Association Of Health Literacy,Sleep Problems And Depressive Symptoms Of Middle School Students In Shenyang Boarding School

Objective: To investigate the actual status of health literacy,sleep problems and depressive symptoms in middle school students,and to explore the correlation of health literacy,sleep problems with depressive symptoms,and to provide guidance for promotion on mental health in middle school students.Methods: A convenient cluster sampling method was used to collect data from the Chinese Adolescent Interactive Health Literacy Questionnaire,Pittsburgh Sleep Quality Index Scale and Self-Rating Depression Scale.815 questionnaires were distributed and rejected from the questionnaires.In addition to incomplete answers,incorrect answers,missing answers,irregular answers and other invalid questionnaires,775 valid questionnaires,the effective recovery rate was 95.1%.Two-independent samples t test and Chi-square analysis of variance were used to compare the differences of health literacy,sleep disorders and depressive symptoms among different groups of middle school students.Multivariate logistic regression analysis was performed to examine the correlation of health literacy,sleep disorders with depressive symptoms.Results: The total rate of depressive symptoms in middle school students was20.9%(351/775).The rates of depressive symptoms with bad self-reported academic record heavy learning burden,low family economy,low health literacy and having sleep problems had a higher prevalence of depressive symptoms than the corresponding other students(?2 = 13.66,18.29,10.20,64.02,68.78,P < 0.01).The total rate of sleep problems was 18.3%(142/775).The prevalence of sleep problems among middle school students with heavy learning burden,low family economy and low health literacy had a higher prevalence of sleep problems than that of the corresponding group(?2 = 8.878,6.71,14.17;P < 0.05).The total scores of health literacy were 106.49(±19.87).Students who were only-child,good self-reported academic record and high family economy had significantly higher health literacy scores than the corresponding other students(t = 2.13,F=4.94,7.83;P < 0.05).In the dimension of physical activity,students who were male,middle school and high family economy had a higher scores than the corresponding other students(t = 2.13,F =4.94,7.83;P < 0.05).In the dimension of interpersonal relationship,students who were female and high family economy had a higher scores than the corresponding other students(t=2.26,F=9.81,P < 0.05).In the dimension of stress management,students who were general learning burden and high family economy had a higher scores than the corresponding other students(F= 4.60,7.19;P <0.05).In the dimension of spiritual growth,students who were only children,good self-reported academic record and high family economy had a higher scores than the corresponding other students(t = 2.45,F= 9.34,4.20;P < 0.05).In the dimension of health awareness,students who were good self-reported academic record had a higher scores than the corresponding other students(F = 4.90,P < 0.05).In the dimension of nutrition,students who were only child,good self-reported academic record and high family economy had a higher scores than the corresponding other students(t = 2.79,F=3.75,3.71;P < 0.05).Multivariate logistic regression models were established with health literacy and sleep quality as independent variables,while depressive symptoms as dependent variable.The results showed that medium,low health literacy and sleep problems were positively correlated with depressive symptoms [OR(95%CI)=4.31(2.57-7.22),4.83(3.20-7.29)] in middle school students.The interaction effects of HL and sleep quality with depressive symptoms,and the crude and adjusted OR(95%CI),were presented for each group in comparison with the reference group(no sleep problems and high HL)for depressive symptoms,respectively.In particular,the students with low HL and sleep problems had the highest risks of depressive symptoms(OR =12.67,95%CI: 5.90-27.20).Further,these associations were also seen in the adjusted models.Conclusion: These results suggest that Chinese middle school students with low HL and sleep problems are intending to exhibit depressive symptoms.The intervention programs of mental health and behavior problems should enhance HL levels and attenuate the severity of sleep problems.