Skip to main content
NCBI home page
Journal of Central South University Medical Sciences logoLink to Journal of Central South University Medical Sciences
. 2025 Feb 28;50(2):281–289. [Article in Chinese] doi: 10.11817/j.issn.1672-7347.2025.240451

未来取向应对对医务人员抑郁的影响：心理弹性和压力知觉的链式中介作用

Impact of future-oriented coping on depression among medical staff: A chain mediation model involving psychological resilience and perceived stress

LIU Minghui 1,2, CHEN Xinyu 2, LU Qing 2, DONG Daifeng 2, ZHANG Yi 2, HU Muli 3, YAO Na 3,✉
Editor: 宋 柳
PMCID: PMC13345949  PMID: 40523771

Abstract

Objective

Depression is a common negative emotion that can significantly impact physical and mental health. Due to their occupational characteristics, medical staff are more susceptible to depression compared to the general population. This study aims to explore the influence of future-oriented coping on depression among medical staff and the mediating roles of psychological resilience and perceived stress, providing theoretical guidance for depression intervention strategies in this group.

Methods

A cross-sectional survey was conducted among medical staff at a tertiary hospital using convenience sampling. Data were collected via the “Wenjuanxing” platform. A total of 754 questionnaires were distributed; after excluding invalid responses (e.g., duplicate IPs or insufficient completion time), 655 valid questionnaires were retained (valid response rate: 86.87%). Instruments included a demographic questionnaire, the Future-Oriented Coping Scale, the Connor-Davidson Resilience Scale, the Perceived Stress Scale, and the Self-Rating Depression Scale. All scales demonstrated high internal consistency (Cronbach’s α>0.88) and validity. SPSS 27.0 was used for descriptive analysis, and PROCESS macro (Model 6) was used to test the chain mediation model. Harman’s one-factor test was applied to control for common method bias.

Results

Descriptive analyses showed that future-oriented coping was positively correlated with psychological resilience and negatively correlated with perceived stress and depression. Mediation analysis revealed that future-oriented coping significantly predicted lower depression levels among medical staff (β=-0.283, P<0.001). Psychological resilience partially mediated the relationship (effect size=-0.329, accounting for 34.13% of the total effect), as did perceived stress (effect size=-0.099, 10.27%). A significant chain mediation path was identified: “future-oriented coping → psychological resilience → perceived stress → depression” (effect size=-0.253, 26.24%). The total indirect effect accounted for 70.64% of the overall effect, highlighting the substantial role of the mediating pathways.

Conclusion

Future-oriented coping can reduce depressive symptoms in medical staff, with psychological resilience and perceived stress serving as key mediators in a chain structure. These findings suggest that enhancing future-oriented coping strategies and psychological resilience may improve stress adaptation and reduce depression levels in this population.

Keywords: depression, future-oriented coping, psychological resilience, perceived stress, medical staff

抑郁是一种常见的负面情绪，表现为情绪或心境的低落、兴趣减退，常伴有不同程度的思维迟缓、躯体不适等，持续的抑郁情绪将影响个体的身心健康，降低人们的生活质量和社会功能。面对高强度、高要求、高风险的工作环境，医务人员更容易出现负面情绪和心理健康问题，抑郁情绪的发生率也显著高于一般群体。对医务人员而言，抑郁情绪不仅会影响其自身的身心健康、降低其工作效率，还会对医疗安全构成潜在威胁[1]。

Lazarus的交互理论指出个体的应对方式在抑郁、焦虑等不良心理状态发生和发展过程中起重要作用[2]。未来取向应对是一种个体指向未来的、积极主动的应对方式。研究发现，未来取向应对方式具有自适应功能[3]，能够促进个体的健康发展，使个体在面临压力事件时能更好地进行情绪调节，降低负面情绪，促进适应性行为以应对压力事件[4]。面对未来的应对方式能负性预测个体的抑郁水平[5]。因此，本研究提出假设1：未来取向应对能负性预测医务人员的抑郁水平。

除应对能力外，个体对负性事件的调节和适应能力同样影响个体的心理健康。心理弹性(又称复原力)是指个体在面对逆境时能有效协调、适应或管理压力或创伤的能力[6]，是促进心理健康的重要因素。心理弹性作为一种保护机制，还可通过降低危险因素带来的负性影响，有效保护个体的身心健康[7]。已有研究表明，心理弹性与医务人员抑郁水平呈负相关[8]；心理弹性还能够作为治疗抑郁的潜在靶点，提升心理弹性的心理干预方案有助于预防和降低个体抑郁情绪[9]。此外，实证研究[10]发现，同样作为心理健康保护因素的未来取向应对与心理弹性呈显著正相关，个体的未来取向应对可以预测其心理弹性水平，即采取积极的未来取向应对方式的个体有更高的心理适应能力。因此，本研究提出假设2：心理弹性在未来取向应对预测医务人员的抑郁中发挥中介作用。

