Analysis Of The Role Of Trait Coping Styles In The Association Between Occupational Stress And Depressive Symptoms Among CDC Personnel

PurposeCDC personnel are medical workers who are fighting against diseases and controlling health hazards.Due to the current high incidence of public health emergencies,CDC personnel have more adverse mental health problems,which affect their work efficiency and ability to work.It is shown that occupational stress has a connection with depressive symptoms.Trait coping styles,which characterize the negative and positive attitudes and behaviors of study subjects in the face of difficulties and setbacks,can alleviate occupational stress and thus ameliorate the adverse effects of depressive symptoms.In terms of the current mental health research conducted on CDC personnel,the following problems exist:among the descriptive studies conducted,there was a lack of investigation on the impact of CDC personnel’s occupation-related characteristics on mental health;among the studies on the mechanism of action,the mediators of CDC personnel were less explored;in the application of occupational stress scales,little attention had been paid to the development of occupational stress scales for specific occupational groups,and no assessment tool for occupational stress in CDC personnel had been found yet.This study will focus on the above questions with the aim of providing a theoretical basis and assessment tool for mental health promotion for CDC personnel.This study included the following aspects:firstly,to investigate the current situation of occupational stress,depressive symptoms and trait coping styles among CDC personnel and their influencing factors;secondly,to verify the correlation between the three,and to explore the mediating role of trait coping styles and construct a structural equation model;then,to revise the Core Occupational Stress Scale（COSS）and develop an occupational stress scale applicable to CDC personnel;finally,to develop a constant model of occupational stress for CDC personnel in Jiangsu Province as an example,and to provide assessment criteria for studying the current situation of occupational stress of CDC personnel.Methods1.The cross-sectional typical survey method was used to collect the required data and information,using whole-group random sampling,and one provincial unit and four municipal units（Nanjing,Suzhou,Yangzhou,and Lianyungang）were selected in three geographic areas of southern,central,and northern Jiangsu Province,using the CDC as the unit,and then 16 district and county units were selected within the selected four municipal units,for a total of 21 CDC as the study subjects.The survey scales included the Basic Profile Questionnaire,the Core Occupational Stress Scale,the Patient Questionnaire,and the Trait Coping Style Questionnaire.The current status and variability of occupational stress,depressive symptoms and trait coping styles among CDC personnel with different demographic and occupation-related characteristics were compared by univariate analysis.2.Spearman correlation analysis was used to find out the correlation between occupational stress,depressive symptoms and trait coping styles among CDC personnel,and multiple stratified regression analysis was performed to analyze the factors influencing trait coping styles and depressive symptoms.The structural equation model was constructed by validating factor analysis and model fit indicators;the mediating role of trait coping style was further validated by Bootstrap method.A neural network multilayer perceptron was used to construct a prediction model of depressive symptoms,and the model was validated and analyzed.3.CDC personnel who participated in the prevention and control of COVID-19 were selected in the previous study.Based on the modified Delphi method and the pool of entries of the Core Occupational Stress Scale,the entries related to occupational stress of CDC personnel were modified or added.Item analysis,exploratory factor analysis and confirmatory factor analysis were used to test the construct validity;Spearman’s correlation analysis was used to test the validity of the calibration and convergent validity using burnout,depressive symptoms and occupational stress self-rated stress as calibration scales,respectively;Cronbach’s alpha coefficient and split-half reliability coefficient were used to assess the internal consistency of the scale.4.Single factor analysis and stepwise regression were used to explore the influencing factors of occupational tension level,determine the classification norm that needs to be constructed,and establish the classification mean norm,percentile norm and T-score norm;meanwhile,the,x+0.5 s,x+s and x+1.5 s of the total COSS scores of CDC personnel were used as the criteria for classifying occupational tension level by the normal distribution method,and analyze the occupational stress level of CDC personnel who involved in the prevent and control of COVID-19.Results1.The Cronbach’sαcoefficients for all dimensions of the scale in this study were greater than 0.8,with good reliability and consistency.A cross-sectional survey of CDC personnel found that the total score of occupational stress,depressive symptoms score and trait coping style score M(P₂₅,P₇₅)of CDC personnel were 42.0（37.0,48.0）,8.0（4.0,9.0）,and 6.0（1.0,13.0）,respectively.The detection rate of occupational stress and depressive symptoms among CDC personnel were 31.0%and 22.0%2.There were statistical differences in occupational stress,depressive symptoms and trait coping styles scores among CDC personnel with different characteristics（P<0.05）.