| Objective: There was a shortage of manpower in mental health centers in China,with a high workload of psychiatric healthcare workers(HCWs)and susceptibility to workplace violence.Over time,their symptoms of depression and anxiety increased,which affected their ability to provide mental health services to patients facing psychological distress.Although most studies have shown that Mindfulness-based Stress Reduction(MBSR)training could alleviate depression and anxiety symptoms in HCWs.However,the effectiveness of online MBSR training on depression and anxiety symptoms of psychiatric HCWs and the possible mechanisms underlying these beneficial outcomes remained unclear.Therefore,this study aimed to examine whether online MBSR training decreased the level of depression and anxiety symptoms among psychiatric HCWs,and whether changes in emotional suppression mediated the intervention effects on depression and anxiety symptoms,to provide a scientific basis for developing positive psychological training for psychiatric HCWs and realizing targeted mental health management.Methods: The study design was a single-center,randomized controlled clinical trial.In August 2022,psychiatric HCWs in a tertiary mental health center in Liaoning Province who met the inclusion criteria were recruited.The control group did not receive any training,and the intervention group was given online 8-week mindfulness-based stress reduction training.Participants completed the online survey of depression and anxiety symptoms(Hospital Anxiety and Depression Scale,HADS)and emotional suppression(Courtauld Emotional Control Scale,CECS)via“wenjuanxing” platform.A total of 165 participants were recruited in this study.IBM SPSS 21.0 was used for statistical analysis.Independent sample t-test and homogeneity chi-square test were used to determine whether there were differences between groups at baseline.Paired t-test was used to compare the level of emotional suppression,depression and anxiety symptoms of intervention group before and after intervention.Analysis of Covariance(ANCOVA)was used to compare the level of emotional suppression,depression and anxiety symptoms between the intervention group and the control group after intervention.Multiple linear regression analysis was used to determine the effect of online MBSR training on emotional suppression,depression and anxiety symptoms,and the relationship between the change of emotional suppression and depression and anxiety symptoms.The bias-corrected percentile Bootstrap method was used to examine whether emotional suppression mediated the effects of MBSR training on depression and anxiety symptoms.Results: In fact,the effective sample size for completing all the intervention was135(74 participants in the intervention group,61 in the control group),and the loss-to-follow-up rate was about 18%.Independent sample t-test and homogeneity chi-square analysis showed that there was no statistical difference between the intervention group and the control group at baseline(P>0.05).Analysis of covariance showed that compared with the control group,the psychiatric HCWs in the intervention group showed lower levels of emotional suppression(P<0.001),depression symptoms(P<0.001)and anxiety symptoms(P=0.002)after the intervention.The multiple linear regression model showed that after controlling for baseline depression and anxiety symptoms in regression model 1,the effect of group condition(intervention group vs.control group)on depression symptoms(B=-2.047,P<0.001)and anxiety symptoms(B=-1.299,P=0.002)was statistically significant.After controlling for baseline emotional suppression and either baseline depression symptoms or baseline anxiety symptoms in regression model 2,reductions in emotional suppression during the intervention were positively associated with 8-week depression symptoms(B=0.142,P<0.001)and 8-week anxiety symptoms(B=0.153,P<0.001).As the group condition and changes in emotional suppression entered regression model 3 simultaneously,the effects of group condition on depression symptoms(B=-0.929,P=0.057)and anxiety symptoms(B=-0.107,P=0.811)became statistically insignificant,preliminarily indicating that there were potential mediating effects.The bias-corrected percentile Bootstrap method showed that the reduction in emotional suppression during the intervention played a complete mediating role in the effect of online MBSR training on depression symptoms or anxiety symptoms at week8,and the 95% bias-corrected confidence intervals were(-1.683,-0.600)or(-1.731,-0.706),respectively.Conclusions: Online MBSR training is expected to be used among psychiatric healthcare workers to address their experience of depression and anxiety symptoms and emotional suppression in their clinical practice.Online MBSR training may alleviate mood disorder symptoms in psychiatric HCWs by reducing emotional expression.Emotional suppression may be the mechanism by which online MBSR training alleviates depression and anxiety symptoms in psychiatric HCWs.The development of psychological training strategies for psychiatric HCWs could focus on the part of MBSR training that is closely related to emotional suppression. |
