创伤后应激障碍在急诊科护士工作压力与抑郁症状间的中介效应

摘要

目的 调查急诊科护士抑郁症状现状,探讨创伤后应激障碍在急诊科护士工作压力与抑郁症状关系中的中介作用。方法 采用便利抽样法,选取491名急诊科护士作为研究对象,使用问卷调查急诊科护士的一般资料、抑郁症状、压力源和创伤后应激障碍症状。结果 急诊科护士工作压力、抑郁症状、创伤后应激障碍得分,分别为（52.03±28.09）分、（5.97±5.85）分、（1.49±1.67）分;急诊科护士工作压力（r=0.364,P<0.01）、创伤后应激障碍（r=0.405,P<0.01）与抑郁症状呈正相关;创伤后应激障碍在急诊科压力源与抑郁症状间发挥部分中介效应,中介效应占总效应的25.13%。结论 创伤后应激障碍加剧了急诊科护士工作压力对抑郁的影响,通过减少护士的创伤后应激障碍发生可缓解其抑郁症状。

关键词

抑郁 / PTSD / 工作压力 / 急诊科护士

[1] 赵晓华,张正,陈曾煜,等. 工作场所暴力对医务工作者职业倦怠的影响:抑郁的中介作用[J]. 中南大学学报(医学版),2023,48(6):903-908.
[2] 雷子辉,冯晶,申鑫,等. 中国急诊科护士抑郁症状发生情况及影响因素分析[J]. 中国公共卫生,2022,38(12):1505-1509.
[3] 张翠娟,程月英,陈冬梅,等. 团队支持在ICU护士压力与焦虑抑郁间的中介作用[J]. 护理学杂志,2023,38(13):18-21.
[4] Segerstrom SC, Miller GE.Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry[J]. Psychol Bull, 2004, 130(4): 601-630.
[5] Lambert VA, Lambert CE, Ito M.Workplace stressors, ways of coping and demographic characteristics as predictors of physical and mental health of Japanese hospital nurses[J]. Int J Nurs Stud, 2004, 41(1): 85-97.
[6] Chu WM, Ho HE, Lin YL, et al.Risk Factors Surrounding an Increase in Burnout and Depression Among Health Care Professionals in Taiwan During the COVID-19 Pandemic[J]. J Am Med Dir Assoc, 2023, 24(2): 164-170.
[7] Association AP.Diagnostic and statistical manual of mental disorders[M]. 5th ed. Washington DC: American Psychiation Press, 2013.
[8] Koenen KC, Ratanatharathorn A, Ng L, et al.Posttraumatic stress disorder in the World Mental Health Surveys[J]. Psychol Med, 2017, 47(13): 2260-2274.
[9] Kroenke K, Spitzer RL, Williams JB.The PHQ-9: validity of a brief depression severity measure[J]. J Gen Intern Med, 2001, 16(9): 606-613.
[10] Yuwanich N, Akhavan S, Nantsupawat W, et al.Development and psychometric properties of the stressor scale for emergency nurses[J]. Int Emerg Nurs, 2018, 39: 77-88.
[11] 张梦杰,李珂,张建霞,等. 急诊护士压力源量表的汉化及信效度检验[J]. 中华急危重症护理杂志,2023,4(12):1105-1111.
[12] Prins A, Bovin MJ, Smolenski DJ, et al.The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5): Development and Evaluation Within a Veteran Primary Care Sample[J]. J Gen Intern Med. 2016, 31(10): 1206-1211.
[13] 裴菊红,豆欣蔓,贺莉. 急诊科护士述情障碍和抑郁对职业倦怠影响的路径分析[J]. 解放军护理杂志,2021,38(5):25-28.
[14] 雷子辉,冯晶,申鑫,等. 中国急诊科护士抑郁症状发生情况及影响因素分析[J]. 中国公共卫生,2022,38(12):1505-1509.
[15] 张翠娟,程月英,陈冬梅,等. 团队支持在ICU护士压力与焦虑抑郁间的中介作用[J]. 护理学杂志,2023,38(13):18-21.
[16] 乔红梅,李葆华,李薇,等. 重症监护与普通病房护士焦虑抑郁症状及职业倦怠比较[J]. 中国心理卫生杂志,2020,34(3):191-195.
[17] 张艳楠,张志英. ICU护士共情疲劳与职业压力的相关性研究[J]. 中华现代护理志,2018,24(15):1764-1767.
[18] American Psychiatric Association.Diagnostic and statistical manual of mental disorders(5th ed)[M]. Arlington: American Psychiatric Pub, 2013: 271-272.
[19] Schuster M, Dwyer PA.Post-traumatic stress disorder in nurses: An integrative review[J]. J Clin Nurs. 2020, 29(15-16): 2769-2787.
[20] Xue M, Yuan Y, Chen H, et al.Perceived stress and symptoms of post-traumatic stress disorder in nurses: A moderated mediation model of maladaptive cognitive emotional regulation and psychological capital[J]. Front Psychiatry, 2022, 13: 902558.
[21] Clark PR, Polivka B, Zwart M, et al.Pediatric Emergency Department Staff Preferences for a Critical Incident Stress Debriefing[J]. J Emerg Nurs, 2019, 45(4): 403-410.
[22] 曹英华,江萍,付迪,等. 急诊科护士突发公共卫生事件心理弹性培训方案的构建与初步应用研究[J]. 军事护理,2024,41(1):56-60.

基金资助

安徽省高校科研项目（2024AH040381）; 安徽省新时代育人质量工程项目（2022jyjxggyj338）; 皖南医学院校级科研项目（SJD202305）; 中华医学会杂志社2025年护理学科研究课题（CMAPH-NRD2025044）