Mediating effect of depressive symptoms on occupational stress and work-related musculoskeletal disorders: an online cross-sectional survey among petrochemical enterprise employees
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摘要:
目的 探讨抑郁症状在石化企业员工职业紧张与工作相关肌肉骨骼疾患（WMSDs）间的中介效应，为制定WMSDs的干预措施提供科学依据。 方法 采用整群抽样方法于2021年7 — 10月在江苏省某石油化工企业抽取4066名员工进行问卷调查，采用Spearman秩相关分析其职业紧张、抑郁症状与WMSDs的关系，并采用分层回归分析和Bootstrap法验证抑郁症状在职业紧张与WMSDs间的中介效应。 结果 最终纳入分析的3763名石化企业员工中，检出WMSDs者2934例，WMSDs检出率为77.97%。石化企业员工WMSDs得分为（3.47 ± 3.17）分，抑郁症状得分为（10.04 ± 5.99）分；职业紧张得分为（45.79 ± 9.48）分，其中社会支持、组织与回报、要求与付出和自主性维度得分分别为（19.81 ± 3.75）、（15.85 ± 4.94）、（12.35 ± 3.39）和（4.62 ± 1.80）分。Spearman秩相关分析结果显示，石化企业员工WMSDs得分与职业紧张、组织与回报、要求与付出和抑郁症状得分均呈正相关（r = 0.334、0.284、0.202和0.463，均P < 0.01），与社会支持和自主性得分均呈负相关（r = – 0.256和 – 0.141，均P < 0.01）；石化企业员工抑郁症状得分与职业紧张、组织与回报和要求与付出得分均呈正相关（r = 0.621、0.540和0.410，均P < 0.01），与社会支持和自主性得分均呈负相关（r = – 0.419和 – 0.196，均P < 0.01）；石化企业员工职业紧张得分与组织与回报和要求与付出得分均呈正相关（r = 0.848和0.639，均P < 0.01），与社会支持和自主性得分均呈负相关（r = – 0.648和– 0.310，均P < 0.01）。中介效应分析结果显示，抑郁症状在石化企业员工职业紧张的社会支持和要求与付出维度与WMSDs间具有部分中介效应，中介效应值分别为– 0.137（– 0.155～– 0.120）和0.177（0.159～0.196），中介效应百分比分别为72.87%和78.67%；抑郁症状在石化企业员工职业紧张的组织与回报和自主性维度与WMSDs间具有完全中介效应，中介效应值分别为0.146（0.131～0.160）和– 0.126（– 0.158～– 0.094），中介效应百分比分别为90.12%和98.44%。 结论 石化企业员工WMSDs检出率较高，抑郁症状在其职业紧张与WMSDs间具有中介效应，可通过缓解员工的抑郁症状来预防或减少部分WMSDs的发生。 -
关键词:
- 工作相关肌肉骨骼疾患（WMSDs） /
- 抑郁症状 /
- 职业紧张 /
- 中介效应 /
- 石化企业员工
Abstract:Objective To explore the mediating effect of depressive symptoms on occupational stress and work-related musculoskeletal disorders (WMSDs) in employees of petrochemical enterprises for developing intervention measures on WMSDs. Methods Totally 4 066 employees were recruited with cluster sampling from a petrochemical enterprise in Jiangsu province for an online survey conducted during July – October 2021. Core Occupational Stress Scale (COSS), Patient Health Questionnaire-9 (PHQ-9), and two questionnaire on demographics and WMSDs developed by Chinese researchers previously were used in the survey. Spearman rank correlation analysis was adopted to analyze the relationships between occupational stress, depression symptoms, and WMSDs; hierarchical regression analysis and bootstrap method were used to verify the mediating effect of depressive symptoms on the correlation between occupational stress and WMSDs. Results Of the 3 763 participants with valid responses, 2 934 (77.97%) were assessed as having WMSDs during past one year. The participants' mean scores were 3.47 ± 3.17 on WMSDs and 10.04 ± 5.99 on depressive symptoms; the mean score on occupational stress was 45.79 ± 9.48, with the dimensional scores of 19.81 ± 3.75 on social support, 15.85 ± 4.94 on organization and reward, 12.35 ± 3.39 on demand and effort, and 4.62 ± 1.80 on autonomy, respectively. Spearman rank correlation analysis revealed following significant correlations among partici-pants' scores on WMSDs, occupational stress and its dimensions, and depression symptoms: (1) positive correlations of WMSDs with overall occupational stress (r = 0.334), occupational stress dimensions of organization and reward (r = 0.284) and demand and effort (r = 0.202), and depression symptoms (r = 0.463) (P < 0.01 for all); (2) negative correlations of WMSDs with occupational stress dimensions of social support (r = – 0.256) and autonomy (r = – 0.141) (both P < 0.01); (3) positive correlations of depression symptoms with overall occupational stress (r = 0.621), occupational stress dimensions of organization and reward (r = 0.540) and demand and effort (r = 0.410) (P < 0.01 for all); (4) negative correlations of depression symptoms with social support (r = – 0.419) and autonomy (r = – 0.196) (both P < 0.01); (5) positive correlations of overall occupational stress with occupational stress dimensions of organization and reward (r = 0.848) and demand and effort (r = 0.639) (both P < 0.01); and (6) negative correlations of overall occupational stress with occupational stress