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Article(id=1240413927641764517, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240413921266429979, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202503103, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1741449600000, receivedDateStr=2025-03-09, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773667326126, onlineDateStr=2026-03-16, pubDate=1754755200000, pubDateStr=2025-08-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773667326126, onlineIssueDateStr=2026-03-16, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773667326126, creator=13701087609, updateTime=1773667326126, updator=13701087609, issue=Issue{id=1240413921266429979, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='15', pageStart='2689', pageEnd='2880', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1773667324606, creator=13701087609, updateTime=1773667356299, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240414054267802325, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240413921266429979, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240414054267802326, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240413921266429979, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=2743, endPage=2748, ext={EN=ArticleExt(id=1240413927897617079, articleId=1240413927641764517, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=The effects of worker occupation fit on occupational stress and its related disorders: a theory model construction and validation, columnId=1228016570660745413, journalTitle=Modern Preventive Medicine, columnName=Environmental and Occupational Health, runingTitle=null, highlight=null, articleAbstract=
Objective

Based on the person-environment fit (PEF) theory, a theoretical model of worker-occupation fit related stress (MWOFS) is constructed to provide theoretical support and practical guidance for the identification and intervention of occupational stress.

Method

Integrating theoretical analysis with empirical validation, the MWOFS model was constructed through literature comparison, inductive reasoning, and programmatic decision-making methods. A logistic regression model was used to examine the interaction effect between worker occupation fit and occupational stress on psychological, physical, and social outcomes. Furthermore, the impact of poor fit on the risk of health outcomes was calculated.

Results

The conceptual model of the MWOFS was established based on the core elements of worker occupation fit, occupational stress, and stress related disorders. The content model provided theoretical guidance for empirical research by expanding the core elements and formulating pathway hypotheses for validation. This study included a total of 3 451 healthcare-related workers as research subjects. The empirical results showed that the interaction between misfit and occupational stress increased the risk of stress-related disorders. Compared to individuals with worker occupation fit, those with misfit exhibited elevated risks for mental responses (34.7%), physiological responses (23.1%), and chronic diseases (10.9%).

Conclusion

MWOFS provides a reasonable framework for integrating influencing factors of occupational stress. It also scientifically evaluates the principal health impairments in working populations arising from the interaction between workeroccupation fit and occupational stress, and proposes innovative approaches for risk stratified management of occupation related diseases and the development of targeted intervention strategies.

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目的

以个人-环境匹配论（person environment fit, PEF）为理论依据，构建工作适配-职业紧张健康效应理论模型（the theoretical model of worker-occupation fit related stress, MWOFS），为职业紧张的识别与干预提供理论支持与实践指导。

方法

结合理论研究方法与实证验证结果，采用文献分析法、归纳推演法及程序化决策法构建MWOFS。采用logistic回归模型分析工作适配-职业紧张交互对心理-躯体-社会效应结局的作用强度，估算适配不良对健康结局发生风险的作用影响。

结果

MWOFS的概念模型基于工作适配-职业紧张-紧张疾患的核心要素建立；内容模型旨在扩展核心要素，归纳实证验证路径。本研究共纳入3 451名医务相关工作者作为研究对象。通过实证验证结果显示，适配不良-职业紧张交互增加紧张相关疾患的发生风险；相较适配人群，适配不良群体心理心理症状、躯体症状及慢性疾患风险分别增加了34.7%、23.1%、10.9%。

结论

MWOFS较为合理归集职业紧张的影响因素，科学评价工作适配-职业紧张交互作用下对职业人群造成的主要健康损害，为职业相关疾病的风险分级管理及干预策略制定提供新思路与新方法。

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兰亚佳，E-mail:
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孙瑞灿（1992—），女，博士，讲师，研究方向：职业紧张理论研究及工作场所职业紧张的识别与评价

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孙瑞灿（1992—），女，博士，讲师，研究方向：职业紧张理论研究及工作场所职业紧张的识别与评价

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孙瑞灿（1992—），女，博士，讲师，研究方向：职业紧张理论研究及工作场所职业紧张的识别与评价