医务人员压力水平普遍较高。据统计，近70%的原发性抑郁是受压力的影响而产生的，压力在诱发抑郁中作用占比大于20%[11-12]。研究发现，对压力事件的主观感知即压力知觉，能正向预测医务人员的抑郁水平[13]，而积极的应对方式可通过影响压力知觉，降低其负面情绪[14]。已有研究发现，面向未来的应对方式预示着较低的压力易感性[5]，且医务人员的未来取向应对与压力知觉存在显著负相关[15]。未来取向应对方式能够调节工作压力和抑郁倾向之间的关系，未来取向应对高偏好者能够更好地应对工作压力，表现出较少的抑郁情绪[16]。因此，本研究提出假设3：压力知觉在未来取向应对预测医务人员抑郁中发挥中介作用。

此外，既往研究[17-18]还发现心理弹性会影响个体应对压力源的认知和反应。在人与环境的相互作用下，心理弹性作为一种保护机制，能够通过改变个体对环境中的压力事件的认知而降低其负面影响[19]；相反，心理弹性较差的个体则无法良好地适应压力事件，出现抑郁、焦虑等心理健康问题[20]。现有研究[21]发现，心理弹性在负性生活事件、压力知觉和抑郁之间起到中介作用。心理弹性对医务人员心理健康尤为重要，高心理弹性指向更低的压力知觉，而低心理弹性预示着医务人员的压力和职业倦怠水平更高、更易抑郁等[22-24]。因此，本研究提出假设4：心理弹性和压力知觉在未来取向应对预测医务人员抑郁中存在链式中介作用，即未来取向应对通过心理弹性降低医务人员压力知觉水平，最终影响抑郁水平。

综上，本研究旨在通过构建链式中介模型，探索未来取向应对方式对医务人员抑郁的影响及其机制，为降低医务人员抑郁水平，提升其心理健康水平提供参考。

1. 对象与方法

1.1. 伦理声明

本研究已获得中南大学湘雅二医院临床研究伦理委员会批准(审批号：LYEC2024-0245)。

1.2. 研究对象

本研究采用方便抽样的方法，在“问卷星”平台对某省三甲医院医务人员开展了线上问卷调查。共收回问卷754份，删除填写时间少于300 s及相同IP地址等无效问卷，最终得到有效问卷655份，有效问卷回收率为86.87%。

1.3. 研究工具

1.3.1. 一般情况调查表

采用自编一般资料收集表采集研究参与者的一般人口学资料，包括性别、年龄、工龄及婚姻状况等。

1.3.2. 未来取向应对量表

未来取向应对量表[25](Future-oriented Coping Inventory，FOCI)由预防应对和预先应对2个维度组成。量表共包括16个条目，采用5点计分，得分越高，表明个体更倾向于采用未来取向应对方式。在本研究中，FOCI的克龙巴赫α系数为0.912。

1.3.3. 心理弹性量表简版

心理弹性量表简版[26](10-item Connor-Davidson Resilience Scale，CD-RISC-10)共包括10个条目，采用5点计分，得分越高，表示心理弹性越强。在本研究中，CD-RISC-10的克龙巴赫α系数为0.948。

1.3.4. 压力知觉量表

采用Cohen等[27]编写的压力知觉量表(Perceived Stress Scale，PSS)，共10个条目，5级评分，其中6个条目属于“危机知觉”、4个条目为“应对能力知觉”。在本研究中，PPS的克龙巴赫α系数为0.880。

1.3.5. 抑郁自评量表

抑郁自评量表[28](Self-Rating Depression Scale，SDS)共包括20个条目，采用4点计分，得分越高，表示抑郁水平越高。在本研究中，SDS的克龙巴赫α系数为0.920。

1.4. 统计学处理

以未来取向应对为预测变量，抑郁作为结果变量，心理弹性和压力知觉为中介变量，控制性别、年龄、工龄以及婚姻状态的影响，采用SPSS 27.0 统计学软件中Hayes编写的PROCESS宏程序Model 6构建链式中介效应检验。P<0.05为差异/效应具有统计学意义。

采用Harman单因素检验法进行共同方差偏差检验。共同方法偏差检验结果显示，未旋转时共生成8个因子，第一个因子解释率为38.48%，小于40%的临界标准，表明不存在明显的共同方法偏差。

2. 结 果

2.1. 研究对象一般情况

研究对象平均年龄为34.39岁，平均工龄为10.04年；女性479人(73.1%)，男性176人(26.9%)；已婚477人(72.8%)，未婚161人(24.6%)，离异16人(2.4%)，丧偶1人(0.2%)。

2.2. 变量描述性统计和相关分析

所有研究参与者的未来取向应对、心理弹性、压力知觉和抑郁水平的得分分别为(57.974±8.163)、(36.815±6.420)、(26.844±5.756)和(46.748±11.673)。相关分析结果显示：未来取向应对与压力知觉(r=-0.580)及抑郁水平(r=-0.684)均呈显著负相关(均P<0.001)；未来取向应对与心理弹性呈显著正相关(r=0.790，P<0.001)；心理弹性与压力知觉呈显著负相关(r=-0.660，P<0.001)；压力知觉与抑郁水平呈显著正相关(r=0.733，P<0.001；表1)。

表1.

