# 理解心理疲劳及其检测：评估方法与工具的比较分析 > AI 辅助翻译，非官方版本。专业判断、引用和争议应以原文及其勘误为准。 - 来源 ID：S0157 - DOI：10.7717/peerj.15744 - 原始来源：https://www.ebi.ac.uk/europepmc/webservices/rest/PMC10460155/fullTextXML - 许可：CC BY 4.0 - 翻译方法：Independent manual review; SHA-256-pinned source and translation - 审校状态：独立人工审校完成 ## 原始文件映射 - [fullTextXML.xml](../original/fullTextXML.xml) ## 许可文件（保留原文） - [creative-commons-legalcode.txt](../license/creative-commons-legalcode.txt)：法律或许可证据原文未翻译 - [europepmc-fullTextXML.xml](../license/europepmc-fullTextXML.xml)：法律或许可证据原文未翻译 ## 原始文件：fullTextXML.xml # 理解心理疲劳及其检测：评估方法与工具的比较分析 - 期刊：PeerJ - 文章类型：研究论文 - 作者：Kaveena Kunasegaran；Ahamed Miflah Hussain Ismail；Shamala Ramasamy；Justin Vijay Gnanou；Brinnell Annette Caszo；Po Ling Chen - 学术编辑：André Aleman - 作者单位：马来西亚吉隆坡武吉加里尔国际医科大学心理学系；马来西亚雪兰莪士毛月诺丁汉大学马来西亚分校心理学学院；马来西亚吉隆坡武吉加里尔国际医科大学生物化学系；马来西亚吉隆坡武吉加里尔国际医科大学生理学系 - 通讯作者：Po Ling Chen（chen.poling@nottingham.edu.my） - 收稿日期：2023-02-09；接受日期：2023-06-21；在线发表日期：2023-08-23 - 卷：11；文章号：e15744 - DOI：10.7717/peerj.15744 - PMCID：PMC10460155；PMCID 版本：PMC10460155.1；PMID：37637168 - 关键词：心理负荷；扫视；执行功能；注意；数字健康；心理健康 - 版权：© 2023 Kunasegaran et al. - 许可：本文依据知识共享署名 4.0 国际许可协议发布。在正确注明原作者、文章标题、发表来源（PeerJ）及 DOI 或网址的前提下，可不受限制地使用、传播、复制和改编。 - 资助：本研究获基础研究资助计划（FRGS）支持，项目编号 FRGS/1/2020/SS0/IMU/02/1。资助方未参与研究设计、数据收集与分析、发表决定或稿件撰写。 ## 摘要 心理疲劳是生产率和整体认知表现下降的根本原因之一，它会削弱个体抑制反应、处理信息和集中注意的能力。心理疲劳可导致职业差错和高速公路交通事故。及早发现心理疲劳能够防止症状加重，避免其进一步发展为慢性疲劳综合征及其他疾病。目前，临床环境主要通过自评问卷评估心理疲劳和压力。此类问卷主观性很强，且无法避免作答偏差，其效度因此受到质疑。本综述考察心理疲劳在普通人群中的广泛存在，并批判性比较多种检测技术，包括自评问卷、心率变异性、唾液皮质醇水平、脑电图和扫视眼动。文章尤其评估这些工具检测抑制反应的能力，因为这种反应足够敏感，会在疲劳状态下表现出来，有望成为可靠识别心理疲劳者的标志。在实验室中，反向扫视任务长期用于评估抑制控制，可能是客观检测心理疲劳最有前景的评估工具。不过，仍需开展更多研究，以验证该方法，并分析其与现有其他心理疲劳检测指标的相关性。本综述主要面向心理健康专业人员、数字健康科学家、视觉研究人员和行为科学家，但读者不限于这些群体。 ## 引言 当今社会中，处于不同人生阶段的人，例如学生和在职成年人，在日常活动中不断承受心理负荷。