知觉压力影响创伤康复期患者事件影响程度的中介效应路径分析

doi:10.3969/j.issn.1006-9771.2023.08.013

Abstract

Abstract:

Objective To explore the effect of perceived stress on the impact of event in rehabilitation patients with traumatic injury, and the mediating role of difficulties in emotion regulation, rumination and sleep.
Methods From March, 2022 to March, 2023, using the convenient sampling method, a questionnaire survey was conducted on 192 rehabilitation patients with traumatic injury from Southwest Hospital, Xinqiao Hospital and Daping Hospital. Assessment tools included Perceived Stress Scale, Difficulties in Emotion Regulation Scale, Brief Ruminative Response Scale, Self-Rating Scale of Sleep, and Impact of Event Scale-revised.
Results Perceived stress, difficulties in emotion regulation, rumination, sleep and the impact of event were correlated with each other in rehabilitation patients with traumatic injury (r = 0.447~0.684, P < 0.01). Perceived stress significant positively predicted the impact of event (β = 0.49, P < 0.001), as well as difficulties in emotion (β = 0.70, P < 0.001), rumination (β = 0.21, P < 0.05) and sleep (β = 0.29, P < 0.001). The direct effect of perceived stress on the impact of event was not significant, but it affected the impact of event through seven mediation paths, among which the independent mediation effect size of difficulties in emotion regulation, rumination and sleep accounted for 24.41%, 11.91% and 24.82%, respectively; the chain mediation effect size of difficulties in emotion regulation and rumination accounted for 13.88%, the chain mediation effect size of difficulties in emotion regulation and sleep accounted for 18.08%, the chain mediation effect size of rumination and sleep accounted for 3.17%, and the chain mediation effect size of difficulties in emotion regulation, meditation and sleep accounted for 3.70%.
Conclusion Perceived stress affected the impact of event in rehabilitation patients with traumatic injury through the independent mediation and chain mediation of difficulties in emotion regulation, rumination and sleep.

Key words: perceived stress, difficulties in emotion regulation, rumination, sleep, impact of event, traumatic injury, rehabilitation

CLC Number:

R641

LIU Yang, ZHANG Peng, HUANG Ying, CHEN Han, XU Chen, LI Min. Path analysis of mediating effect of perceived stress affecting impact of event in rehabilitation patients with traumatic injury[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 954-960.

