初入高原工作的医务人员不同应对方式与焦虑抑郁的关系以及心理弹性的中介作用

宋兵; 孙咏冰; 刘慧娟; 孙小坚; 郭佳佳; 王婉雪; 王新华

doi:10.16766/j.cnki.issn.1674-4152.002599

初入高原工作的医务人员不同应对方式与焦虑抑郁的关系以及心理弹性的中介作用

doi: 10.16766/j.cnki.issn.1674-4152.002599

1.
解放军总医院第五医学中心感染病医学部, 北京 100039
2.
解放军总医院第五医学中心新生儿科
3.
西南大学数学与统计学院, 重庆 400715
4.
北京大学医学部, 北京 100191

基金项目:

国家重点研发计划项目 2020YFC0860900

详细信息

通讯作者:
王新华, E-mail: 302wangxh@sina.com

中图分类号: R395.1 R749.92
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- 被引次数: 0
出版历程
- 收稿日期: 2021-11-29
- 网络出版日期: 2022-09-26

The relationship between coping style and anxiety and depression and the mediating effect of psychological elasticity in medical staff aiding at high altitude in the primary stage

1.
Department of Infectious Diseases Medicine, the Fifth Medical Center of PLA General Hospital, Beijing 100039, China

摘要

摘要: 目的探索赴高原执行任务的医务人员的不同应对方式、心理弹性和焦虑抑郁之间的关系以及心理弹性的中介效应。方法使用一般调查问卷、简易应对方式问卷(SCSQ)、心理弹性量表(CD-RISC)、医院焦虑抑郁量表(HADS)对2021年9-11月某医院赴高原执行任务的113名医务人员进行问卷调查。结果 (1) 经分析, 性别、学历和收入在焦虑水平上; 婚姻状态、收入水平在抑郁水平上; 学历和收入在应对方式上; 婚姻状态和收入在心理弹性得分上比较差异有统计学意义(均P < 0.05)。(2)应对方式与心理弹性之间呈正相关(r=0.390, P < 0.01), 与焦虑抑郁之间呈正相关(r=0.371, P < 0.01);心理弹性与焦虑抑郁之间呈正相关(r=0.206, P < 0.05)。其中, 焦虑与消极呈正相关(r=0.550, P < 0.01), 与积极、力量、坚韧呈负相关(r=-0.221, 0.257, -0.221;均P < 0.05);抑郁与积极、乐观、力量、坚韧呈正相关(r=0.425, 0.560, 0.696, 0.694;均P < 0.01)。验证心理弹性在应对方式与焦虑抑郁之间存在中介效应(P=0.001, R²=0.142)。其中, 心理弹性在积极应对与抑郁水平存在完全中介效应; 力量与坚韧在积极应对与焦虑水平存在部分中介效应。结论初入高原工作的医务人员存在焦虑、抑郁状态, 应对方式、心理弹性与焦虑抑郁之间有相关性, 心理弹性在应对方式与焦虑抑郁之间存在中介效应。
- 应对方式 /
- 心理弹性 /
- 焦虑 /
- 抑郁
Abstract: Objective To explore the coping style, the relationship between psychological resilience and anxiety and depression, and the mediating effect of psychological resilience among medical staff who perform tasks at plateau area. Methods A questionnaire survey was conducted among 113 medical staff who went to plateau areas to perform tasks, using general questionnaires, simple coping style questionnaire (SCSQ), connor-davidson resilience scale (CD-RISC) and hospital anxiety and depression scale (HADS). Results (1) There were differences in anxiety level among gender, educational background and income; There were differences in marital status and income level in depression level; There are differences in coping styles between education and income; There were significant differences in the scores of psychological elasticity between marital status and income (all P < 0.05).(2) There was a positive correlation between coping style and psychological elasticity (r=0.390, P < 0.01).There was a positive correlation between coping style and anxiety and depression (r=0.371, P < 0.01).There was a positive correlation between psychological elasticity and anxiety and depression (r=0.206, P < 0.05).Among them, anxiety was positively correlated with negativity (r=0.550, P < 0.01), and negatively correlated with positivity, strength and tenacity (r=-0.221, 0.257, -0.221, all P < 0.05).Depression was positively correlated with positivity, optimism, strength and tenacity (r=0.425, 0.560, 0.696, 0.694, all P < 0.01).It was proved that psychological resilience had a mediating effect between coping style and anxiety and depression (P=0.001, R²=0.142).Among them, psychological resilience had a complete mediating effect between positive coping and depression.Strength and tenacity had some mediating effects in the level of positive coping and anxiety. Conclusion There are anxiety and depression in medical staff who work at plateau area for the first time.There is a correlation between coping style, psychological elasticity and anxiety and depression; and psychological resilience has a mediating effect between coping style and anxiety and depression.
- Coping style /
- Resilience /
- Anxiety /
- Depression

