护理专业学生接触冲突相关新闻和心理困扰：睡眠困难和学习中断的中介作用

摘要(中文译文)

武装冲突与地缘政治不稳定日益通过持续的媒体报道和数字信息传播，对直接暴露人群之外的心理健康产生影响。护理专业学生可能尤为脆弱，原因在于其学业要求高、对人类苦难具有情感敏感性，以及对社会化媒体和在线新闻平台的高度参与。本研究考察了2026年2月涉及伊朗的地区军事升级期间，沙特阿拉伯护理专业学生冲突相关新闻暴露与抑郁、焦虑和压力之间的关联，并探讨了感知安全担忧的作用以及涉及睡眠困难和学业中断的潜在间接关联。本研究在沙特阿拉伯五个地区不同公立大学的护理专业学生中开展了一项多中心横断面研究。心理困扰采用抑郁-焦虑-压力量表进行评估。基于冲突新闻的接触频率和暴露强度指标构建了冲突暴露综合指数。我们使用Gamma广义线性模型、交互作用分析和结构方程模型来评估关联、信息来源的调节作用以及中介路径。结果以算术均值比（AMR）及95%置信区间报告，表示每个预测变量相关的心理困扰平均得分的相对变化。模型对 sociodemographic、学业和生活相关因素进行了调整。共纳入247名护理专业学生。分别有50.2%、59.9%和32.4%的参与者报告了中度至重度抑郁、焦虑和压力。我们的研究结果显示，较高的冲突暴露与压力水平升高相关（AMR = 1.17，95% CI：1.02-1.34），而与抑郁（AMR = 1.14，95% CI：0.99-1.30）和焦虑（AMR = 1.13，95% CI：0.99-1.28）的关联较弱。在考虑感知安全担忧后，冲突相关暴露与抑郁、焦虑和压力之间的关联大幅减弱，而感知安全担忧仍与所有心理困扰结局强烈相关（AMR = 1.32，95% CI：1.19-1.47）、焦虑（AMR = 1.31，95% CI：1.18-1.44）和压力（AMR = 1.36，95% CI：1.24-1.51）。与电视新闻使用者相比，依赖在线新闻的学生表现出显著更高的抑郁（AMR = 1.92，95% CI：1.32-2.78）、焦虑（AMR = 1.84，95% CI：1.29-2.64）和压力得分（AMR = 1.88，95% CI：1.29-2.74）。结构方程模型识别出涉及睡眠困难和学业中断的显著间接关联，而暴露与心理困扰之间的直接关联相对较弱。冲突相关媒体暴露与护理专业学生较差的心理健康相关，感知不安全感、睡眠困难和学业中断与心理困扰表现出强关联，且模式与间接关系一致。大学和护理教育项目应考虑在地区地缘政治不稳定时期实施心理健康支持、媒体素养干预、睡眠健康促进和心理社会支持策略。

Abstract

Armed conflict and geopolitical instability increasingly affect mental health beyond directly exposed populations through continuous media exposure and digital information dissemination. Nursing students may be particularly vulnerable because of high academic demands, emotional sensitivity to human suffering, and intensive engagement with social media and online news platforms. This study examined the association between conflict related news exposure and depression, anxiety, and stress among nursing students in Saudi Arabia during the February 2026 regional military escalation involving Iran, and explored the role of perceived safety concern and the potential indirect associations involving sleep difficulty and study disruption. A multi-center cross sectional study was conducted among nursing students from different public universities across five regions of Saudi Arabia. Psychological distress was assessed using the Depression Anxiety Stress Scale. A composite conflict exposure index was developed from conflict news following frequency and exposure intensity measures. We used Gamma generalized linear models, interaction analyses, and structural equation modeling to evaluate associations, moderation by information source, and mediation pathways. Results were reported as arithmetic mean ratios (AMRs) with 95% confidence intervals, representing the relative change in mean psychological distress scores associated with each predictor. Models were adjusted for sociodemographic, academic, and living-related factors. A total of 247 nursing students were included. Moderate to severe depression, anxiety, and stress were reported by 50.2%, 59.9%, and 32.4% of participants, respectively. Our findings showed that higher conflict exposure was associated with increased stress levels (AMR = 1.17, 95% CI: 1.02-1.34), while associations with depression (AMR = 1.14, 95% CI: 0.99-1.30) and anxiety (AMR = 1.13, 95% CI: 0.99-1.28) were weaker. Associations between conflict-related exposure and depression, anxiety, and stress were substantially attenuated after accounting for perceived safety concern, which remained strongly associated with all psychological distress outcomes (AMR = 1.32, 95% CI: 1.19-1.47), anxiety (AMR = 1.31, 95% CI: 1.18-1.44), and stress (AMR = 1.36, 95% CI: 1.24-1.51). Compared with television news users, students relying on online news demonstrated substantially higher depression (AMR = 1.92, 95% CI: 1.32-2.78), anxiety (AMR = 1.84, 95% CI: 1.29-2.64), and stress scores (AMR = 1.88, 95% CI: 1.29-2.74). Structural equation modeling identified significant indirect associations involving sleep difficulty and study disruption, whereas direct associations between exposure and psychological distress were comparatively weak. Conflict-related media exposure was associated with poorer mental health among nursing students, with perceived insecurity, sleep difficulties, and study disruption showing strong associations with psychological distress and patterns consistent with indirect relationships. Universities and nursing education programs should consider implementing mental health support, media literacy interventions, sleep health promotion, and psychosocial support strategies during periods of regional geopolitical instability.

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