Quintao Gaspar, Leite Noviyanti Carla Tilman, Pang Nicholas Tze Ping, Koh Eugene Boon Yau, Woo Jhia Mae, Sabri Marina Abdul Rahman, Wan Kah Mun, Hadi Noor Melissa Noor, Tan Ming Gui, Kamu Assis, Ho Chong Mun
Guido Valdarez National Hospital, Dili, Timor-Leste.
Pradet Timor Leste, Dili, Timor-Leste.
Discov Ment Health. 2025 Aug 7;5(1):116. doi: 10.1007/s44192-025-00253-y.
Mental health workers in post-conflict settings such as Timor Leste face distinct stressors stemming from limited human resources, underdeveloped systems, and ongoing socio-political instability, all of which increase the risk of psychological distress among these professionals. Consequently, constructs such as mindfulness, cognitive fusion, and coping strategies are essential not only theoretically significant, but also serve as practical targets for strengthening mental resilience of these professionals in these high-burden environments. This study aims to investigate the relationships between mindfulness, cognitive fusion, coping strategies, and psychological distress (depression, anxiety, and stress) among mental health workers in Timor Leste.
A cross-sectional study design was employed, involving a convenience sample of 37 mental health workers from PRADET and the national referral hospital in Dili. Mindfulness was assessed using the Toronto Mindfulness Questionnaire (TMQ), psychological flexibility using the Acceptance and Action Questionnaire (AAQ-II), cognitive fusion was measured using the Cognitive Fusion Questionnaire (CFQ), and coping strategies were evaluated using the DBT-Ways of Coping Checklist (DBT-WCCL). Depression, anxiety, and stress were measured using the Depression Anxiety Stress Scales (DASS-21). All scales were using English validated versions. Descriptive statistics, Pearson correlation coefficients, and multiple regression analyses were used to analyze the data.
Significant positive correlations were found between Depression and Anxiety (Spearman's rho = 0.649, p < 0.001), and between Depression and Stress (Spearman's rho = 0.753, p < 0.001). Depression was also significantly correlated with Cognitive Fusion (Spearman's rho = 0.445, p = 0.006) and Blaming Others (Spearman's rho = 0.422, p = 0.009), and negatively correlated with Coping Strategies (Skills Use) (Spearman's rho =- 0.341, p = 0.039). Anxiety and Stress were highly correlated (Spearman's rho = 0.855, p < 0.001), and both were significantly associated with Cognitive Fusion, General Dysfunctional Coping, and Blaming Others. Mindfulness (De-Centering) showed a strong positive correlation with Mindfulness (Curiosity) (Spearman's rho = 0.770, p < 0.001), and was also weakly associated with General Dysfunctional Coping (Spearman's rho = 0.343, p = 0.038). Overall, the results suggest that higher levels of depression, anxiety, and stress are linked to greater cognitive fusion and dysfunctional coping, while effective coping skills are negatively associated with depression.
The findings highlight the critical roles of cognitive fusion and coping strategies in predicting psychological distress among mental health workers in Timor Leste. Cognitive fusion and dysfunctional coping strategies were associated with higher levels of depression, anxiety, and stress. Adaptive coping strategies, such as skills use, were linked to lower levels of depression. Given the high risk of vicarious trauma, compassion fatigue, and secondary traumatic stress disorder in this population, targeted interventions promoting mindfulness and adaptive coping skills are essential. Addressing these factors can enhance resilience and well-being among mental health professionals, ultimately improving the quality of care provided to their clients.
在东帝汶等冲突后环境中的心理健康工作者面临着独特的压力源，这些压力源源于人力资源有限、系统不完善以及持续的社会政治不稳定，所有这些都增加了这些专业人员出现心理困扰的风险。因此，诸如正念、认知融合和应对策略等概念不仅在理论上具有重要意义，而且作为在这些高负担环境中增强这些专业人员心理韧性的实际目标。本研究旨在调查东帝汶心理健康工作者的正念、认知融合、应对策略与心理困扰（抑郁、焦虑和压力）之间的关系。
采用横断面研究设计，纳入了来自东帝汶心理创伤研究与培训项目（PRADET）和帝力国家转诊医院的37名心理健康工作者作为便利样本。使用多伦多正念问卷（TMQ）评估正念，使用接受与行动问卷（AAQ-II）评估心理灵活性，使用认知融合问卷（CFQ）测量认知融合，使用辩证行为疗法应对方式清单（DBT-WCCL）评估应对策略。使用抑郁焦虑压力量表（DASS-21）测量抑郁、焦虑和压力。所有量表均使用英文验证版本。采用描述性统计、Pearson相关系数和多元回归分析对数据进行分析。
抑郁与焦虑之间存在显著正相关（斯皮尔曼等级相关系数rho = 0.649，p < 0.001），抑郁与压力之间也存在显著正相关（斯皮尔曼等级相关系数rho = 0.753，p < 0.001）。抑郁还与认知融合（斯皮尔曼等级相关系数rho = 0.445，p = 0.006）和责备他人（斯皮尔曼等级相关系数rho = 0.422，p = 0.009）显著相关，与应对策略（技能运用）呈负相关（斯皮尔曼等级相关系数rho = -0.341，p = 0.039）。焦虑和压力高度相关（斯皮尔曼等级相关系数rho = 0.855，p < 0.001），且两者均与认知融合、一般功能失调性应对和责备他人显著相关。正念（去中心化）与正念（好奇心）呈强正相关（斯皮尔曼等级相关系数rho = 0.770，p < 0.001），与一般功能失调性应对也呈弱相关（斯皮尔曼等级相关系数rho = 0.343，p = 0.038）。总体而言，结果表明较高水平的抑郁、焦虑和压力与更大程度的认知融合和功能失调性应对相关，而有效的应对技能与抑郁呈负相关。
研究结果突出了认知融合和应对策略在预测东帝汶心理健康工作者心理困扰方面的关键作用。认知融合和功能失调性应对策略与较高水平的抑郁、焦虑和压力相关。适应性应对策略，如技能运用，与较低水平的抑郁相关。鉴于该人群中替代性创伤、同情疲劳和继发性创伤后应激障碍的高风险，针对性地促进正念和适应性应对技能的干预措施至关重要。解决这些因素可以增强心理健康专业人员的恢复力和幸福感，最终提高为其客户提供的护理质量。