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图 1 中介效应模型

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表 1 初入高原医务人员一般资料调查表

Table 1. General information questionnaire for medical staff newly admitted to plateau

项目	类别	例数	百分比(%)
性别	男性	82	72.5
	女性	31	27.5
年龄(岁)	18~25	11	9.7
	26~30	22	19.5
	31~40	61	54.0
	41~50	17	15.0
	＞50	2	1.8
婚姻	已婚	38	33.6
	未婚	75	66.4
学历	大专	54	47.8
	本科	40	35.4
	硕士	7	6.2
	博士	12	10.6
收入(元)	5 000以下	10	8.8
	5 000~10 000	52	46.1
	10 000~15 000	27	23.9
	15 000~20 000	19	16.8
	20 000以上	5	4.4

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表 2 初入高原医务人员SCSQ、CD-RISC及HADS的单因素分析(x ±s，分)

Table 2. Univariate analysis of SCSQ, CD-RISC and HADS in medical staff newly admitted to plateau(x ±s, scores)

项目	类别	人数	焦虑得分	抑郁得分	应对方式总分	心理弹性总分
性别	男性	82	9.80±0.52	16.39±0.33	59.80±1.02	63.35±1.71
	女性	31	13.55±0.53	15.61±0.47	63.32±1.23	59.39±1.96
t值			-4.652	1.321	-1.929	1.976
P值			0.002	0.275	0.056	0.052
学历	大专	54	8.41±0.60	15.76±0.43	57.50±1.22	64.85±2.34
	本科	40	12.55±0.67	16.62±0.45	62.78±1.23	60.75±1.95
	硕士	7	12.71±1.48	17.00±0.49	64.29±1.61	60.86±3.01
	博士	12	11.00±1.55	17.17±0.61	66.75±2.16	70.17±2.39
F值			7.551	0.810	6.215	1.559
P值			< 0.001	0.491	0.001	0.203
婚姻	未婚	38	9.95±0.85	15.61±0.54	57.92±1.20	61.61±2.51
	已婚	75	10.65±0.52	16.45±0.31	62.21±1.04	64.79±1.62
t值			1.220	-2.206	-1.607	-2.661
P值			0.230	0.033	0.116	0.011
年龄(岁)	18~25	11	9.09±1.24	16.27±0.78	58.91±2.03	65.09±4.20
	26~30	22	8.95±1.05	15.77±0.68	59.14±1.99	66.45±2.89
	31~40	61	11.11±0.65	16.34±0.42	61.03±1.21	63.34±2.01
	41~50	17	10.94±0.96	16.06±0.36	62.82±1.70	60.59±3.24
	＞50	2	8.00±0.00	15.50±0.50	63.50±0.50	64.00±1.00
F值			1.239	0.183	0.603	0.416
P值			0.299	0.947	0.661	0.797
收入(元)	5 000以下	10	9.90±1.14	13.30±0.88	50.60±2.33	48.20±3.93
	5 000~10 000	52	8.52±0.64	16.44±0.44	59.21±1.22	68.37±2.12
	10 000~15 000	27	13.26±0.81	16.41±0.56	62.74±1.36	59.19±2.56
	15 000~20 000	19	11.11±1.00	16.68±0.58	66.79±1.56	65.84±1.88
	20 000以上	5	9.40±2.09	15.80±0.74	63.80±1.28	62.80±4.08
F值			6.021	2.873	8.201	5.755
P值			< 0.001	0.026	< 0.001	< 0.001

