心理弹性在医务人员抑郁与体液免疫功能指标之间的中介效应分析

Mediating role of psychological resilience between depression and humoral immunological biomarkers in medical staff

  • 摘要:
    背景 目前医务人员的抑郁状况较为严重,可能对其免疫功能产生不同程度的影响。心理弹性在抑郁与免疫功能关系中产生的作用不容忽视,但目前这方面的研究较为缺乏。
    目的 探讨心理弹性在医务人员抑郁与体液免疫功能关系中的中介效应。
    方法 2022年9月至2022年12月,采用分层整群随机抽样的方法,选择河南某三级医院的108名医务工作人员为研究对象,采用心理弹性量表、中文版病人健康问卷调查研究对象的心理弹性和抑郁状况;采集空腹静脉血检测研究对象的血清免疫球蛋白(Ig)M(IgM)、IgG、IgA、补体C3和补体C4水平;采用Mann-Whitney U检验、Kruskal-Wallis H检验、独立样本t检验和单因素方差分析进行不同人口学特征组间的差异性分析;采用Spearman进行相关分析;采用PROCESS插件进行心理弹性在抑郁与体液免疫功能指标之间的中介效应检验。
    结果 研究对象的心理弹性得分MP25P75)为65.50(53.25,75.00)分,心理弹性水平处于低、中、高三个程度的比例分别为2.78%(3/108)、51.85%(56/108)和45.37%(49/108)。抑郁得分MP25P75)为6.00(2.00,8.00)分,抑郁检出率为61.11%(66/108)。相关分析结果显示,心理弹性与抑郁、C3呈负相关(r=−0.416、−0.309,P<0.01),与IgG、IgA呈正相关(r=0.302、0.517,P<0.01);乐观性、自强性和坚韧性分别与抑郁呈负相关(r=−0.387、−0.446、−0.312,P<0.01),与IgG呈正相关(r=0.194、0.284、0.239,P<0.05),与IgA呈正相关(r=0.377、0.378、0.444,P<0.01);坚韧性与C3呈负相关(r=−0.304,P<0.01),抑郁与IgG、IgA呈负相关(r=−0.516、−0.522,P<0.01),与C3呈正相关(r=0.195,P<0.05)。中介效应检验结果显示,心理弹性在抑郁与IgA、C3之间发挥中介效应,效应值分别为−0.148(95%CI:−0.051~−0.012)、0.111(95%CI:0.001~0.010),中介效应百分比为28.30%和56.92%。
    结论 医务人员的心理状况不容乐观,抑郁会导致部分体液免疫功能指标发生改变,心理弹性可通过中介效应影响抑郁与体液免疫功能指标之间的相互作用。医疗机构应采取积极措施提高职工心理弹性水平,促进员工身心健康的发展。

     

    Abstract:
    Background At present, high level of depression is a serious problem in medical staff and may affect their immune function. The role of psychological resilience between depression and immunity cannot be ignored. However, it is still lack of research report in this area.
    Objective To explore the mediating effect of psychological resilience on the association between depression and humoral immunological biomarkers in medical staff.
    Methods A total of 108 medical staff from a tertiary hospital in Henan Province were selected using stratified cluster sampling from September 2022 to December 2022. The Connor-Davidson Resilience Scale and Patient Health Questionnaire-9 were used to evaluate their psychological resilience and depression. Serum immunoglobulin (Ig) M (IgM), IgG, IgA, complement 3 (C3), and complement 4 (C4) were detected in fasting venous blood samples. Mann-Whitney U test, Kruskal-Wallis H test, independent-samples t-test, and One-way ANOVA were used for comparisons among different demographic groups. Spearman correlation was used to evaluate correlations among measured variables. PROCESS plug-in was used to verify potential mediating effect of psychological resilience on the relationship between depression and humoral immunological biomarkers.
    Results The M (P25, P75) score of psychological resilience was 65.50 (53.25, 75.00) in the participating medical staff. The ratios of low, medium, and high levels of psychological resilience were 2.78% (3/108), 51.85% (56/108), and 45.37% (49/108), respectively. The M (P25, P75) score of depression was 6.00 (2.00, 8.00). The positive rate of depression was 61.11% (66/108). The correlation analysis results showed that psychological resilience was negatively correlated with depression and serum complement C3 (r=−0.416 and −0.309, P<0.01), positively correlated with serum IgG and serum IgA (r=0.302 and 0.517, P<0.01); optimism, self-improvement, and resilience were negatively correlated with depression (r=−0.387, −0.446, and −0.312, P<0.01), positively correlated with IgG (r=0.194, 0.284, and 0.239, P<0.05), and positively correlated with IgA (r=0.377, 0.378, and 0.444, P<0.01), respectively; resilience was negatively correlated with C3 (r=−0.304, P<0.01), and depression was negatively correlated with serum IgG and serum IgA (r=−0.516 and −0.522, P<0.01), positively correlated with serum complement C3 (r=0.195, P<0.05). The mediating effect test showed that psychological resilience showed mediating effects on the relationship between depression and serum IgA and serum complement C3, with mediating effect values of −0.148 (95%CI: −0.051, −0.012) and 0.111 (95%CI: 0.001, 0.010), and their mediating effect ratios were 28.30% and 56.92%.
    Conclusion The mental health status of the target medical staff is not optimistic. Depression is associated with changes in some humoral immunological biomarkers. Psychological resilience can mediate the correlations between depression and humoral immunological biomarkers. The managers should take measures to improve the levels of psychological resilience and promote the physical and mental health of medical staff.

     

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