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STRESS, TRAM CAM, LOAU VA CHAT LUONG CUOC SONG LIEN QUAN DEN SQC KHOE CUA HOC SINH TRUNG HOC PHO THONG Nguyin Thj Thanh Mai Vu Thi/dng Huy^n Bg man Nhi, Trudng Dgi hgc Y Hd Ndi I TOM TAT Vi thdnh nien la giai doan phdt trien cd nhiiu thay ddi vi ca thi vd tdm ly, do nhiing rdi loan siic khde tdm thdn nhu trdm cdm, lo du vd stress a giai doan ndy can dugc quan tdm Mue tieu eiia nghien ciru la ddnh gid stress, trdm cdm, lo du vd chdt luang cupc sdng lien quan den sire khde, su hdi long vd mdt lien quan giira cdc linh vuc ndy ciia hgc sinh THPT Nghien ciru md td cat ngang duac tien hdnh trin 100 hgc sinh trung hge thdng thupe Trudng Hermann Gmeiner Hd Ngi ndm 2018 Cong cu nghien cuu dugc su dung la thang Trdm cdm, Ig du, stress (DASS-21), thang Ddnh gid chdt lugng cupc sdng tdng qudt a ire em 4.0 vd thang Su hdi long tong qudt Kit qud chi rdng, ty le hgc sinh nghien cuu cua chiing tdi cd bieu Men trim cdm, lo du vd stress Idn luat Id 54%, 52% vd 45% Theo tre tu trd lai, tdng 3iem chdt lugng cupc sdng lien quan den sire khde la 72,97 ± 11,57 Cd mdi tuang quan chat che giUa trdm cdm, lo du, stress vd chdt lugng cupc song cUng nhu mire dg hdi idng ting qudt Nghien ciru ciia chung tdi cho thdy, cdc vdn de sire khde tdm thdn a hgc sinh THPT, dde biet Id cdc vdn di cdm xiic a tudi vi thdnh niin cdn cd su quan tdm nhieu han Tir khoa: Stress; Trdm cdm; Lo du; DASS-21; Hoc sinh THPT Ngdy nhdn bdi; 8/8/2018; Ngdy duyet ddng bdi; 25/2/2019 Bat van de Tudi vi thdnh nien, dac biet giai doan trung hge phi thdng duge xem nhu giai doan nhiiu cang thdng, thach thire bdi nhung thay dii Idn ve mat co thi va lam ly Day Id giai doan md cde vdn di vi sue khde tam thdn nhu stress, lo du vd trdm cam gia tdng, ed thi ddn tdi nhQng xung dot, mdu thudn gia dinh, tinh trang bao lye, nghien chat, rii loan an uing vd thdm ehi ed ty sdt Theo ket qua cuOc khdo sdt vi gidi tre Via Nam S A W (Survey Assessment of Vietnamese TAP CHf TAM Ly HOC, Sd (240), - 2019 89 Youth - khao sdt tren 7.584 ngudi tre lua tuii tir 14 - 25 d 42 tinh/thanh tren ed nude) dugc edng b i ndm 2005, cd khoang 1/3 (32,4%) s i hg ed cam gide buin ehdn vi cugc sing, 21% sd ngudi trd Idi hg thye sy thieu by vgng ve tuong lai, 25,3% si ngudi cam thdy rat buon ehdn bode thiiu sy giilp da (Ministry of Health Vietnam, 2005) Nghien ciru cua Dat Tan Nguyen va edng sy nam 2011 khag sat vi trdm cdm, Ig au va y tudng tu sdt tren 1.161 hge sinh trung hge phd thdng tai Cdn Thg eho ket qua: ty le lo au vd trdm cam lan lugt la 22,8% va 41,1%, cd y tudng ty sdt la 26,3%, do, 12,9% s i ngudi cd ki hoaeh ty sdt vd 3,8% - ci gdng thuc hien tu sdt (Dat Tan Nguyen, Christine Dedding, Tam Thi Pham, 2013) Ndm 2012, Nguyin Cao Minh tiin hdnh nghien cuu tren 233 tre dg tuii tu 12 din 16 tren dia ban tinh Hd Ngi, Hdi Phdng, Hda Binh vd Thdi Nguyen dua ket qud ed 18% sd tre ed van de sire khde tam than, thu minh tram cam ehiem 6,6%, lo du/trdm cam chiem 5,5% (Nguyen Cao Minh, 2012) Nhimg van de sue khde tam than nhu stress, lo