认知歪曲和绝望感在应激事件与亚临床抑郁和焦虑症状之间的链式中介作用

Serial mediating roles of cognitive distortion and hopelessness in the associations of stressful life events with subclinical depressive and anxiety symptoms

中文关键词:  亚临床抑郁  亚临床焦虑  应激事件  认知歪曲

英文关键词:Subclinical depression  Subclinical anxiety  Stressful life events  Cognitive distortion

中文摘要:

      背景 应激事件常导致个体出现亚临床抑郁和焦虑症状，增加抑郁障碍和焦虑障碍的发生风险，但现有研究对亚临床抑郁、焦虑人群的关注较少，应激事件与亚临床抑郁、焦虑症状之间的关系及作用路径尚不明确。目的 探索应激事件后，亚临床抑郁、焦虑人群的临床特征，分析应激事件对亚临床抑郁、焦虑症状的影响机制，为应激背景下早期识别和干预个体的情绪症状提供参考。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和首都医科大学附属北京回龙观医院公众号招募80名亚临床抑郁和（或）焦虑者（研究组）及80名健康被试（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）及功能失调性态度量表（DAS）进行评定。采用Spearman相关分析考查研究组各量表评分之间的相关性。采用Process 4.1中的模型6检验认知歪曲和绝望感在应激事件与亚临床焦虑症状及亚临床抑郁症状之间的链式中介作用。结果 研究组和对照组最终完成研究者分别为72人、76人。研究组PHQ-9评分、GAD-7评分、LES评分、SIOSS绝望感维度评分、DAS评分均高于对照组（Z/t=10.294、9.197、4.659、6.918、3.517，P均<0.01）。研究组GAD-7评分与LES评分、DAS评分、SIOSS绝望感维度评分均呈正相关（r_s=0.233、0.465、0.588，P<0.05或0.01）；SIOSS绝望感维度评分与DAS评分、LES评分均呈正相关（r_s=0.393、0.309，P均<0.01）；DAS评分与LES评分呈正相关（r_s=0.432，P<0.01）。应激事件可直接影响亚临床焦虑症状（β=0.040，95% CI：0.015~0.065，P<0.05），也可以通过认知歪曲和绝望感的链式中介作用间接影响亚临床焦虑症状，中介效应值为0.006（95% CI：0.001~0.017，P<0.01），占总效应的7.15%。应激事件可直接影响亚临床抑郁症状（β=0.087，95% CI：0.060~0.115，P<0.01），但认知歪曲和绝望感在应激事件与亚临床抑郁症状之间的中介作用均无统计学意义（P均>0.05）。结论 经历应激事件后，亚临床抑郁、焦虑人群表现出更突出的认知歪曲与绝望感。应激事件既可以直接影响亚临床焦虑症状，也可以通过认知歪曲与绝望感的链式中介作用影响亚临床焦虑症状；应激事件可直接影响亚临床抑郁症状，但认知歪曲与绝望感的中介效应无统计学意义。

英文摘要:

      Background Stressful life events are associated with subclinical depressive and anxious symptoms， which may increase the risk of subsequent depressive and anxiety disorders. However， the mechanisms linking stressful life events to subclinical emotional symptoms remain unclear.Objective To explore the clinical characteristics of individuals with subclinical depression and anxiety following stressful events， and to analyze the mechanisms by which stressful events affect subclinical depressive and anxious symptoms， so as to provide a reference for the early identification and intervention of emotional symptoms in individuals under stress.Methods From December 2024 to April 2025， 80 individuals with subclinical depression and/or anxiety （study group） and 80 healthy controls were recruited via the online official accounts of Beijing Anding Hospital， Capital Medical University and Beijing Huilongguan Hospital， Capital Medical University. Participants completed the Patients' Health Questionnaire Depression Scale-9 item （PHQ-9）， the Generalized Anxiety Disorder Scale-7 item （GAD-7）， the Life Event Scale （LES）， the Self-rating Idea of Suicide Scale （SIOSS）， and the Dysfunctional Attitude Scale （DAS）. Spearman rank correlation analysis was used to examine the associations in the study group. Serial mediation analyses were conducted using model 6 of Process version 4.1， to test whether cognitive distortion and hopelessness mediated the associations of stressful life events with subclinical depressive and anxious symptoms.Results Compared with healthy controls， participants with subclinical depressive and anxious symptoms had higher scores on PHQ-9， GAD-7， LES， SIOSS hopelessness subscale， and DAS scores （Z/t=10.294， 9.197， 4.659， 6.918， 3.517， P<0.01）. In the study group， GAD-7 score was positively correlated with LES， DAS， and SIOSS hopelessness subscale scores （r_s=0.233， 0.465， 0.588， P<0.05）； SIOSS hopelessness subscale score was positively correlated with DAS and LES scores （r_s=0.393， 0.309， P<0.01） and cognitive distortion was positively correlated with stressful life events（r_s=0.432， P<0.01）. Stressful life events were directly associated with subclinical anxiety symptoms （β=0.040， 95% CI： 0.015–0.065， P<0.05）， and showed a significant serial indirect association with subclinical anxiety symptoms （indirect effect=0.006， 95% CI： 0.001–0.017， P<0.01）， accounting for 7.15% of the total effect. Stressful life associated with subclinical depressive symptoms （β=0.087， 95% CI： 0.060–0.115， P<0.01）， however， the indirect effect through cognitive distortion and hopelessness were not statistically significant.Conclusion After experiencing stressful events， individuals with subclinical depression and anxiety exhibit more pronounced cognitive distortions and hopelessness. Stressful events can both directly affect subclinical anxiety symptoms and indirectly affect them through the serial mediating effects of cognitive distortion and hopelessness. Stressful events have a direct effect on subclinical depressive symptoms， whereas the mediating effects of cognitive distortion and hopelessness are no statistically significant. ［Funded by the Training Program for the Development of High-level Public Health Technical Talents （number， Academic Leader-01-22）； www.chictr.org.cn number， ChiCTR2400093516］