各变量相关分析表

Table 1 Correlation analysis among variables

变量 未来取向应对 心理弹性 压力知觉

抑郁

水平
未来取向应对 1
心理弹性 0.790*** 1
压力知觉 -0.580*** -0.660*** 1
抑郁水平 -0.684*** -0.737*** 0.733*** 1
Open in a new tab

***P<0.001。

2.3. 链式中介效应检验结果

回归分析结果如表2所示，未来取向应对正向预测心理弹性(β=0.617，t=32.367，P<0.001)，负向预测压力知觉(β=-0.115，t=-3.431，P=0.001)和抑郁 (β=-0.283，t=-5.346，P<0.001)；心理弹性负向预测压力知觉(β=-0.477，t=-11.177，P<0.001)和抑郁(β=-0.533，t=-7.315，P<0.001)；压力知觉正向预测抑郁(β=0.863，t=14.024，P<0.001)。

表2.

链式中介模型中各变量关系的回归分析

Table 2 Regression analysis of the relationships among variables in the chain mediation model

变量 心理弹性 压力知觉 抑郁
β t β t β t
常量 -0.016 -0.007 54.174*** 22.147 64.025 12.614***
性别 -0.367 -0.938 -0.408 -0.960 0.167 0.251
年龄 0.050 0.926 -0.045 -0.762 -0.206 -2.244
工龄 -0.013 -0.283 -0.026 -0.539 0.256** 3.377
婚姻 0.100 0.307 -0.475 -1.348 -0.158 -0.286
未来取向应对 0.617*** 32.267 -0.115** -3.431 -0.283*** -5.346
心理弹性 -0.477*** -11.177 -0.533*** -7.315
压力知觉 0.863*** 14.024
联合解释力 0.627 0.454 0.675
模型显著性 217.667*** 89.655*** 191.985***
Open in a new tab

**P<0.01，***P<0.001。

中介效应分析结果如表3所示，模型总效应值为-0.964，直接效应值为-0.283，占比29.36%，总间接效应值为-0.681，占比70.64%。心理弹性(效应值：-0.329，占比34.13%；SE=0.059；95% CI -0.447~-0.216)和压力知觉(效应值：-0.099，占比10.27%；SE=0.033；95% CI -0.164~-0.034)在未来取向应对和抑郁之间的中介效应显著。心理弹性和压力知觉在未来取向应对和抑郁之间的序列中介效应显著(效应值：-0.253，占比26.24%；SE=0.034；95% CI -0.321~-0.186)。链式中介效应模型图见图1。

表3.

中介效应检验的Bootstrap分析

Table 3 Bootstrap analysis of mediating effect test

中介效应 效应值 Boot SE Boot 95% CI 效应占比/%
上限 下限
总效应 -0.964 0.041 -1.045 -0.883 100.00
直接效应 -0.283 0.053 -0.386 -0.179 29.36
总间接效应 -0.681 0.060 -0.801 -0.564 70.64
未来取向应对→心理弹性→抑郁 -0.329 0.059 -0.447 -0.216 34.13
未来取向应对→压力知觉→抑郁 -0.099 0.033 -0.164 -0.034 10.27
未来取向应对→心理弹性→压力知觉→抑郁 -0.253 0.034 -0.321 -0.186 26.24
Open in a new tab

图1.

图1

Open in a new tab

心理弹性和压力知觉在医务人员未来取向应对与抑郁之间的链式中介效应

Figure 1 Chain mediating effect of resilience and stress perception on the relationship between future orientation coping and depression in healthcare workers

n=655; ***P<0.001.

3. 讨 论

本研究在控制了性别、年龄、工龄和婚姻状态的情况下，采用中介效应检验探究未来取向应对对医务人员抑郁水平的影响。结果显示，未来取向应对既可以直接影响医务人员的抑郁水平，还可通过心理弹性或压力知觉间接作用于抑郁，还可以通过未来取向应对→心理弹性→压力知觉的链式中介影响医务人员抑郁水平。

首先，未来取向应对可以负向预测医务人员的抑郁水平。医务人员心理健康问题普遍存在，尤其是在新型冠状病毒肺炎(COVID-19)感染疫情暴发之后，医务人员抑郁检出率大于20%[29-31]。目前，针对抑郁的发生和发展机制尚无定论，认知内容特异性假说认为面向未来的思维是焦虑、抑郁发生和发展的核心。本研究关注的未来取向应对，是个体指向未来的一种积极的、主动的应对方式[25]。研究[32-33]发现，未来取向应对方式可以正向预测个体的主观幸福感和正性情绪，负向预测个体的负性情绪。目前较少有研究直接探索医务人员未来取向应对方式与抑郁之间的关系，本研究为此提供了参考。且本研究结果与笔者前期研究[15]发现共同提示，指向未来的应对方式不仅能改善医务人员的压力、焦虑水平，还能负向预测抑郁水平，为医务人员抑郁的预防和缓解提供了干预靶点。

