住培医师压力知觉对睡眠质量的影响:自我控制和焦虑情绪的链式中介作用

Effect of Perceived Stress on Sleep Quality in Resident Physicians: The Serial Mediation of Self-Control and Anxiety.

中文关键词:  住培医师  压力知觉  自我控制  焦虑情绪  睡眠质量

英文关键词:resident physician  stress perception  self-control  anxiety  sleep quality

中文摘要:

      【摘要】 背景 住培医师是睡眠质量问题的高风险人群，其睡眠质量问题发生率显著高于普通人群，严重损害其身心健康。压力知觉可能通过消耗自我控制资源、引发焦虑情绪等心理路径影响睡眠质量，此机制有待验证。目的 探讨自我控制和焦虑情绪在住培医师压力知觉与睡眠质量之间的中介作用，揭示压力知觉影响住培医师睡眠的具体心理机制，为制定有针对性的心理干预方案提供参考。方法 采用横断面调查，于2025年4月，选取阜阳市某医院第一至第三学年全体在培住培医师为研究对象（n=372）。采用压力知觉量表（CPSS）、自我控制双系统量表（DMSC-S）、匹兹堡睡眠指数量表（PSQI）和广泛性焦虑量表（GAD-7）进行团体施测。使用Process 4.1宏程序中的模型6考查自我控制和焦虑情绪在压力知觉与睡眠质量之间的作用路径。结果 共回收有效问卷322份，有效回收率为86.56%。检出146名（45.34%）住培医师存在睡眠质量问题。住培医师CPSS评分和GAD-7评分与PSQI评分均呈正相关（r=0.727、0.784，P均<0.01），DMSC-S评分与PSQI评分呈负相关（r=-0.615，P<0.01）。住培医师压力知觉可直接正向预测睡眠质量（B=0.124，t=4.035，P<0.01），直接效应占总效应 31.31%；同时可通过三条路径间接影响睡眠质量：一是自我控制的独立部分中介作用（间接效应值为0.054，占总效应13.64%）；二是焦虑情绪的独立部分中介作用（间接效应值为0.192，占总效应48.48%）；三是自我控制与焦虑情绪的链式中介作用（间接效应值为0.026，95% CI：0.005~0.049，P<0.01，占总效应的6.57%）。结论 住培医师的压力知觉可通过降低自我控制、升高焦虑情绪以及二者的链式作用路径影响睡眠质量。

英文摘要:

      【Abstract】 Background Resident physicians are a high-risk group for sleep disorders, exhibiting a significantly higher prevalence of such conditions compared to the general adult population, which severely impairs their physical and mental health. Perceived stress is hypothesized to detrimentally affect sleep quality through psychological mechanisms, such as depleting self-control resources and triggering anxiety; however, this pathway requires empirical validation. Objective This study examines the mediating effects of self-control and anxiety in the relationship between perceived stress and sleep quality among resident physicians. It aims to uncover the specific psychological mechanisms through which perceived stress influences sleep in this population, thereby providing a theoretical foundation for developing targeted psychological interventions. Methods In April 2025, a cross-sectional survey was conducted at a hospital in Fuyang City. Participants included 372 resident physicians in their first to third years of standardized residency training (PGY-1 to PGY-3). The Chinese Perceived Stress Scale (CPSS), the Dual-Mode of Self-Control Scale (DMSC-S), the Pittsburgh Sleep Quality Index (PSQI), and the Generalized Anxiety Disorder-7 item scale (GAD-7) were administered to the participants in group settings. The Bootstrap method was used for mediation analysis to examine the mediating roles of self-control and anxiety in the association between perceived stress and sleep quality. Results A total of 322 valid questionnaires were recovered, with an effective recovery rate of 86.56%. The prevalence of sleep disturbance (PSQI≥7) was 45.34% (n=146). CPSS score was positively correlated with GAD-7 and PSQI scores (r=0.727, 0.784, all P<0.01), and DMSC-S score was negatively correlated with PSQI score (r=-0.615, P<0.01). Perceived stress could directly and positively predict sleep quality (B=0.124, t=4.035, P<0.01), with the direct effect accounting for 31.31% of the total effect. Meanwhile, perceived stress affected sleep quality indirectly through three paths: first, the independent partial mediating effect of self-control (indirect effect=0.054, accounting for 13.64%); second, the independent partial mediating effect of anxiety (indirect effect=0.192, accounting for 48.48%); third, the serial mediating effect of self-control and anxiety (indirect effect=0.026, 95% CI:0.005–0.049, P<0.01, accounting for 6.57%). Conclusion The relationship between perceived stress and sleep quality is serially mediated by self-control and anxiety.