Executive dysfunction and depression are common among ICU survivors, yet the mechanisms linking these two factors remain poorly understood. Self-confidence has been implicated as a key mediator in the relationship between cognitive impairments and mental health outcomes. This study aimed to explore the mediating role of self-confidence in the association between executive functioning and depression in ICU survivors. A provisional questionnaire was used in a cross-sectional study to assess quality of life in 395 adult ICU survivors, each with a minimum 72-h stay at one of three ICUs at a Swedish university hospital, six months to three years post-discharge. Responses to questions on executive function, self-confidence, and depression were analysed. Structural equation modelling and confirmatory factor analysis were employed to examine the mediating effect of self-confidence on the relationship between executive function and depression. Model fit was evaluated using established indicators. Reliability of the measures was assessed using McDonald’s Omega and Cronbach’s Alpha. A significant positive correlation was found between depressive symptoms and both diminished self-confidence (r = 0.80, p < 0.001) and poorer executive function (r = 0.55, p < 0.001). Additionally, a correlation was observed between reduced self-confidence and compromised executive function (r = 0.62, p < 0.001). Age was negatively associated with depression, self-confidence, and executive function, while male gender was positively correlated with higher self-confidence. Mediation analysis revealed that the effect of impaired executive function on depressive symptoms was fully mediated by diminished self-confidence (B = 0.45; 95% CI 0.34–0.59). The direct effect of executive function on depression became non-significant when self-confidence was included in the model (B = 0.07, p = 0.18), suggesting complete mediation. The overall model fit was satisfactory (CFI = 0.962; RMSEA = 0.075), highlighting the robustness of the mediation pathway. Self-confidence mediates the relationship between executive function and depression among ICU survivors. Interventions aimed at enhancing self-confidence could mitigate depressive symptoms in the ICU survivor population. Longitudinal studies are needed to confirm these findings and further explore the causal pathways involved. Trial registration ClinicalTrials.gov Ref# NCT02767180; Registered 28 April 2016.

中文翻译：

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自 信心作为 ICU 幸存者执行功能与抑郁之间关系的中介：潜在变量分析


执行功能障碍和抑郁在 ICU 幸存者中很常见，但将这两个因素联系起来的机制仍然知之甚少。自信被认为是认知障碍与心理健康结果之间关系的关键中介。本研究旨在探讨自信在 ICU 幸存者执行功能与抑郁之间关系中的中介作用。在一项横断面研究中使用了一份临时问卷来评估 395 名成年 ICU 幸存者的生活质量，每名幸存者在出院后 6 个月至 3 年内在瑞典大学医院的三个 ICU 之一中至少住院 72 小时。分析了对执行功能、自信心和抑郁问题的回答。采用结构方程建模和验证性因子分析来检验自信对执行功能与抑郁之间关系的中介作用。使用既定指标评估模型拟合度。使用麦当劳的 Omega 和 Cronbach 的 Alpha 评估措施的可靠性。发现抑郁症状与自信心下降 （r = 0.80，p < 0.001） 和执行功能较差 （r = 0.55，p < 0.001） 之间存在显著的正相关。此外，观察到自信心降低与执行功能受损之间存在相关性 （r = 0.62，p < 0.001）。年龄与抑郁、自信心和执行功能呈负相关，而男性与较高的自信心呈正相关。中介分析显示，执行功能受损对抑郁症状的影响完全由自信心减弱介导 （B = 0.45;95% CI 0.34–0.59）。 当模型包括自信时，执行功能对抑郁症的直接影响变得不显著 （B = 0.07，p = 0.18），表明完全中介。总体模型拟合令人满意 （CFI = 0.962;RMSEA = 0.075），突出了中介途径的稳健性。自信心在 ICU 幸存者执行功能与抑郁之间的关系中起中介作用。旨在增强自信心的干预措施可以减轻 ICU 幸存者人群的抑郁症状。需要纵向研究来证实这些发现并进一步探索所涉及的因果途径。试验注册 ClinicalTrials.gov Ref# NCT02767180;2016 年 4 月 28 日注册。