其次，本研究也发现未来取向应对降低医务人员抑郁水平可通过影响其心理弹性来实现。有学者将心理弹性定义为个体积极应对负面事件的过程[34]，强调心理弹性促进个体主动地、动态地适应压力的能力[35]。心理弹性动态模型指出心理弹性在保护因素和危险因素的相互作用下形成[36]。积极的应对方式正是心理弹性的保护因素[37]。积极的应对方式有助于缓冲危险因素对心理弹性的影响[38]。对医务人员而言，心理弹性可以缓解多种负性心理状态，心理弹性的提高能帮助个体应对负面情绪，降低抑郁水平。本研究结果提示未来取向应对方式作为心理弹性的保护因素，可能促进了个体心理弹性的正向发展，并以此降低医务人员的抑郁水平[39]。

同时，本研究发现压力知觉也是医务人员未来取向应对与抑郁之间的中介变量。本研究结果与前人研究[40]结果一致，即压力知觉是抑郁的预测因子，医务人员的压力主观感受越强，抑郁水平则越高。既往研究[32]表明压力知觉水平高的个体会采取更消极的应对方式，应对方式在压力知觉和消极情绪之间起中介作用。而本研究将压力知觉作为应对方式和消极心理结果之间的中介变量，发现在未来取向应对方式对抑郁的影响中，压力知觉起到了显著的中介作用，提示压力知觉和应对方式之间并非简单的单向关系，可能存在相互影响的双向关系。此外，研究也发现，积极应对方式是压力知觉的一个独立影响因素，个体的应对方式越积极，其感知到的压力强度就越低，负性情绪也越少[41]，提示未来取向应对作为一种积极应对方式具有心理接种效应，即高未来取向应对的个体在压力事件中能更好地处理与目标有关的冲突[16]，促进机体对压力源的良好适应；同时，未来取向应对的时间序列模型指出，在压力事件的不同时期，个体采取的未来取向应对方式不同，个体会根据压力事件的距离远近调整对未来的应对方式(预防应对或预先应对)[42]。针对医务人员的研究[15]也指出，采用未来取向应对的个体能更好应对潜在压力，表现出更少的消极情绪。结合本研究结果，提示未来取向应对可能通过影响个体对压力的认知和应对，从而影响个体的压力知觉水平，进而影响其抑郁水平。

最后，本研究建立的链式中介模型发现未来取向应对通过正向影响医务人员的心理弹性，随之影响其压力知觉水平，最终影响抑郁。心理应激理论模型指出，负面情绪的产生会经历应激源、应激中间变量和应激反应一系列过程，即个体在经历应激事件后，受生理、心理社会因素的影响，最终导致适应或适应不良的不同结局[43]。研究指出，作为应激的中间变量—压力知觉长期存在时，会导致抑郁的出现[44]；而心理弹性被认为是应激中间变量的保护因素，能提升个体在应激事件后的情绪调节能力和复原能力，即高心理弹性的个体，在应激事件后感知到的压力较小，能更快的从逆境中恢复[45]。脑机制研究也佐证了这一观点，研究发现，受到威胁时，低心理弹性个体的岛叶对厌恶和中性图片表现出长时间的激活，而高心理弹性的个体仅对厌恶性图片表现出岛叶的激活，且高心理弹性的个体在受到负性威胁激活后能更快地恢复到正常水平[46]；电刺激眶额叶皮质可以提高心理弹性水平[47]，而眶额叶皮质可能通过对负面刺激的重新评估来调节负性情绪[48]。以上研究提示，在面对应激事件时，心理弹性可能影响个体对威胁事件的评估和恢复，提示高心理弹性的个体可能知觉到的压力更小，并且能更快恢复，避免了机体长期处于高压力和负性情绪状态。因此，心理弹性作为应激中介变量可能通过作用于医务人员的压力感知水平从而影响其抑郁水平。

综上所述，本研究结果表明未来取向应对方式可负向预测医务人员抑郁情绪，而链式中介模型揭示了其潜在的心理机制，即未来取向应对作为一种积极的应对方式，为医务人员的心理弹性提供了保护，而高心理弹性又避免个体知觉到过多的压力或持久处于压力中，从而缓解医务人员的抑郁水平。该研究结果为医务人员的抑郁预防与干预提供了靶点，如以未来取向应对为靶点的未来导向心理疗法(future directed therapy，FDT)强调培养个体专注于未来的思维方式和应对未来风险事件的技能，提高个体对未来的积极期望，从而减轻负面情绪[49]。而具体到医务人员的FDT干预，应结合其工作特点模拟关于未来的情境，指导医务人员制定和演练未来的计划，以此提高其对未来的积极期望，从而改善抑郁。同时，本研究结果也指出了心理弹性作为抑郁干预靶点的可能性，而认知行为疗法、接纳承诺疗法、正念减压疗法等均可提高个体的心理弹性能力[50-52]。此外，从管理者层面而言，可通过全媒体不断优化医务人员工作环境，加大心理健康的宣传普及，强化医务人员压力应对策略和技能；提升其抗压能力；畅通医务人员情绪疏导和压力释放渠道，缓解其负性情绪和心理问题，从而全面促进医务人员身心健康。