au, trdm cam, ty sat, chdt lugng euge sdng eua tudi vj thdnh nien giai dgan trung hgc phd thdng thye sy trd thdnh van de quan tam ddi vdi gia dinh, nhd trudng, edng ddng, he thdng y te va todn xa hdi Vi vay, ehung tdi tien hanh nghien eiiu nhdm myc tieu: 1/ Xac djnh ty le stress, lo du, trdm cam bang thang DASS-21 ciia hge sinh tnmg hgc phd thdng; 2/ Danh gid chdt lugng euge sdng, su hdi long va xdc djnh mdi tuong quan giQa tram cam, lo du, stress vdi ehat lugng cugc sdng, sy hdi Idng eila hge sinh trung hge phd thdng Khach the va phirtrng phdp nghien ciru 2.1 Khdeh the nghien eiiu 100 hge sinh so 150 hge sinh Idp 11 vd 12 Trudng Hermann Gmeiner Ha Ndi, dugc chgn ngdu nhien bdng viee bic thdm chgn Idp tham gia nghien ciiu NhOng tre khdng ding y tham gia bode eg thi dang ed benh tram trgng se dugc loai khdi nghien cuu Trong miu nghien eim cd 52 hge sinh nam va 48 hgc sinh nQ; 61 hge sinh 16 tudi va 39 hge sinh 17 tuoi, tuii trung binh la 16,39 ± 0,49 tuii 2.2 Dia diem nghien ciru Trudng Hermann Gmeitier Id trudng hgc thugc Ldng Tre em SOS Quic te dugc lap ndm 1994, gim cdp tiiu hge, trung hgc ca sd va trung hgc phd thdng Chuang trinh hge theo khung chuang trinh cua Bd Gido due vd Ddo tao, trudng ed khodng 15% hge sinh Id tre em thugc Lang Tre em SOS euiig vdi 85% cdc ban eung tuoi d khu vyc xung quanh trudng thugc Quan Cau Gidy, Hd Ndi Thdi gian nghien euu: 12/2017 - 1/2018 Thiet ke nghien eiiu: md td edt ngang 90 TAP CHI TAM ly HOC, Si (240), 2019 2.3 Cong cu nghien ciiu Cdng cu dugc dung di thu thap dQ lieu gdm nhung thang sau ddy: + Thang Ddnh gid stress, trdm cdm vd lo du DASS-21 (Depression, Anxiety, Stress Scale - bdn rut ggn) gdm 21 eau hdi, dd cd vdn de lien quan din sic khde tdm M n Id: trdm cam (7 eau hdi), lo du (7 cau hdi) vd stress (7 eau hoi) Khdeh thi trd Idi v i tinh trang md minh earn thdy vdng tudn vQa qua tren thang diem mQe do, diem: diiu hoan todn khdng xdy vdi tdi; diim: diiu ndy xay vdi tdi mgt phdn nag hay thinh thoang; diim: diiu ndy thucmg xdy vdi tdi hay nhiiu lan va diim: diiu ndy rdt thudng xdy hay hdu het liie ndo eung ed MQc ciia cae rdi loan duge danh gid bdng edeh nhan hai Idn ting si diim cila timg van di (do day Id ban nit ggn so vdi bdn ehinh gdm 42 cdu) Ting dilm dao dgng tu den 42 diem tuong ung vdi mue eua tung vdn di Kit qua danh gid dugc phdn loai thdnh mue binh thudng vd mQe rii loan gim nhe, vita, ndng va rat ndng rieng eho van de duge ddnh gid Thang da duge thich nghi tiing Viet (Thaeh Due Tran, Tuan Tran, Fisher, 2013) Nam 2017, thang duge Le Thi Hong Minh vd edng sy su dyng nghien euu tren 1.745 hpc sinh THPT va nit ket ludn rang, thang ndy ddng tin cay va phu hgp de danh gia ttieu chiing trdm edm, lo du, stress d tre vj thdnh nien Viet Nam (Alpha ciia Cronbaeh: 0,761 - 0,906) (Le M.T.H., Tran T.D., Fisher J vd edng sy, 2017) Dotincdy Alpha etia Cronbaeh cua tieu thang nghien eiiu eua ehung toi la: 0,855 (trdm earn); 0,816 (lo du) va 0,803 (stress) + Thang Ddnh gid ehat luang cuoc song tong qudt a tre em (Pediatric quality of life inventory^'^ 4.0 generic