I HC QUC GIA H NI TRNG I HC GIO DC NGUYN TH THU SNG MI TNG QUAN GIA LO U - TRM CM V MC B BT NT CA HC SINH TRUNG HC C S LUN VN THC S TM Lí HC H NI - 2015 I HC QUC GIA H NI TRNG I HC GIO DC NGUYN TH THU SNG MI TNG QUAN GIA LO U TRM CM V MC B BT NT CA HC SINH TRUNG HC C S LUN VN THC S TM Lí HC CHUYấN NGNH: TM Lí HC LM SNG TR EM V V THNH NIấN Mó s: Thớ im Ngi hng dn khoa hc: PGS.TS NGC KHANH H NI - 2015 LI CM N Tụi xin chõn thnh cm n cỏc Thy Cụ ca trng i Hc Giỏo Dc ó to iu kin v giỳp tụi quỏ trỡnh hc v nghiờn cu ti trng Tụi xin gi li cm n ti PGS TS Ngc Khanh, l giỏo viờn hng dn lun ca tụi, ó dnh nhiu thi gian v tõm huyt hng dn nghiờn cu, ng viờn tinh thn, giỳp tụi hon thnh lun Thc s ny Cui cựng, tụi xin gi n gia ỡnh, bn bố li cm n chõn thnh v sõu sc vỡ ó luụn bờn cnh ng viờn, to mi iu kin tt nht cho tụi sut thi gian tụi nghiờn cu v hon thnh lun Mc dự bn thõn ó c gng nhng chc chn lun khụng trỏnh c nhng thiu sút, tụi rt mong nhn c nhng ý kin úng gúp, b sung ca quý thy cụ v cỏc bn Xin trõn trng cm n! Bn Tre, ngy 10 thỏng 11 nm 2015 Tỏc gi Nguyn Th Thu Sng i DANH MC CC CH VIT TT BLH : Bo lc hc ng BNKT : Bt nt kinh t BNTC : Bt nt th cht BNTD : Bt nt tỡnh dc BNTT : Bt nt tinh thn DSM IV : S tay thng kờ v chn oỏn cỏc ri lon tõm thn rỳt gn ln th IV (DSM IV) HKHXH&NV : i hc khoa hc xó hi v nhõn TB : im trung bỡnh GAD- : Thang o lo õu (Generalized Anxiety Disorder 7-item (GAD-7)) ICD 10 : Phõn loi bnh quc t ln th 10 v cỏc RLTT v hnh vi Mụ t lõm sng v cỏc nguyờn tc ch o chn oỏn, bn dch ting Vit (ICD-10) PHQ- : Thang o trm cm (Patient Health Questionnaire 9) RLLA : Ri lon lo õu SKTT : Sc kho tõm thn SPSS : Phn mm x lý s liu h tr x lý v phõn tớch d liu s cp (Statistical Package for the Social Sciences) THCS : Trung hc c s THPT : Trung hc ph thụng YLDs : Ch s s nm sng b mt khuyt tt (Year lost due to disability-YLDs) ii MC LC LI CM N i DANH MC CC CH VIT TT ii MC LC iii DANH MC BNG v DANH MC BIU vi M U Chng 1: C S L LUN Error! Bookmark not defined 1.1.Vi Nột v lch s nghiờn cu Error! 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Bookmark not defined iv DANH MC CC BNG Trang Bng 2.1 Cỏc nhúm khỏch th theo c im nhõn khu hc 33 Bng 2.2 : S bn thõn ca khỏch th 34 Bng 3.1: Trung bỡnh cỏc loi bt nt 41 Bng 3.2: S lng v t l (%) hc sinh tr li mi phng ỏn tiu thang ú bt nt v tinh thn 42 Bng 3.3: S lng v t l (%) hc sinh tr li mi phng ỏn tiu thang ú bt nt v kinh t 44 Bng 3.4: S lng v t l (%) hc sinh b bt nt v th cht 45 Bng 3.5: S lng v t l (%) hc sinh tr li mi phng ỏn tiu thang o bt nt v tỡnh dc 46 Bng 3.6: Trung bỡnh cỏc hỡnh thc b bt nt theo khi/lp 47 Bng 3.7: Trung bỡnh cỏc hỡnh thc bt nt theo gii tớnh 48 Bng 3.8: Trung bỡnh cỏc hỡnh thc bt nt theo trng 49 Bng 3.9: a im hc sinh