Latent Class Analysis On The Emotional And Behavioral Problems And Related Cumulative Risk Among "3+2" Vocational High School Nursing Students

ObjectiveThis study aimed to analyze the sub-types of the emotional and behavioral problems using latent class analysis,and test its relationship with the cumulative risk among nursing students in a "3+2" vocational high school.MethodsThis is a cross-sectional survey study.A questionnaire survey was conducted among "3+2" vocational high school nursing students in Shandong Province in April 2018.Survey questionnaires included the General Data Questionnaire,the Chinese Versions of Depression Anxiety and Stress Scale(DASS-21),12-item Aggression Questionnaire(12-AQ),Adolescent Self-Rating Life Events Checklist(ASLEC),Adolescent Social Support Scale and Childhood Trauma Questionnaire-28 item Short Form(CTQ-SF).Latent class analysis was conducted to explore the latent classes of emotional and behavioral problems among the participants.Chi-square test and analysis of variance were used to analyze the differences among different classes.The relationship between risk factors,including their cumulative effect,and different latent classes were also tested.Results(1)Depressive symptoms were found in 24.7%,anxiety symptoms were found in 53.0%and stress symptoms were found in 18.5%"3+2" vocational high school nursing students.The depression level of female students was significantly lower than that of male students.(2)The total score of aggression was(22.26±8.08),and there was no significant gender difference.The order of mean scores was:verbal aggression>anger>hostility>physical aggression.The anger level of female students was significantly higher than that of male students.(3)The latent class analysis indicated that emotional and behavioral problems could be classified into three classes:"Behavioral problem"(Category 1),"Emotional problem"(Category 2),and "Good emotion and behaviors"(Category 3).(4)There was a significant distinction among different classes.Compared to"Good emotion and behaviors",the percentages of male students,students in grade four and students whose father has a college degree were higher in "Emotional problem";The percentages of female students,students in grade three and students who smoke or drink alcohol were higher in "Behavioral problem".(5)According to the cumulative risk index,the order of the latent classes was:"Behavioral problem"(6.23±2.49)>"Emotional problem"(5.34±2.42)>"Good emotion and behaviors"(4.21±2.67).Male students had higher cumulative risk index than female students.(6)The participants in the"Low risk group","Medium risk group" and "High risk group" were more likely to be assigned to "Behavioral problem"(OR values were 2.17,4.10 and 7.87 respectively).Compared to the "Single risk group",participants in"Medium risk group" and "High risk group" were more likely to be assigned to the"Emotional problem"(OR values were 3.96 and 5.63 respectively).Among female students,the participants in the "Low risk group","Medium risk group" and "High risk group" were more likely to be assigned to "Behavioral problem"(OR values were 2.85,4.53 and 10.44 respectively).Participants in "Medium risk group" and "High risk group" were more likely to be assigned to "Emotional problem"(OR values were 4.52 and 8.34 respectively).However,in male students,the relationship between latent classes and cumulative risk was not statistically significant.Conclusions:(1)Negative emotion and aggression are relatively prevalent among "3+2"vocational high school nursing students.Anxiety and verbal aggression need more attention.(2)The emotional and behavioral problems of "3+2" vocational high school nursing students have obvious classification characteristics.A model containing 3 latent categories is established.They are named "Behavioral problem","Emotional problem" and "Good emotion and behaviors".(3)Female students,students in grade three and students who smoke or drink have more behavioral problems.Male students,students in grade four and students whose father has a college degree have more emotional problems.(4)Higher cumulative risk level was related with more emotional and behavioral problems.This relationship exists among girls but not boys.