基金资助

湖南省哲学社会科学基金(2023JD002)；湖南省社科评审委项目(XSP24YBZ047)。This work was supported by the Philosophy and Social Science Foundation of Hunan Province (2023JD002) and the Project of Social Science Evaluation Committee of Hunan Province (XSP24YBZ047), China.开放获取(Open access)：本文遵循知识共享许可协议，允许第三方用户按照署名-非商业性使用-禁止演绎4.0(CC BY-NC-ND 4.0)的方式，在任何媒介以任何形式复制、传播本作品(https://creativecommons.org/licenses/by-nc-nd/4.0/)。

利益冲突声明

作者声称无任何利益冲突。

作者贡献

刘明辉 研究设计，文献收集，数据收集，论文构思与撰写；陈欣雨、陆清 数据采集、统计与分析，论文修改；董戴凤、胡牡丽 数据统计与分析；张逸、姚娜 研究设计，论文构想、审阅与修订。所有作者阅读并同意最终的文本。

Footnotes

http://dx.chinadoi.cn/

原文网址

http://xbyxb.csu.edu.cn/xbwk/fileup/PDF/202502281.pdf

参考文献

  • 1. 陈丽红, 赵卓, SenSrijan, 等. 住院医师培训期间抑郁的发展和相关因素: 一项前瞻性队列研究[J]. 中国临床心理学杂志, 2021, 29(5): 1019-1022, 942. 10.16128/j.cnki.1005-3611.2021.05.025. [DOI] [Google Scholar]; CHEN Lihong, ZHAO Zhuo, SEN S, et al. Residents depression development trends and influencing factors: a prospective cohort study[J]. Chinese Journal of Clinical Psychology, 2021, 29(5): 1019-1022, 942. 10.16128/j.cnki.1005-3611.2021.05.025. [DOI] [Google Scholar]
  • 2. Folkman S, Lazarus RS, Gruen RJ, et al. Appraisal, coping, health status, and psychological symptoms[J]. J Pers Soc Psychol, 1986, 50(3): 571-579. 10.1037//0022-3514.50.3.571. [DOI] [PubMed] [Google Scholar]
  • 3. Gan Y, Miao M, Zheng L, et al. Temporal doppler effect and future orientation: adaptive function and moderating conditions[J]. J Pers, 2017, 85(3): 313-325. 10.1111/jopy.12242. [DOI] [PubMed] [Google Scholar]
  • 4. Zheng L, Chen Y, Gan Y. Future orientation helps regulate emotion in the future[J]. J Appl Soc Psychol, 2021, 51(9): 920-926. 10.1111/jasp.12811. [DOI] [Google Scholar]
  • 5. Serrano C, Andreu Y, Greenglass E, et al. Future-oriented coping: Dispositional influence and relevance for adolescent subjective wellbeing, depression, and anxiety[J]. Pers Individ Differ, 2021, 180: 110981. 10.1016/j.paid.2021.110981. [DOI] [Google Scholar]
  • 6. Luthar SS, Cicchetti D, Becker B. The construct of resilience: a critical evaluation and guidelines for future work[J]. Child Dev, 2000, 71(3): 543-562. 10.1111/1467-8624.00164. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7. Emirza S, Kozcu GY. Protecting healthcare workers’ mental health against COVID-19-related stress: The effects of stress mindset and psychological resilience[J]. Nurs Health Sci, 2023, 25(2): 216-230. 10.1111/nhs.13018. [DOI] [PubMed] [Google Scholar]
  • 8. 王礼申, 蔡瑶瑶. 生活满意度在医护人员心理弹性与抑郁关系中介作用[J]. 中国职业医学, 2021, 48(2): 177-181. 10.11763/j.issn.2095-2619.2021.02.011. [DOI] [Google Scholar]; WANG Lishen, CAI Yaoyao. The mediating role of life satisfaction in relationship between mental resilience and depression in medical staffs[J]. China Occupational Medicine, 2021, 48(2): 177-181. 10.11763/j.issn.2095-2619.2021.02.011. [DOI] [Google Scholar]
  • 9. Chen N, Xi J, Fan X. Correlations among psychological resilience, cognitive fusion, and depressed emotions in patients with depression[J]. Behav Sci (Basel), 2023, 13(2): 100. 10.3390/bs13020100. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10. 陈琼, 张玮琦, 王长福, 等. 信任在受艾滋病影响儿童心理弹性与未来取向间的中介作用[J]. 中国特殊教育, 2017(7): 91-96. [Google Scholar]; CHEN Qiong, ZHANG Weiqi, WANG Changfu, et al. The intermediary role of trust in the relationship between psychological resilience and future orientations in children affected by HIV/AIDS[J]. Chinese Journal of Special Education, 2017(7): 91-96. [Google Scholar]
  • 11. Hammen C. Stress and depression[J]. Annu Rev Clin Psychol, 2005, 1: 293-319. 10.1146/annurev.clinpsy.1.102803.143938. [DOI] [PubMed] [Google Scholar]
  • 12. Monroe SM, Harkness KL. Life stress, the “kindling” hypothesis, and the recurrence of depression: considerations from a life stress perspective[J]. Psychol Rev, 2005, 112(2): 417-445. 10.1037/0033-295X.112.2.417. [DOI] [PubMed] [Google Scholar]