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BMC Public Health, 2024, 24(1): 1432., articleTitle=The interaction of occupational stress and job burnout on depressive symptoms in railway workers in Fuzhou city, refAbstract=null)], funds=[Fund(id=1240424356422144677, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413927641764517, awardId=82073521, language=CN, fundingSource=国家自然科学基金(82073521), fundOrder=null, country=null), Fund(id=1240424356552168112, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413927641764517, awardId=MZGC20230027, language=CN, fundingSource=四川省科技计划资助(MZGC20230027), fundOrder=null, country=null), Fund(id=1240424356648637111, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413927641764517, awardId=CSXL-23302, language=CN, fundingSource=成都医学院四川应用心理学研究中心资助项目(CSXL-23302), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1240424348956283201, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413927641764517, xref=1., ext=[AuthorCompanyExt(id=1240424348977254725, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413927641764517, companyId=1240424348956283201, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Public Health, Chengdu Medical College, Chengdu, Sichuan 610500, China), AuthorCompanyExt(id=1240424348998226246, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413927641764517, companyId=1240424348956283201, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.成都医学院公共卫生学院，四川 成都 610500)]), AuthorCompany(id=1240424349119861076, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413927641764517, xref=2., ext=[AuthorCompanyExt(id=1240424349132443990, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413927641764517, companyId=1240424349119861076, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.四川大学华西公共卫生学院/华西第四医院，四川 成都 610041)])], figs=[ArticleFig(id=1240424353121227304, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413927641764517, language=EN, label=Figure 1, caption=Pathway for theoretical model construction, figureFileSmall=XZCi/csQ406oL9wKqQoZSQ==, figureFileBig=Pzto5UltByHqU5oxZwHAIg==, tableContent=null), ArticleFig(id=1240424353251250739, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413927641764517, language=CN, label=图1, caption=理论模型构建路径图, figureFileSmall=XZCi/csQ406oL9wKqQoZSQ==, figureFileBig=Pzto5UltByHqU5oxZwHAIg==, tableContent=null), ArticleFig(id=1240424353372885564, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413927641764517, language=EN, label=Figure 2, caption=Conceptual model of the MWOFS, figureFileSmall=Cj1McTr/kR3Dscq+E7Ju1w==, figureFileBig=7drtHKsHCJte11O6Ea+XIw==, tableContent=null), ArticleFig(id=1240424353502908994, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413927641764517, language=CN, label=图2, caption=MWOFS概念模型, figureFileSmall=Cj1McTr/kR3Dscq+E7Ju1w==, figureFileBig=7drtHKsHCJte11O6Ea+XIw==, tableContent=null), ArticleFig(id=1240424353595183690, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413927641764517, language=EN, label=Figure 3, caption=Content model of the MWOFS, figureFileSmall=NCt5j0SAjPZ5zvo/MyDW8Q==, figureFileBig=lPoyq/B1QZZhvOxAATuhog==, tableContent=null), ArticleFig(id=1240424353737790035, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413927641764517, language=CN, label=图3, caption=MWOFS内容模型, figureFileSmall=NCt5j0SAjPZ5zvo/MyDW8Q==, figureFileBig=lPoyq/B1QZZhvOxAATuhog==, tableContent=null), ArticleFig(id=1240424353880396376, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413927641764517, language=EN, label=Figure 4, caption=The finalized MWOFS framework, figureFileSmall=cGbuFpN49WtrRgTvZ3dt7w==, figureFileBig=07r0cuMiEVMrVZYOti42AQ==, tableContent=null), ArticleFig(id=1240424354018808417, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413927641764517, language=CN, label=图4, caption=最终MWOFS模型

注：理论模型路径“─”表示工作适配、职业紧张均在独立作用与交互作用；“┈”表示工作适配-职业紧张对效应结局仅存在交互作用。

, figureFileSmall=cGbuFpN49WtrRgTvZ3dt7w==, figureFileBig=07r0cuMiEVMrVZYOti42AQ==, tableContent=null), ArticleFig(id=1240424354207552106, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413927641764517, language=EN, label=Table 1, caption=

