Abstract: Objective To investigate the mediating role of sleep quality on the association between specific forms of adverse childhood experiences(ACEs) and depressive symptoms as well as the difference by gender of the mediated pathways among junior middle school students,in order to provide basis for mental health promotion. Methods A total of 1 086 participants were selected from a boarding school in Shenyang using a stratified cluster sampling method from December 2017 to January 2018.Independent sample t-test and χ² test were used to analyze the difference of demographic characteristics between boys and girls.Pearson correlation was used to analyze the association among ACEs,sleep quality score and depression symptoms score.Bootstrap program and PROCESS software were applied to test the mediating effect of sleep quality in the relationship between ACEs and depression symptoms. Results ACEs were positively correlated with sleep quality and depression symptom scores (r=0.194,0.378,P<0.01).The sleep quality score was also positively related to depression symptom score (r=0.361,P<0.01).In adjusted model,the mediating effects of sleep quality among ACEs,abuse,neglect and mediation effects were 14.58%,21.66% and 11.60%,respectively.Sleep quality played a complete mediating role in the association between family dysfunction and depression symptoms,with a mediating effect of 59.79%.The mediating effect of sleep quality was greater in girls than that in boys. Conclusions Sleep quality has a mediating effect on the relationship between ACEs and depression symptoms.Enhancing sleep quality in middle school students,especially girls,may contribute to the prevention and control of depressive symptoms for those who have experienced ACEs.

Key words: adverse childhood experiences, sleep quality, depression symptoms, mediation effect

摘要： 目的 探讨睡眠质量在不同类型童年期不良经历(ACEs)与中学生抑郁症状关联中的中介效应及性别差异,为中学生心理健康的促进提供参考。方法 采用分层整群抽样的方法,于2017年12月-2018年1月选取沈阳市某寄宿制中学1 086名在校生为研究对象,采用独立样本t检验和χ²检验比较不同性别一般人口学特征差异,使用Pearson相关分析ACEs、睡眠质量和抑郁症状评分的关联性,自举(Bootstrap)程序和PROCESS软件检验睡眠质量的中介效应。结果 ACEs与睡眠质量和抑郁症状得分呈正相关(r=0.194、0.378,P<0.01),睡眠质量得分和抑郁症状得分呈正相关(r=0.361,P<0.01)。总样本中,调整混杂因素后,睡眠质量在ACEs、虐待和忽视与抑郁症状关联中起部分中介作用,中介效应分别为14.58%、21.66%、11.60%;睡眠质量在家庭功能不全与抑郁症状关联中起完全中介作用,中介效应为59.79%。女生中睡眠质量在ACEs及其各维度(虐待、忽视、家庭功能不全)与抑郁症状关联中的中介效应均高于男生。 结论 睡眠质量在ACEs与中学生抑郁症状关联中起中介作用,提高中学生尤其是女生的睡眠质量,有助于ACEs经历者抑郁症状的防控。

关键词: 童年期不良经历, 睡眠质量, 抑郁症状, 中介效应