Effects Of MBSR On Anxiety And Depression In ICU Nurses And The Role Of Gut Microbiota

Background:Intensive Care Unit(ICU)nurses play an important role in the treatment and monitoring of critically ill patients.ICU patients are in critical condition,which requires meticulous treatment and nursing,strict observation of the condition,rapid rescue and disposal,strict monitoring of various medical instruments and life support.This requires ICU nurses to master high standards of technical specifications,but also brings huge workload and negative emotions such as anxiety and depression to them.Anxiety and depression of ICU nurses not only have a great negative impact on clinical work,but also affect physical health.As a psychological intervention,mindfulness-based stress reduction(MBSR)has been proved to have a positive effect on the regulation of negative emotions in many populations.However,there are few studies in ICU nurses and the specific mechanism of action is still unclear.Some studies have shown that gut microbiota plays an important role in the regulation of anxiety and depression,which provides a new idea for studying the mechanism of MBSR in improving anxiety and depression.Abjective:The purpose of this study is to investigate the current situation of anxiety and depression in ICU nurses and its relationship with perceived stress,mindful attention awareness and mental resilience;To evaluate the effect of MBSR on anxiety and depression of ICU nurses;To analyze the effect of MBSR on gut microbiota and explore the role of gut microbiota in improving anxiety and depression of ICU nurses.Method:1.Study on the current situation of anxiety and depression in ICU nurses and its relationship with perceived stress,mindful attention awareness and mental resilienceUsing the convenience sampling method,in April-July 2021,using general data questionnaire,Self-rating Anxiety Scale(SAS),Self-rating depression Scale(SDS),Chinese Perceived Stress Scale(CPSS),Resilience Scale(CD-RISC)and Mindful attention Awareness Scale(MAAS)of 15 hospitals in Chongqing 563 ICU nurses on-site questionnaire survey,understand the anxiety and depression status of ICU nurses and related factors.To analyze the relationship between anxiety,depression,perceived stress,resilience and mindful attention awareness in ICU nurses.2.Effect of MBSR on anxiety and depression in ICU nursesFrom September 2021 to March 2022,56 ICU nurses in a hospital in Chongqing were selected as the research objects.They were divided into the experimental group(n = 28)and the control group(n = 28)by random number method.The general information questionnaire,Self-rating Anxiety Scale,Self-rating depression Scale,Chinese Perceived Stress Scale,Resilience Scale and Mindful attention Awareness Scale were used to investigate the effects of MBSR on anxiety and depression of ICU nurses before,at the end of intervention and 3months after intervention.3.Effect of gut microbiota on mindfulness-based stress reduction in improving anxiety and depression in ICU nursesAt the same time of study 2,fresh fecal samples of the two groups were collected at three time points of the questionnaire survey,and 16 SrRNA sequencing was performed on the fecal samples to analyze the effect of mindfulness-based stress reduction therapy on the structure and function of gut microbiota,and to explore the role of gut microbiota in the improvement of anxiety and depression in ICU nurses.Results:1.Study on the current situation of anxiety and depression in ICU nurses and its relationship with perceived stress,mindful attention awareness and resilience(1)The SAS and SDS scores of ICU nurses were(45.99±10.10)and(48.62±11.41),respectively.Among them,37.1% ICU nurses had anxiety and 36.1% of ICU nurses had depression.(2)Univariate analysis showed that gender and monthly income were the influencing factors of anxiety in ICU nurses(P < 0.05),while gender,professional title,monthly income and current disease were the influencing factors of depression in ICU nurses(P < 0.05).(3)Pearson correlation analysis showed that anxiety was positively correlated with perceived stress(r=0.578,P<0.01),and negatively correlated with mental resilience and mindful attention awareness(r=-0.487 、-0.525,P < 0.01).Depression was positively correlated with perceived stress(r=0.591,P<0.01),and negatively correlated with mental resilience and mindful attention awareness(r=-0.569、-0.552,P<0.01).(4)Multiple linear regression analysis showed that perceived stress,mental resilience and mindful attention awareness were the main influencing factors of ICU nurses’ anxiety(P< 0.05),and the total explanation rate of anxiety was 43%.Current illness,perceived stress,resilience and mindful attention awareness were the main influencing factors of depression in ICU nurses(P < 0.05),and the total explanation rate of depression was 48.9%.(5)PROCESS 3.3 was used to test the mediating model of perceived stress,mindful attention awareness,mental resilience and anxiety.The results showed that the mediating effect value of mindful attention awareness and mental resilience on perceived stress and anxiety of ICU nurses was 0.333,with 95%CI [0.232,0.420],indicating significant mediating effect.The mediating effect was composed of three indirect effects:(1)Perceived stress→Mindful attention awareness → Anxiety,95%CI is [0.159,0.272] and the mediating effect was significant,effect size was 0.213;(2)Perceived stress → Mental resilience → Anxiety,95%CI is [0.024,0.178] and the mediating effect was significant,effect size was 0.106;(3):Perceived stress → Mindful attention awareness → Mental resilience → Anxiety,95%CI is[0.002,0.027] and the chain mediation effect was significant,effect size was 0.013.