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表 3 SCSQ、CD-RISC及HADS的相关性(r值)

Table 3. SCSQ, CD - RISC and HADS correlation (r value)

项目	应对方式	心理弹性
心理弹性	0.390^a
焦虑抑郁	0.371^a	0.206^b
注：^aP＜0.01，^bP＜0.05。

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表 4 SCSQ、CD-RISC及HADS各维度的相关性(r值)

Table 4. SCSQ, CD - RISC and HADS correlation of each dimension (r value)

项目	积极	消极	乐观性	力量性	坚韧性	焦虑
消极	0.128
乐观性	0.427^a	0.341^a
力量性	0.587^a	-0.033	0.656^a
坚韧性	0.493^a	-0.047	0.647^a	0.884^a
焦虑	-0.221^b	0.550^a	0.079	-0.257^a	-0.221^b
抑郁	0.425^a	0.147	0.560^a	0.696^a	0.694^a	0.049
注：^aP＜0.01，^bP＜0.05。

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表 5 SCSQ、CD-RISC、HADS的回归分析

Table 5. Regression analysis of SCSQ, CD-RISC and HADS

自变量	因变量	B	SE	β	t值	P值	R²
应对方式	焦虑抑郁	0.243	0.058	0.371	4.212	＜0.001	0.138
应对方式	心理弹性	0.649	0.145	0.390	4.461	＜0.001	0.152
心理弹性	焦虑抑郁	0.081	0.037	0.206	2.222	0.028	0.043
应对方式	焦虑抑郁(含协变量)	0.225	0.063	0.343	3.576	0.001	0.142

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表 6 SCSQ、CD-RISC与焦虑抑郁的多元线性回归分析

Table 6. Multiple linear regression analysis of SCSQ, CD-RISC and anxiety and depression

自变量	因变量	B	SE	β	t值	P值	R²
焦虑	积极	-0.239	0.060	-0.297	-3.948	< 0.001	0.049
	消极	0.493	0.063	0.588	7.831	< 0.001	0.303
抑郁	积极	0.205	0.043	0.413	4.776	< 0.001	0.181
	消极	0.048	0.045	0.094	1.085	0.280	0.022
乐观性	积极	0.169	0.036	0.390	4.732	＜0.001	0.182
	消极	0.131	0.037	0.291	3.534	0.001	0.116
力量性	积极	0.530	0.068	0.601	7.791	＜0.001	0.344
	消极	-0.102	0.071	-0.110	-1.432	0.155	0.001
坚韧性	积极	0.669	0.109	0.507	6.114	＜0.001	0.243
	消极	-0.155	0.114	-0.112	-1.355	0.178	0.002
焦虑	乐观性	0.147	0.176	0.079	0.839	0.403	0.006
	力量性	-0.235	0.084	-0.257	-2.804	0.006	0.066
	坚韧性	-0.135	0.056	-0.221	-2.384	0.019	0.049
抑郁	乐观性	0.640	0.090	0.560	7.114	< 0.001	0.313
	力量性	0.391	0.038	0.696	10.198	< 0.001	0.484
	坚韧性	0.261	0.026	0.694	10.147	< 0.001	0.481
焦虑	积极	-0.189	0.076	-0.235	-2.492	0.014	0.401
	消极	0.451	0.073	0.538	6.143	< 0.001
	乐观性	0.202	0.217	0.109	0.934	0.353
	力量性	-0.169	0.163	-0.185	-1.037	0.302
	坚韧性	0.008	0.101	0.014	0.082	0.014
抑郁	积极	0.001	0.041	0.002	0.019	0.985	0.544
	消极	0.085	0.039	0.164	2.153	0.034
	乐观性	0.038	0.116	0.033	0.329	0.743
	力量性	0.200	0.087	0.356	2.288	0.024
	坚韧性	0.137	0.054	0.364	2.524	0.013