core scale - PedsQL™ 4.0) dugc xdy dung bdi W Vami vd cgng sy, duge cdng b i ndm 2001 ban ddnh chg tre tu 13 • 18 tuii Tre ty trd Idi vi ede linh vuc gdm thi lye, cam xue, quan he xa hdi vd hgc tap Thang diim miic phan dnh tdn sudt xudt hien cae khd khan trcpng cugc sdng etia tre, vdi diim: khdng bao gid; diim: gdn nhu khdng; diem: ddi khi; diim: thudng xuyen vd diim: hdu nhu ludn ludn Dg tin cay dd duge tde gid ddnh gia vdi Alpha eiia Cronbaeh eho ede linh vye va tdng qudt theo thii tu Id 0,80; 0,73; 0,71; 0,68 va 0,88 Diim danh gia dugc quy dii cho limg linh vuc vd ting diim ehung (Vami J.W., Seid M.P.S., 2001) Trong nghien eim cua ehung tdi, tin eay Alpha eua Cronbaeh cua todn bd thang la 0,888 vd ciia cdc linh vye theo tiiu ty Idn lugt la: 0,811; 0,819; 0,699; 0,650 + Thang Su hdi long tdng qudt (PedsQL™ general well-being scale) ban danh ehoti-etir 13 - 18 mii duge xay dyng bdi W Vami va edng sy (1998) Tre ty trd Idi edu hdi vi edm nhan tich eye, sy hdi ldng eua ban than tre vong I thdng qua vdi sue khde hien tai va tucmg lai, sy hd trg tir gia dinh vdi TAP CHf TAM Ly HOC, S i (240), - 2019 91 mue ddnh gia tuong ung thang diim nhu sau: diem: khdng bao gid, dietn gdn nhu khdng, diim: ddi khi, diim: fliudng xuyen vd diim: hdu nhu ludn ludn (Vami J.W., 1998) Do tin eay Alpha eua Cronbaeh etia thang ndy nghien cQu la 0,809 Xir Iy si lieu; Chung tdi su dyng phdn mim thing ke SPSS 16.0, trcjng dd su dung cdc gid tri thing ke md td (ty le %, trang binh ting vd lech ehudn) vd he si tuong quan Pearson di phdn tieh dQ lieu Nghien eim ndy dp dung ehudn danh gia mQe trdm edm, lo du, stress dya vao phien bdn dd thieh nghi nhu trinh bdy d tren (Thach Due Tran, Tuan Tran, Fisher, 2013) Theo dd, diem phan mue nhu sau: Bang 1: Phdn bo mire diem Tram cam Lo au Stress Binh thuang 0-4 0-3 0-7 Nhe 5-6 4-5 8-9 Vua 7- 10 6-7 10-12 Nang U -13 8-9 13- 16 14-1- 10-1- 17+ Mire Rat nang Thang Chdt lugng cupc sdng tdng qudt va Su hdi long tong qudt cd diem tho tu den diim nhu da gidi thieu, sau dd dugc quy dii thdnh thang diem tu den 100 eho tung thang nhu sau: - Ddi vdi thang Chdt lugng cugc sing ting quat: = 100; = 75; = 50; = 25 va = Nhu vay, diem edng eao thi hgc sinh edng ed chdt lugng sing cao hon Thang gdm tiiu thang (thi lue, cdm xue, quan he xd hdi vd hge tap), tuong ung Id diem ede tiiu thang cdng eao thi chdt lugng sing eiia timg mdt dd eung cang cao - Ddi vdi thang Su hdi Idng ting qudt: = 0; = 25; = 50; = 75 va = 100 Thang diem cd y nghia la diem cdng eao thi hge sinh cang ed mQc dd hai Idng eao hon vdi euge sdng eua minh Diem ddnh gid eua thang ting qudt vd ede tiiu thang Id trung binh ting diem cua ede edu thdnh phdn eua thang hoac tieu thang tuong irng Vdi edeh tinh ndy, diim tii da eua tung tiiu thang vd eua todn bd thang diu la 100 va tii thiiu laO 92 TAP CHf TAM Ly HOC, Si (240), - 2019 Kit quit nghien ciru DQ lieu md td ve tram cdm, lo au va stress eiia mdu chgn vd mii tuang quan giua chiing dugc hien thj d bdng Bang 2: Ty le, mire dp trdm edm, lo du, stress a hge sinh trung hge thong vd tuang