| ObjectiveBy conducting the survey of the adolescent mental health status,family socioeconomic status(SES)and social relationships,mental health status and mental health equity of adolescents in different dimensions of SES were analyzed.And on this basis,the contribution of various influencing factors to mental health equity was further analyzed.Furthermore this study explored whether social relationships of family and school contexts could mediate the influence of SES on adolescents’ mental health.The study not only provided the reference basis for improving the mental health level of adolescents and reducing their mental health inequity,but also provided the theoretical basis for making relevant prevention strategies and intervening measures.MethodsA school-based cross-sectional study was performed among 13-18 adolescents enrolled in East China from September,2018 to May,2019,which recruited 6902 students from junior and senior high schools and used the stratified random sampling method.In this study,investigators who had received unified professional training and passed the examination conducted a questionnaire survey on the respondents.The questionnaire included general demographic characteristics,measures of family SES(subjective socioeconomic status,parents’ educational and occupational),measures of mental health(Symptom Check List-90,SCL-90),and measures of social relationships(parent-child relationship,peer relationship,student-teacher relationship).Data entry was performed using EpiData 3.0 software.Descriptive statistical analysis and statistical inference were performed using SPSS 23.0 statistical software.The evaluation of adolescent mental health equity and the analysis of the contribution of various influencing factors using the concentration index and the Wagstaff nonlinear decomposition method,using the SAS 10.0、STATA 15.1 statistical software package.By analyzing the structural equation model,this paper expounded the effect of socioeconomic status on adolescent mental health through parent-child relationship,peer relationship,student-teacher relationship,and analyzed the use of Amos 24.0 statistical software.Results1.The general situation of adolescent mental health.Among the 6902 adolescents in East China,the average score of the Global Severity Index(GSI)of the SCL-90 scale was 1.74±0.69,and the GSI of 1926 adolescents was≥2,accounting for 27.9%.The detection rates from mild to severe were 21.6%,5.4%and 0.9%,respectively.Among different dimensions of mental health problems in this scale,the detection rate of obsessive-compulsive was the highest,which was 44.3%.The mental health status of adolescents with different demographic characteristics was different.The detection rates of GSI,somatization,hostility,depression,anxiety and phobic anxiety in girls were higher than those in boys.High school students,rural students and adolescents who are not raised by their parents had higher detection rate of GSI and each dimension of mental health symptoms than junior high school students,urban students and adolescents raised by their parents.And the detection rates of GSI,interpersonal sensitivity,anxiety,hostility,phobic anxiety and psychoticism of the only child were higher than those of the non-only child.In addition,compared with the mental health status data of 2390 male and 2546 female students aged 13-18 years in Hangzhou,Suzhou and Hefei in 2000,it was found that the score of GSI and various dimensions and the detection rate of severity of mental health problems of boys and girls in 2019 were significantly higher than that of boys and girls in 2000(p<0.001).2.Characteristics of mental health problems among adolescents with different socioeconomic status.There were statistical differences in the detection rate of mental health problems in all dimensions among different SES groups(p<0.05),and the detection rate among adolescents in low SES group was higher than others.There was a negative correlation between different dimensions of SES and the GSI of mental health problems and the nine dimensions(r ranged from-0.04 to-0.12,all p<0.001).After controlling for demographic characteristics and other SES indicators,the results of further analysis by different genders showed that the mental health problem detection rate of boys:in the middle subjective socioeconomic status group was 0.80 times than that in the low group;in the middle mother’s education group was 0.63 times than that in the low group;in the in the middle and higherlow father’s occupational group was 0.37 times and 0.42 times than that in the low group;in the high mother’s occupational group was 0.62 times than that in the low group.For girls:in the middle subjective socioeconomic status group was 0.58 times than that in the low group;in the middle and high mother’s education group was 0.48 times and 0.39 times than that in the low group;in the high father’s occupational group was 0.50 times that in the low group;in the middle mother’s occupational group was 0.66 times that in the low group.3.The social relationship environment of adolescents with various socioeconomic status.There were statistical differences in the scores of parent-child relationship,peer relationship,and student-teacher relationship among adolescents with different SES(p<0.05).The results showed that the five indicators of SES had a weak positive correlation with the different dimensions of parent-child relationship,peer relationship and student-teacher relationship(r value ranged from 0.04 to 0.19,all p<0.001),except the mother’s education level was not correlated with the conflict of parent-child relationship.After controlling for demographic characteristics and other indicators of SES,the results showed that for boys:the parent-child relationship increased along with the increase of family subjective socioeconomic status(B=0.28)and father’s occupational status(B=0.77);the peer relationship was significantly positively correlated with the subjective socioeconomic status(B=2.70),the father’s education level(B=1.90),the mother’s education level(B=1.34),and the father’s occupational status(B=2.03);the student-teacher relationship increased along with the increase of the subjective socioeconomic status(B=1.80),the education level of the mother(B=1.71)and the occupational status of the father(B=0.96).The results of girls showed that the parent-child relationship increased along with the increase of father’s education level(B=0.95);the peer relationship was significantly