  • 13. Li P, Liang Z, Yuan Z, et al. Relationship between perceived stress and depression in Chinese front-line medical staff during COVID-19: a conditional process model[J]. J Affect Disord, 2022, 311: 40-46. 10.1016/j.jad.2022.05.064. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14. 陈文雅, 王海城, 赵民. 儿童期虐待与大学生快感缺失的关系: 积极应对方式和压力知觉的链式中介作用[J]. 中国健康心理学杂志, 2023, 31(11): 1690-1695. 10.13342/j.cnki.cjhp.2023.11.017. [DOI] [Google Scholar]; CHEN Wenya, WANG Haicheng, ZHAO Min. Relationship between childhood maltreatment and anhedonia in college students: a chain mediation of active coping styles and stress perception[J]. China Journal of Health Psychology, 2023, 31(11): 1690-1695. 10.13342/j.cnki.cjhp.2023.11.017. [DOI] [Google Scholar]
  • 15. 袁东玲, 吴佳玲, 胡牡丽, 等. 压力知觉对医务人员焦虑水平的影响: 复合式多重中介模型[J]. 中国临床心理学杂志, 2022, 30(4): 814-819. 10.16128/j.cnki.1005-3611.2022.04.012. [DOI] [Google Scholar]; YUAN Dongling, WU Jialing, HU Muli, et al. Effects of perceived stress on anxiety levels in medical staff: a composite multiple mediation model[J]. Chinese Journal of Clinical Psychology, 2022, 30(4): 814-819. 10.16128/j.cnki.1005-3611.2022.04.012. [DOI] [Google Scholar]
  • 16. 郑磊, 甘怡群. 未来取向的情绪调控效应[C]// 第二十届全国心理学学术会议—心理学与国民心理健康摘要集. 重庆, 2017: 110. [Google Scholar]
  • 17. Jo S, Kurt S, Bennett JA, et al. Nurses’ resilience in the face of coronavirus (COVID-19): an international view[J]. Nurs Health Sci, 2021, 23(3): 646-657. 10.1111/nhs.12863. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18. 刘霞, 翁金华, 王月琴. 南昌市助产士职业认同现状及与心理弹性和知觉压力的相关分析[J]. 职业与健康, 2024, 40(21): 2960-2963. 10.13329/j.cnki.zyyjk.2024.0545. 37066983 [DOI] [Google Scholar]; LIU Xia, WENG Jinhua, WANG Yueqin. Analysis on current status of professional identity of midwives in Nanchang City and its correlation with psychological resilience and perceived stress[J]. Occupation and Health, 2024, 40(21): 2960-2963. 10.13329/j.cnki.zyyjk.2024.0545. [DOI] [Google Scholar]
  • 19. Poudel-Tandukar K, Chandler GE, Jacelon CS, et al. Resilience and anxiety or depression among resettled Bhutanese adults in the United States[J]. Int J Soc Psychiatry, 2019, 65(6): 496-506. 10.1177/0020764019862312. [DOI] [PubMed] [Google Scholar]
  • 20. Rossi R, Jannini TB, Socci V, et al. Stressful life events and resilience during the COVID-19 lockdown measures in Italy: association with mental health outcomes and age[J]. Front Psychiatry, 2021, 12: 635832. 10.3389/fpsyt.2021.635832. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21. Glantz M D, Johnson J L. Resilience and development: positive life adaptations[J]. Kluwer Academic/Plenum Publishers, 1999. [Google Scholar]
  • 22. Croghan IT, Chesak SS, Adusumalli J, et al. Stress, resilience, and coping of healthcare workers during the COVID-19 pandemic[J]. J Prim Care Community Health, 2021, 12: 21501327211008448. 10.1177/21501327211008448. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23. Ogińska-Bulik N, Michalska P. Psychological resilience and secondary traumatic stress in nurses working with terminally ill patients-The mediating role of job burnout[J]. Psychol Serv, 2021, 18(3): 398-405.10.1037/ser0000421 [DOI] [PubMed] [Google Scholar]
  • 24. Yörük S, Güler D. The relationship between psychological resilience, burnout, stress, and sociodemographic factors with depression in nurses and midwives during the COVID-19 pandemic: a cross-sectional study in Turkey[J]. Perspect Psychiatr Care, 2021, 57(1): 390-398. 10.1111/ppc.12659. [DOI] [PubMed] [Google Scholar]
  • 25. Gan Y, Yang M, Zhou Y, et al. The two-factor structure of future-oriented coping and its mediating role in student engagement[J]. Pers Individ Differ, 2007, 43(4): 851-863. 10.1016/j.paid.2007.02.009. [DOI] [Google Scholar]
  • 26. Campbell-Sills L, Stein MB. Psychometric analysis and refinement of the connor–Davidson resilience scale (CD-RISC): Validation of a 10-item measure of resilience[J]. J Trauma Stress, 2007, 20(6): 1019-1028. 10.1002/jts.20271. [DOI] [PubMed] [Google Scholar]