quan giira chiing « Tv le % Tram cam Loan Blnh thuong 46,0 48,0 55,0 Co trieu chirng 54,0 52,0 45,0 Gi&i tinh' Stress + Nhe 6,0 9,0 19,0 + Vira 31,0 15,0 11,0 -l-Nang 11,0 13,0 13,0 + Rat nang 6,0 15,0 2,0 Nam (n = 52) 46,2 51,9 38,5 Nu (n = 48) 62,5 42,1 42,1 Tirffng quan giira stress - tram cam - lo au Stress r = 0,734'""' Lo au r = 0,746 '•••' r = 0,719''"' Ghichii: ***:p< 0,001 (miic y nghia cua luang quan luyin linh giiia tram cdm, lodu, stress '": Ty le co trieu chiing trdm cdm, lo du, stress a nam vdnUso vdi long n cua limg gidi Kit qud chg thdy, ty le ed trieu ehung tidm edm, lo du va stress ti-ong 100 hge sinh duge khdo sat idn lugt la 54%, 52% va 45% (theo thang DASS-21) Trong dd, 15% - 28% so hgc sinh ed trieu ehung trdm cam hoac lo au hoac stress d mue tir nang din rdt ndng Khdng ed sy khae biet giua nam vd nu ve ty le cd trieu ehiing tram earn, lo au, stress (p > 0,05) Dong thdi, kit qua eQng chi rdng, cd mii tuong quan tuyen tinh thudn giOa ting diim stress vdi trdm edm, stress vdi lo du, tram cam vdi lo au, miic tiiong quan rdt ehat che vdi he s i tucmg quan lan lugt la 0,734; 0,719 vd 0,746 (p < 0,001) Cd thi hiiu, day Id ba dang rii Igan cam xue ed mdi quan he mat thiet vdi TAP CHfTAM Ly HOC, So (240), 3-2019 93 Bdng 3: Chdt luang cuoc song lien quan den sice khoe vd su hdi long ciia hpc sinh THPT Cae linh vuc danh gia Chung (DTB ± DLC) So san h theo gioi tinh Nam (DTB ± DLC) Nir (DTB ± DLC) P Chat lircrng cuoc song tong quat Theluc 77,69± 13,85 80,89 ±13,23 74,22 ± 13,8 0,01 Cam xue 62,5 ±18,23 66,83 ± 17,26 57,81 ± 18,27 0,01 Quan he xa hoi 79,75 ±13,39 80,29 ± 13,11 79,I7± 13,81 0,67 Hoc tap 69,1 ±13,75 68,85 ± 13,7 69,38 ± 13,93 0,85 Tong quat 72,97 ± 11,57 75,08 ±11,28 70,67 ± 11,55 0,05 Su hai long 65,35 ± 16,16 65,88 ±15,77 64,82 ± 16,7 0,75 Tuorng quan giir a chat lugng cuoc song tong quat va sir hai long: r = 0,585; p< 0,001 Ghi chii: Diem trung binh (BTB); dg lech ehudn (DLC) Bang md ta ehat lugng euge sdng duge xem xet tu gdc dg sue khde vd sy hai Idng ehung eua hge sinh trung hge phd thdng Diem chat lugng cugc sdng ting qudt cho nhdm hge sinh dugc khag sdt la 72,97 ± 11,57, d mue dd khd eao cua thang diim 100 So sanh diim giua linh vyc cua thang cd thi thdy, hgc sinh ed ehdt lugng quan hS xa hgi eae nhdt vd ehdt lugng edm xQe thdp nhdt d linh vye chdt lugng cam xQe, diem cd dd leeh ehudn eao han cdc linh vye khdc eho thdy, day la linh vyc md hge sinh cd sy ddnh gid khde biet hon ed ve ehdt lugng sing eua minh so vdi eae linh vuc khde So sanh chat lucmg cugc sing cua nam vd nu eho thay, diim trang binh chat lugng euge sing d linh vye thi lye vd edm xue d nu ttidp ban d nam (vdi p < 0,01) Cde linh vuc khde khdng ed sy khdc biet dang ki giQa nam vd nu Su hdi ldng lugng gid bdng thang ddnh eho mil 13 - 18 mil (Well-being Scale) la 65,35/100 diim, khdng ed su khae biet ed y nghia giQa nam vd nQ Cd mdi tuang qitan ddng bien ehat giua chdt lugng cugc sing ting qudt va su hdi Idng vdi he sd Wong quan r = 0,585 (p < 0,001) Diiu dd cd nghia la nhQng tre ed chat lugng cugc sdng