分析职业应激源及其应激心理反应对原发性高血压作用的路径

A path analysis of the effect of occupational stressor and its psychological stress reaction on essential hypertension among train staff

目的探讨慢性职业应激源及其应激心理反应作用于原发性高血压(EH)的过程,并初步构建应激性高血压职业应激作用的模式。方法选择某铁路分局工龄≥3年的在职男性,包括全部乘警和2个列车组的全部列车员,共403人为研究对象,采用结构方程模式(SEM)分析职业应激源、应激心理反应、焦虑、A型行为及高血压的常见危险因素对EH作用的路径。结果①职业应激源是各种心理生理等应激反应和焦虑等情绪障碍发生的诱因,通过引起心理应激反应和心理应激反应下的特质焦虑,间接对EH产生影响。②A型行为对EH影响最大,总效应为0.398,紧张反应和职业任务次之,总效应分别为0.336、0.271,焦虑影响最小,总效应为0.160。③A型行为对紧张反应的影响主要为直接效应,而对焦虑的影响既有直接影响,又有间接效应;对EH的作用,一方面表现独立的危险因素,另一方面通过紧张反应和焦虑的调节间接对EH产生影响;而紧张反应、特质焦虑对EH主要表现为直接影响。结论本研究表明,职业应激源、应激反应、中介因素间相互依存、相互作用的关系构建了慢性职业应激诱发原发性高血压可能的机制模型。

Objective To explore the process and effect of occupational stressor and its psychological stress reaction on essential hypertension（EH）,and to establish an initial mode of hypertension caused by occupational stress.Methods The study had 403 male participants that included 139 policemen and 264 train attendants with similar age,and had been employed by Fuzhou Railway Branch for at least 3 years.A structure equation model（SEM）was used to analyze the pathways that cause hypertension by occupational stressor,psychological stress reaction,anxiety,type A behavior and other common risk factors.Results Occupational stressor motivated various kinds of psycho-physiological stress reaction and emotional disorders such as anxiety,which together contributed to hypertension induction;Type A behavior was the most important risk factor of hypertension and had standardized effects（SE）of 0.398.The other significant risk factors included stress reaction（SE 0.336）,job responsibility（SE 0.271）and anxiety（SE 0.160）;Type A behavior could affect hypertension directly and indirectly.The later was done by activating stress reaction and anxiety.Conclusion The interdependent and interactive relationship among occupational stressor,psychological stress reaction and other mediator factors constructed the hypertension pathogenesis model induced by chronic occupational stress.