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表 7 心理弹性在应对方式和焦虑抑郁中的中介效应

Table 7. Mediating effect of resilience on coping style and anxiety and depression

中介方程	系数c	系数a	系数b	系数c’	是否有中介效应	Sobel检验Z值
积极-乐观-焦虑	0.000	0.000	0.403	0.014	不显著	0.070
积极-力量-焦虑	0.000	0.000	0.006	0.014	部分中介效应
积极-坚韧-焦虑	0.000	0.000	0.019	0.014	部分中介效应
消极-乐观-焦虑	0.000	0.001	0.403	0.000	不显著	0.481
消极-力量-焦虑	0.000	0.155	0.006	0.000	不显著	0.605
消极-坚韧-焦虑	0.000	0.178	0.019	0.000	不显著	1.052
积极-乐观-抑郁	0.000	0.000	0.000	0.985	完全中介效应
积极-力量-抑郁	0.000	0.000	0.000	0.985	完全中介效应
积极-坚韧-抑郁	0.000	0.000	0.000	0.985	完全中介效应
消极-乐观-抑郁	0.280	0.001	0.000	0.034	不显著
消极-力量-抑郁	0.280	0.155	0.000	0.034	不显著
消极-坚韧-抑郁	0.280	0.178	0.000	0.034	不显著

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参考文献(24)