（1）Demographic characteristics:（1）The occupational stress score of men was higher than that of women（P<0.05）;（2）The total score of occupational stress in the 31-40-year-old group was the highest,and the depressive symptoms and negative coping styles of the≤40-year-old group were higher than those of other groups.The total score of trait coping style was lower than that of other groups（P<0.05）;（3）The distribution of trait coping style scores in master degree and above group was lower than that of other groups,and the depressive symptom score was higher than those of other groups（P<0.05）.（2）Occupation-related characteristics:（1）The total score of occupational stress of the group with income<7,000 yuan was higher than that of the group>11,000 yuan（P<0.05）;（2）Those who worked≤40h per week had the lowest total occupational stress score,and the depressive symptom score of the 49-58h group was higher than that of the≤40h group;（3）Employees who worked shifts while having night shifts had higher total occupational stress score and depressive symptom score than those of the other two groups,while the total score of positive trait coping style and trait coping style total scores were lower than the other two groups（P<0.05）;（4）The depressive symptoms scores of the group whose work age>20 years were lower than the<9 years group,while the positive coping style score were greater than the other groups（P<0.05）;（5）The total score of occupational stress of CDC personnel at provincial level was lower than that at city level,the score of depressive symptoms of CDC personnel at county level was lower than that of provincial and city level units,and the score of trait coping style was higher than that of city level group（P<0.05）.;（6）The total occupational stress score in the northern Jiangsu was higher than that in the southern Jiangsu（P<0.05）.3.Spearman’s correlation analysis showed that total score of occupational stress and each dimension score were positively correlated with depressive symptoms and negative coping style（r=0.112-0.541,P<0.01）and negatively correlated with positive coping style（r=-0.079～-0.616,P<0.01）.Regression analysis revealed that the dimensions of occupational stress significantly and positively predicted depressive symptoms（P<0.001）and were able to explain 27.7%of the variance in depressive symptoms.Social support,organization and reward,and autonomy negatively predicted positive coping style（P<0.001）;the dimensions of occupational stress positively predicted negative coping style（P<0.001）;and two dimensions of trait coping style were statistically different in predicting depressive symptoms（P<0.001）.There was a mediating effect of trait coping style between occupational stress dimensions and depressive symptoms,with the percentage of mediating effect being 48.16%,47.50%,37.98%and 77.69%,respectively.The top three importance of independent variables in the neural network prediction model of depressive symptoms were negative coping style,positive coping style and social support.4.The entry"I feel overwhelmed by shift work"was changed to"The occurrence of public health emergencies has significantly increased my work stress".The results of the exploratory factor analysis extracted 4 dimensions and 17 items,with 4 factors accounting for 66.047%of the explained variance.The interpretable factor loadings for all entries ranged from 0.491 to 0.928.The model fit indicators NFI,IFI,CFI and GFI were 0.953 to 0.969,the CR values of each latent variable were 0.853 to 0.920,and the AVE values were 0.545 to 0.852.Burnout,depressive symptom scores and occupational stress self-rated stress were positively correlated with the total COSS score and each dimension score of CDC personnel（r=0.123-0.563,P<0.001）.The Cronbach’s alpha coefficients for the dimensions ranged from 0.787 to 0.896,and the split-half reliability ranged from 0.814 to 0.871.5.Four sets of categorical norms were established for gender,income,work hours per week,and region.The COSS total score of CDC personnel was（45.23±8.69）.The 50th,75th,95th percentiles were 45,51 and 60.When the total score was<50,50-54,55-58,and>58 for CDC personnel,occupational stress would be classified into none,mild,moderate,and severe levels.The proportion of each occupational stress level of CDC personnel involved in prevent and control of COVID-19 in Jiangsu Province were 69.7%,17.6%,5.9%and 6.8%,respectively.And the detection rate of occupational stress was 30.3%.Conclusion1.The occupational stress level of CDC personnel involved in prevent and control of COVID-19 in Jiangsu Province is relatively high.Demographic and occupation-related characteristics have an impact on occupational stress,depressive symptoms and trait coping styles of CDC personnel,and attention should be paid to the mental health problems of high-risk groups such as men,young and middle-aged,low-income,long-hour work,and unreasonable shift systems groups.2.Trait coping styles play a mediating role between each dimension of occupational stress and depressive symptoms among CDC personnel,and the adverse effects of occupational stress and depressive symptoms can be reduced by increasing the trait coping styles of CDC personnel.3.The revised Core Scale of Occupational Stress in CDC personnel has high reliability and validity,and the model fits well and is suitable for assessing occupational stress in CDC personnel.4.The norm is consistent with the occupational characteristics and psychological assessment requirements of CDC personnel,easy to understand and operate,and provides theoretical support and guidance for the promotion of mental health of CDC personnel.