Pepe Alessandro, Cavazzoni Federica, Addimando Loredana, Jaradah Alaa, Obaid Hania, Veronese Guido
Department of Human Sciences and Education "Riccardo Massa", University of Milano-Bicocca, Milano, Italy.
Department of Human Sciences and Education "Riccardo Massa", University of Milano-Bicocca, Milano, Italy.
Lancet. 2021 Jul;398 Suppl 1:S44. doi: 10.1016/S0140-6736(21)01530-0.
Professional helpers working in adverse circumstances are at risk of developing psychosocial stress and signs of primary and secondary trauma (eg, anxiety and hyperarousal). We used modelling to investigate whether and to what extent personal resources (ie, post-traumatic growth, sense of coherence, and wellbeing) of Palestinian helpers affected their experience of psychological distress and trauma symptoms.
Eligible participants were professional health-care providers working in Gaza and the West Bank, occupied Palestinian territory, between June and October, 2018. We used the following quantitative measures: WHO Well Being Index (WHO-5), General Health Questionnaire (GHQ-12), Impact of Event Scale (IES-13), Sense of Coherence Scale (SOC-3), and Post-traumatic Growth Index (PTGI-10). Data were analysed by multivariate structural equation modelling with latent and empirical indicators to test the fit of these constructs to the empirical data. The model was specified to evaluate whether and to what extent mental resources may be interpreted as a set of protective factors mitigating risk factors. The study was approved by the ethics board of the University of Milano-Bicocca, Milan, Italy. Written consent was obtained from participants.
181 participants were enrolled, ranging in age from 18 to 65 years (mean 31·1, SD 8·7). 135 (75%) were men. The mean GHQ-12 score was 17·7 (SD 7·5), revealing a medium to high degree of psychological trauma. 60 (33%) participants reported low mood (although not necessarily depression) on WHO-5. The structural model showed an excellent fit (χ [24] 31·8, p=0·132, root mean square error of approximation 0·043, 90% CI 0·019-0·077). Stronger personal resources were associated with lower levels of both psychological distress (β=-0·25, p<0·01) and trauma (β=-0·16, p<0·01). Personal resources were especially associated with reduced levels of anxiety (β=-0·23, p<0·01) and intrusion symptoms (β=-0·22, p<0·01).
Our integrated model showed that, despite heavy psychological burden, perceptions of post-traumatic growth, coherence, and wellbeing are associated with reduced psychological distress. Targeted training of health-care providers focused on self-awareness of their personal skills and survival resources could improve their psychological health. The study was limited by the cross-sectional research design, and the outcomes of the structural model should be read in terms of probabilistic associations rather than cause-effect relationships. A second limitation concerns the kind of data collected. All the research instruments yielded self-reported quantitative scores, meaning that the standardised β weights in the model could potentially be an artifact of common method variance (ie, attributable to the measurement method rather than to the constructs themselves.
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在恶劣环境中工作的专业助人者有产生心理社会压力以及原发性和继发性创伤迹象（如焦虑和过度警觉）的风险。我们运用建模方法来研究巴勒斯坦助人者的个人资源（即创伤后成长、连贯感和幸福感）是否以及在多大程度上影响了他们的心理困扰和创伤症状体验。
符合条件的参与者为2018年6月至10月期间在巴勒斯坦被占领土加沙和西岸工作的专业医疗保健提供者。我们使用了以下定量测量方法：世界卫生组织幸福感指数（WHO-5）、一般健康问卷（GHQ-12）、事件影响量表（IES-13）、连贯感量表（SOC-3）和创伤后成长指数（PTGI-10）。通过具有潜在和实证指标的多变量结构方程建模对数据进行分析，以检验这些构念与实证数据的拟合度。该模型旨在评估心理资源是否以及在多大程度上可被解释为一组减轻风险因素的保护因素。该研究获得了意大利米兰比可卡大学伦理委员会的批准。参与者均签署了书面知情同意书。
共招募了181名参与者，年龄在18至65岁之间（平均31.1岁，标准差8.7岁）。其中135名（75%）为男性。GHQ-12的平均得分为17.7（标准差7.5），表明存在中度至高度的心理创伤。60名（33%）参与者在WHO-5上报告情绪低落（尽管不一定是抑郁）。结构模型显示拟合度极佳（χ[24]31.8，p = 0.132，近似均方根误差0.043，90%置信区间0.019 - 0.077）。更强的个人资源与较低水平的心理困扰（β = -0.25，p < 0.01）和创伤（β = -0.16，p < 0.01）相关。个人资源尤其与焦虑水平降低（β = -0.23，p < 0.01）和侵入性症状减少（β = -0.22，p < 0.01）相关。
我们的综合模型表明，尽管心理负担沉重，但对创伤后成长、连贯感和幸福感的认知与心理困扰的减轻相关。针对医疗保健提供者进行侧重于其个人技能和生存资源自我意识的定向培训，可能会改善他们的心理健康。该研究受限于横断面研究设计，结构模型的结果应从概率关联而非因果关系的角度来解读。第二个局限性涉及所收集数据的类型。所有研究工具均产生自我报告的定量分数，这意味着模型中的标准化β权重可能潜在地是共同方法方差的产物（即归因于测量方法而非构念本身）。
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