  • 27. Lee S, Crockett MS. Effect of assertiveness training on levels of stress and assertiveness experienced by nurses in Taiwan, Republic of China[J]. Issues Ment Health Nurs, 1994, 15(4): 419-432. 10.3109/01612849409006918. [DOI] [PubMed] [Google Scholar]
  • 28. Zung WW. A self-rating depression scale[J]. Arch Gen Psychiatry, 1965, 12: 63-70. 10.1001/archpsyc.1965.01720310065008. [DOI] [PubMed] [Google Scholar]
  • 29. Ning L, Jia H, Yu J, et al. Mental health among healthcare workers during the prolonged COVID-19 pandemic: a cross-sectional survey in Jilin Province in China[J]. Front Public Health, 2022, 10: 1030808. 10.3389/fpubh.2022.1030808. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 30. Yang X, Miao J, Fan W, et al. Analysis of psychological trends and policy recommendations of medical staff in northern China in the latter stages of the COVID-19 pandemic[J]. Front Psychol, 2021, 12: 747557. 10.3389/fpsyg.2021.747557. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31. Zhu J, Sun L, Zhang L, et al. Prevalence and influencing factors of anxiety and depression symptoms in the first-line medical staff fighting against COVID-19 in Gansu[J]. Front Psychiatry, 2020, 11: 386. 10.3389/fpsyt.2020.00386. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32. Sohl SJ, Moyer A. Refining the conceptualization of an important future-oriented self-regulatory behavior: proactive coping[J]. Pers Individ Dif, 2009, 47(2): 139-144. 10.1016/j.paid.2009.02.013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33. 陈欣雨, 陆清, 张逸, 等. 高校附属医院临床教师压力知觉与职业倦怠的关系及未来取向应对的影响: 基于网络分析[J]. 中国临床心理学杂志, 2024, 32(6): 1225-1232. 10.16128/j.cnki.1005-3611.2024.06.006. [DOI] [Google Scholar]; CHEN Xinyu, LU Qing, ZHANG Yi, et al. Perceived stress and burnout of clinical faculty in university affiliated hospitals and the role of future orientation coping on its relationship: a network analysis[J]. Chinese Journal of Clinical Psychology, 2024, 32(6): 1225-1232. 10.16128/j.cnki.1005-3611.2024.06.006. [DOI] [Google Scholar]
  • 34. Tusaie K, Dyer J. Resilience: a historical review of the construct[J]. Holist Nurs Pract, 2004, 18(1): 3-8; quiz 9- 10. 10.1097/00004650-200401000-00002. [DOI] [PubMed] [Google Scholar]
  • 35. Kalisch R, Baker DG, Basten U, et al. The resilience framework as a strategy to combat stress-related disorders[J]. Nat Hum Behav, 2017, 1(11): 784-790. 10.1038/s41562-017-0200-8. [DOI] [PubMed] [Google Scholar]
  • 36. Richardson GE. The metatheory of resilience and resiliency[J]. J Clin Psychol, 2002, 58(3): 307-321. 10.1002/jclp.10020. [DOI] [PubMed] [Google Scholar]
  • 37. Cameron F, Brownie S. Enhancing resilience in registered aged care nurses[J]. Australas J Ageing, 2010, 29(2): 66-71. 10.1111/j.1741-6612.2009.00416.x. [DOI] [PubMed] [Google Scholar]
  • 38. 吾超, 张琳苑, 杜艳玲, 等. 西安市某军队三级甲等医院护士心理弹性在应对方式与压力知觉影响中的调节作用[J]. 职业与健康, 2021, 37(14): 1942-1945. [Google Scholar]; WU Chao, ZHANG Linyuan, DU Yanling, et al. Moderating role of psychological resilience in coping style and stress perception among nurses in a military grade-a tertiary hospital in Xi’an City[J]. Occupation and Health, 2021, 37(14): 1942-1945. [Google Scholar]
  • 39. Mace RA, Doorley J, Bakhshaie J, et al. Psychological resiliency explains the relationship between emotional distress and quality of life in neurofibromatosis[J]. J Neurooncol, 2021, 155(2): 125-132. 10.1007/s11060-021-03852-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 40. Wang L, Yu J, Diao X, et al. The chain mediating effects of resilience and perceived social support in the relationship between perceived stress and depression in patients with COVID-19[J]. Front Psychol, 2024, 15: 1400267. 10.3389/fpsyg.2024.1400267. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 41. Guruprakash KV, Mehta SG, Atul B, et al. A study of relationship between perceived stress, coping pattern, burnout, and general psychopathology among the postgraduate medical students[J]. Ind Psychiatry J, 2018, 27(1): 141-146. 10.4103/ipj.ipj_20_18. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 42. 甘怡群. 未来取向应对的双阶段序列模型及其时间透视机制[J]. 心理科学进展, 2011, 19(11): 1583-1587. 22083622 [Google Scholar]; GAN Yiqun. The sequential model of future-oriented coping and its time perspective mechanism[J]. Advances in Psychological Science, 2011, 19(11): 1583-1587. [Google Scholar]
