基于网络和移动的接受与承诺疗法干预对护士焦虑和抑郁症状的效果及机制：完全去中心化随机对照试验。

Effects and Mechanisms of a Web- and Mobile-Based Acceptance and Commitment Therapy Intervention for Anxiety and Depression Symptoms in Nurses: Fully Decentralized Randomized Controlled Trial.

机构信息

Department of Nursing Psychology, School of Nursing and Rehabilitation, Shandong University, Jinan, China.

School of Nursing, The University of Texas at Austin, Austin, TX, United States.

出版信息

J Med Internet Res. 2023 Nov 27;25:e51549. doi: 10.2196/51549.

DOI:10.2196/51549

PMID:38010787

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10714267/

Abstract

BACKGROUND

Acceptance and commitment therapy (ACT) is a promising intervention for improving mental health. However, there is limited evidence on its effectiveness for nurses, particularly in web- and mobile-based intervention forms, in mitigating anxiety and depression symptoms.

OBJECTIVE

In this study, we aimed to examine the effect and underlying psychological mechanisms of a web- and mobile-based ACT intervention on nurses' anxiety and depression symptoms.

METHODS

In this fully decentralized randomized controlled trial, nurses were recruited nationwide across China through advertisements and posters. They were randomly assigned to either the 5-week fully automated intervention or the waiting group. Primary outcomes (anxiety and depression symptoms); secondary outcomes (sleep quality, burnout, and work performance); and mediators (psychological flexibility, cognitive defusion, mindfulness, and values) were assessed using the Wenjuanxing platform. Data collectors were blinded to the group assignments throughout the study period.

RESULTS

A total of 145 nurses with anxiety or depression symptoms were randomly assigned to either the intervention group (n=72, 49.7%) or the control group (n=73, 50.3%); 97.2% (n=141) were female. During the study, 36 (24.8%) nurses were lost to follow-up, and 53 (73.6%) completed the entire intervention. Nurses in the intervention group showed significant improvement in anxiety (d=0.67, 95% CI 0.33-1.00) and depression symptoms (d=0.58, 95% CI 0.25-0.91), and the effects were sustained for 3 months after the intervention (anxiety: d=0.55, 95% CI 0.22-0.89; depression: d=0.66, 95% CI 0.33-1.00). Changes in psychological flexibility, cognitive defusion, and values mediated the effect of the intervention on anxiety and depression symptoms, while mindfulness did not have a mediating effect.

CONCLUSIONS

The web- and mobile-based ACT intervention used in this study significantly improved nurses' anxiety and depression symptoms by improving psychological flexibility, cognitive defusion, and values. The results provide new ideas for hospital administrators to prevent and intervene in nurses' psychological issues.

TRIAL REGISTRATION

Chinese Clinical Trial Register ChiCTR2200059218; https://tinyurl.com/4mb4t5y9.

摘要

背景

接受和承诺疗法（ACT）是一种改善心理健康的很有前途的干预措施。然而，针对护士群体的有效性证据有限，特别是在基于网络和移动的干预形式中，其对减轻焦虑和抑郁症状的效果证据有限。

目的

本研究旨在探讨基于网络和移动的 ACT 干预对护士焦虑和抑郁症状的效果及其潜在的心理机制。

方法

本完全去中心化随机对照试验通过广告和海报在全国范围内招募护士。他们被随机分配到 5 周的全自动干预组或等待组。主要结局（焦虑和抑郁症状）；次要结局（睡眠质量、倦怠和工作表现）；以及中介变量（心理灵活性、认知解离、正念和价值观）使用问卷星平台进行评估。在整个研究期间，数据收集者对分组情况保持盲态。

结果

共有 145 名有焦虑或抑郁症状的护士被随机分配到干预组（n=72，49.7%）或对照组（n=73，50.3%）；97.2%（n=141）为女性。在研究期间，有 36 名（24.8%）护士失访，有 53 名（73.6%）完成了整个干预。干预组的护士焦虑（d=0.67，95%CI 0.33-1.00）和抑郁症状（d=0.58，95%CI 0.25-0.91）显著改善，并且在干预后 3 个月仍能持续（焦虑：d=0.55，95%CI 0.22-0.89；抑郁：d=0.66，95%CI 0.33-1.00）。心理灵活性、认知解离和价值观的变化中介了干预对焦虑和抑郁症状的影响，而正念没有中介作用。