[1]	唐英, 党永进. 高原驻训部队官兵心理问题剖析及对策[J]. 解放军医药杂志, 2020, 32(1): 2, 117. https://www.cnki.com.cn/Article/CJFDTOTAL-HBGF202001001.htm TANG Y, DANG G J. Analysis and countermeasures of psychological problems of soldiers in Plateau training[J]. Medical & Pharmaceutical Journal of Chinese People's Liberation Army, 2020, 32(1): 2, 117. https://www.cnki.com.cn/Article/CJFDTOTAL-HBGF202001001.htm
[2]	谭天赐, 胡光丽, 张小远, 等. 临床医学研究生抑郁与焦虑状况与应对方式的关系[J]. 中国临床神经外科杂志, 2021, 26(2): 95-97. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGLC202102011.htm TAN T C, HU G L, ZHANG X Y, et al. Status of depression and anxiety in graduates of clinical medicine and its correlation with coping styles for depression and anxiety[J]. Chinese Journal of Clinical Neurosurgery, 2021, 26(2): 95-97. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGLC202102011.htm
[3]	苑杰, 尚翠华, 张蒙, 等. 2016年唐山市4所医院医护人员焦虑抑郁的影响因素及与心理弹性的关系[J]. 职业与健康, 2017, 33(21): 2918-2922. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYJK201721010.htm YUAN J, SHANG C H, ZHANG M, et al. Influencing factors of anxiety and depression among medical staff and its relationship with psychiatric resilience in 4 hospitals of Tangshan City in 2016[J]. Occupation and Health, 2017, 33(21): 2918-2922. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYJK201721010.htm
[4]	李品品. 医学生心理弹性与应对方式的相关研究[J]. 铜陵职业技术学院学报, 2018, 17(2): 8-10. https://www.cnki.com.cn/Article/CJFDTOTAL-TLZY201802003.htm LI P P. Correlation study on the psychological resilience and coping style of medical students[J]. Journal of Tongling Vocational & Technical College, 2018, 17(2): 8-10. https://www.cnki.com.cn/Article/CJFDTOTAL-TLZY201802003.htm
[5]	张建国, 陈艾彬, 刘瑛, 等. 某海军陆战队官兵心理健康状态及其与心理弹性、感觉加工敏感性和应对方式的关系[J]. 海军医学杂志, 2021, 42(4): 398-402. https://www.cnki.com.cn/Article/CJFDTOTAL-HJYX202104004.htm ZHANG J G, CHEN A B, LIU Y, et al. Mental health status of the marine corps personnel and its relationship with mental resilience, sensory-processing sensitivity and coping style[J]. Journal of Navy Medicine, 2021, 42(4): 398-402. https://www.cnki.com.cn/Article/CJFDTOTAL-HJYX202104004.htm
[6]	王婧, 邹宇, 刘芮寒, 等. 2型糖尿病病人自我效能、疾病感知和社会支持对心理弹性影响的路径分析[J]. 护理研究, 2018, 32(23): 3729-3732. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ201823020.htm WANG J, ZOU Y, LIU M H, et al. Path analysis of the effects of self-efficacy, disease perception and social support on psychological resilience in patients with type 2 diabetes mellitus[J]. Chinese Nursing Research, 2018, 32(23): 3729-3732. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ201823020.htm
[7]	宦佳丽, 顾永梅, 康小玲, 等. 多学科协作护理对脑卒中患者神经功能及主要照顾者心理弹性的影响[J]. 河北医药, 2021, 43(18): 2874-2877. https://www.cnki.com.cn/Article/CJFDTOTAL-HBYZ202118037.htm HUAN J L, GU Y M, KANG X L, et al. Effects of multidisciplinary collaborative nursing on neurological function of patients with cerenral stroke and the psychological elasticity of primary caregivers[J]. Hebei Medical Journal, 2021, 43(18): 2874-2877. https://www.cnki.com.cn/Article/CJFDTOTAL-HBYZ202118037.htm
[8]	张宇静, 邓海燕, 梁超. 妇科肿瘤焦虑抑郁现状调研及疏肝解郁法对其干预效果评估[J]. 蚌埠医学院学报, 2022, 47(1): 63-66, 70. https://www.cnki.com.cn/Article/CJFDTOTAL-BANG202201016.htm ZHANG Y J, DENG H Y, LIANG C. Investigation on the status quo of anxiety and depression of gynecological tumors and evaluation of the intervention effect of liver-soothing and depression-relieving method[J]. Journal of Bengbu Medical College, 2022, 47(1): 63-66, 70. https://www.cnki.com.cn/Article/CJFDTOTAL-BANG202201016.htm