General information of the study subjects（n=3 451）

, figureFileSmall=null, figureFileBig=null, tableContent=
变量分类人数占比（%）
性别男性3279.48
女性3 12490.52
年龄（年）<2546113.36
25～3083824.28
31～351 04130.17
>351 11132.19
婚姻状态单身92126.69
恋爱同居351.01
已婚2 43470.53
离异及丧偶611.77
子女数量无1 18934.45
独生子女80623.36
二胎98428.51
三胎2106.09
三胎及以上2627.59
文化水平大专及以下86725.12
本科2 50872.67
研究生及以上762.2
工龄（年）<12798.08
1～352015.07
4～101 33438.66
11～1987625.38
≥2044212.81
夜班01 16033.61
（次/周）1～23409.85
3～43119.01
5～61 64047.52
工作时长<4094527.38
（小时/周）40～491 67348.48
50～5951114.81
≥603229.33
), ArticleFig(id=1240424354337575540, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413927641764517, language=CN, label=表1, caption=

研究对象一般资料情况（n=3 451）

, figureFileSmall=null, figureFileBig=null, tableContent=
变量分类人数占比（%）
性别男性3279.48
女性3 12490.52
年龄（年）<2546113.36
25～3083824.28
31～351 04130.17
>351 11132.19
婚姻状态单身92126.69
恋爱同居351.01
已婚2 43470.53
离异及丧偶611.77
子女数量无1 18934.45
独生子女80623.36
二胎98428.51
三胎2106.09
三胎及以上2627.59
文化水平大专及以下86725.12
本科2 50872.67
研究生及以上762.2
工龄（年）<12798.08
1～352015.07
4～101 33438.66
11～1987625.38
≥2044212.81
夜班01 16033.61
（次/周）1～23409.85
3～43119.01
5～61 64047.52
工作时长<4094527.38
（小时/周）40～491 67348.48
50～5951114.81
≥603229.33
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Interaction analysis of worker occupational fit and occupational stress with psychological effects, physical effects and social effects

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健康效应结局工作适配职业紧张适配不良-职业紧张
OR95% CIOR95% CIOR95% CI
抑郁症状3.18**2.220～4.38617.78**12.794～24.69647.52**33.113～68.189
焦虑症状3.41**2.601～4.46423.41**16.624～32.970116.89**67.379～202.770
职业心理疲劳2.49**1.910～3.2344.91**3.651～6.5948.61**5.400～13.743
睡眠紊乱2.92**1.523～5.5885.90**3.964～8.7869.94**6.473～15.275
血压异常1.080.218～5.0391.160.658～3.9372.56*1.0413～6.311
职业躯体疲劳2.95**2.227～3.9029.55**7.041～12.96016.56**10.622～25.828
离职意愿3.81**2.787～5.2034.66**2.502～8.67821.42**9.943～46.137
职业幸福感2.96**2.026～4.3335.53**3.578～8.5559.19**5.890～14.336
工作满意度2.71**2.093～3.60914.95**9.064～24.66921.71**14.754～31.974
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工作适配-职业紧张对心理-躯体-社会效应结局的交互作用分析

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健康效应结局工作适配职业紧张适配不良-职业紧张
OR95% CIOR95% CIOR95% CI
抑郁症状3.18**2.220～4.38617.78**12.794～24.69647.52**33.113～68.189
焦虑症状3.41**2.601～4.46423.41**16.624～32.970116.89**67.379～202.770
职业心理疲劳2.49**1.910～3.2344.91**3.651～6.5948.61**5.400～13.743
睡眠紊乱2.92**1.523～5.5885.90**3.964～8.7869.94**6.473～15.275
血压异常1.080.218～5.0391.160.658～3.9372.56*1.0413～6.311
职业躯体疲劳2.95**2.227～3.9029.55**7.041～12.96016.56**10.622～25.828
离职意愿3.81**2.787～5.2034.66**2.502～8.67821.42**9.943～46.137
职业幸福感2.96**2.026～4.3335.53**3.578～8.5559.19**5.890～14.336
工作满意度2.71**2.093～3.60914.95**9.064～24.66921.71**14.754～31.974
), ArticleFig(id=1240424356099183243, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413927641764517, language=EN, label=Table 3, caption=

Estimation of the risk of psychological symptoms, physical symptoms and chronic diseases

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年龄组（岁）心理症状风险躯体症状风险慢性疾患风险
适配适配不良Δ Risk适配适配不良Δ Risk适配适配不良Δ Risk
20～<300.2150.5600.3440.1660.3900.2240.4350.5580.123
30～<400.2280.5770.3500.1900.4290.2390.5410.6610.120
40～<500.2230.5710.3480.1820.4170.2350.6020.7160.113
≥500.2260.5750.3490.1480.3590.2100.8440.9020.058
合计0.2230.5700.3470.1770.4080.2310.5720.6810.109
), ArticleFig(id=1240424356195652246, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413927641764517, language=CN, label=表3, caption=

