【作者】 黄可心；

【导师】 陈立； 贾勇；

【作者基本信息】 吉林大学 ， 护理学， 2024， 硕士

【摘要】 背景:阈下抑郁(Subthreshold Depression,StD)被认为是重度抑郁障碍(Major Depressive Disorder,MDD)的前驱阶段。大学生由于人际关系困扰、学业压力等诸多问题,已成为阈下抑郁的易发群体。大学生持续处于阈下抑郁状态容易增加心理负担、功能损伤和重度抑郁障碍的发生风险,甚至产生自杀念头或行为。运动疗法(Exercise Therapy)作为英国国家卫生与临床卓越研究所(National Institute for Health and Care Excellence,NICE)指南的推荐疗法之一,已被证实能有效缓解抑郁症状,但是部分研究表示传统运动形式单调、内容枯燥、趣味性较低且缺乏足够的刺激和变化,降低了参与者的参与意愿和长期坚持的可持续性。运动游戏(Exergame)通过增加游戏元素弥补了传统运动的局限性,通过提供更有趣、刺激和个性化的运动选择,使运动形式和内容更富有趣味性、互动性和享受性等特点,提高了个体参与运动的动机,增强了运动改善效果。目前,任天堂Switch是使用最广泛的运动游戏设备之一。现有研究显示,运动游戏在康复治疗、功能恢复等领域具有一定益处,在心理健康方面也具有较大潜力。然而,目前尚缺乏基于任天堂Switch的运动游戏干预改善阈下抑郁大学生心理健康效果的证据。目的:1.探讨基于任天堂Switch的运动游戏干预对StD大学生抑郁症状、焦虑症状和睡眠质量的干预效果。2.了解StD大学生参与基于任天堂Switch的运动游戏干预的体验,分析影响参与运动游戏干预的因素。方法:1.基于任天堂Switch的运动游戏干预对StD大学生的干预效果:首先,成立研究小组,结合运动游戏改善成年人抑郁症状的证据总结、《健身环大冒险》的游戏类目总结、StD大学生对实用且有效运动游戏干预方案的需求以及运动游戏干预三阶段设置构建基于任天堂Switch的运动游戏组合方案初稿,并通过小组会议法及预实验进行运动游戏组合方案的修订与完善。接着,2023年1月至2023年8月在吉林省长春市某高校内开展一项随机对照试验。本研究共招募StD大学生183名,根据纳入和排除标准,确定84名纳入研究,将其按1:1分配到干预组(n=42)和对照组(n=42)。干预组大学生采用基于任天堂Switch的运动游戏组合方案进行干预,每周2-3次,每次50-60分钟,共干预8周,对照组则维持原日常生活方式。主要结局包括抑郁症状,次要结局包括焦虑症状和睡眠质量。在基线(T0)、干预第8周结束(T1)、干预结束后1个月(T2)和干预结束后2个月(T3)四个时间点进行评估。评估工具包括一般资料调查表、流行病学研究中心抑郁量表(CES-D)、患者健康问卷-9项(PHQ-9)、广泛性焦虑量表-7项(GAD-7)和匹兹堡睡眠质量指数量表(PSQI)。采用SPSS 25.0软件进行数据分析。2.StD大学生对参加基于任天堂Switch的运动游戏干预体验的质性研究:采用描述性质性分析,通过目的抽样法,选取17名完成8周基于任天堂Switch的运动游戏干预的大学生作为访谈对象,进行一对一、半结构化访谈。运用内容分析法,使用质性分析软件NVivo12.0对访谈资料进行整理和分析。结果:1.基于任天堂Switch的运动游戏干预对StD大学生的干预效果:两组组间的一般人口学资料和基线数据比较差异无统计学意义(P>0.05)。采用GEE分析运动游戏对大学生抑郁症状、焦虑症状和睡眠质量的干预效果。在抑郁症状方面,组间×时间交互效应、组间效应和时间效应均具有统计学意义(P<0.001)。参数估计结果显示,在T1、T2和T3三个时间点的组间×时间交互相效应均显著(P<0.05)。估计边际均值的成对比较结果显示,干预组大学生的抑郁得分在T1、T2和T3三个时间点均显著低于T0(P<0.05),组间比较显示,两组抑郁得分在T1、T2和T3三个时间点的差异具有统计学意义(P<0.05)。在焦虑症状方面,组间×时间交互效应和组间效应均无统计学意义(P=0.081;P=0.067),时间效应具有统计学意义(P<0.001)。在睡眠质量方面,组间效应、时间效应和组间×时间交互效应均具有统计学意义(P<0.05)。2.StD大学生对参加基于任天堂Switch的运动游戏干预的质性研究:对访谈资料分析和提炼,形成“运动游戏自身属性”的主观体验感、“运动游戏相关益处”的主观体验感和影响参与依从性的因素三个主要类别。其中,“运动游戏自身属性”的主观体验感包括发展性元素、反馈机制、奖励机制、增强社会联结和视听效果;“运动游戏相关益处”的主观体验感包括心理状态的改善、身体素质的提升和生活质量的提高;影响参与依从性的因素包括游戏元素、个体属性和环境因素。结论:1.基于任天堂Switch的运动游戏干预能够改善StD大学生的抑郁症状、焦虑症状和睡眠质量。2.参与者主观感受到运动游戏的发展性元素、反馈机制、奖励机制、增强社会联结和视听效果等因素能够提供积极的主观体验,并且认为这种运动游戏干预对于提升个体身心健康和生活质量具有潜在益处。同时,参与者表示游戏元素、个体属性和环境因素可能会影响其参加运动游戏的依从性。因此,未来推广应用中,增加促进因素,减少或避免阻碍因素,将有助于完善干预方案内容并且提高参与者的依从性和满意度促进干预方案的实施。更多还原

【Abstract】 Background:Subthreshold Depression(StD)is considered a precursor stage to Major Depressive Disorder(MDD).College students,due to various issues such as interpersonal relationship difficulties and academic pressure,have become a vulnerable group for StD.Prolonged exposure to StD states among college students may escalate psychological burden,impair functioning,and elevate the risk of developing MDD,which may even lead to suicidal thoughts or behaviors.Exercise therapy,recommended by the National Institute for Health and Care Excellence(NICE)as one of the treatment modalities,has been proven effective in alleviating symptoms of depression.However,some studies suggest that traditional forms of exercise are perceived as monotonous,with content being dull and lacking in excitement,thereby reducing interest and compromising the sustainability of long-term participation.Exergames address the limitations of traditional exercise by incorporating gaming elements,offering more