cao hon thi ed su hai ldng eao hon vdi euge sing va nguge lai, nhQng tre ed chdt lugng euge sing thdp ban thi it hdi long han vdi cugc sdng eua minh 94 TAP CHf TAM Ly HOC, Si (240), - 2019 Bang 4: Moi tuang quan ^lira stress, tram edm, lo du v&i chdt luang cupc song vd miie dp hdi ldng Thang DASS-21 Chat luong cuoc s6ng tong quat r P r P Stress -0,527 < 0,001 -0,613 < 0,001 Tram cam -0,623 < 0,001 -0,674 < 0,001 Loan -0,495 < 0,001 -0,489 < 0,001 Su hai long tong quat Bdng hien thj mdi tuang quan giQa stress, tram edm, lo du vdi ehdt lugng euge sdng va sy hai ldng cila hgc sinh DQ lieu chg thay, diim lugng gid stress, lo du va tram cam ddnh gid qua DASS-21 ed mdi tucmg quan tuyen tinh nghjeh bien tu miic trung binh trd len vdi diim chat lugng cugc sdng vd diem mue hai Idng (he s i tuang quan r khodng tir 0,489 den 0,674; p < 0,001), chung td stress, lo au vd tram cam cang nang thi chat lucmg euge sdng va mQe hdi Idng edng thap vd nguge lai, nhQng hge sinh cd it trieu chung stress, tram cdm hay Ig au thi chat lugng euge sdng vd mQe hdi Idng edng eao hem Ban luan Nghien euru eua ehung tdi khdo sat van de stress, tram cam, lo au vd chat lugng euge sdng tren nhdm ddi tugng hge sinh trang hge phd thdng khdi Idp II, 12 la nhdm ddi tugng cd nhieu van de ban so vdi nhdm tudi eua ddi tugng nghien ciiu ede nghien eiiu trudc day Tre dung truoc nhieu van de thdeh thirc eila tuii vj nien NhQng trdn trd van de lua chgn ngdnh hgc, nghi nghiep tuong lai, dp luc hge hdnh eila nhiing nam eudi cdp trudc ky thi hiyin sinh dai hgc cdng thing Id nguyen nhdn cua nhiiu vdn di ve sue khde lam thdn Kit qua sang Igc theo thang Ddnh gid ttdm cdm, lo au vd stress DASS-21 nghien eiiu etia ehiing tdi (bdng 2) eho thdy, ty le trdm cam, lo au vd stress cua nhdm dii tugng nghien euu idn lugt Id 54%, 52% va 45%, khdng ed sy khde biet giQa nam vd nQ Ty le ndy cho thdy, rii loan edm xue la van de tuong ddi phd biin mdu nghien cQu va rat edn duge quan tam Ty le ndy cao hon ede nghien euu trade day ciia Nguyen Tdn Dat vd edng sy (2011) vdi ty 1$ lo au vd tram cam idn lugt la 22,8% va 41,1% vd cua Nguyin Cag Minh (2012) vdi ty le thu minh trdm edm la 6,6% vd lo du/tiam cdm la 5,5% Sy khdc biet Idn ndy cd thi ly gidi vi nhdm dii tugng nghien cuu cua Nguyin Tdn TAP CHf TAM Ly HOC, Sd (240), - 2019 95 Dat va edng sy ed tuii phdn b i tQ 12 - 15 tuii vd ti-ong nghien eiiu cua Nguyen Cao Minh Id IQa tudi tu 12 - 16 eung thuge nhdm tuii vj thdnh nien, nhung nhQng vdn di dp lye tam ly eua nhdm tuii ndy khong nhiiu nhu ddi tugng nghien cQu nghien cQu cua chung tdi vdi liia tuii 16-17 Han nQa, trcing mdu nghien euu eua chung tdi ed mdt s i tre cd hoan ednh dde biet thugc Lang Tre em SOS hgc hda nhap eiing eae hge sinh Icip binh thudng Ddy Id nhQtig em chju nhiiu thiet tiidi trgng cuge sing tren nhiiti phuang dien khde nen rdt ed thi dd Id nhung yiu ti dnh hudng din cae vdn de ve sue khde tam than o ede em Cdng eu ddnh gid khde biet ti-ong ede nghien euu ke tren eung la mdt diim ddng luu •
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