Figures/Tables 5

References 36

[1]	TANG E H M, BEDFORD L E, YU E Y T, et al. Unintentional injury burden in Hong Kong: results from a representative population-based survey[J]. Int J Environ Res Public Health, 2021, 18(16): 8826. doi: 10.3390/ijerph18168826
[2]	赵海峰, 董超群, 汤妍, 等. 意外创伤者早期自我表露与创伤后成长的关系研究[J]. 护理学杂志, 2020, 35(1): 57-60.
	ZHAO H F, DONG C Q, TANG Y, et al. Relationship between self-disclosure and post-traumatic growth among patients at the early stage of accidental trauma[J]. J Nurs Sci, 2020, 35(1): 57-60.
[3]	POZZATO I, CRAIG A, GOPINATH B, et al. Biomarkers of autonomic regulation for predicting psychological distress and functional recovery following road traffic injuries: protocol for a prospective cohort study[J]. BMJ Open, 2019, 9(4): e24391.
[4]	ALI A M, AL-AMER R, KUNUGI H, et al. The Arabic version of the Impact of Event Scale-revised: psychometric evaluation among psychiatric patients and the general public within the context of COVID-19 outbreak and quarantine as collective traumatic events[J]. J Pers Med, 2022, 12(5): 681. doi: 10.3390/jpm12050681
[5]	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. doi: 10.3389/fpsyt.2022.902558
[6]	ESKILDSEN A, FENTZ H N, ANDERSEN L P, et al. Perceived stress, disturbed sleep, and cognitive impairments in patients with work-related stress complaints: a longitudinal study[J]. Stress, 2017, 20(4): 371-378. doi: 10.1080/10253890.2017.1341484 pmid: 28605986
[7]	JEFTIC A, IKIZER G, TUOMINEN J, et al. Connection between the COVID-19 pandemic, war trauma reminders, perceived stress, loneliness, and PTSD in Bosnia and Herzegovina[J]. [ahead of print]. Curr Psychol, 2021. doi: 10.1007/s12144-022-02876-8.
[8]	FORBES C N, TULL M T, RAPPORT D, et al. Emotion dysregulation prospectively predicts posttraumatic stress disorder symptom severity 3 months after trauma exposure[J]. J Trauma Stress, 2020, 33(6): 1007-1016. doi: 10.1002/jts.v33.6
[9]	HUA Z, MA D, XIA X. Emotional dysregulation and time structure mediate the link between perceived stress and insomnia among unemployed young people in China: a cross-sectional study[J]. Int J Environ Res Public Health, 2022, 19(19): 11883. doi: 10.3390/ijerph191911883
[10]	PENCEA I, MUNOZ A P, MAPLES-KELLER J L, et al. Emotion dysregulation is associated with increased prospective risk for chronic PTSD development[J]. J Psychiatr Res, 2020, 121: 222-228. doi: S0022-3956(19)30946-X pmid: 31865212
[11]	SHNAIDER P, BOYD J E, CAMERON D H, et al. The relationship between emotion regulation difficulties and PTSD outcomes during group cognitive processing therapy for PTSD[J]. Psychol Serv, 2021, 19(4): 751-759. doi: 10.1037/ser0000546 pmid: 34726458
[12]	HAYES J P, VANELZAKKER M B, SHIN L M. Emotion and cognition interactions in PTSD: a review of neurocognitive and neuroimaging studies[J]. Front Integr Neurosci, 2012, 6: 89.
[13]	PUGACH C P, CAMPBELL A A, WISCO B E. Emotion regulation in posttraumatic stress disorder (PTSD): rumination accounts for the association between emotion regulation difficulties and PTSD severity[J]. J Clin Psychol, 2019, 76(3): 508-525. doi: 10.1002/jclp.v76.3
[14]	EHRING T, EHLERS A. Does rumination mediate the relationship between emotion regulation ability and posttraumatic stress disorder?[J]. Eur J Psychotraumatol, 2014, 5(1): 23547. doi: 10.3402/ejpt.v5.23547
[15]	ZETSCHE U, EHRING T, EHLERS A. The effects of rumination on mood and intrusive memories after exposure to traumatic material: an experimental study[J]. J Behav Ther Exp Psychiatry, 2009, 40(4): 499-514. doi: 10.1016/j.jbtep.2009.07.001
[16]	MOULDS M L, BISBY M A, WILD J, et al. Rumination in posttraumatic stress disorder: a systematic review[J]. Clin Psychol Rev, 2020, 82: 101910. doi: 10.1016/j.cpr.2020.101910
[17]	LIND M J, BAYLOR A, OVERSTREET C M, et al. Relationships between potentially traumatic events, sleep disturbances, and symptoms of PTSD and alcohol use disorder in a young adult sample[J]. Sleep Med, 2017, 34: 141-147. doi: S1389-9457(17)30114-4 pmid: 28522083
[18]	严由伟, 刘明艳, 唐向东, 等. 压力反应、压力应对与睡眠质量关系述评[J]. 心理科学进展, 2010, 18(11): 1734-1746.
