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Abstract：
BACKGROUND: Few studies have simultaneously focused on the associations of vegetable and fruit intake, physical activity, school bullying, and Internet addiction (IA) with depressive symptoms. This study aimed to explore the direct and indirect effects of the above factors on depressive symptoms in adolescents by constructing a structural equation model (SEM).
METHODS: This study was conducted in Qingdao from September to November 2021. A total of 6195 secondary school students aged 10-19 years were included in the analysis. Information on all variables was assessed using a self-administered questionnaire. An SEM was constructed with depressive symptoms as the endogenous latent variable, IA as the mediating variable, and vegetable and fruit intake, physical activity, and school bullying as the exogenous latent variables. The standardized path coefficients (β) were the direct effects between the latent variables, and the indirect effects were obtained by the product of direct effects between relevant latent variables.
RESULTS: The median value with the interquartile range of depressive symptom scores was 7 (3,12). Vegetable and fruit intake (β=-0.100, P<0.001) and physical activity (β=-0.140, P<0.001) were directly negatively related to depressive symptoms. While school bullying (β=0.138, P<0.001) and IA (β=0.452, P<0.001) were directly positively related to depressive symptoms. IA had the greatest impact on depressive symptoms. Vegetable and fruit intake, physical activity, and school bullying could not only directly affect depressive symptoms, but also indirectly affect depressive symptoms through the mediating effect of IA, the indirect effects and 95% confidence intervals (CIs) were -0.028 (-0.051, -0.007), -0.114 (-0.148, -0.089) and 0.095 (0.060, 0.157), respectively. The results of the multi-group analysis showed that the SEM we constructed still fit in boy and girl groups.
CONCLUSIONS: The results indicated that vegetable and fruit intake, physical activity, school bullying, and IA had a significant direct impact on depressive symptoms, among which IA had the greatest impact. In addition, both vegetable and fruit intake, school bullying, and physical activity indirectly affected depressive symptoms through the mediating effect of IA. The impact of IA on depressive symptoms should be given extra attention by schools and parents. This study provides a scientific and effective basis for the prevention and control of adolescent depressive symptoms.
METHODS: This study was conducted in Qingdao from September to November 2021. A total of 6195 secondary school students aged 10-19 years were included in the analysis. Information on all variables was assessed using a self-administered questionnaire. An SEM was constructed with depressive symptoms as the endogenous latent variable, IA as the mediating variable, and vegetable and fruit intake, physical activity, and school bullying as the exogenous latent variables. The standardized path coefficients (β) were the direct effects between the latent variables, and the indirect effects were obtained by the product of direct effects between relevant latent variables.
RESULTS: The median value with the interquartile range of depressive symptom scores was 7 (3,12). Vegetable and fruit intake (β=-0.100, P<0.001) and physical activity (β=-0.140, P<0.001) were directly negatively related to depressive symptoms. While school bullying (β=0.138, P<0.001) and IA (β=0.452, P<0.001) were directly positively related to depressive symptoms. IA had the greatest impact on depressive symptoms. Vegetable and fruit intake, physical activity, and school bullying could not only directly affect depressive symptoms, but also indirectly affect depressive symptoms through the mediating effect of IA, the indirect effects and 95% confidence intervals (CIs) were -0.028 (-0.051, -0.007), -0.114 (-0.148, -0.089) and 0.095 (0.060, 0.157), respectively. The results of the multi-group analysis showed that the SEM we constructed still fit in boy and girl groups.
CONCLUSIONS: The results indicated that vegetable and fruit intake, physical activity, school bullying, and IA had a significant direct impact on depressive symptoms, among which IA had the greatest impact. In addition, both vegetable and fruit intake, school bullying, and physical activity indirectly affected depressive symptoms through the mediating effect of IA. The impact of IA on depressive symptoms should be given extra attention by schools and parents. This study provides a scientific and effective basis for the prevention and control of adolescent depressive symptoms.
摘要：
背景：很少有研究同时关注蔬菜和水果的摄入，身体活动,校园欺凌,以及伴有抑郁症状的网络成瘾(IA)。本研究通过构建结构方程模型(SEM),探讨上述因素对青少年抑郁症状的直接和间接影响。
方法：本研究于2021年9月至11月在青岛进行。共有6195名10-19岁的中学生被纳入分析。有关所有变量的信息均使用自我管理问卷进行评估。以抑郁症状作为内源性潜在变量，构建了SEM，IA作为中介变量，蔬菜和水果的摄入量，身体活动,和学校欺凌作为外生潜在变量。标准化路径系数(β)是潜在变量之间的直接影响，间接效应是由相关潜在变量之间的直接效应的乘积获得的。
结果：抑郁症状评分四分位数范围的中位数为7（3,12）。蔬菜和水果摄入量（β=-0.100，P<0.001）和体力活动（β=-0.140，P<0.001）与抑郁症状直接负相关。学校欺凌(β=0.138,P<0.001)和IA(β=0.452,P<0.001)与抑郁症状直接相关。IA对抑郁症状的影响最大。蔬菜和水果的摄入量，身体活动,校园欺凌不仅会直接影响抑郁症状，但也通过IA的中介作用间接影响抑郁症状，间接效应和95%置信区间(CI)为-0.028(-0.051，-0.007)，-0.114（-0.148，-0.089）和0.095（0.060，0.157），分别。多组分析结果表明，我们构建的SEM仍然适合男孩和女孩组。
结论：结果表明，蔬菜和水果的摄入量，身体活动,校园欺凌,IA对抑郁症状有显著的直接影响，其中IA影响最大。此外,蔬菜和水果的摄入量，校园欺凌,体力活动通过IA的中介作用间接影响抑郁症状。IA对抑郁症状的影响应引起学校和家长的特别关注。本研究为青少年抑郁症状的防治提供了科学有效的依据。
方法：本研究于2021年9月至11月在青岛进行。共有6195名10-19岁的中学生被纳入分析。有关所有变量的信息均使用自我管理问卷进行评估。以抑郁症状作为内源性潜在变量，构建了SEM，IA作为中介变量，蔬菜和水果的摄入量，身体活动,和学校欺凌作为外生潜在变量。标准化路径系数(β)是潜在变量之间的直接影响，间接效应是由相关潜在变量之间的直接效应的乘积获得的。
结果：抑郁症状评分四分位数范围的中位数为7（3,12）。蔬菜和水果摄入量（β=-0.100，P<0.001）和体力活动（β=-0.140，P<0.001）与抑郁症状直接负相关。学校欺凌(β=0.138,P<0.001)和IA(β=0.452,P<0.001)与抑郁症状直接相关。IA对抑郁症状的影响最大。蔬菜和水果的摄入量，身体活动,校园欺凌不仅会直接影响抑郁症状，但也通过IA的中介作用间接影响抑郁症状，间接效应和95%置信区间(CI)为-0.028(-0.051，-0.007)，-0.114（-0.148，-0.089）和0.095（0.060，0.157），分别。多组分析结果表明，我们构建的SEM仍然适合男孩和女孩组。
结论：结果表明，蔬菜和水果的摄入量，身体活动,校园欺凌,IA对抑郁症状有显著的直接影响，其中IA影响最大。此外,蔬菜和水果的摄入量，校园欺凌,体力活动通过IA的中介作用间接影响抑郁症状。IA对抑郁症状的影响应引起学校和家长的特别关注。本研究为青少年抑郁症状的防治提供了科学有效的依据。