engaging,stimulating,and personalized physical activity options.They enhance the appeal of exercise by making it more enjoyable,interactive,and enjoyable,thereby increasing individual motivation to participate in physical activities and augmenting the effectiveness of exercise interventions.Currently,Nintendo Switch stands out as one of the most widely used exergaming devices.Existing research indicates the potential benefits of exergaming in areas such as rehabilitation and functional recovery,with substantial promise for mental health.However,there is currently a lack of evidence regarding the effectiveness of Nintendo Switch-based exergame interventions in improving the mental health of college students with StD.Objectives:1.To explore the effects of Nintendo Switch-based exergame on improving depressive symptoms,anxiety symptoms and sleep quality of college students with StD.2.To examine the experiences of college students with StD participating in Nintendo Switch-based exergame interventions,and analyze the factors influencing their engagement in the exergaming intervention.Methods:1.Intervention effects of Nintendo Switch-based exergame intervention on college students with StD: First,a team was set up to construct the first draft of the Nintendo Switch-based exergame combination programme based on the results of the evidence summary,the characteristics and needs of the college students with StD and the exercise prescription guidelines,and to revise and improve the intervention programme through the group conferencing method and the pre-experiment.Next,a randomized controlled trial was conducted from January 2023 to August 2023 at a university in Changchun,Jilin Province,China.This study recruited a total of 183 college students with StD,84 participants were identified according to the inclusion criteria and allocated in a 1:1ratio into the intervention group(n=42)and the control group(n=42).The intervention group of college students underwent an intervention using a combination of exergames based on Nintendo Switch,conducted 2-3 times per week for 50-60 minutes each session,spanning a total intervention period of 8 weeks.The control group,on the other hand,maintained their regular daily lifestyle.Primary outcomes included depressive symptoms,and secondary outcomes encompassed anxiety symptoms and sleep quality.Assessments were conducted at baseline(T0),after the 8-week intervention(T1),1month after the intervention(T2),and 2 months after the intervention(T3).Evaluation tools included a general information questionnaire,the Center for Epidemiologic Studies Depression Scale(CES-D),the Patient Health Questionnaire-9(PHQ-9),the Generalized Anxiety Disorder Scale-7(GAD-7),and the Pittsburgh Sleep Quality Index(PSQI).Data analysis was performed using SPSS 25.0 software.2.Qualitative study on the experiences of college students with StD participating in Nintendo Switch-based exergaming intervention: Descriptive qualitative analysis was employed using purposeful sampling.Participants who completed the 8-week Nintendo-based exergaming intervention were selected for one-on-one semi-structured interviews.Content analysis method was applied,and the interview data were organized and analyzed using qualitative analysis software NVivo 12.0.Results:1.Effects