positively correlated with the subjective socioeconomic status(B=2.19),the father’s education level(B=2.16),the mother’s education level(B=2.49),and the father’s occupational status(B=2.06);the student-teacher relationship increased along with the increase of the father’s educational level(B=1.96),mother’s educational level(B=1.27)and father’s occupational status(B=1.23).4.The relationship between social relationship environment and adolescent mental health problems.The score of mental health problems in each dimension and GSI was negatively correlated with parent-child relationship(r value ranged from-0.07 to-0.25,all p<0.001),peer relationship(r value ranged from-0.12 to-0.23,all p<0.001),and student-teacher relationship(r value ranged from-0.13 to-0.29,all p<0.001).After controlling for demographic characteristics and other social relationships indicators,the results showed that the detection rate of mental health problems in boys decreased with their better parent-child intimacy and emotional expression,and less parent-child conflict and student-teacher conflict.Meanwhile,the detection rate of mental health problems of girls decreased with their better parent-child intimacy,interpersonal concordance of peer relationship,intimacy and support of teacher-student relationship,and less parent-child conflict and student-teacher conflict.5.Equity and influencing factors of adolescent mental health.The concentration index of each dimension and GSI of adolescent mental health problems was negative,ranging from-0.02 to-0.07.Compared with other dimensions of mental health problems,interpersonal relationship was more inequitable.Furthermore,combined with the concentration curve,it can be seen that the detection rate of GSI and each dimension of adolescent mental health problems were above the fairness line.The decomposition of GSI concentration index showed that the influencing factors included in the model could account for 98.80%and 96.96%of the mental health inequality of boys and girls respectively.The contribution rates of demographic characteristics,social relationship environment and socioeconomic status in boys were 29.95%,40.31%and 28.54%,respectively.Among girls,they were 5.50%,45.86%and 45.61%,respectively.In addition,a single index showed that mother’s occupational status,mother’s education level,subjective socioeconomic status,parent-child relationship,peer relationship,student-teacher relationship increased the degree of mental health inequality of male adolescents.And mother’s education level,mother’s occupational status,father’s occupational status,subjective socioeconomic status,parent-child relationship,peer relationship,student-teacher relationship increased the degree of mental health inequality of female adolescents.Among them,mother’s occupational status and mother’s education level was the main factor affecting the mental health inequality of boys and girls,contributing 46.632%and 34.285%respectively.6.The influence path of socioeconomic status on adolescent mental healthIn this study,the influence directions of different paths in the model were the same for both male and female adolescents.After controlling for age,SES was significantly correlated with parent-child relationship(Bboy=0.63,Bgirl=1.08,all p<0.001),peer relationship(Bboy=1.71,Bgirt=2.36,all p<0.001),student-teacher relationship(Bboy=1.98,Bgirl=3.06,all p<0.001)and mental health problems(Bboy=-0.09,Bgirl=-0.13,all p<0.01).The scores of parent-child relationship(Bboy=-0.04,Bgirl=-0.07,all p<0.001),peer relationship(Bboy=-0.01,Bgirl=-0.01,all p<0.001)and student-teacher relationship(Bboy=-0.03,Bgirl=-0.02,all p<0.001)were negatively correlated with mental health problems.And the student-teacher relationship also had a positive effect on the peer relationship(Bboy=0.63,Bgirl=0.53,all p<0.001).In addition,the standardized indirect effects of parent-child relationship,peer relationship,student-teacher relationship in boys were-0.027[95%CI=(-0.064,-0.008)],-0.022[95%CI=(-0.046,-0.005)]and-0.053[95%CI=(-0.098,-0.026)],and in girls were-0.081[95%CI=(-0.177,-0.004)],-0.035[95%CI=(-0.075,-0.004)]and-0.065[95%CI=(-0.128,-0.014)]respectively.It was worth noting that SES could also influence the outcome indicator first via the student-teacher relationship and then via the peer relationship,with a standardized indirect effect of-0.016[95%CI=(-0.034,-0.003)]and-0.024[95%CI=(-0.049,-0.003)]for boys and girls,respectively.The direct effect sizes of SES on mental health of boys and girls were-0.090[95%CI=(-0.174,-0.007)]and-0.132[95%CI=(-0.283,0.010)].Conclusion1.The mental health of adolescents was not satisfying.They have high rates of mental health problems.Obsessive-compulsive was the most common symptom factor in adolescents.And girls showed more mental health problems than boys.In addition,compared with adolescents of the same age in the same area 20 years ago,mental health problems have increased significantly for both boys and girls.2.Socioeconomic status,social relationship environment and adolescent mental health were closely related.Low socioeconomic status may have a negative impact on the parent-child relationship,peer relationship,student-teacher relationship,and mental health of adolescents.And positive parent-child relationship,student-teacher relationship and peer relationship had positive influence on the development of adolescent’s mental health.3.There was a certain degree of inequity in the mental health of adolescents.Adolescents with different socioeconomic status showed different characteristics of mental health problems.Mental health problems were mainly in adolescents with low socioeconomic status,which means there is mental health inequality in groups with high socioeconomic status.Social relationship environment and socioeconomic status have important influence on mental health equity of adolescents.4.Socioeconomic status can influence the mental health of adolescents through social relationship environment.Parent-child relationship,peer relationship and student-teacher relationship play a mediating role in the effect of socioeconomic status on adolescent mental health.5.In view of the mental health problems of adolescents,we should pay attention to the mental health of adolescents from families with low socioeconomic status.At the same time,we should endeavor to improve their social relationship environment,so as to comprehensively and effectively improve the equity of mental health of adolescents. |
PDF Full Text Request