[9]	梁艳, 杨惠敏, 赵杰刚, 等. 突发公共卫生事件下护理人员心理现状及其影响因素分析[J]. 河南医学研究, 2021, 30(20): 3652-3656. https://www.cnki.com.cn/Article/CJFDTOTAL-HNYX202120002.htm LIANG Y, YANG H M, ZHAO J G, et al. Analysis of psychological status and influencing factors of nursing staff in public health emergencies[J]. Henan Medical Research, 2021, 30(20): 3652-3656. https://www.cnki.com.cn/Article/CJFDTOTAL-HNYX202120002.htm
[10]	王阳, 温忠麟, 付媛姝, 等. 效性检验: 结构方程模型评价和测量不变性分析的新视角[J]. 心理科学进展, 2020, 28(11): 1961-1969. https://www.cnki.com.cn/Article/CJFDTOTAL-XLXD202011014.htm WANG Y, WEN Z L, GU Y S, et al. Equivalence testing: A new perspective on structural equation model evaluation and measurement invariance analysis[J]. Advances in Psychological Science, 2020, 28(11): 1961-1969. https://www.cnki.com.cn/Article/CJFDTOTAL-XLXD202011014.htm
[11]	温忠麟, 方杰, 沈嘉琦, 等. 新世纪20年国内心理统计方法研究回顾[J]. 心理科学进展, 2021, 29(8): 1331-1344. https://www.cnki.com.cn/Article/CJFDTOTAL-XLXD202108001.htm WEN Z L, FANG J, SHEN J Q, et al. A review of research on psychological statistics in China ' s mainland from 2001 to 2020[J]. Advances in Psychological Science, 2021, 29(8): 1331-1344. https://www.cnki.com.cn/Article/CJFDTOTAL-XLXD202108001.htm
[12]	汤丹丹, 温忠麟. 共同方法偏差检验: 问题与建议[J]. 心理科学, 2020, 43(1): 215-223. https://www.cnki.com.cn/Article/CJFDTOTAL-XLKX202001030.htm TANG D D, WEN Z L. Statistical approaches for testing common method bias: Problems and suggestions[J]. Journal of Psychological Science, 2020, 43(1): 215-223. https://www.cnki.com.cn/Article/CJFDTOTAL-XLKX202001030.htm
[13]	王兵兵, 闫红磊, 刘娇洁. 吉林省临床医务人员心理健康与职业倦怠情况分析[J]. 河北医药, 2021, 43(10): 1576-1580. https://www.cnki.com.cn/Article/CJFDTOTAL-HBYZ202110033.htm WANG B B, YAN H L, LIU J J. Analysis about the psychological health and occupation lassitude of clinical medical staff in Jilin province[J]. Hebei Medical Journal, 2021, 43(10): 1576-1580. https://www.cnki.com.cn/Article/CJFDTOTAL-HBYZ202110033.htm
[14]	刘贤俊, 占克斌. 医务人员焦虑、抑郁状况的研究概况[J]. 神经损伤与功能重建, 2018, 13(2): 90-91. https://www.cnki.com.cn/Article/CJFDTOTAL-GWKF201802012.htm LIU X J, ZHAN K B. Research overview of anxiety and depression in medical staff[J]. Neural Injury and Functional Reconstruction, 2018, 13(2): 90-91. https://www.cnki.com.cn/Article/CJFDTOTAL-GWKF201802012.htm
[15]	谢超, 宋剑英, 高风丽, 等. 周围性面瘫患者健康相关生命质量的研究及影响因素的调查[J]. 四川医学, 2021, 42(8): 788-793. https://www.cnki.com.cn/Article/CJFDTOTAL-SCYX202108007.htm XIE C, SONG J Y, GAO F L, et al. The status and influence factors of health-related quality of life in patients with peripheral facial paralysis[J]. Sichuan Medical Journal, 2021, 42(8): 788-793. https://www.cnki.com.cn/Article/CJFDTOTAL-SCYX202108007.htm
[16]	彭天元, 宋瑰琦, 范西真, 等. 新冠肺炎疫情期间某院住院医师规范化培训学员焦虑与抑郁水平调查分析[J]. 中华全科医学, 2022, 20(1): 92-94, 108. doi: 10.16766/j.cnki.issn.1674-4152.002285 PENG T Y, SONG G Q, FAN X Z, et al. Investigation and analysis of anxiety and depression status of residents standardised training student in a hospital during the COVID-19 pandemic[J]. Chinese Journal of General Practice, 2022, 20(1): 92-94, 108. doi: 10.16766/j.cnki.issn.1674-4152.002285