dimensions of social support (r = – 0.648) and autonomy (r = – 0.310) (both P < 0.01). The results of mediating effect analysis showed that depressive symptoms had a partial mediating effect on the correlations of WMSDs with occupational stress dimensions of social support (effect value = – 0.137; confidence interval [CI]: –0.155, – 0.120; effect percentage = 72.87%) and demand and effort (effect value = 0.177; CI: 0.159, 0.196; effect percentage = 78.67%) but a complete mediating effect on the correlations of WMSDs with occupational stress dimensions of organization and reward (effect value = 0.146; CI: 0.131, 0.160; effect percentage = 90.12%) and autonomy (effect value = – 0.126; CI: – 0.158, – 0.094; effect percentage = 98.44%). Conclusion Among the employees in a petrochemical enterprise in a province of China, the detection rate of WMSDs was high and depressive symptoms showed a mediating effect on the correlation of occupational stress with WMSDs, suggesting that the prevalence of WMSDs could be decreased through intervention on depression symptoms in the occupational population. -
图 1 抑郁症状在石化企业员工职业紧张与WMSDs间中介效应
注：各线上数据为β值，a P < 0.05。
Figure 1. Mediating effect of depressive symptoms on the correlation between occupational stress dimensions and WMSDs among 3 763 employees of a petrochemical enterprise in Jiangsu province, China
表 1 不同特征石化企业员工WMSDs检出情况比较
Table 1. Detection rate of WMSDs by demographic and occupation factors among 3 763 employees of a petrochemical enterprise in Jiangsu province, China
特征 调查人数 WMSDs检出人数 WMSDs检出率（%） χ2 值 P 值 性别 男性 3046 2336 76.69 15.224 < 0.001 女性 717 598 83.40 年龄（岁） ≤ 30 443 290 65.46 67.836 < 0.001 31～40 452 336 74.34 41～50 1469 1223 83.25 > 50 1399 1085 77.56 文化程度 初中及以下 161 123 76.40 31.979 < 0.001 高中/中专 1202 988 82.20 大专/高职 1171 916 78.22 本科 992 747 75.30 硕士及以上 237 160 67.51 婚姻状况 未婚 374 249 66.58 33.008 < 0.001 已婚 3128 2470 78.96 离异/丧偶 261 215 82.38 月平均收入（元） < 3000 59 49 83.05 17.888 0.003 3000～4999 635 516 81.26 5000～6999 891 716 80.36 7000～8999 896 700 78.13 9000～10999 729 545 74.76 ≥ 11000 553 408 73.78 职务 一般工作人员 2962 2303 77.75 24.023 < 0.001 班组长 553 462 83.54 中层干部 248 169 68.15 岗位工龄（年） ≤ 5 1131 819 72.41 19.143 < 0.001 6～10 700 560 80.00 11～20 815 657 80.61 > 20 1117 898 80.39 
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表 2 石化企业员工职业紧张、抑郁症状与WMSDs得分的Spearman相关分析
Table 2. Correlation coefficients between scores on COSS, PHQ-9 and WMSDs among 3 763 employees of a petrochemical enterprise in Jiangsu province, China: Spearman correlation analysis
项目 社会支持 组织与回报 要求与付出 自主性 抑郁症状 WMSDs 职业紧张 – 0.648 a 0.848 a 0.639 a – 0.310 a 0.621 a 0.334 a 社会支持 1.000 – 0.391 a – 0.126 a 0.171 a – 0.419 a – 0.256 a 组织与回报 1.000 0.439 a – 0.132 a 0.540 a 0.284 a 要求与付出 1.000 – 0.062 a 0.410 a 0.202 a 自主性 1.000 – 0.196 a – 0.141 a 抑郁症状 1.000 0.463 a WMSDs 1.000 注：a P < 0.01。
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表 3 石化企业员工职业紧张、抑郁症状与WMSDs关系的分层回归分析
Table 3. Relationships between scores on COSS, PHQ-9 and WMSDs among 3 763 employees of a petrochemical enterprise in Jiangsu province, China: hierarchical regression analysis
变量 第1步 第2步 第3步 β t 值 P 值 β t 值 P 值 β t 值 P 值 性别 0.027 1.651 0.099 0.077 4.849 < 0.001 0.083 5.555 < 0.001 年龄 0.041 1.937 0.053 0.051 2.546 0.011 0.075 3.960 < 0.001 文化程度 – 0.076 – 3.954 < 0.001 – 0.047 – 2.511 0.012 – 0.034 – 1.919 0.055 婚姻状况 0.072 4.035 < 0.001 0.055 3.214 0.001 0.048 3.011 0.003 月平均收入 – 0.103 – 5.801 < 0.001 – 0.090 – 5.291 < 0.001 – 0.073 – 4.567 < 0.001 职务 – 0.040 – 2.303 0.021 – 0.017 – 1.057 0.291 – 0.005 – 0.293 0.770 岗位工龄 0.047 2.443 0.015 0.027 1.454 0.146 0.018 1.065 0.287 社会支持 – 0.159 – 9.744 < 0.001 – 0.062 – 3.880 < 0.001 组织与回报 0.119 6.225 < 0.001 – 0.006 – 0.291 0.771 要求与付出 0.154 8.557 < 0.001 0.055 3.141 0.002 自主性 – 0.028 – 1.801 0.072 0.006 0.381 0.703 抑郁症状 0.397 21.558 < 0.001 F 值 32.750 62.729 103.337 P 值 < 0.001 < 0.001 < 0.001 调整R2 值 0.056 0.153 0.246 ∆R2 值 0.058 0.098 0.093
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