以上班族为例，早晨醒来查看手机里的新消息或电子邮件时，心理负荷便已开始。一天之中，他们既要处理组织、规划和管理等复杂工作，还会遇到照应同事等意外打断。下班回家后，清洁、照顾孩子和购买日用品等家务及个人责任又会进一步增加心理负荷。持续的心理负荷使人感到心理疲劳、紧张，并为当天尚未完成的一长串事务焦虑。我们偶尔会看到医生或护士因睡眠不足或工作过度而遭遇交通事故的新闻。澳大利亚统计数据显示，10–40% 的交通事故源于心理疲劳造成的驾驶疲劳（Victorian Transport Resources, 2019）。然而，疲劳的起因往往不是驾驶本身，而是驾驶前已经承受的心理负荷，例如会计师高强度处理数字，或心脏外科医生连续完成 12-h 手术的繁重工作（Victorian Transport Resources, 2019）。心理疲劳影响多个年龄群体，可能造成致命事故，使疲劳者本人和旁观者都陷入危险。 易受心理疲劳影响的并不只有上班族。许多大学生每天要听 4–6 h 的课，课外还要复习 2–3 h。美国高中生平均每天上课 6 h（Jin, 2012）。学生常常一节课结束后直接去上另一节，中间没有休息。研究表明，讲座开始 10–15 min 后，学生的注意力便会下降（Bradbury, 2016），但教育环境中仍普遍存在这种漫长的课程安排。在压力条件下学习，也就是长时间接收过量信息，会增加个体的心理负荷（Gaillard, 1993）。学生的注意持续时间有限，仍需长时间坐在课堂中，这会加重心理负荷，许多人在课程结束时已感到心理疲劳（Petrov et al., 2020）。 压力会使心理疲劳问题更加复杂。个体执行认知和注意要求很高的任务时，压力可能加重疲劳。压力还会直接影响控制工作记忆的脑区，提高认知超负荷风险，从而妨碍学习（Bong, Fraser & Oriot, 2016）。它会加剧心理疲劳，使人逐渐陷入抑郁及自杀、焦虑等心理健康和社会问题（Craik, 2014；Tanaka, Ishii & Watanabe, 2014；Forster & Lavie, 2016）。自 2019 年开始的全球大流行以来，自杀病例数有所增加（Sher, Peters & Sher, 2020）；医生因职业倦怠和心理耗竭而自杀的比例比普通人群高 44%（Reger, Piccirillo & Buchman-Schmitt, 2020），因此，工作场所若能检测员工的心理疲劳，将会有所帮助。大流行期间，许多公司和教育机构采用居家办公或学习的方式维持业务和教学，工作与生活的平衡随之发生剧烈变化，越来越多人承受更大压力（Charles et al., 2021）。心理疲劳危害显著，影响背景和年龄各异的人，包括在职成年人和大学中的年轻人。现有文献尚无单项研究全面评价并比较各种主观和客观心理疲劳检测与评估工具及其优缺点，这构成了本比较分析的主要依据。本文还讨论心理疲劳对普通人群的影响、现有检测方法，以及这些方法在健康监测技术中的应用。 ### 心理疲劳 心理疲劳与身体疲劳是两种不同的状态。身体疲劳是重复肌肉运动引起的疲倦（Mizuno et al., 2011）。心理疲劳则指长时间从事要求高、会引起认知负荷的活动后产生的一种心理生物学疲倦状态，它会降低认知表现的效率（Craik, 2014；Tanaka, Ishii & Watanabe, 2014）。心理负荷可从知觉负荷和加工容量两方面解释。知觉负荷与处理相关任务时涉及的信息量有关（Forster & Lavie, 2016）。知觉负荷过高会造成无意视盲，并损害记忆（Murphy, Groeger & Greene, 2016；Murphy & Greene, 2016）。高知觉负荷是心理负荷过高的原因之一；不过，无论知觉负荷是否较高，需要执行功能技能的任务同样可能造成较高心理负荷（Blair, 2016）。加工容量是个体在任一时刻能够处理的信息量（Hancock et al., 2021；van Elburg et al., 2021）。容量达到上限后，新信息便难以处理，导致心理超负荷。心理超负荷持续时间过长，最终会引起心理疲劳（Mizuno et al., 2011）。 #### 压力与心理疲劳的差异 压力与心理疲劳可依据诱因加以区分（Gaillard, 2001）。二者的内在机制不同，产生的生物行为状态也可以辨别。应激源，即感知到的威胁，会促使身体释放应激激素，引起行为和生理变化，从而诱发压力（Lupien et al., 2009；Reznikov et al., 2007）。与心理疲劳不同，压力并不产生疲倦感，而会使身体作出战斗或逃跑反应（Johnson et al., 1992）。它会唤起中枢神经系统（CNS）或交感神经系统（SNS），使个体根据情境产生不同的应激反应（Adams et al., 1969；Schneiderman, Ironson & Siegel, 2005）。压力的生物学反应促使身体释放皮质醇和肾上腺素等激素，帮助身体应对感知到的威胁。但身体若长期受应激激素激活，认知表现、睡眠和消化等正常功能便会受到干扰（Chu et al., 2021；Yaribeygi et al., 2017）。研究表明，长期压力会引起心理疲劳，还会改变多个脑区的结构（Mariotti, 2015；Kocalevent et al., 2011）。心理疲劳不像压力那样伴有恐慌、挫败感或求胜压力，也不会引起战斗或逃跑反应（Adamsson & Bernhardsson, 2018）。它使人感到心智疲倦，导致注意力下降和执行功能受损。心理疲劳来自持续的心理负荷，而压力可能只需一个刺激便会产生（Kocalevent et al., 2011）。 #### 主动与被动疲劳状态 Desmond & Hancock（2001）最早提出两种心理疲劳状态：“主动疲劳”，即长时间进行与任务有关的知觉运动调节所引起的心理疲劳；以及“被动疲劳”，即长时间不活动，例如驾驶汽车，所造成的心理疲劳。被动疲劳具有单调性，会使人困倦并降低注意力，却不一定出现打哈欠等典型困倦症状（He et al., 2023；Hu & Lodewijks, 2020）。处于被动和主动心理疲劳状态时，大脑会呈现不同的判别性功能连接特征，说明功能连接可能成为区分和检测心理疲劳的生物标志（Dimitrakopoulos et al., 2018）。Bernhardt et al.（2019）利用脑电图（EEG）指标研究了两种疲劳的差异。他们发现，与主动疲劳者相比，被动疲劳者的顶枕中线 EEG 参与程度显著较低，具体表现为任务参与减弱导致 alpha 功率谱密度降低。主动心理疲劳者和被动心理疲劳者也呈现不同的扫视眼动特征，前者如眨眼变慢，后者如瞳孔扩张显著减小（Desmond & Hancock, 2001）。不过，引起这两种状态的脑机制尚未得到研究。本综述重点讨论主动疲劳，因为持续工作负荷很可能诱发这种状态，也更符合现代人日常忙碌的一天。 #### 心理疲劳的环境诱因 心理疲劳通常由高压职业、工作时间过长和工作紧张等环境因素引起。个体长时间执行需要工作记忆、灵活思维和自我控制等执行功能的任务或活动时，便会产生心理疲劳（Diamond, 2013）。外科医生、空中交通管制员等高压职业从业者长期承受较高心理工作负荷，因而容易出现心理疲劳（Diamond, 2013；Nealley & Gawron, 2015）。外科医生完成一次手术可能需要长达 12 h，具体取决于手术的复杂程度。这类职业要求从业者始终保持注意和专注，也因此造成心理疲劳。工作时间过长还会引起身体和心理两方面的一般性疲劳。研究表明，每月工作超过 280 h 会增加一般性疲劳、身体疾病、焦虑和慢性疲倦；每月最多工作 260 h 较有利于减少疲劳症状（Petrut et al., 2020；Nagashima et al., 2007）。尽管如此，经济资源不足的人往往为摆脱贫困而不得不超过建议时长工作（Bick, Fuchs-Schündeln & Lagakos, 2018）。一项对巴西甘蔗收割工人的研究中，17.9% 的工人提到，心理疲劳是贫困生活带来的困难之一（Rocha, Marziale & Robazzi, 2007）。他们所说的心理疲劳源于工作节奏过快、持续保持注意和专注、单调、重复，以及失业威胁。