医护人员职业紧张对心理健康的影响：情感承诺的中介效应和内在投入的调节效应
Influence of occupational stress on mental health of medical staff: mediating effect of affective commitment and moderating effect of overcommitment
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摘要:
背景 职业紧张已被证明是影响职业人群心理健康的重要因素。职业人群对于组织的情感承诺和对于工作的过度内在投入所产生的作用不容忽视，但目前我国关于此方面的研究较为缺乏。
目的 探讨情感承诺在医护人员职业紧张影响心理健康这一过程中的中介效应以及内在投入对情感承诺中介效应的调节作用。
方法 采用横断面调查方法，以兰州市某三级甲等医院的1372名医护人员作为研究对象。采用付出回报失衡量表、情感承诺量表、Kessler 10量表调查研究对象的职业紧张、情感承诺、心理困扰情况。采用SPSS 26.0进行相关分析、中介效应分析和有调节的中介效应分析，使用Harman单因素检验法进行共同方法偏差检验。
结果 本次调查共发放问卷1372份，其中回收有效问卷1277份，有效回收率为93.08%。研究对象职业紧张得分为（1.14±0.23）分，内在投入得分为（20.26±3.21）分，情感承诺得分为（20.25±3.34）分，心理困扰得分为（26.26±7.90）分。Spearman相关性分析结果显示，医护人员职业紧张与内在投入、心理困扰呈正相关（
r =0.153、0.410，P ＜0.01），与情感承诺呈负相关（r =−0.341，P ＜0.01）；内在投入与情感承诺呈负相关，与心理困扰呈正相关（r =−0.107、0.312，P ＜0.01）；情感承诺与心理困扰呈负相关（r =−0.464，P ＜0.01）。职业紧张对医护人员心理困扰的正向作用有统计学意义（b =0.41，t =15.42，P ＜0.001）；情感承诺在职业紧张与心理困扰之间起部分中介作用（效应值=0.13），占总效应的31.71%；内在投入在“职业紧张-情感承诺-心理困扰”这一中介过程中调节作用显著（P ＜0.01）。结论 医护人员的情感承诺在职业紧张影响其心理健康的过程中起部分中介作用，内在投入在“职业紧张-情感承诺-心理困扰”这一中介过程中调节作用显著。
Abstract:Background Occupational stress has been shown to be an important factor affecting the mental health of workers. The role of affective commitment to the organization and overcommitment to work cannot be ignored. However, there is a lack of research on this topic in China.
Objective To explore a potential mediating effect of affective commitment on how occupational stress affects the mental health of medical staff and a potential moderating effect of overcommitment on the mediating effect of affective commitment.
Methods A total of 1372 health care workers in a tertiary Grade A hospital in Lanzhou City were selected as study subjects for a cross-sectional survey. The occupational stress, emotional commitment, and psychological distress of the subjects were evaluated by the Effort-Reward Imbalance Scale, Affective Commitment Scale, and Kessler 10 Scale. SPSS 26.0 was used for correlation analysis, mediation analysis, and moderated mediation analysis. Common method bias wasevaluated by Harman one-factor test.
Results A total of 1372 questionnaires were distributed, of which 1277 valid questionnaires were returned, with a valid recovery rate of 93.08%. The mean occupational stress score was 1.14±0.23, the mean overcommitment score was 20.26±3.21, the mean affective commitment score was 20.25±3.34, and the mean psychological distress score was 26.26±7.90. The Spearman correlation analysis results showed that occupational stress among medical staff was positively correlated with overcommitment and psychological distress (
r =0.153, 0.410,P ＜0.01) and negatively correlated with affective commitment (r =−0.341,P ＜0.01); overcommitment was negatively related to affective commitment and positively related to psychological distress (r =−0.107, 0.312,P ＜0.01); affective commitment was negatively related to psychological distress (r =−0.464,P ＜0.01). The positive effect of occupational stress on psychological distress of medical staff was significant (b =0.41,t =15.42,P <0.001); affective commitment presented a partial mediating effect on the relationship between occupational stress and psychological distress (effect value=0.13), accounting for 31.71% of the total effect; overcommitment moderated the process of occupational stress-affective commitment-psychological distress (P ＜0.01).Conclusion Affective commitment of medical staff has a partial mediating effect on the relationship between occupational stress and psychological distress, and overcommitment plays a significant role in moderating the process of occupational stress-affective commitment-psychological distress.
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