	YAN Y W, LIU M Y, TANG X D, et al. Review on the relationship between stress response, stress coping and sleep quality[J]. Adv Psychol Sci, 2010, 18(11): 1734-1746.
[19]	GERMAIN A, BUYSSE D J, NOFZINGER E. Sleep-specific mechanisms underlying posttraumatic stress disorder: integrative review and neurobiological hypotheses[J]. Sleep Med Rev, 2008, 12(3): 185-195. doi: 10.1016/j.smrv.2007.09.003 pmid: 17997114
[20]	杨廷忠. 社会转型中城市人群心理压力研究[J]. 中华流行病学杂志, 2002, 23(6): 473-474.
	YANG T Z. A study on the psychological stress of urban population in social transformation[J]. Chin J Epidemiol, 2002, 23(6): 473-474.
[21]	王力, 柳恒超, 杜卫, 等. 情绪调节困难量表在中国人群中的初步测试[J]. 中国健康心理学杂志, 2007, 15(4): 336-340.
	WANG L, LIU H C, DU W, et al. Test of Difficulties in Emotion Regulation Scale in Chinese people[J]. Chin J Health Psychol, 2007, 15(4): 336-340.
[22]	TREYNOR W, GONZALEZ R, NOLEN-HOEKSEMA S. Rumination reconsidered: a psychometric analysis[J]. Cognit Ther Res, 2003, 27(3): 247-259. doi: 10.1023/A:1023910315561
[23]	李建明. 睡眠状况自评量表(SRSS)简介[J]. 中国健康心理学杂志, 2012, 20(12): 1851.
	LI J M. Seff-rating Scale of Sleep (SRSS)[J]. Chin J Health Psychol, 2012, 20(12): 1851.
[24]	黄国平, 张亚林, 向慧, 等. 事件影响量表-修订版(IES-R)在女性犯人中的信度、效度分析[J]. 中国心理卫生杂志, 2006, 20(1): 28-31.
	HUANG G P, ZHANG Y L, XIANG H, et al. The Chinese version of the Impact of Event Scale-revised: reliability and validity[J]. Chin Mental Health J, 2006, 20(1): 28-31.
[25]	邓稳根, 黎小瑜, 陈勃, 等. 国内心理学文献中共同方法偏差检验的现状[J]. 江西师范大学学报(自然科学版), 2018, 42(5): 447-453.
	DENG W G, LI X Y, CHEN B, et al. Analysis on application of common methods bias test to psychological studies during recent five years in China[J]. J Jiangxi Normal Univy (Nat Sci), 2018, 42(5): 447-453.
[26]	项少茜, 周雪来, 金聪慧. 意外伤害导致骨科手术患者事件影响程度调查研究[J]. 中国卫生统计, 2022, 39(1): 115-117.
	XIANG S Q, ZHOU X L, JIN C H. Investigation on the degree of impact of accidents on orthopedic surgery patients[J]. Chin J Health Statistic, 2022, 39(1): 115-117.
[27]	CHERRY M L, WILCOX M M. Decreasing perceived and academic stress through emotion regulation and nonjudging with trauma-exposed college students[J]. Int J Stress Manag, 2020, 27(2): 101-110. doi: 10.1037/str0000138
[28]	GORI A, TOPINO E, MUSETTI A. The relationship among anxiety, worry, perceived stress, defense mechanisms, and high levels of post-traumatic stress symptoms: a discriminant analytic approach[J]. J Pers Med, 2023, 13(2): 237. doi: 10.3390/jpm13020237
[29]	ROOS L E, KNIGHT E L, BEAUCHAMP K G, et al. Acute stress impairs inhibitory control based on individual differences in parasympathetic nervous system activity[J]. Biol Psychol, 2017, 125: 58-63. doi: S0301-0511(17)30049-2 pmid: 28268165
[30]	MILLON E M, SHORS T J. How mental health relates to everyday stress, rumination, trauma and interoception in women living with HIV: a factor analytic study[J]. Learn Motiv, 2021, 73: 101680. doi: 10.1016/j.lmot.2020.101680
[31]	BASTA M, CHROUSOS G P, VELA-BUENO A, et al. Chronic insomnia and stress system[J]. Sleep Med Clin, 2007, 2(2): 279-291. doi: 10.1016/j.jsmc.2007.04.002 pmid: 18071579
[32]	NG R M K, BHUGRA D. Relationship between filial piety, meta-cognitive beliefs about rumination and response style theory in depressed Chinese patients[J]. Asian J Psychiatr, 2008, 1(2): 28-32. doi: 10.1016/j.ajp.2008.09.009 pmid: 23050992
[33]	MEI S, LIANG L, REN H, et al. Association between perceived stress and post-traumatic stress disorder among medical staff during the COVID-19 epidemic in Wuhan city[J]. Front Public Health, 2021, 9: 666460. doi: 10.3389/fpubh.2021.666460
[34]	BABSON K A, FELDNER M T. Temporal relations between sleep problems and both traumatic event exposure and PTSD: a critical review of the empirical literature[J]. J Anxiety Disord, 2010, 24(1): 1-15. doi: 10.1016/j.janxdis.2009.08.002 pmid: 19716676
[35]	GERMAIN A. Sleep disturbances as the hallmark of PTSD: where are we now?[J]. Am J Psychiatr, 2013, 170(4): 372-382. doi: 10.1176/appi.ajp.2012.12040432
[36]	LIU X, WEN X, ZHANG Q, et al. Buffering traumatic reactions to COVID-19: mindfulness moderates the relationship between the severity of the pandemic and posttraumatic stress symptoms[J]. Psychol Trauma, 2023, 15(3): 474-482. doi: 10.1037/tra0001227