心理症状-躯体症状-慢性疾患发生风险估计

, figureFileSmall=null, figureFileBig=null, tableContent=
年龄组（岁）心理症状风险躯体症状风险慢性疾患风险
适配适配不良Δ Risk适配适配不良Δ Risk适配适配不良Δ Risk
20～<300.2150.5600.3440.1660.3900.2240.4350.5580.123
30～<400.2280.5770.3500.1900.4290.2390.5410.6610.120
40～<500.2230.5710.3480.1820.4170.2350.6020.7160.113
≥500.2260.5750.3490.1480.3590.2100.8440.9020.058
合计0.2230.5700.3470.1770.4080.2310.5720.6810.109
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工作适配-职业紧张健康效应理论模型构建及验证
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孙瑞灿 1 , 兰亚佳 2
现代预防医学 | 环境与职业卫生 2025,52(15): 2743-2748
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现代预防医学 | 环境与职业卫生 2025, 52(15): 2743-2748
工作适配-职业紧张健康效应理论模型构建及验证
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孙瑞灿1, 兰亚佳2
作者信息
  • 1.成都医学院公共卫生学院，四川 成都 610500
  • 2.四川大学华西公共卫生学院/华西第四医院，四川 成都 610041

    • 孙瑞灿（1992—），女，博士，讲师，研究方向：职业紧张理论研究及工作场所职业紧张的识别与评价

通讯作者:

兰亚佳，E-mail:
The effects of worker occupation fit on occupational stress and its related disorders: a theory model construction and validation
Rui-can SUN1, Ya-jia LAN2
Affiliations
  • School of Public Health, Chengdu Medical College, Chengdu, Sichuan 610500, China
出版时间: 2025-08-10 doi: 10.20043/j.cnki.MPM.202503103
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摘要
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目的

以个人-环境匹配论（person environment fit, PEF）为理论依据，构建工作适配-职业紧张健康效应理论模型（the theoretical model of worker-occupation fit related stress, MWOFS），为职业紧张的识别与干预提供理论支持与实践指导。

方法

结合理论研究方法与实证验证结果，采用文献分析法、归纳推演法及程序化决策法构建MWOFS。采用logistic回归模型分析工作适配-职业紧张交互对心理-躯体-社会效应结局的作用强度，估算适配不良对健康结局发生风险的作用影响。

结果

MWOFS的概念模型基于工作适配-职业紧张-紧张疾患的核心要素建立；内容模型旨在扩展核心要素，归纳实证验证路径。本研究共纳入3 451名医务相关工作者作为研究对象。通过实证验证结果显示，适配不良-职业紧张交互增加紧张相关疾患的发生风险；相较适配人群，适配不良群体心理心理症状、躯体症状及慢性疾患风险分别增加了34.7%、23.1%、10.9%。

结论

MWOFS较为合理归集职业紧张的影响因素，科学评价工作适配-职业紧张交互作用下对职业人群造成的主要健康损害，为职业相关疾病的风险分级管理及干预策略制定提供新思路与新方法。

工作适配  /  职业紧张  /  理论模型  /  健康效应  /  紧张相关疾患
Objective

Based on the person-environment fit (PEF) theory, a theoretical model of worker-occupation fit related stress (MWOFS) is constructed to provide theoretical support and practical guidance for the identification and intervention of occupational stress.

Method

Integrating theoretical analysis with empirical validation, the MWOFS model was constructed through literature comparison, inductive reasoning, and programmatic decision-making methods. A logistic regression model was used to examine the interaction effect between worker occupation fit and occupational stress on psychological, physical, and social outcomes. Furthermore, the impact of poor fit on the risk of health outcomes was calculated.

Results

The conceptual model of the MWOFS was established based on the core elements of worker occupation fit, occupational stress, and stress related disorders. The content model provided theoretical guidance for empirical research by expanding the core elements and formulating pathway hypotheses for validation. This study included a total of 3 451 healthcare-related workers as research subjects. The empirical results showed that the interaction between misfit and occupational stress increased the risk of stress-related disorders. Compared to individuals with worker occupation fit, those with misfit exhibited elevated risks for mental responses (34.7%), physiological responses (23.1%), and chronic diseases (10.9%).