一项针对孤儿和弱势儿童的描述性调查也指出，过度劳动和疲劳是这些儿童在深度贫困中生存面临的主要困难（Ganga & Chinyoka, 2010）。 工作紧张是心理疲劳的另一个诱因，出现在严格的工作要求与不足的适应和应对能力失衡时。工作紧张是一种压力，源于工作场所常见的高要求，以及个人无法控制或参与决策（Shakerian, Habibi & Poorabdian, 2015）。结构化问卷研究发现，工作紧张程度较高的人会出现心理疲劳（Perrier et al., 2016；Tran et al., 2020），随后可能发展为职业倦怠（Ekstedt et al., 2006）。职业倦怠会使在职成年人出现抑郁等心理健康问题，使许多人逐渐产生自杀想法乃至采取自杀行为（Ahola et al., 2014）。 #### 心理疲劳的神经机制 大脑额叶和枕叶皮层主要与心理疲劳有关。EEG 反应研究显示，心理疲劳者的整个皮层慢波活动增加（Craig et al., 2012；Qi et al., 2019）。这些变化在 theta 和 alpha 脑波中最明显，主要分布于大脑额叶、中央区和后叶（Craig et al., 2012；Perrier et al., 2016；Tran et al., 2020）。频带活动的变化说明，心理负荷增加时，大脑会逐渐失去应对能力，脑活动随之减慢（Klimesch, Sauseng & Hanslmayr, 2007），导致警觉性和执行功能下降。研究还发现，因执行认知任务而心理疲劳的个体，其枕中回，即负责物体识别的区域、楔叶和颞中回的 alpha 频带（8–13 Hz）功率降低。颞中回对应 Brodmann 19 区和 39 区，参与语言与语义记忆加工、视觉感知和多模态感觉整合（Tanaka, Ishii & Watanabe, 2015）。大多数证据把脑活动降低与心理疲劳联系起来，但 Tanaka et al. 利用脑磁图观察到，个体执行引起心理疲劳的任务时，额叶皮层 beta 频带增强（Tanaka, Ishii & Watanabe, 2014）。近期一项功能性近红外光谱研究也报告，重度心理疲劳条件下前额叶区域内的功能连接尤其强（Peng et al., 2022）。综合来看，额叶和枕叶皮层的脑活动变化说明心理疲劳会影响这些脑区；但心理疲劳究竟表现为脑活动增强、减弱，还是二者兼有，仍需进一步研究。 心理疲劳双重调节系统是描述其神经机制的概念模型。该模型认为，心理疲劳是心理促进系统和心理抑制系统共同作用的结果（Ishii, Tanaka & Watanabe, 2014）。诱发心理负荷的任务中，心理促进系统被激活以维持任务表现；当个体的加工容量达到上限时，心理抑制系统的激活则会损害任务表现。心理促进系统涉及丘脑-额叶环路，该环路连接边缘系统、基底神经节、丘脑和眶额皮层；心理抑制系统则由岛叶皮层和后扣带皮层构成（Mohammadzadeh, Farsi & Khosrowabadi, 2020）。总体而言，额叶皮层和视觉皮层受心理疲劳的影响很大，心理促进和抑制系统共同调节个体的认知表现（Sabeti, Boostani & Rastgar, 2018；Faber, Maurits & Lorist, 2012）。 #### 心理疲劳的影响 ### 认知表现 研究表明，心理疲劳者在需要警觉、持续注意和分配注意的认知任务中往往表现较差（Smith et al., 2019）。这一现象可能部分与疲劳状态下的动机有关。动机在心理疲劳者认知表现下降的过程中发挥作用。一项认知表现比较研究发现，两组参与者都报告心理疲劳时，与期待奖励的参与者相比，没有奖励的参与者认知努力较少、扫视频率降低而眨眼增加（Herlambang, Taatgen & Cnossen, 2019）。同样，无论是否心理疲劳，内在动机较强者在认知任务中的表现都优于内在动机较弱者（Herlambang, Cnossen & Taatgen, 2021）。不过，目前缺少客观指标，尚不能确切认定心理疲劳导致的动机下降是认知表现变差的核心因素（Jimura, Locke & Braver, 2010）。 