| 摘要: |
| 目的 探究军医大学学员疲劳在负性情绪与倦怠间的中介效应。方法 采取随机抽样的方法，选择某军医大学临床医学专业五年制本科学员发放抑郁-焦虑-应激自评量表21（DASS-21）、多维疲劳问卷（MFI-20）和Maslach工作倦怠问卷（MBI），对学员的负性情绪、疲劳、倦怠情况进行调查。采用Pearson积差相关和多元分层回归分析各变量之间的关系；构建结构方程模型，采用Bootstrap检验进行中介效应分析。结果 发放问卷270份，回收有效问卷250份，回收率为92.6%。负性情绪3个维度（抑郁、焦虑、应激）得分均高于常模（P均<0.01）；疲劳各维度中体力疲劳得分高于常模（P<0.01），脑力疲劳、动力下降、活动减少3个维度得分均低于常模（P<0.05，P<0.01）；倦怠各维度中情绪衰竭和玩世不恭得分与常模比较差异无统计学意义，但低成就感得分高于常模（P<0.01）。负性情绪、疲劳、倦怠各维度均两两相关（P均<0.01）。多元分层回归分析结果显示，疲劳可以解释倦怠方差变异的53.3%（F=71.140，P<0.01），体力疲劳与脑力疲劳均对倦怠有正向预测作用（β=0.516，P<0.01；β=0.188，P<0.01）。在疲劳基础上，负性情绪可独立解释倦怠方差变异的1.9%（F=44.243，P<0.01）。焦虑、抑郁、应激可以解释倦怠方差变异的33.5%（F=42.333，P<0.01），其中抑郁与应激对倦怠均具有正向预测作用（β=0.236，P<0.01；β=0.258，P<0.05），在负性情绪基础上，疲劳可独立解释倦怠方差变异的21.7%（F=44.243，P<0.01），其中体力疲劳与脑力疲劳对倦怠有正向预测作用（β=0.423，P<0.01；β=0.166，P<0.01）。中介效应模型和Bootstrap检验结果显示，负性情绪能够通过疲劳间接影响倦怠[χ2=74.508，df=17，χ2/df=4.383，比较适配指数（CFI）=0.955，增值适配指数（IFI）=0.956，相对适配指数（RFI）=0.943，Tucker-Lewis指数（TLI）=0.926）]，疲劳的中介效应效果量为65.3%。结论 疲劳在负性情绪与倦怠之间起到部分中介作用，因此对高焦虑、高抑郁和高应激的军医大学学员应加强重视，积极采取有效手段，避免加重其疲劳、倦怠状态。 |
| 关键词: 军医大学学员 倦怠 情绪障碍 中介效应 |
| DOI：10.16781/j.0258-879x.2019.05.0554 |
| 投稿时间：2019-01-19修订日期：2019-04-22 |
| 基金项目:海军军医大学（第二军医大学）大学生创新能力培养基金（MS2016047）. |
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| Relationship between negative emotion and burnout of military medical university students: mediating effect of fatigue |
| YANG Liu1△,JIANG Wen-di1△,CAI Wen-peng2,DONG Wei2* |
(1. The Fourth Student Team, College of Basic Medical Sciences, Naval Medical University(Second Military Medical University), Shanghai 200433, China;
2. Department of Naval Aeronautic and Special Psychology, Faculty of Psychology, Naval Medical University(Second Military Medical University), Shanghai 200433, China
△Co-first authors.
* Corresponding author) |
| Abstract: |
| Objective To explore the mediating effect of fatigue on the relationship between negative emotion and burnout in military medical university students. Methods By random sampling, depression anxiety stress scale 21 (DASS- 21), multidimensional fatigue questionnaire (MFI-20) and Maslach burnout questionnaire (MBI) were used to investigate the negative emotion, fatigue and burnout of five-year undergraduates of clinical medicine in a military medical university. Pearson product moment correlation and multivariate hierarchical regression were used to analyze the relationships among different variables. Structural equation model was constructed and Bootstrap test was used to analyze the mediating effect.Results A total of 270 questionnaires were distributed, and 250 valid questionnaires were enrolled, with a response rate of 92.6%. The scores of three dimensions (depression, anxiety and stress) of negative emotion were significantly higher than the norm (all P<0.01). The score of physical fatigue was significantly higher than the norm (P<0.01), and the scores of mental fatigue, power loss and activity reduction were significantly lower than the norm (P<0.05, P<0.01). There were no differences between the scores of emotional exhaustion and cynicism and the norm, but the low achievement score was significantly higher than the norm (P<0.01). There were significant correlations between negative emotion, fatigue and burnout in all dimensions (all P<0.01). Multivariate hierarchical regression analysis showed that fatigue could explain 53.3% of variance variation of burnout (F=71.140, P<0.01). Both physical fatigue and mental fatigue had positive predictive effects on burnout (β=0.516, P<0.01; β=0.188, P<0.01). On the basis of fatigue, negative emotion could independently explain 1.9% of variance variation of burnout (F=44.243, P<0.01). Anxiety, depression and stress could explain 33.5% of the variation variance of burnout (F=42.333, P<0.01), and depression and stress had positive predictive effects on burnout (β=0.236, P<0.01; β=0.258, P<0.05). On the basis of negative emotion, fatigue could independently explain 21.7% of variance variation of burnout (F=44.243, P<0.01). Physical fatigue and mental fatigue had positive predictive effects on burnout (β=0.423, P<0.01; β=0.166, P<0.01). Mediation effect models and Bootstrap test results showed that negative emotion could indirectly affect burnout through fatigue (χ2=74.508, df=17, χ2/df=4.383, comparative fit index[CFI]=0.955, incremental fit index[IFI]=0.956, relative fit index[RFI]=0.943, Tucker-Lewis index[TLI]=0.926). The mediating effect of fatigue was 65.3%. Conclusion Fatigue plays a mediating role between negative emotion and burnout. The military medical students with high anxiety, depression and stress need more attention and effective measures should be adopted to avoid the aggravation of their fatigue and burnout. |
| Key words: military medical university students burnout mood disorders mediating effect |