Conclusion

MWOFS provides a reasonable framework for integrating influencing factors of occupational stress. It also scientifically evaluates the principal health impairments in working populations arising from the interaction between workeroccupation fit and occupational stress, and proposes innovative approaches for risk stratified management of occupation related diseases and the development of targeted intervention strategies.

Worker occupation fit  /  Occupational stress  /  Theoretical model  /  Health effects  /  Stress-related disorders
孙瑞灿, 兰亚佳. 工作适配-职业紧张健康效应理论模型构建及验证. 现代预防医学, 2025 , 52 (15) : 2743 -2748 . DOI: 10.20043/j.cnki.MPM.202503103
Rui-can SUN, Ya-jia LAN. The effects of worker occupation fit on occupational stress and its related disorders: a theory model construction and validation[J]. Modern Preventive Medicine, 2025 , 52 (15) : 2743 -2748 . DOI: 10.20043/j.cnki.MPM.202503103
正文
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国际劳工组织(International Labour Organization,ILO)提示职业紧张已成为全球范围的流行病[1]。长期处于高职业紧张水平，且无法得到及时缓解与调节，可诱发诸多心身疾患，不仅影响劳动者职业生命质量，增加疾病负担，甚至阻碍社会经济发展。工作适配的提出源于社会科学技术水平的持续提高，现代新型工作模式的出现，工作内容的可替代性增强，劳动者需要储能蓄电提高自身价值以满足工作要求，个体与职业环境间的适配不良现象日益突显。工作适配问题已然成为职业健康的新型危害因素。既往研究显示，中国的职业人群无论是紧张水平还是紧张对健康的危害程度，相较于发达国家来说有过之而无不及[2]。当前，公众对职业紧张的感知越发明显，且对于职业紧张带来的健康问题越来越关注与重视。个人-环境匹配理论（person-environment fit theory, PEF）是职业紧张核心理论模型，是最为契合职业紧张理论内涵，且最早提出的研究理论框架[3-4]。该理论框架在职业卫生领域一直停滞在概念框架下，未得到进一步的发展与应用。
PEF在社会科学领域的运用较为广泛，在组织行为学、公共管理学等领域具有较高应用价值且多有研究报道[5-6]。在组织管理学与组织行为学领域有较多的适配理论模型推出，有研究者表示，适配不良问题会导致组织人员的组织公民行为减少[7]，工作满意度降低[8]及人员流失率增加[9]等不良组织效应结局的发生。目前，职业卫生领域未建立围绕工作适配的相关理论模型，且现有的理论框架未能有效体现个人与环境相互作用下对职业相关疾患的作用机制，对职业紧张影响因素系统归集的合理性、劳动者-职业环境交互作用评价的科学系统性、预防干预策略理论依据的推进造成阻碍。
因此，本研究以PEF理论为主要理论依据，围绕“模型初构-实证验证-模型完善”研究路径构建工作适配-职业紧张健康效应理论模型（the theoretical model of worker-occupation fit related stress, MWOFS），该模型具有明确的现实需求，通过引入工作适配概念，开展职业卫生领域适配理论的应用，为后续职业紧张研究领域发展及干预策略制定提供理论支持。
1　对象与方法
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1.1　研究对象
