自我隐瞒对消防员创伤后应激反应的影响:经验回避和反刍的链式多重中介作用（英文）

Self-Concealment and Posttraumatic Stress Symptoms in Firefighters: The Serial Multiple Mediation of Experiential Avoidance and Rumination

人格特质和情绪调节策略是创伤后应激反应的重要影响因素。作为一种在个人感到痛苦时有意地向他人隐藏自身状况的人格特质,自我隐瞒会通过适应不良的情绪调节策略影响心理健康。然而,鲜有研究考察自我隐瞒、适应不良的情绪调节策略与创伤后应激反应的关系。对创伤后应激反应的情绪调节策略的研究发现,经验回避和反刍是两种有重要影响的适应不良的情绪调节策略。在创伤后应激反应的研究对象上,前人主要关注在创伤事件中幸存的直接受害者身上,而对频繁处理各类突发事件而成为创伤后应激反应高危人群的消防员一直缺乏研究。因此,本研究意在考察自我隐瞒对经历职业创伤的消防员创伤后应激反应的影响以及经验回避和反刍这两种适应不良的情绪调节策略的中介作用。研究被试为215名将个人经历的职业创伤作为首要创伤事件的一线消防员。他们来自我国3个城市,均为男性,平均年龄22.90±3.38岁。使用中文修订版的埃森创伤问卷、自我隐瞒量表、反刍反应量表、接受与承诺问卷第二版和事件影响量表进行现场调查。被试均匿名填写调查问卷。使用SPSS 20.0进行描述性统计和相关性分析。使用Mplus7.4进行结构方程模型的分析。采用Harman单因子检验的方法进行共同方法偏差检验。采用偏差矫正的百分位Bootstrap方法进行中介效应的显著性检验。结果表明,自我隐瞒、经验回避、反刍和创伤后应激反应之间存在两两显著正相关;自我隐瞒对创伤后应激反应具有直接效应;自我隐瞒通过反刍对创伤后应激反应产生间接效应;自我隐瞒通过经验回避-反刍的中介链对创伤后应激反应产生间接效应;自我隐瞒影响创伤后应激反应的总效应值为.427,其中总间接效应值为.217,占总效应值的50.82%。本研究还发现,64名(29.77%)将个人经历的职业创伤作为首要创伤事件的一线消防员达到了严重创伤后应激反应的水平。总之,自我隐瞒可以通过三条路径影响创伤后应激反应:直接影响、反刍的中介作用和经验回避-反刍的系列中介作用。在理论层面,这拓展了对影响创伤后应激反应的人格特质的理解和对自我隐瞒影响的心理健康状况的理解。在实践层面,这提示我们重视自我隐瞒、经验回避和反刍在预防和治疗创伤后应激反应中的潜在贡献。此外,本研究还发现,消防员确实是创伤后应激反应的高危人群。作为突发事件的第一响应人,消防员的心理健康应该得到更多关注与研究。

The susceptibility for posttraumatic stress symptoms(PTSS) appears to depend on individual personality traits and emotional regulation strategies. As a personality tendency to actively conceal from others personal information that is perceived as distressing, self-concealment can affect mental health through maladaptive emotion regulation processes. However, there is little research examining the links among self-concealment, maladaptive emotion regulation strategies, and PTSS. Alternatively, there is substantial empirical evidence supporting the effects of experiential avoidance and rumination on PTSS. Firefighters constituted a high-risk group for PTSS due to repeated exposure to traumatic events, but studies of PTSS have focused largely on the survivors of traumatic events while there is a paucity of research on firefighters. The object of this study was to investigate the effect of self-concealment on PTSS and the mediating effects of experiential avoidance and rumination in Chinese firefighters who experienced work-related trauma. This study included 215 male firefighters from 24 Fire Alarm squadrons in 3 large cities of Northern China(mean age ± standard deviation, 22.90 ± 3.38 years) who had experienced work-related trauma. Participants anonymously completed Chinese versions of the following self-report measures: Essen Trauma Inventory, Self-Concealment Scale, Nolen-Hoeksema Ruminative Responses Scale, Acceptance and Action QuestionnaireSecond Edition, and Impact of Event Scale-Revised. Correlation analyses were performed using SPSS 20.0. The path analysis model was tested using Mplus7.4. The Harman’s single factor was used to test whether there was a common method bias. The bias-corrected percentile bootstrap method was used to analyze multiple mediation effects.Correlation analysis revealed significant and positive correlations among self-concealment, experiential avoidance, rumination, and PTSS scale scores. Analysis of the structural equation model revealed that self-concealment can directly promote PTSS(total effect size =.427). There were two indirect paths from self-concealment to PTSS: the serial mediation by experiential avoidance and rumination, and mediation by rumination alone. The total indirect effect of self-concealment was.217, accounting for 50.82% of the total effect. In addition, 64(29.77%) firefighters who had experienced work-related trauma exhibited severe PTSS as measured by the Impact of Event Scale-Revised.In conclusion, self-concealment affects PTSS both directly as well as indirectly by rumination and through the serial mediation of experiential avoidance and rumination. Thus, while self-concealment is often used by survivors as a self-protective strategy for emotion regulation, it may actually prove harmful in the long-term. These findings expand our understanding of how personality traits influence PTSS susceptibility and of the damaging effects of self-concealment on mental health. Effective prevention and treatment of PTSS must address the underlying contributions of selfconcealment, experiential avoidance, and rumination. Further, this study found that firefighters are at high risk of PTSS. PTSS in firefighters warrants more intensive monitoring and research.