变量	评分
知觉压力	23.91±9.35
情绪调节困难	80.92±21.79
沉思	20.16±6.41
睡眠	22.43±7.42
事件影响程度	28.51±18.89

变量	知觉压力	情绪调节困难	沉思	睡眠	事件影响程度
知觉压力	1
情绪调节困难	0.656^a	1
沉思	0.447^a	0.487^a	1
睡眠	0.539^a	0.585^a	0.447^a	1
事件影响程度	0.467^a	0.582^a	0.581^a	0.684^a	1

变量		整体拟合指数			回归系数显著性
结果变量	预测变量	R	R²	F	β	t值
事件影响程度		0.51	0.26	21.47^c
	性别				0.11	0.78
	年龄				0.29	2.68
	知觉压力				0.49	7.39^c
情绪调节困难		0.68	0.46	53.46^c
	性别				-0.08	-0.65
	年龄				0.30	3.27
	知觉压力				0.70	12.38^c
沉思		0.52	0.27	16.99^c
	性别				0.05	0.32
	年龄				-0.05	-0.48
	知觉压力				0.21	2.35^a
	情绪调节困难				0.35	4.09^c
睡眠		0.65	0.42	27.19^c
	性别				-0.08	-0.60
	年龄				0.22	2.24
	知觉压力				0.29	3.64^c
	情绪调节困难				0.30	3.85^c
	沉思				0.18	2.75^b
事件影响程度		0.77	0.59	44.41^c
	性别				0.17	1.53
	年龄				0.07	0.88
	知觉压力				-0.04	-0.55
	情绪调节困难				0.18	2.66^b
	沉思				0.30	5.37^c
	睡眠				0.45	7.26^c

项目	效应值	Boot标准误	95%CI		效应占比/%
项目	效应值	Boot标准误	下限	上限	效应占比/%
直接效应	-0.0385	0.0699	-0.1763	0.0993
总间接效应	0.5265	0.0694	0.3903	0.6633	100.00
间接效应1	0.1285	0.0503	0.0317	0.2287	24.41
间接效应2	0.0627	0.0317	0.0036	0.1287	11.91
间接效应3	0.1307	0.0428	0.0521	0.2205	24.82
间接效应4	0.0731	0.0249	0.0313	0.1287	13.88
间接效应5	0.0952	0.0311	0.0378	0.1612	18.08
间接效应6	0.0167	0.0112	0.0003	0.0426	3.17
间接效应7	0.0195	0.0092	0.0042	0.0400	3.70