采用多中心分层整群抽样方法，以四川省和河南省的7家医院的医务人员为目标人群，按照科室类别分层，以工种类别为单位进行整群抽样。调查的医院包括3家三级甲等综合医院和4家专科医院，调查时间是2020年12月—2022年12月。纳入标准：（1）在职的医院工作者，工种包括医生、护士、医技、管理、后勤工作；（2）工龄1年及以上；（3）知情同意参加调查工作。排除标准：（1）现患有肿瘤及严重器质性疾病，以及患有抑郁、焦虑等精神疾患者或服用相关精神类药物者；（2）初始量表填写内容不完整。回收问卷3 597份，有效问卷3 451份，问卷有效率为95.94%。本研究经四川大学华西第四医院/华西公共卫生学院伦理委员会审查批准（伦理审查批件号：Gwll2021070）。
1.2　研究方法
1.2.1　理论框架构建
理论模型构建以PEF理论为理论依据，采用文献分析法、归纳推演法、程序化决策法形成MWOFS初步理论框架及工作适配测量工具，并用于职业人群实施现场调查，对收集的实证数据进行统计分析与评价，对理论框架进行修正与完善，形成最终MWOFS，构建路径见图1。
决策小组由10位领域专家组成，学科背景包含公共卫生与预防医学、临床医学、公共管理学及护理学。以公共卫生与预防医学专业人员为MWOFS理论模型构建的核心小组。文献分析过程包括系统检索、整理和分析既往文献资料，归纳整理PET的理论起源及理论发展轨迹，并挖掘“工作适配”的概念界定。实证验证包括两个阶段，小样本验证阶段的主要目的是评价和修正理论框架结构，并建立初步适配测量工具；大样本验证阶段目的是综合工作适配测量与职业健康结局的分析评价结果，完善并形成最终MWOFS。
1.2.2　测量评价工具
工作适配测量采用Molar测量法[10]，使用工作适配量表（worker-occupation fit scale, WFITS）[11]进行评价。该量表由三个维度组成，包含素质能力匹配度（personal traits fit，PTF）、需求供应满意度（needs supplies fit，NSF）和能力要求适配度（demands abilities fit，DAF），共16条目组成。WFITS的Cronbach α为0.888。采用抑郁-焦虑-紧张量表（depression-anxiety-stress scale，DASS-21）[12]评价研究对象的紧张、抑郁及焦虑的症状反应水平。采用英国心理医学研究所Tudie与 Berelowitz研究组共同编制的疲劳量表（fatigue scale，FS-14）[13]评价职业性疲劳，该量表包含心理疲劳和躯体疲劳两部分，粗分越高说明职业性疲劳水平越高。FS-14量表的Cronbach α为0.934。睡眠紊乱[14]的评价采用匹兹堡睡眠质量指数（Pittsburgh sleep quality index, PSQI），该量表共有24条目，7个维度指标进行测量，包含主观睡眠质量、入睡时间、睡眠效率、睡眠障碍、催眠药物及日间功能障碍等内容。PSQI量表的Cronbach α为0.756。采用自行设计的离职意愿问卷及工作满意度的问卷评价研究对象的离职意愿及工作满意度水平，得分越高说明离职意愿越强，工作满意度水平越高。离职意愿问卷的Cronbach α为0.793，KMO为0.620;工作满意度的Cronbach α为0.934，KMO为0.826。职业幸福感测量采用的可视化评分，按照被调查者距离表达以判定职业幸福感程度，满分为100分，得分越高，职业幸福感水平越高。慢性疾患评价来自研究对象最近一年的医疗体检记录，将医疗检查中发现的慢性疾患归并为五类，即心血管异常、肺部异常、消化系统异常、泌尿系统异常、代谢指标异常，以代表研究人群的慢性疾患患病情况。
1.2.3　统计分析方法
采用logistic回归模型分析工作适配-职业紧张交互作用对心身健康结局（抑郁症状、焦虑症状、职业心理疲劳）、躯体健康结局（职业躯体疲劳）以及社会效应结局（离职意愿、职业幸福感、工作满意度）的作用关系，以OR值表示工作适配、职业紧张、工作适配-职业紧张交互作用对健康结局的效应强度；采用边际效应分析方法进一步探讨不同年龄阶段，适配不良对心理反应-生理反应-慢性疾患的风险估计。数据分析采用R 4.4.2统计分析软件进行研究数据的分析与处理。检验水准α=0.05。
2　结果
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2.1　理论模型定义
MWOFS基于PEF理论框架与本研究理论模型构建目标，将理论模型定义为在劳动者与职业环境相互作用过程中，劳动者的个人素质、需求及其能力与职业环境倡导的组织文化、供应及要求无法适应并匹配时，形成适配不良，诱发职业紧张症状，长期持续该健康状态造成负性心理-躯体-社会效应结局，对劳动者的职业健康造成损害。
2.2　MWOFS模型框架初步构建
2.2.1　MWOFS的概念模型