of Nintendo Switch-based exergame intervention on college students with StD: No statistically significant differences were found between the two groups in terms of general demographic information and baseline data(P>0.05).GEE was used to analyze the effectiveness of exergame on depressive symptoms,anxiety symptoms and sleep quality in college students with StD.In terms of depression,the group × time interaction effect,between-group effect and time effect all statistically significant(P<0.001).The parameter estimation results indicate that the group × time interaction effects are significant at T1,T2,and T3 three time points(P<0.05).The paired comparison results of estimated marginal means indicate that the depression scores of the intervention group college students are significantly lower at T1,T2,and T3 three time points than T0(P<0.05).The between-group comparison shows that the differences in depression scores between the two groups at T1,T2,and T3 are statistically significant(P<0.05).In the context of anxiety,both the group × time interaction effect and the between-group effect are not statistically significant(P=0.081;P=0.067).However,the time effect is statistically significant(P<0.001),indicating that the GAD-7 scores for both groups of college students change over time.In the realm of sleep,all the between-group effect,time effect,and the group × time interaction effect are statistically significant(P<0.05).2.A qualitative study of participating in Nintendo Switch-based exergame intervention by college students with StD: The analysis and synthesis of interview data resulted in three main categories: subjective experiences of "Inherent Attributes of Nintendo Switch-based exergame",subjective experiences of "Benefits Associated with Nintendo Switch-based exergame" and factors influencing participation compliance.The first main category encompasses five general subcategories: developmental elements,feedback mechanisms,reward systems,enhanced social connections,and aesthetic experiences.The second main category comprises three general subcategories:improvement in psychological states,enhancement of physical fitness,and improvement in quality of life.The third main category includes three subcategories:game elements,individual attributes,and environmental factors.Conclusions:1.Nintendo Switch-based exergame intervention can improve depressive symptoms,anxiety symptoms,and sleep quality in college students with StD.2.Participants subjectively perceive positive experiences from the developmental elements,feedback mechanisms,reward systems,enhanced social connections,and aesthetic experiences of exergame.They believe that this form of exergame intervention has the potential to enhance individual physical and mental well-being,as well as overall quality of life.Additionally,they indicate that factors such as game elements,individual attributes,and environmental factors may influence compliance with participating in exergame.Therefore,in future applications and implementations,enhancing facilitative factors and minimizing or avoiding hindering factors will contribute to refining intervention program content and improving participant compliance and satisfaction,thereby promoting the successful implementation of the intervention program.更多还原