Path analysis of mediating effect of perceived stress affecting impact of event in rehabilitation patients with traumatic injury

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 5

References 36

Related Articles 15

Metrics

Comments

Recommended 0

[1]	LUO Lihua, WANG Yusheng, LI Jianfeng, DONG Jige. Effect of early postoperative comprehensive rehabilitation on children and youth with supracondylar fracture of humerus complicated with ulnar nerve injury [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 105-110.
[2]	WANG Zihao, LI Xinhua, JIANG Huiping, GUO Sainan, LIANG Qiuman, SHI Tingqi. Short-term knee function after total knee arthroplasty and related factors [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 111-118.
[3]	GE Keke, FAN Yonghong, WANG Hangyu, DU Lilu, LI Changjiang, ZOU Min. Health benefit of mindfulness intervention for older adults with insomnia disorders: a systematic review [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 54-60.
[4]	CHEN Junwen, CHEN Qian, CHEN Cheng, LI Shuyue, LIU Lingling, WU Cunshu, GONG Xiang, LU Jun, XU Guangxu. Effect of modified Baduanjin exercise on cardiopulmonary function, motor function and activities of daily living for stroke patients [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 74-80.
[5]	SHI Jiawei, LI Lingyu, YANG Haojie, WANG Qinlu, ZOU Haiou. Effect of preoperative prerehabilitation training on total knee arthroplasty: a systematic review of systematic reviews [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(9): 1057-1064.
[6]	CAI Huanian, FEI Sixian, ZHANG Yichen, SUN Qing, GUO Shuai, SONG Tao. Motion assistance analysis for robot-assisted tele-rehabilitation based on bilateral admittance control [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(9): 1104-1109.
[7]	YI Qifeng, HUANG Zhuoer, YANG Guoli, XIE Lihua, XIE Shengfeng, WU Xiaoxia, YAN Jin. Development, and reliability and validity testing of a knowledge needs questionnaire of respiratory rehabilitation training for in-service healthcare workers [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 985-992.
[8]	LI Ziyi, SONG Weiqun, DU Jubao, CAO Guanglei, ZHANG Yanming, LI Ran. Effect of motor imagery on knee function after unicompartmental knee arthroplasty [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(7): 745-749.
[9]	REN Yi, WANG Rui, ZHANG Yaohua. Effect of proprioceptive neuromuscular facilitation combined with neuromuscular electrical stimulation on chronic ankle instability [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(7): 750-755.
[10]	LI Fang, HUO Su, DU Jubao, LIU Xiuzhen, LI Xiaoshuang, SONG Weiqun. Effect of transcranial direct current stimulation combined with task-oriented rehabilitation training on forelimb motor dysfunction in rats with spinal cord injury [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(7): 777-781.
[11]	WANG Jingxuan, LÜ Diyang, FANG Boyan. Non-drug rehabilitation for gait abnormality of Parkinson's disease: a review based on ClinicalTrials.gov [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(7): 816-821.
[12]	MA Tiantian, YU Zifu, QIN Fang, LENG Xiaoxuan, LIU Xihua. Application of constraint-induced movement therapy in the field of rehabilitation: a visualized analysis [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(7): 822-832.
[13]	TANG Qiang, ZHENG Shuang, WANG Lei, WANG Yan, LI Baolong, LIU Guijun, ZHU Luwen. Development of traditional Chinese medicine rehabilitation curriculum based on World Health Organization rehabilitation competency framework [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(7): 862-868.
[14]	WU Qianhao, HOU Rongjie, FU Liyuan. Pelvic floor rehabilitation domestic and abroad in the last decade: a visualized analysis [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(6): 673-685.
[15]	ZHAO Yaxian, TANG Zhiqing, SUN Xinting, WANG Rongrong, LIU Tianhao, ZHANG Hao. Effects of different intensity of wearable lower limb rehabilitation robot-assisted training on lower limb function after stroke [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(5): 497-503.