目的:探讨中国人群从青春期到成年早期,自我控制与抑郁症状和超重或肥胖并存的关系,并为今后针对不同风险个体的个性化干预提供科学依据。
方法:来自持续10年的前瞻性队列研究:中国家庭小组研究(CFPS),共纳入608名符合以下纳入和排除标准的儿童和青少年作为研究对象:(1)10至19岁,根据中国标准,在正常体重下,2010年无抑郁症状;(2)有自我控制评分,并在2010年至2020年之间对抑郁症状和体重指数(BMI)进行至少两次测量;(3)每个家庭中唯一或最小的儿童和青少年。抑郁症状与超重或肥胖的共同发生以三种方式定义:随着时间的推移,多个测量结果的抑郁症状标准化评分和BMIZ评分的平均水平均处于较高水平,或基于属于“风险类型”的潜在分类轨迹模型(LCTM)的抑郁症状和BMI随时间的轨迹,或个体在最后一次随访调查中出现抑郁症状和超重/肥胖.使用多项Logistic回归模型来检查自我控制的标准化得分与抑郁症状和超重或肥胖的同时发生之间的关联。
结果:在调整年龄(岁)后,使用健康个体作为参照组时,自我控制得分与抑郁症状和超重或肥胖的同时发生有关,性别(男/女),地区(城市/农村),每周体力活动持续时间(高/低),父母教育水平(大专或以上学历/高中或以下),父母体重状况(超重或肥胖或不肥胖),和父母的抑郁症状(是否有抑郁症状),无论风险人群的定义如何。具体来说,抑郁症状和超重或肥胖同时发生的风险降低了33%(95CI:14%至48%,基于一段时间内多次测量的平均水平)到78%(95CI:6%到95%,基于抑郁症状和BMI随时间的联合轨迹),每1个标准差(1-SD)增加自我控制评分。此外,抑郁症状为主和超重或肥胖为主的风险降低了25%(95CI:4%至42%,仅基于一段时间内多次测量的平均水平)和21%(95CI:1%至37%,仅基于抑郁症状和BMI随时间的联合轨迹)自我控制评分每增加1-SD,分别。根据世界卫生组织(WHO)标准定义个体体重状态的敏感性分析结果与我们的主要发现一致。
结论:从青春期到成年早期,自我控制评分较高的个体出现抑郁症状和超重或肥胖的风险较低,这表明,未来可以根据自我控制评分对抑郁症状和超重或肥胖的同时发生进行个性化干预。
OBJECTIVE: To explore the association between self-control and the co-occurrence of depressive symptoms and overweight or obesity from adolescence to early adulthood in the Chinese population, and to provide a scientific basis for personalized interventions targeting individuals with different risks in the future.
METHODS: From a prospective cohort study that lasted for 10 years: The
China family panel studies (CFPS), a total of 608 children and adolescents meeting the following inclusion and exclusion criteria were included as study subjects: (1) Aged 10 to 19 years, at normal weight according to Chinese standards, and without depressive symptom in 2010; (2) Had self-control scores, and with at least two measurements of depressive symptoms and body mass index (BMI) between 2010 and 2020; (3) The only one or the youngest child and adolescent from each family. The co-occurrence of depressive symptoms and overweight or obesity was defined in three ways: Both of the average level of standardized scores of depressive symptoms and BMI Z-scores across multiple measurements over time were at a high level, or both of the trajectories of depressive symptoms and BMI over time based on the latent classification trajectory model (LCTM) belonging to the \"risk-type\", or individuals had depressive symptoms and overweight/obesity at the last follow-up survey. The multinomial Logistic regression model was used to examine the association between standardized scores of self-control and the co-occurrence of depressive symptoms and overweight or obesity.
RESULTS: The score of self-control was associated with the co-occurrence of depressive symptoms and overweight or obesity when using healthy individuals as the reference group after adjusting for age (years), gender (male/female), area (urban/rural), weekly physical activity duration (high/low), parental education level (college or above/high school or below), parental weight status (overweight or obese or not), and parental depressive symptoms (with depressive symptoms or not), regardless of the definition of the risk population. Specifically, the risk of co-occurrence of depressive symptoms and overweight or obesity was reduced by 33% (95%CI: 14% to 48%, based on the average level across multiple measurements over time) to 78% (95%CI: 6% to 95%, based on the joint trajectories of depressive symptoms and BMI over time) per 1-standard deviation (1-SD) increase in self-control score. In addition, the risk of depressive-symptom-dominant and overweight-or-obesity-dominant was reduced by 25% (95%CI: 4% to 42%, only based on the average level across multiple measurements over time) and 21% (95%CI: 1% to 37%, only based on the joint trajectories of depressive symptoms and BMI over time) per 1-SD increase in self-control score, respectively. The results from sensitivity analysis that defined individuals\' weight status according to World Health Organization (WHO) standards were consistent with our main findings.
CONCLUSIONS: Individuals with higher self-control scores from adolescence to early adulthood have a lower risk of co-occurrence of depressive symptoms and overweight or obesity, suggesting that personalized interventions for co-occurrence of depressive symptoms and overweight or obesity can be carried out based on self-control scores in the future.