Du Juan, Wu Chao, Zheng Wen-Kai, Cui Sheng-Nan, Li Ling, Liu Zhuo, Gao Li, Heng Chun-Ni, Lang Hong-Juan
School of Nursing, the Fourth Military Medical University, Xi'an, 710032, China.
School of Basic Medicine, Inner Mongolia Medical University, Hohhot, 010110, China.
BMC Nurs. 2024 Apr 1;23(1):221. doi: 10.1186/s12912-023-01563-8.
The outbreak of Corona Virus Disease (COVID-19) in 2019 has continued until now, posing a huge threat to the public's physical and mental health, resulting in different degrees of mental health problems. As a vulnerable segment of the public, anxiety is one of the most common mental health problems among COVID-19 patients. Excessive anxiety aggravates the physical and psychological symptoms of COVID-19 patients, which is detrimental to their treatment and recovery, increases financial expenditure, affects family relations, and adds to the medical burden.
This study aimed to explore the role of psychological capital and self-esteem in the relationship between insomnia and anxiety, thereby shedding light on the mechanism of the effect of insomnia on anxiety in COVID-19 patients.
A cross-sectional study was conducted from April to May 2022 in Fangcang hospital in Shanghai, China. The self-administered questionnaires were distributed to 718 COVID-19 patients via cell phone using the Internet platform "Questionnaire Star", which included Athens Insomnia Scale, Psychological Capital Questionnaire, Self-esteem Scale, Self-Rating Anxiety Scale, gender, age, marital status, education. Data analysis was performed using descriptive analysis, independent-samples t-test, one-way analysis of variance, Pearson correlation analysis, ordinary least-squares regression, and bootstrap method.
Education background had significant impact on anxiety in COVID-19 patients (F = 7.70, P < 0.001). Insomnia, psychological capital, self-esteem and anxiety were significantly correlated, respectively (P < 0.001). And Regression analysis showed that insomnia had a direct negative predictive effect on psychological capital (β = -0.70, P < 0.001) and self-esteem (β = -0.13, P < 0.001). Psychological capital had a direct positive predictive effect on self-esteem (β = 0.12, P < 0.001). Insomnia had a direct positive predictive effect on anxiety (β = 0.61, P < 0.001). Both psychological capital and self-esteem had significant negative predictive effects on anxiety (β = -0.06, P < 0.05; β = -0.72, P < 0.001). The results showed that the mediating effect of psychological capital and self-esteem was significant, and the mediating effect value was 0.21. First, the indirect effect consisting of insomnia - psychological capital - anxiety was 0.04, showing that psychological capital had a significant mediating effect. Second, the indirect effect consisting of insomnia-self-esteem-anxiety had a value of 0.10, indicating that self-esteem had a significant mediating effect. Third, the indirect effect consisting of insomnia-psychological capital-self-esteem-anxiety had a value of 0.06, suggesting that psychological capital and self-esteem had a significant chain mediating effect between insomnia and anxiety.
Insomnia had a significant positive predictive effect on anxiety. Insomnia was first associated with a decrease in psychological capital, followed by a sequential decrease in self-esteem, which in turn was associated with increased anxiety symptoms in COVID-19 patients. Therefore, focusing on improving the psychological capital and self-esteem of patients can help alleviate the anxiety caused by insomnia in COVID-19 patients. It is recommended that patients and health care professionals increase the psychological capital and Self-esteem of COVID-19 patients through various methods to counter the effects of insomnia on anxiety.
2019年冠状病毒病（COVID-19）疫情持续至今，对公众身心健康构成巨大威胁，导致不同程度的心理健康问题。作为公众中的弱势群体，焦虑是COVID-19患者中最常见的心理健康问题之一。过度焦虑会加重COVID-19患者的身心症状，不利于其治疗和康复，增加经济支出，影响家庭关系，加重医疗负担。
本研究旨在探讨心理资本和自尊在失眠与焦虑关系中的作用，从而阐明失眠对COVID-19患者焦虑影响的机制。
2022年4月至5月在中国上海方舱医院进行了一项横断面研究。通过互联网平台“问卷星”以手机方式向718例COVID-19患者发放自填式问卷，问卷包括雅典失眠量表、心理资本问卷、自尊量表、自评焦虑量表、性别、年龄、婚姻状况、文化程度。采用描述性分析、独立样本t检验、单因素方差分析、Pearson相关分析、普通最小二乘法回归和Bootstrap法进行数据分析。
文化程度对COVID-19患者的焦虑有显著影响（F = 7.70，P < 0.001）。失眠、心理资本、自尊与焦虑分别显著相关（P < 0.001）。回归分析显示，失眠对心理资本（β = -0.70，P < 0.001）和自尊（β = -0.13，P < 0.001）有直接的负向预测作用。心理资本对自尊有直接的正向预测作用（β = 0.12，P < 0.001）。失眠对焦虑有直接的正向预测作用（β = 0.61，P < 0.001）。心理资本和自尊对焦虑均有显著的负向预测作用（β = -0.06，P < 0.05；β = -0.72，P < 0.001）。结果显示心理资本和自尊的中介效应显著，中介效应值为0.21。其一，由失眠-心理资本-焦虑构成的间接效应为0.04，表明心理资本有显著的中介作用。其二，由失眠-自尊-焦虑构成的间接效应值为0.10，表明自尊有显著的中介作用。其三，由失眠-心理资本-自尊-焦虑构成的间接效应值为0.06，表明心理资本和自尊在失眠与焦虑之间有显著的链式中介作用。
失眠对焦虑有显著的正向预测作用。失眠首先与心理资本降低相关，随后依次是自尊降低，这反过来又与COVID-19患者焦虑症状增加相关。因此，关注提高患者的心理资本和自尊有助于减轻COVID-19患者因失眠引起的焦虑。建议患者和医护人员通过多种方法提高COVID-19患者的心理资本和自尊，以应对失眠对焦虑的影响。
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