[17]	丁玲, 孙广胜, 张亿桥, 等. 急诊科护士工作压力、应对方式与焦虑抑郁水平的相关性分析[J]. 护理实践与研究, 2019, 16(8): 12-14. DING L, SUN G S, ZHANG Y Q, et al. Correlation analysis between work stress, coping style as well as anxiety and depression level among nurses in the emergency department[J]. Nursing Practice and Research, 2019, 16(8): 12-14.
[18]	曾巍, 陈亚岚, 钱小芳, 等. 心理弹性对畸胎引产孕产妇正念和焦虑、抑郁的中介作用[J]. 解放军护理杂志, 2017, 34(20): 25-28. https://www.cnki.com.cn/Article/CJFDTOTAL-JFHL201720008.htm ZENG W, CHEN Y L, QIAN X F, et al. The mediating role of psychological resilience for mindfulness and anxiety and depression among women in the pregnancy termination for fetal abnormality[J]. Nursing Journal of Chinese People ' s Liberation Army2017, 34(20): 25-28. https://www.cnki.com.cn/Article/CJFDTOTAL-JFHL201720008.htm
[19]	顾漪, 陈皞, 徐燕玲. 医务人员心理压力和应对方式的调查研究[J]. 中国临床医生杂志, 2020, 48(9): 1130-1132. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLYS202009046.htm GU Y, CHEN H, XU Y L. Investigation on psychological stress and coping style of medical staff[J]. Chinese Journal For Clinicians, 2020, 48(9): 1130-1132. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLYS202009046.htm
[20]	肖红, 王佳, 赵景平, 等. 某部高原军人心理弹性现状及其影响因素分析[J]. 解放军预防医学杂志, 2020, 38(9): 58-60. https://www.cnki.com.cn/Article/CJFDTOTAL-JYYX202009019.htm XIAO H, WANG J, ZHAO J P, et al. Current situation and influencing factors of mental resilience of soldiers in a plateau[J]. Journal of Preventive Medicine of Chinese People's Liberation Army, 2020, 38(9): 58-60. https://www.cnki.com.cn/Article/CJFDTOTAL-JYYX202009019.htm
[21]	张伟红, 梁学军, 甘景梨, 等. 高原官兵心理应激水平与觉察压力及应对方式的相关分析[J]. 实用医药杂志, 2020, 37(7): 577-579, 585. https://www.cnki.com.cn/Article/CJFDTOTAL-QEYY202007003.htm ZHANG W H, LIANG X J, GAN J L, et al. Relationship between coping style, perceived stress and psychological stress level of officers and soldiers at high altitude[J]. Practical Journal of Medicine & Pharmacy, 2020, 37(7): 577-579, 585. https://www.cnki.com.cn/Article/CJFDTOTAL-QEYY202007003.htm
[22]	杨国帅, 安花花, 闫保华, 等. 高原特战官兵情绪和认知偏向对心理应激的影响研究[J]. 西南国防医药, 2019, 29(7): 787-789. https://www.cnki.com.cn/Article/CJFDTOTAL-XNGF201907026.htm YANG G S, AN H H, YAN B H, et al. Study on effects of emotional and cognitive bias on psychological stress of special operational officers and soldiers at high altitude[J]. Medical Journal of National Defending Forces in Southwest China, 2019, 29(7): 787-789. https://www.cnki.com.cn/Article/CJFDTOTAL-XNGF201907026.htm
[23]	胡光涛, 陈许波, 杨柳, 等. 高原驻训军人抑郁情绪与心理应激、心理弹性的相关性[J]. 西南国防医药, 2019, 29(4): 485-487. https://www.cnki.com.cn/Article/CJFDTOTAL-XNGF201904031.htm HU G T, CHEN X B, YANG L, et al. Correlation of depression with psychological stress and resilience of soldiers stationed at high altitude[J]. Medical Journal of National Defending Forces in Southwest China, 2019, 29(4): 485-487. https://www.cnki.com.cn/Article/CJFDTOTAL-XNGF201904031.htm
[24]	赵力慧, 孙秋雪, 郭玉成, 等. 脑卒中患者领悟社会支持与抑郁间的中介效应及心理弹性的调节效应[J]. 解放军护理杂志, 2021, 38(9): 6-10. https://www.cnki.com.cn/Article/CJFDTOTAL-JFHL202109002.htm ZHAO L H, SUN Q X, GUO Y C, et al. Mediating effect between perceived social support and depression among stroke patients and the moderating effect of resilience[J]. Nursing Journal of Chinese People ' s Liberation Army, 2021, 38(9): 6-10. https://www.cnki.com.cn/Article/CJFDTOTAL-JFHL202109002.htm