b bt nt 51 Bng 3.10: i tng thc hin bt nt 51 Bng 3.11: s lng v t l hc sinh phn ng thy bn bố cựng la b bt nt 52 Bng 3.12: Phõn loi lo õu 53 Bng 3.13: phõn loi trm cm 53 Bng 3.14: So sỏnh lo õu trm cm theo gii tớnh 54 Bng 3.15: So sỏnh lo õu trm cm theo hc lc 55 Bng 3.16: Mi tng quan gia vic b bt nt v lo õu trm cm 55 v Bng 3.17: So sỏnh trung bỡnh cỏc hỡnh thc bt nt vi cỏc hc sinh cú mc lo õu khỏc 56 Bng 3.18: So sỏnh trung bỡnh cỏc hỡnh thc bt nt vi cỏc hc sinh cú mc trm cm khỏc 57 Bng 3.19: D bỏo lo õu theo trung bỡnh bt nt 58 Bng 3.20: D bỏo lo õu theo cỏc bin thớch hc, lp, gii, o c, hc lc, trng 59 Bng 3.21: D bỏo trm cm theo trung bỡnh bt nt 60 Bng 3.22: D bỏo trm cm theo cỏc bin thớch hc, lp, gii, o c, hc lc, trng 60 DANH MC CC BIU Trang Biu 2.1: Biu s lng hc sinh theo tng 31 Biu 2.2: Biu s lng hc sinh theo tng trng 32 Biu 2.3: Biu s lng hc sinh theo gii 32 vi M U Lý chn ti Hin nc ta, chm súc v bo v tr em ngy cng c quan tõm ca Chớnh ph, c bit bo v tr b bo lc v th cht v tinh thn Nu nh nhng nm trc, xó hi v d lun thng quan tõm nhiu hn n vic bo v tr em di gúc ngi ln lm tn thng tr em nh: lm dng tỡnh dc, bo lc tinh thn, ỏnh p, lm dng sc lao ng thỡ thi gian gn õy, truyn thụng v d lun bt u quan tõm n vic tr b chớnh bn cựng la gõy tn thng Bng chng l, trờn cỏc phng tin thụng tin i chỳng, ó cú nhiu bi bỏo cp n vic hc sinh bt nt nhau, ú cú nhng trng hp ó gõy hu qu nghiờm trng v ht sc thng tõm Nhng nghiờn cu gn õy cng cho thy s phc v mi nguy hi ca nhng hnh vi bt nt tui hc trũ Khong 22,6% tr mu giỏo b bt nt t mc trung bỡnh n nng, khong 10% tr t n 12 c bn cựng lp xem l nn nhõn thng xuyờn ca bt nt [40] Bt nt trng hc thng c coi l nghiờm trng v mt cỏ nhõn, xó hi v giỏo dc Bt nt khụng ch gõy hu qu xu cho nn nhõn thi im b bt nt [41] [85][86][87][94][107], m cũn gõy hu qu v mt phỏt trin cm xỳc sau ny ca tr [76][87] Tr b bt nt cú th cú hnh vi sa sỳt, hn ch cỏc c hi giao lu v kt bn dn ti gim k nng xó hi Bt nt cng gõy nh hng xu c i vi ngi cú hnh vi bt nt Hc sinh chuyờn i bt nt hc sinh khỏc thng phỏt trin thnh thỳ vui vic th hin sc mnh v uy th i vi nn nhõn v khụng th phỏt trin s ng cm vi ngi khỏc C nh vy, nhng tr ú cú th s dn hỡnh thnh nhng hnh vi phm phỏp v ti ỏc [98] Ngoi nhng hu qu v mt xó hi nh b cụ lp, b loi nhúm bn, v hu qu hc nh hc gim sỳt, ớt tham gia hot ng trng lp [98] Bt nt cú th gõy nhiu hu qu nghiờm trng v mt cm xỳc v nhn thc nn nhõn, nh cụ n, lo õu, trm cm, thu mỡnh, kộm t tin Cỏc nghiờn cu v bt nt cú nh hng n sc kho tõm thn cho thy: Trong cỏc mu chn hc sinh trung hc ó kim tra ti Istabul, Th Nh K, t l b bt nt cao v liờn quan n biu hin ca trm cm S tip tc tri nghim bo lc v cng thng cỏc mi quan h xó hi s dn n cỏc biu hin tõm thn [99] Thanh thiu niờn nam l nn nhõn