概念模型基于PEF理论框架，保留核心适配要素，旨在对MWOFS核心概念间关系进行基本梳理与推演。相较PEF理论模型，MWOFS概念模型更为强调劳动者与职业环境的相互作用，以及MWOFS补充工作适配对紧张相关疾患的作用影响。在劳动者与职业环境相互作用过程中，如若劳动者在个体素质、需求、供应无法适配于职业环境的要求与供给，进而发生相似性适配不良（supplementary poor-fit）与互补性适配不良（complementarity poor-fit）。相似性适配，指劳动者个体素质与职业环境无法适应且匹配；互补性适配，指劳动者需求与职业环境供应无法形成一致性，或劳动者在持续性努力后无法达到职业环境对个体的目标与要求。长期工作适配不良诱发职业紧张症状，慢性职业紧张状态诱发紧张相关健康损害。见图2。
2.2.2　MWOFS的内容模型
如图3所示，在MWOFS概念模型基础上，MWOFS内容模型主要通过文献分析法、程序化决策法整合构建，系统剖析与刻画工作适配-职业紧张所致健康效应结局路径，旨在阐述工作适配-职业紧张及其交互作用对紧张相关疾患的作用机理。内容模型理论路径主要阐明：（1）劳动者与职业环境间的相互作用水平决定工作适配不良的发生发展；工作适配度由WFITS总分评价与分级，以判定个体工作适配水平；（2）由概念模型的两种适配类型（相似性适配与互补性适配）扩展为三种适配类型，相似相适配为PTF，互补性适配包含NSF和DAF。通过WFITS的分量表评估PTF、NSF及DAF水平；（3）工作适配不良及PTF、NSF、DAF不良导致职业紧张症状；（4）工作适配不良导致职业紧张，进而诱发紧张相关疾患，围绕现代医学模式及紧张相关疾患的结局类型，主要包含心理效应结局、躯体效应结局、社会效应结局。
2.3　MWOFS实证分析结果
2.3.1　研究对象的一般资料情况
本研究共调查医务人员3 451人，平均年龄为32.33岁（S=7.59）；男性占比为9.48%（n=327），女性为90.52%（n=3 124）；以大学本科学历为主，占比为72.67%（n=2 508）；婚姻状况以已婚为主，占比为70.53%（n=2 434）；工龄4～10年比例较高，为38.66%（n=1 334）。见表1。
2.3.2　工作适配-职业紧张与心理效应、躯体效应、社会效应结局的关系及其风险估计
如表2所示，工作适配-职业紧张对健康结局的交互作用分析显示，控制混杂因素后，工作适配和职业紧张对所纳入的健康结局均存在交互作用。其中，工作适配与职业紧张交互显著增加了焦虑症状的发生风险（OR=116.89，95%CI: 67.379～202.770，P<0.001）。
如表3所示，以是否存在心理症状、躯体症状及慢性疾患为（0,1）变量，根据二分类logistic模型进一步估算心理症状、躯体症状、慢性疾患的发生风险。工作适配不良人群中，发生心理症状的风险是57.0%，相较工作适配人群的发生风险增加了近34.7%；发生躯体症状的风险是40.8%，相较适配人群的发生风险增加了近23.1%；发生慢性疾患症状的风险是68.1%，相较适配人群的发生风险增加了近10.9%。在各年龄组均存在适配不良人群心理-躯体-慢性疾患风险增加的情况，各年龄组的心理症状风险增加均达到30%以上。
2.4　最终MWOFS的建立
围绕初步构建模型的路径假设，基于实证验证结果，确定最终MWOFS。实证验证分析显示，MWOFS的假设路径基本符合初步构建的模型假设[15-20]。相较躯体效应结局，工作适配与心理效应结局具有更强的关联性及预测效能。实证结果分析显示，工作适配、职业紧张与血压异常无相关性，工作适配、职业紧张对血压异常具有交互作用。因此，工作适配-职业紧张对血压异常的模型表达用“虚线”表示；其他路径均符合初步理论模型的研究假设。最终MWOFS见图4。
3　讨论
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本研究以构建MWOFS为主要研究目标，该模型由概念模型与内容模型组成。概念模型旨在阐述核心概念间的关系线索，内容模型基于概念模型延伸，揭示、拓展工作适配及其类型与效应结局间关系脉络。MWOFS是较为全面完整的“检索式”理论模型，系统连接职业紧张源、职业紧张及其紧张相关疾患，促使职业紧张研究系统化开展。MWOFS的逻辑线索较为符合职业紧张的理论内容，融入工作适配理论内涵，补充劳动者-职业环境交互作用对职业健康的作用影响，为进一步了解职业紧张-紧张疾患间内在机制提供理论依据与技术支持。