(6)PROCESS 3.3 was used to test the mediating model of perceived stress,mindful attention awareness,mental resilience and depression.The results showed that the mediating effect value of mindful attention awareness and mental resilience on perceived stress and depression of ICU nurses was 0.506,95%CI was [0.406,0.615],indicating significant mediating effect.The mediating effect was composed of three indirect effects:(1)Perceived stress → Mindful attention awareness → Depression,95%CI is [0.190,0.316] and the mediating effect was significant,effect size was 0.253;(2)Perceived stress → Mental resilience → Depression,95%CI is [0.140,0.322] and the mediating effect was significant,effect size was 0.223;(3): Perceived stress → Mindful attention awareness → Mental resilience → Depression,95%CI is [0.011,0.054] and the chain mediation effect was significant,effect size was 0.031.2.Effect of MBSR on anxiety and depression in ICU nurses(1)In the experimental group,6 people left the group,and a total of 22 people were included in the statistical analysis and in the control group,5 people left the group,and a total of 22 people were included in the statistical analysis.There was no difference in baseline data between the experimental group and the control group(P > 0.05).(2)Repeated measures ANOVA showed that there were significant differences in the time effects of anxiety,depression,perceived stress,resilience and mindful attention awareness between the experimental group and the control group(P < 0.05),The interaction effects of depression,perceived stress,resilience and mindful attention awareness in the time* group were significantly different between the experimental group and the control group(P< 0.05).(3)Further analysis showed that the anxiety,depression and perceived stress in the experimental group were lower than those in the control group at the end of the intervention(P < 0.05),and the mental resilience was higher than that in the control group(P < 0.05);The anxiety,depression and perceived stress of the experimental group were lower than those of the control group at 3 months after the intervention(P < 0.05),and the mental resilience and mindful attention awareness of the experimental group were higher than those of the control group(P < 0.05);At the end of the intervention and 3 months after the intervention,the anxiety,depression and perceived stress of the experimental group were lower than those before the intervention(P < 0.05),and the mental resilience and mindful attention awareness were higher than those before the intervention(P < 0.05);In the control group,there were no differences in anxiety,depression,perceived stress,resilience and mindful attention awareness at the end of intervention and 3 months after intervention compared with those before intervention(P > 0.05).3.Effect of gut microbiota on MBSR in improving anxiety and depression in ICU nurses(1)At the end of intervention,the α and β diversity of gut microbiota was significantly different between the experimental group and the control group(P < 0.05);There was no significant difference in α diversity between the experimental group and the control group at 3months after the intervention(P > 0.05),but there was significant difference in β diversity between the experimental group and the control group(P < 0.05);There was no significant difference in α diversity between the experimental group and the end of intervention and 3months after the end of intervention(P > 0.05),but there was significant difference in βdiversity(P < 0.05);There was no significant difference in the α and β diversity of intestinal microbiota in the control group before intervention,at the end of intervention and 3 months after intervention(P > 0.05).(2)At the end of the intervention and 3 months after the intervention,the abundance of Blautia and Anaerostipes in the experimental group was higher than that in the control group(P < 0.05),and the abundance of Bacteroides in the experimental group was lower than that in the control group(P < 0.05);At the end of the intervention and 3 months after the intervention,the abundance of Blautia and Anaerostipes in the experimental group was higher than that before the intervention(P < 0.05),and the abundance of Bacteroides was lower than that before the intervention(P < 0.05).(3)KEGG pathway analysis indicated that thiamine metabolism pathway was enriched at the end of intervention and 3 months after intervention(P<0.05).Conclusion:1.ICU nurses work due to the particularity,there is a higher level of anxiety and depression,mindfulness attention awareness and mental resilience play a chain mediating role in ICU nurses’ perceived stress,anxiety and depression.Nursing managers should actively seek relevant measures to improve ICU nurses’ mindfulness attention awareness and psychological resilience,so as to reduce their anxiety and depression and promote their mental health.2.MBSR can improve the mindfulness attention awareness and mental resilience of ICU nurses,reduce perceived stress,and have positive effects on improving anxiety and depression of ICU nurses.The application of MBSR in the psychological intervention of ICU nurses’ negative emotions has good feasibility,effectiveness and safety.3.The change of gut microbiota may be the potential mechanism of MBSR to improve anxiety and depression in ICU nurses: MBSR can change the intestinal microbiota diversity of ICU nurses,especially the β diversity of gut microbiota.MBSR can also improve the abundance of intestinal Blautia and Anaerostipes,reduce the abundance of Bacteroides,and increase the metabolism of intestinal thiamine.It has a positive effect on promoting intestinal balance,protecting intestinal mucosal barrier,reducing intestinal inflammation and alleviating anxiety and depression.The results suggest that Blautia and Anaerostipes may have the same effect as MBSR on anxiety and depression in ICU nurses.