ca bt nn cựng la tri nghim mc stress v lo lng cao Cỏc em cho rng mụi trng trng hc ca cỏc em khụng an ton v s cú bo lc hc ng [92] Nhng nm gn õy, bt nt hc ng c nghiờn cu rt nhiu trờn th gii, nhiờn, ti Vit Nam cỏc nghiờn cu ch dng li vic nghiờn cu v thc trng, cỏc nguyờn nhõn, cng nh a mt vi gii phỏp phũng nga bo lc hc ng nh trng, gia ỡnh v xó hi Gn õy, ó cú nghiờn cu ti cp b Vin Tõm lý hc v bo lc hc ng, nguyờn nhõn v hu qu, nhiờn nghiờn cu trờn mu chn hc sinh ph thụng Bc v Trung Vy tỡnh trng bo lc hc ng hc sinh trung hc c s Nam v mi tng quan n sc kho tõm thn, c th l lo õu v trm cm nh th no rt cn c lm sỏng t Nghiờn cu ti: Mi tng quan gia lo õu trm cm v b bt nt ca hc sinh trung hc c s khụng nhng cú ý ngha v mt lý lun m cũn cú ý ngha v mt thc tin, s giỳp tr li cõu hi trờn Mc tiờu nghiờn cu Nghiờn cu ny nhm tỡm hiu v mi tng quan gia mc b bt nt v biu hin ca lo õu trm cm hc sinh trung hc c s Nhim v nghiờn cu 3.1 H thng hoỏ mt s lớ lun cú liờn quan n ti Lo õu, trm cm, bt nt, hc sinh trung hc c s, bt nt gia hc sinh vi hc sinh trung hc c s TI LIU THAM KHO Ti liu Ting Vit Vừ Vn Bn (2002), Thc hnh v iu tr tõm lý, NXB y hc H Ni Nguyn Thanh Cao (2012), Thc trng trm cm v mt s yu t nguy c n trm cm ngi trng thnh ti phng Sụng Cu, th xó Bc Kn nm 2011 v xut mt s gii phỏp, lun ỏn chuyờn khoa cp II Trn Vn Cụng, Bahr Weiss, David Cole (2009) B bt nt bi bn cựng la v mi liờn h vi nhn thc bn thõn, trm cm hc sinh ph thụng, Tp tõm lý hc s 11(128), 11-2009, S c bit nhõn thnh lp Trng i hc Giỏo dc Trn Vn Cụng, Bahr Weiss, David Cole, Phỏt trin v thớch nghi thang o bt nt v b bt nt cho tr em Vit Nam (cha xut bn) V Dng (2013), T in Tõm Lý hc, NXB T in bỏch khoa Nguyn Th Duyờn (2012), Nghiờn cu mi liờn h gia c im nhõn cỏch v hin tng bt nt hc sinh trung hc ph thụng trờn i bn tnh Bc Ninh, Lun thc s tõm lớ hc lõm sng tr em v v thnh niờn Dng Th Diu Hoa (ch biờn) (2012), Giỏo trỡnh tõm lớ hc phỏt trin, NXB i Hc S Phm inh ng Hoố (1997), Tp ti liu tõm bnh hc, NXB y hc Nguyn Cụng Khanh (2000), T v tr liu tõm lý cho tr em cú ri nhiu hnh vi v khú khn hc ng, Hi tho Vit Phỏp v tõm lý hc H Ni 10 ng Bỏ Lóm, Weiss Barh (ch biờn) (2007), giỏo dc, tõm lớ v sc kho tõm thn tr em Vit Nam, Nxb HQG H Ni 11 Nguyn Th Nga (2011), Tỡm hiu hin tng b bt nt hc sinh ph thụng trờn a bn huyn Thanh H, Hi Dng, Lun Thc s, Trng i hc khoa hc xó hi v nhõn vn, i hc Quc gia H Ni 12 Trn Vit Ngh (ch biờn) (2003), Cỏc ri lon lo õu liờn quan ti stress v iu tr hc tõm thn, NXB i hc Y H Ni 13 Trn Vit Ngh, Nguyn Vit Thờm, Ló Th Bi v cng s (2000), Nghiờn cu dch t lõm sng 10 bnh tõm thn ch yu ti mt phng thnh ph Thỏi Nguyờn, Bỏo cỏo tng kt, hi ngh hun ICD 10, H Ni 14 V Th Nho (2001), Tõm 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