失眠障碍和社会功能的关系:疲劳和抑郁情绪的链式中介作用

The relationship between insomnia disorders and social functioning:the chain mediating effects of fatigue and depression

目的 探讨失眠障碍对社会功能的影响,以及疲劳与抑郁情绪的链式中介作用。方法 采用便利抽样法,选取2022年2—8月在北京回龙观医院睡眠门诊就诊的131例失眠障碍患者为研究对象。采用匹兹堡睡眠质量指数(PSQI)、多维度疲乏量表(MFI-20)、患者健康问卷抑郁量表(PHQ-9)、席汉残疾量表(SDS)评估患者的失眠程度、疲劳情况、抑郁情绪、社会功能。采用Spearman相关分析患者社会功能、抑郁情绪、失眠障碍、疲乏之间的相关性。采用SPSSPROCESSV4.1插件中的模型6构建链式中介模型,并使用偏差矫正的非参数百分位Bootstrap法进行中介效应检验。结果 131例患者的SDS得分为(14.12±6.46)分,PHQ-9得分为(9.23±5.29)分,MFI-20总分为(57.97±11.82)分,PSQI得分为(15.74±4.89)分。相关分析结果显示,患者的社会功能、抑郁情绪、失眠、疲乏两两之间呈正相关(r=0.383~0.657,P<0.01)。中介效应分析显示,总效应值为0.736,失眠对社会功能存在直接效应,效应值为0.294,占总效应的39.95%;疲劳、抑郁情绪在失眠和社会功能之间均存在中介效应,效应值分别为0.266、0.089,分别占总效应的36.14%、12.09%;疲劳和抑郁情绪在失眠和社会功能之间存在链式中介效应,效应值为0.086,占总效应的11.68%。结论 失眠障碍患者的失眠情况会损害其社会功能,也会通过疲劳、抑郁情绪的链式中介作用间接损害其社会功能。

Objective To explore the effect of insomnia disorder on social function,and the chain mediation effect of fatigue and depression.Methods A total of 131 patients with insomnia disorder,who were treated in the sleep clinic of Beijing Huilongguan Hospital from February to August 2022,were recruited as the research objects by convenience sampling method.The insomnia level,fatigue status,depressive mood and social function of patients were assessed by Pittsburgh Sleep Quality Index(PSQI),the Multidimensional Fatigue Inventory-20(MFI-20),Patient Health Questionnaire-9(PHQ-9),Sheehan Disability Scale(SDS).Spearman correlation analysis was conducted to investigate the correlation among patients' social function,depressive mood,insomnia disorder and fatigue.The chain mediating model was constructed by Model 6 in SPSS PROCESS V4.1 plug-in.Non-parametric percentile Bootstrap method with deviation correction was used to test the significance of the mediation effect.Results The score of SDS was(14.12±6.46),PHQ-9(9.23±5.29),MFI-20(57.97±11.82),PSQI(15.74±4.89).The correlation analysis results showed that there was a positive correlation between patients' social function,depression,insomnia,and fatigue(r=0.383-0.657,P<0.01).The results of mediating effect showed that the total effect value was 0.736.Insomnia had a direct effect on social function,and the effect value was 0.294,accounting for 39.95% of the total effect.Fatigue and depression had a mediating effect between insomnia and social function,with effect value of 0.266 and 0.089,respectively,accounting for 36.14% and 12.09% of the total effect.Fatigue and depression had a chain mediating effect between depression and social function.The effect value was 0.086,accounting for 11.68% of the total effect.Conclusions The insomnia situation of patients with insomnia disorder can damage their social function,and it can also indirectly damage their social function through the chain mediating effect of fatigue and depression emotions.