Hopstaken et al.（2016）和 Gergelyfi et al.（2015）则认为，表现下降并非个人动机减弱所致，而是因为缺少高效处理并投入任务所需的心理资源。前额叶皮层在产生目标导向信号、切换注意方面起重要作用（Rossi et al., 2009）。研究显示，个体心理疲劳时，额叶皮层过度激活，进而抑制信息加工（Tanaka, Ishii & Watanabe, 2014；Ishii, Tanaka & Watanabe, 2014；Goodman & Marino, 2020）。这可以解释执行控制下降，例如抑制反应减弱，以及执行任务时反应时间延长（Gantois et al., 2020；Guo et al., 2018；Jaydari Fard, Tahmasebi Boroujeni & Lavender, 2019）。心理疲劳者的认知表现因此下降（Sasahara et al., 2015），也更难发现可能危及职业安全的危险（Rocha, Marziale & Robazzi, 2007）。他们难以抑制无关信息（Faber, Maurits & Lorist, 2012；Csathó et al., 2012）。心理疲劳会抑制目标导向行为，使刺激驱动行为更加突出（Boksem, Meijman & Lorist, 2005）。简言之，心理疲劳者更难抑制刺激驱动行为，执行需要主动压制无关信息的任务时，反应时间和错误率会增加。这反映出心理疲劳造成的选择性视觉注意下降（Guo et al., 2016）。 ### 身体表现 注意加工受损时，心理疲劳还会损害平衡控制等身体表现（Webster, Richter & Kruglanski, 1996）。Pires et al.（2018）发现，心理疲劳者的平衡控制、体力等身体表现下降，同时前额叶皮层激活增强，表现为慢 theta 脑波增加，并导致自下而上的反应增加、自上而下的加工减少。Marcora, Staiano & Manning（2009）同样指出，心理疲劳者进行身体活动时感知到的用力程度更高，因而更快达到主观体力极限并停止活动。Penna et al.（2018a）的结果也支持这一发现：心理疲劳者身体表现下降与摄氧量、心率或血乳酸等生理变量无关，而可归因于心理疲劳造成的较高主观用力感。心理疲劳不影响个体能够发挥的最大力量和功率，而是改变其对已经付出或完成任务所需努力的感知，由此降低身体表现（Van Cutsem et al., 2017）。 #### 心理疲劳检测 健康监测技术可用于监测日常生活活动、认知衰退、心理健康和心脏疾病等多种情况（Liu et al., 2016）。在工作场所使用类似技术，可以帮助企业方便地发现心理疲劳者。心理疲劳严重影响日常生活，人们日益需要更稳健的方法，在造成过多损害前及早识别。心理疲劳是一种非特异性症状，其根源难以确定，因此仅评估一个参数并不足够，必须组合多种检测方法来验证单一参数。下文讨论以往用于检测心理疲劳的多种方法，包括自评问卷、注意网络测验（ANT）、EEG、心率变异性（HRV）、唾液皮质醇水平和扫视眼动。 ### 自评问卷 为检测心理疲劳，研究者开发了多种自我评估工具。表 1 汇总了测量心理疲劳的各类问卷及其优缺点。总体而言，自评问卷等主观测量常因偏倚受到批评，因为参与者的诚实程度，即是否如实回答而非按社会可接受行为作答，以及内省能力，即能否准确评估自己，都很容易受到影响。人也无法准确判断自身认知状态（Schmidt et al., 2009）。因此，专家强烈建议把问卷与其他客观测量结合使用（Tempelaar, Rienties & Nguyen, 2020）。这也暴露出一个局限：问卷无法快速、简便地检测短暂的心理疲劳状态，不能反映心理疲劳每时每刻的波动，而且往往受到认知能力、情绪和焦虑水平影响。 #### 表 1：用于检测心理疲劳的自评问卷汇总 | 问卷名称 | 说明 | 优点 | 缺点 | | --- | --- | --- | --- | | 职业疲劳-耗竭-恢复量表（OFER）（Winwood et al., 2005） | 15 个条目，用于划分和区分心理疲劳的三个分量表：慢性工作相关疲劳特质、急性及下班时状态，以及轮班间的有效疲劳恢复。 | 稳健，心理测量特征不受性别偏倚和工作状态影响。 | 只能检测心理疲劳的三个领域。 | | 疲劳严重程度视觉模拟量表（VAS-F）（Lee, Hicks & Nino-Murcia, 1991） | 18 个条目；视觉模拟线长 100 mm，范围从“完全不累”到“极度疲倦”两个端点。 | 使用语义差异量表，以独特的双极顺序量表格式捕捉个人对特定条目的感受。 | 个体常不愿选择最高和最低两个极端。 | | 疲劳评估量表（FAS） | 10 个条目，用于评估慢性疲劳症状。一半条目测量身体疲劳，另一半测量心理疲劳。该量表为单维量表，测量疲劳时不受抑郁影响（Michielsen, De Vries & Van Heck, 2003）。 | 与其他五种疲劳问卷相比，它被认为是最有前景的疲劳测量工具（De Vries, Michielsen & Van Heck, 2003）。 | 四个条目存在性别偏倚，女性得分往往显著高于男性（De Vries et al., 2004）。 | | 多维疲劳量表（MFI）（Smets et al., 1995） | 20 个条目，涵盖一般疲劳、身体疲劳、心理疲劳、动机降低和活动减少。 | 内部一致性良好（Cronbach’s Alpha = 0.84）。 | 尚未在心理疲劳者中得到验证。 | | 疲劳严重程度量表（FSI） | 14 个条目，评估感知严重程度、频率和对日常功能干扰等疲劳的多个方面（Donovan & Jacobsen, 2011）。 | 已在年龄范围为 18–24 的女性和男性癌症患者中验证，内部一致性为 0.94（Hann, Denniston & Baker, 2000）。 | 与 MFI 中的心理疲劳不相关（Lou et al., 2001）。 | ### 注意网络测验（ANT） 另一种拟用于检测心理疲劳的方法是 ANT（Fan et al., 2002）。该测验主要从警觉、定向和执行控制三个基本方面检查个体的注意网络（Federico et al., 2013）。警觉网络通过警告信号引起的反应时间变化来检查。定向网络通过提示目标出现位置的线索所引起的反应时间变化来评估。执行网络效率的检查方法是，要求受试者按键报告中央箭头的方向，箭头周围是方向一致、不一致或中性的侧翼刺激。该方法认为，心理疲劳会损害注意，因此心理疲劳者的表现应差于未疲劳者（Lou, 2009）。研究显示，与对照组相比，心理疲劳者的执行和注意网络效率及准确率均显著较低（Pauletti et al., 2017；Togo et al., 2015）。 ANT 在健康监测技术中的应用前景并不理想。Jones et al.（2016）发现，健康成年人间隔 24-h 重复测验时普遍出现练习效应，说明若把该工具用于每日评估心理疲劳，测验得分可能受到影响。注意系统还包含多个相互独立的成分，过于复杂，不能通过一项任务完成评估（Wang et al., 2015）。例如，注意由内源性、外源性、空间和客体四个独立系统构成，各系统的行为效应不同，也有特定的神经基础（Chica, Bartolomeo & Lupiáñez, 2013；Weinbach & Henik, 2012）。此外，该检测工具尚未与心理疲劳的客观或主观测量，如唾液皮质醇、自评问卷和扫视眼动等，相互验证。ANT 的测验时间也较长，平均需要 25 至 30 min，具体取决于测验长度。较长的测验时间可能带来依从性和负担问题（Kas, Serretti & Marston, 2019）。尽管这种方法不像问卷作答那样主观，并能通过按键等操作提供可量化的客观测量，但 ANT 本质上更接近主要用于推断的认知评估（Kayser et al., 2020）。它缺少清晰、直接的观察结果，检测心理疲劳的效度因而可能受到质疑。 ### 脑电图（EEG） 心理疲劳也可通过 EEG 的 theta、alpha 和 beta 波频谱变化测量，见表 2（Cheng & Hsu, 2011）。近期一项研究认为，theta 波活动是很有前景的心理疲劳主要生物标志，alpha 波活动可作为次级生物标志（Tran et al., 2020）。