职业紧张的核心理论框架包含工作要求-自主模型（job demand-control model，JDC）、付出-回报失衡模式（effort-reward imbalance model，ERI）及工作需求-资源模型（job demands-resources model，JDR）[21-24]。这些理论框架陆续研发了相应的职业紧张评价工具[21,25-26]。关于劳动者-工作场所匹配理论运用较多的为Chuang等人[27]提出的中国文化背景下的个人-环境匹配模型（Chinese model of person-environment fit，CMPEF），该理论框架及其评价工具致力于为组织有效管理与运行提供指导思想与评价策略，在组织管理学、组织行为学普遍使用，具有较高的领域认可度与应用价值，但对于职业健康研究领域应用而言，存在适用局限。在职业紧张评价工具中，工作内容问卷（job content questionnaire, JCQ）和付出-回报失衡量表（effort-reward imbalance, ERI）较为广泛应用，通过对工作环境任务内容的有效测量以评估职业紧张现状，其优势在于量表的短小精悍，在实际现场操作较为方便使用[28-29]。目前而言，无论是职业紧张的理论框架及评价工具，紧张表达较多从职业特征与工作任务层面进行评估，缺乏劳动者个体与职业环境交互作用角度表达紧张的方式。从社会需求层面考虑，工作适配问题是职业环境快速变化的必然结果，是当前工作环境中职业紧张发生的重要决定因素，急需纳入职业紧张评价范围，进而有效改善职业紧张理论全面性与评价普适性。
在理论模型实证验证中，工作适配及工作适配-职业紧张交互作用表现出对不良健康结局的显著影响。工作适配-职业紧张交互对心理反应结局具有较好的风险预测效能，尤其是对焦虑症状与抑郁症状，OR值分别为116.89（95% CI: 67.379～202.770,P <0.001）和47.52（95%CI: 33.113～68.189, P<0.001）。工作适配-职业紧张交互作用分析结果表明在控制了其他变量的影响后，工作适配与职业紧张具有较强的叠加效应，强调二者共同作用下提高了不良心理反应、生理反应和慢性疾患的发生风险。Yu等人[30]对职业紧张与职业倦怠的交互作用对抑郁症状进行分析，发现职业紧张与职业倦怠的交互作用表明，在高职业紧张水平下，职业倦怠程度较高的人群对抑郁症状具有较高风险效应。在本研究中，在适配不良人群中，职业紧张人群的抑郁症状发生风险是非职业紧张人群的47.52倍。结果提示，在职业健康干预中，除了关注单一的职业紧张因素外，工作适配水平及二者的交互效应同样应被纳入考量。
本研究结合理论研究与实证验证构建MWOFS，该模型将工作适配理念拟合职业健康问题，旨在破解职业紧张影响因素控制干预难点，以促进职业紧张理论的全面与完整。该研究存在一定的研究局限，主要体现在本研究的目标人群主要选取医务人员作为研究对象。尽管，医务人员是职业紧张的代表性群体，是职业紧张高危人群，但由于职业种类繁多，不同职业在工作环境、工作压力源等方面存在差异。理论模型的后续研究，我们将开展多种职业群体的工作适配-职业紧张研究内容，涵盖不同职业类型劳动者，以提高研究结果的普适性。同时，进一步扩展心理-躯体-社会健康效应结局，深入开展工作适配-职业紧张与职业健康的关系探索，不断丰富理论内涵，持续完善理论模型。
基金
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  • 国家自然科学基金(82073521)
  • 四川省科技计划资助(MZGC20230027)
  • 成都医学院四川应用心理学研究中心资助项目(CSXL-23302)
文献
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参考文献 引证文献
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2025年第52卷第15期
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doi: 10.20043/j.cnki.MPM.202503103
  • 接收时间：2025-03-09
  • 首发时间：2026-03-16
  • 出版时间：2025-08-10
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  • 收稿日期：2025-03-09
基金
国家自然科学基金(82073521)
四川省科技计划资助(MZGC20230027)
成都医学院四川应用心理学研究中心资助项目(CSXL-23302)
作者信息
    1.成都医学院公共卫生学院，四川 成都 610500
    2.四川大学华西公共卫生学院/华西第四医院，四川 成都 610041

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2种不同金属材料的力学参数
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Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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