinch". Age (chi 2=26.63, P0.01), grade (chi square, P0.01), specialty (chi 2=28.13, P0.01), home The annual per capita income (chi 2=11.10, P0.05) and self injury were statistically different. Ethnic, parental occupation, home location, and students' monthly consumption level were not related to self injury. The incidence of self injury was high in students with low age, the highest rate of self injury in the freshmen and the incidence of self injury in nursing students was higher than that of public health and clinical medicine. Students with a per capita annual income of more than 40 thousand have low self injury rate.
2) the results of the multiple Logistic regression model of self injury showed that the uncertainty of psychological stress (OR=1.734, P0.01), social network (OR=1.352, P0.01), cognitive social capital (OR=1.902, P0.01), social participation (OR=1.328, P0.01) had statistical significance for self injury behavior, and there was no significant difference between learning, family and interpersonal stress on self injury in the model. The greater the uncertainty psychological pressure and the less social capital, the more likely to be self injurious behavior.
3) the result of structural equation model analysis shows that the normalized path coefficient of self injury is 0.068, the direct scaling coefficient of cognitive social capital to self injury behavior is -0.121, the indirect scaling path coefficient is -0.051, and the combination of the two is -0.172; the direct scaling coefficient of the social network for self injury is -0.059 and the indirect standardization path. The coefficient is -0.007, the total is -0.066; the indirect normalized path coefficient of social participation on self injury is 0.017.
research conclusion
This study constructs and validates the uncertain psychological stress of self injury - social capital theory model, which confirms that psychological stress has an impact on the self injury of medical students, especially the uncertainty of psychological stress. The effect of learning, family and interpersonal stress on self injury is more significant, and is one of the predictors of self injury. Social capital has a direct and indirect effect on the self injury of medical students. Social capital plays an intermediary role in the relationship between the uncertainty of psychological stress and self injury, in which social capital is cognitively affected by the influence of uncertain psychological pressure on the behavior of self injury and the influence of social capital on self injury. In addition, age / grade, gender, specialty and family income all affect the self injury of medical students. This research opens up the research field of uncertain psychological pressure, and provides the theoretical basis and scientific evidence for the design, implementation and evaluation of the relevant policy makers and follow-up medical students' self injury intervention projects.

【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2015
【分類號(hào)】：G444

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