研究显示，同时记录 EEG 和眼电图（EOG，测量眼球前后部之间的角膜-视网膜静息电位）可以提高心理疲劳检测的准确性（Jia & Tyler, 2019），并有报告称这种方法能提供最准确的心理疲劳测量。与此相反，Smith et al.（2019）发现，用认知要求较高的任务诱发心理疲劳，对 EEG 结果的影响并不明确。EEG 作为心理疲劳检测工具的主要局限在于设备过于复杂，需要实验室环境才能尽量降低信号噪声（Read & Innis, 2017）。EEG 信号高度敏感，个体间电信号存在差异，因此需要一种稳健的评估方法来处理这些变化（Monteiro et al., 2019）。EEG 还要求把电极准确放置在头部，才能测得 alpha、beta 和 theta 波节律。这使其很难集成到智能手机、监控装置等简易健康监测设备中，无法在个体执行日常任务时连续监测心理疲劳。多项研究尝试解决这一问题：研究者只用一个 EEG 传感器检测心理疲劳，建立了与整套 EEG 设备同样有效的简化测量技术，从而降低检测方法的复杂度（Resalat & Saba, 2015；Rohit et al., 2017；Hu, 2017）。近期一项关于心理疲劳影响脑活动的研究显示，使用整套 EEG 设备时，个体处于静息状态下的 EEG 相对功率指数比主动执行任务时更能评估心理疲劳（Li et al., 2020）。总体来看，EEG 能反映心理疲劳相关脑变化；但近期结果（Smith et al., 2019）表明，它可能无法准确检测心理疲劳者执行认知要求较高任务时的脑变化，因而限制了用途。人们通常长时间工作后才休息；若要防止持续心理疲劳未被发现，更有益的做法是在任务进行期间检出疲劳，以此提示应先休息再继续下一项任务。 #### 表 2：EEG 测量的脑波类型 | 脑波类型 | 频率（Hz） | 说明 | 心理疲劳时的变化 | | --- | --- | --- | --- | | Beta | 14–30 | 清醒、正常警觉、有意识。高/快 beta 波出现在复杂思维过程中；慢/低 beta 波出现在反复思考时。 | 额叶频带增加（Tanaka, Ishii & Watanabe, 2014）。 | | Alpha | 9–13 | 身体和心理放松时活跃；人保持清醒但有困意。 | 大脑中央区、额叶和后叶的慢波活动增加（Craig et al., 2012）。枕中回、楔叶和颞中回的频带降低（Tanaka, Ishii & Watanabe, 2015）。 | | Theta | 4–8 | 深度放松或处于自动驾驶状态时活跃。该波对信息加工和记忆形成很重要。 | 大脑中央区、额叶和后叶的慢波活动增加（Craig et al., 2012）。 | ### 心率变异性（HRV） Apparies, Riniolo & Porges（1998）报告称，这项心血管指标能够灵敏测量疲劳和心理工作负荷。心率由自主神经系统，例如 SNS，控制；雌激素等激素的释放会造成心率波动（Leicht, Hirning & Allen, 2003）。这种波动随 HRV 测得的绝对低频功率与高频功率之比而变化（Goldberger, 1999）。HRV 是一种简便、无创的指标，利用心电图（ECG）测量相邻心搏之间随时间发生的变化（ChuDuc, NguyenPhan & NguyenViet, 2013）。HRV 还反映身体在执行引起心理疲劳的任务时，自我调节能力，例如行为、认知和情绪过程，的增强。身体的自我调节过程，尤其是认知过程，在改变或抑制信息方面发挥重要作用（Barutchu et al., 2013；Heatherton, 2011）。Segerstrom & Nes（2007）发现，高度自我调节用力期间 HRV 增加。多项研究也报告了相似结果，即心率增加与心理疲劳高度相关（Huang et al., 2018；Delliaux et al., 2019；Melo, Nascimento & Takase, 2017）。