  • 43. 姜乾金. 心理应激多因素系统(综述): 20年来对心理应激理论及其应用的探索[C]// 中华医学会心身医学分会第12届年会论文集. 上海, 2006: 14-19. [Google Scholar]
  • 44. 刘朝霞, 郑凯莉, 储珺, 等. 心理弹性与神经质中介压力知觉与抑郁症状的关系: 基于路径分析[J]. 中国临床心理学杂志, 2021, 29(2): 352-356. 10.16128/j.cnki.1005-3611.2021.02.027. [DOI] [Google Scholar]; LIU Zhaoxia, ZHENG Kaili, CHU Jun, et al. The mediation of resilience and neuroticism on the relationship between perceived stress and depression: based on path analysis[J]. Chinese Journal of Clinical Psychology, 2021, 29(2): 352-356. 10.16128/j.cnki.1005-3611.2021.02.027. [DOI] [Google Scholar]
  • 45. 侯田雅, 刘志远, 董薇, 等. 焦虑敏感性与跳伞参训人员跳伞训练前心理应激的关系: 心理弹性的中介作用[J]. 海军军医大学学报, 2024, 45(11): 1455-1459. 10.16781/j.CN31-2187/R.20230688. [DOI] [Google Scholar]; HOU Tianya, LIU Zhiyuan, DONG Wei, et al. Relationship between anxiety sensitivity and psychological stress before parachuting training among parachuting trainees: mediating role of resilience[J]. Academic Journal of Naval Medical University, 2024, 45(11): 1455-1459. 10.16781/j.CN31-2187/R.20230688. [DOI] [Google Scholar]
  • 46. Waugh CE, Wager TD, Fredrickson BL, et al. The neural correlates of trait resilience when anticipating and recovering from threat[J]. Soc Cogn Affect Neurosci, 2008, 3(4): 322-332. 10.1093/scan/nsn024. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 47. Ali Salehinejad M, Nejati V, Derakhshan M. Neural correlates of trait resiliency: evidence from electrical stimulation of the dorsolateral prefrontal cortex (dLPFC) and orbitofrontal cortex (OFC)[J]. Pers Individ Differ, 2017, 106: 209-216. 10.1016/j.paid.2016.11.005. [DOI] [Google Scholar]
  • 48. Golkar A, Lonsdorf TB, Olsson A, et al. Distinct contributions of the dorsolateral prefrontal and orbitofrontal cortex during emotion regulation[J/OL]. PLoS One, 2012, 7(11): e48107[2024-10-11]. 10.1371/journal.pone.0048107. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 49. Vilhauer JS, Cortes J, Moali N, et al. Improving quality of life for patients with major depressive disorder by increasing hope and positive expectations with future directed therapy (FDT)[J]. Innov Clin Neurosci, 2013, 10(3): 12-22. [PMC free article] [PubMed] [Google Scholar]
  • 50. 廖俪雯, 王琳. 护士心理弹性干预的研究进展[J]. 中华护理杂志, 2023, 58(8): 942-949. [Google Scholar]; LIAO Liwen, WANG Lin. Research progress on resilience intervention for nurses[J]. Chinese Journal of Nursing, 2023, 58(8): 942-949. [Google Scholar]
  • 51. 贺方, 宋红静, 张欣, 等. 优势认知行为治疗对抑郁青少年心理弹性的干预[J]. 中国临床心理学杂志, 2022, 30(6): 1468-1475. 10.16128/j.cnki.1005-3611.2022.06.041. 36030058 [DOI] [Google Scholar]; HE Fang, SONG Hongjing, ZHANG Xin, et al. Intervention study of strengths-based cognitive behavioral therapy on resilience in adolescent with depression[J]. Chinese Journal of Clinical Psychology, 2022, 30(6): 1468-1475. 10.16128/j.cnki.1005-3611.2022.06.041. [DOI] [Google Scholar]
  • 52. 张晓妍, 杨亚萍, 闫旭平, 等. 接受与承诺疗法为基础的心理干预对颌面创伤患者心理弹性和应对方式的影响[J]. 中国健康心理学杂志, 2025, 33(1): 76-80. 10.13342/j.cnki.cjhp.2025.01.015. [DOI] [Google Scholar]; ZHANG Xiaoyan, YANG Yaping, YAN Xuping, et al. Correlation between psychological resilience, health-promoting behaviors, and quality of life in patients with Ulcerative Colitis[J]. China Journal of Health Psychology, 2025, 33(1): 76-80. 10.13342/j.cnki.cjhp.2025.01.015. [DOI] [Google Scholar]

Articles from Journal of Central South University Medical Sciences are provided here courtesy of Central South University

RESOURCES