首诊肺结节患者感知压力与睡眠质量的关系:焦虑抑郁的中介作用

Relationship between perceived stress and sleep quality in patients with initial diagnosis of pulmonary nodules:Mediating effect of anxiety and depression

目的:探讨焦虑抑郁在首诊肺结节患者感知压力与睡眠质量中的中介作用。方法:选取2020年10月至2023年10月电子科技大学医学院附属绵阳医院首诊肺结节患者410例为研究对象。分别采用医院焦虑抑郁量表(Hospital Anxiety and Depression Scale,HADS)、感知压力量表(Perceived Stress Scale,PSS)、匹兹堡睡眠质量指数(Pittsburgh Sleep Quality Index,PSQI)评估患者焦虑抑郁情绪、感知压力及睡眠质量。分析首诊肺结节患者HADS、PSS、PSQI评分之间的关系及焦虑抑郁在感知压力与睡眠质量中的中介作用。结果:410例首诊肺结节患者HADS焦虑、抑郁评分分别为12.36±3.28、10.97±3.05,PSS、PSQI评分分别为32.89±4.82、12.69±2.98。PSS与PSQI评分呈正相关(r=0.522,P<0.001),HADS焦虑、抑郁评分与PSS(r=0.591,r=0.613)、PSQI评分(r=0.293,r=0.326)均呈正相关(均P<0.05)。控制混杂因素后,HADS焦虑及抑郁评分可解释PSQI评分的46.6%、50.3%,引入PSS评分后,PSS评分可解释PSQI评分的55.9%。最终模型中不适症状、HADS焦虑及抑郁评分、PSS评分进入回归方程,上述影响因素可解释首诊肺结节患者PSQI的67.7%。感知压力可正向预测睡眠质量(β=0.436,P<0.001)。焦虑、抑郁可正向预测感知压力(β=0.574,P<0.001;β=0.496,P<0.001)。感知压力(β=0.299,P=0.006)、焦虑(β=0.396,P<0.001)、抑郁(β=0.445,P<0.001)对睡眠质量有正向预测作用,焦虑、抑郁在感知压力与睡眠质量之间起部分中介作用,中介效应占比分别为63.60%和64.79%。结论:首诊肺结节患者的感知压力既能直接影响患者睡眠质量,也可以通过焦虑抑郁间接影响患者睡眠质量,提示医护人员应该积极进行心理疏导,减轻患者感知压力及焦虑抑郁情绪,以改善患者的睡眠质量。

Objective:To explore the mediating effect of anxiety and depression in the relationship between perceived stress and sleep quality in patients with initial diagnosis of pulmonary nodules.Methods:A total of 410 patients with initial diagnosis of pulmonary nodules in the Mianyang Hospital Affiliated to School of Medicine,University of Electronic Science and Technology from October 2020 to October 2023 were selected as the study subjects.The Hospital Anxiety and Depression Scale(HADS),the Perceived Stress Scale(PSS),and the Pittsburgh Sleep Quality Index(PSQI)were used to evaluate the anxiety and depression mood,perceived stress,and sleep quality of the patients.The relationship between HADS,PSS,and PSQI scores in patients with initial diagnosis of pulmonary nodules and the mediating role of anxiety and depression on perceived stress and sleep quality were analyzed.Results:The HADS anxiety and depression scores of the 410 patients with initial diagnosis of pulmonary nodules were 12.36±3.28 and 10.97±3.05,respectively,while the PSS and PSQI scores were 32.89±4.82 and 12.69±2.98,respectively.PSS was positively correlated with PSQI scores(r=0.552,P<0.001),and HADS anxiety and depression scores were positively correlated with PSS(r=0.591,r=0.613)and PSQI(r=0.293,r=0.326)scores(all P<0.05).After controlling for confounding factors,HADS anxiety and depression scores explained 46.6%and 50.3%of PSQI scores,and PSS scores explained 55.9%of PSQI scores after introducing PSS scores.In the final model,discomfort symptoms,HADS anxiety and depression scores,and PSS scores were included in the regression equation,and these influencing factors explained 67.7%of PSQI in patients with initial diagnosis of pulmonary nodules.Perceived stress positively predicted sleep quality(β=0.436,P<0.001).Anxiety and depression positively predicted perceived stress(β=0.574,P<0.001;β=0.496,P<0.001).Perceived stress(β=0.299,P=0.006),anxiety(β=0.396,P<0.001),and depression(β=0.445,P<0.001)positively predicted sleep quality.Anxiety and depression partially mediated the relationship between perceived stress and sleep quality,with mediation effects accounting for 63.60%and 64.79%,respectively.Conclusion:Perceived stress in patients with initial diagnosis of pulmonary nodules can directly affect sleep quality and also indirectly affect sleep quality through anxiety and depression,suggesting that medical staff should actively provide psychological counseling to alleviate patients’perceived stress and anxiety and depression,thereby improving sleep quality.