应激事件后认知失调和绝望感在亚临床抑郁、焦虑症状中的链式中介作用

The chained mediation role of cognitive dissonance and hopelessness in depressive and anxiety symptoms among subclinical individuals exposed to stressful events

中文关键词:  亚临床抑郁  亚临床焦虑  应激事件  心率变异性  认知失调

英文关键词:Subclinical depression  Subclinical anxiety  Stressful Events  Heart Rate Variability  Cognitive dissonance

中文摘要:

      背景　应激事件常导致个体出现抑郁、焦虑等负性情绪，增加疾病转化率，但现有研究对亚临床抑郁、焦虑人群的关注少，应激事件与亚临床抑郁、焦虑症状的关系及作用路径阐不明确。目的　探索应激事件后人群亚临床抑郁、焦虑的临床特征，探讨应激事件对亚临床抑郁、焦虑症状的影响机制，为应激背景下对个体负性情绪的早期识别和干预提供参考。方法　于2024年12月—2025年4月经首都医科大学附属北京安定医院及首都医科大学附属北京回龙观医院线上公众号招募80名亚临床抑郁、焦虑被试者（研究组）和80名健康被试者（对照组）。采用患者健康问卷抑郁量表（PHQ-9）、广泛性焦虑障碍量表（GAD-7）、生活事件量表（LES）、自杀意念自评量表（SIOSS）、功能失调性态度量表（DAS）和心率变异性（HRV）评估临床特征。采用Spearman相关分析考查各量表评分及HRV之间的相关性。采用Process 4.1中的模型6检验认知失调和绝望在应激事件和亚临床焦虑症状及亚临床抑郁症状之间的中介作用。结果 研究组PHQ-9、GAD-7、LES、SIOSS绝望维度、DAS评分均高于对照组（Z/t=10.294、9.197、4.659、6.918、3.517，P均<0.05），HRV数据中SDNN、RMSSD、NN50、pNN50、HF低于对照组（Z/t=-2.230、-2.884、-2.487、-2.306、-2.310，P均<0.05）。研究组GAD-7评分与LES评分、DAS评分、SIOSS绝望维度评分均呈正相关 （r=0.233、0.588、0.465，P均<0.05）；SIOSS绝望维度评分与DAS评分、LES评分呈正相关（r=0.309、0.432，P均<0.01）；DAS评分与LES评分呈正相关（r=0.393，P<0.01）。应激事件直接影响焦虑症状（β=0.307，95% CI：0.015~0.065，P<0.05），且通过认知失调（β=0.084，95% CI：0.025~0.157，P<0.01）和绝望感（β=0.207，95% CI：0.065~0.338，P<0.01）的链式中介作用间接影响焦虑症状，链式中介效应占总效应的7.29%（β=0.047，95% CI：0.005~0.099，P<0.01）。应激症状能直接影响抑郁症状（β=0.630，95% CI：0.060~0.115，P<0.01），但认知失调和绝望感的中介作用均不显著（均P＞0.05）。 结论 经历应激事件后，亚临床抑郁、焦虑群体的症状、认知功能、自主神经调节力均出现损害。应激事件可直接引发人群的亚临床焦虑症状，也可通过认知失调和绝望感的链式中介作用间接影响，但这一间接作用在亚临床抑郁症状的产生未表现出相同的影响。

英文摘要:

      Background Stressful events frequently induce negative emotions such as depression and anxiety in individuals, thereby increasing the rate of disease progression. However, researches have paid limited attention to subclinical depression and anxiety, and the relationship between stressful events subclinical depressive and anxiety symptoms, as well as the underlying pathways of their effects remain unclear. Objective To explore the clinical characteristics of subclinical depression and anxiety in individuals exposed to stressful events and investigate the mechanism of influences of stressful events through subclinical depressive and anxiety, and to provide a reference for the early identification and intervention of individuals with abnormal emotions exposed to stressful events. Methods A total of 80 participants with subclinical symptoms and 80 healthy controls were recruited between December 2024 and April 2025 through online public accounts of Beijing Anding Hospital, Capital Medical University, and Beijing Huilongguan Hospital, Capital Medical University. Patients’ Health Questionnaire Depression Scale-9 item, Generalized Anxiety Disorder 7-item scale, Life Events Scale, Self-rating Idea of Suicide Scale, Dysfunctional Attitudes Scale, and Heart Rate Variability were implemented to assess clinical characteristics. Subsequently, spearman correlation analysis was used to explore the correlations among clinical features, and Model 6 in SPSS Process 4.1 was employed to test the mediating roles of cognitive dissonance and hopelessness in the relationship between stressful events and subclinical depression and anxiety. Results Compared to the healthy control group, the subclinical group showed significant higher scores in PHQ-9, GAD-7, LES, SIOSS hopelessness and DAS (Z/t=10.294, 9.197, 4.659, 6.918,3.517, all P<0.05), and in terms of HRV parameters, SDNN, RMSSD, NN50, pNN50, and HF were significantly lower (Z/t=-2.230, -2.884, -2.487, -2.306, -2.310, all P<0.05). Within the subclinical group, GAD-7 was significantly positively correlated with LES, DAS, and SIOSS hopelessness (r= 0.233, 0.588, 0.465; all P<0.05). SIOSS hopelessness was significantly positively correlated with DAS and LES (r= 0.309, 0.432; all P<0.01). DAS was significantly positively correlated with LES (r= 0.393, P<0.01). Stressful events showed direct effect on anxiety symptoms (β=0.307, 95% CI:0.015-0.065, P<0.05), and a significant indirect effect through cognitive dissonance (β=0.084, 95% CI:0.025-0.157, P<0.01) and hopelessness (β=0.207, 95% CI:0.065-0.338, P<0.01) and their chain mediating effect. The chain mediating effect accounted for 7.29% of the total effect (β=0.047, 95% CI:0.005-0.099, P<0.01). Conclusion Exposed to stressful events, individuals with subclinical depression and anxiety exhibit impairments across emotional symptoms, cognition function, and autonomic nervous regulation. Stressful events can directly induce subclinical anxiety symptoms and can also exert an indirect effect through the serial mediation of cognitive dissonance and hopelessness. However, this indirect pathway did not demonstrate an equivalent effect on subclinical depressive symptoms.