EEG 数据支持这些发现：代表注意下降的 P300 波幅降低与心率增加相关（Zhang & Yu, 2010；Zhao et al., 2012）。 HRV 检测工具已集成到智能手表、健身手环等智能设备中，用作健康监测技术（Naranjo-Hernández et al., 2017）。它主要用于实时测量心率，以监测心血管健康，但尚未成功改造为专门检测心理疲劳的工具。Nelesen et al.（2008）研究了疲劳与心率之间的关系，发现疲劳与心率无关，而与静息时心脏指数和每搏输出指数显著降低有关。由此可见，HRV 检测心理疲劳的可靠性并不一致；多项研究没有发现心理疲劳与心率等生理变量之间的联系（Penna et al., 2018b；Thompson et al., 2019）。 HRV 还会受到许多混杂变量影响，例如评估期间的身体动作可能造成错误读数；影响神经系统的病理状况，如退行性疾病、脑损伤；心脏疾病，如心律失常；其他器官疾病，如肾衰竭；以及抑郁等心理健康障碍、吸烟、咖啡因和药物（Acharya et al., 2006；Hayano et al., 1990；Monda et al., 2013；Massaro & Pecchia, 2016）。身体疲劳与心率有关是合理的，但尚无心率与心理疲劳直接相关的证据。Gonzalez et al.（2017）指出，智能手表和简易心率检测设备目前用于 HRV 检测的算法无法区分心理疲劳与身体疲劳。因此，HRV 本身可能不足以检测心理疲劳。 ### 皮质醇水平 研究发现，心理疲劳会调节身体的自主神经和内分泌反应（Moreira et al., 2018）。疲劳者的下丘脑-垂体-肾上腺轴会释放皮质醇，使体内皮质醇水平升高（Torres-Harding et al., 2008；Thompson et al., 2016）。在诱发疲劳的任务后，皮质醇升高与认知功能，尤其是注意，下降有关（Bohnen et al., 1990；Lee et al., 2007）。唾液皮质醇水平能够反映血液皮质醇水平，而人在压力下血液皮质醇会上升，因此它被认为是可靠的心理疲劳指标（Kirschbaum & Hellhammer, 2007）。 Powell et al.（2013）却发现，皮质醇总输出量几乎与疲劳无关。该方法还有一项局限：上述研究并非全都专门考察皮质醇水平与心理疲劳之间的关系。多数研究把身体和心理疲劳作为一个整体评估，没有单独研究心理疲劳。例如 Torres-Harding et al.（2008）观察到皮质醇水平与慢性疲劳综合征症状相关，但与唾液皮质醇水平有关的是一般性疲劳，而非特指心理疲劳。如前所述，身体疲劳和心理疲劳是两种不同的疲劳，需要分别评估，因为一个人可能身体疲劳而心理不疲劳，反之亦然。因此，能够把皮质醇水平变化明确关联到心理疲劳的数据有限。近期一篇综述也认为，缺少唾液皮质醇与压力及疲劳相关的证据，说明心理疲劳与皮质醇水平之间的关系仍无定论（de Assis, de Resende & Marziale, 2018）。 尽管如此，把唾液皮质醇测量与健康监测技术结合，似乎能很好地判断驾驶员是否疲劳。智能手机及智能手表、监控装置等类似设备有潜力成为集成心理健康检测工具的平台。研究者已经提出一种基于智能手机的皮质醇检测技术，用于估计驾驶员疲劳（Russell et al., 2022）。这种“智能疲劳手机”通过免疫传感器和与智能手机相连的荧光信号读取器实时检测疲劳。免疫传感器测量个体唾液中的皮质醇浓度。研究还用 EEG 测量验证了这套设备：心理疲劳引起的 beta 节律降低，与智能疲劳手机测得的高皮质醇水平相关（Shin et al., 2019）。 为提高设备准确性，还应分析疲劳相关生物标志，如 alpha-淀粉酶、血液皮质醇和乳酸，与唾液皮质醇水平的相关性。运动环境研究发现，唾液生物标志不能很好地客观反映心理疲劳，因为观察到的皮质醇和 alpha-淀粉酶变化与心理疲劳无关（Russell et al., 2022）。以唾液皮质醇为评估工具的另一项局限是，唾液很容易被口腔内的血液和食物颗粒污染，造成皮质醇水平结果不准确（Kamodyová et al., 2015）。这使检测略显不便，因为个体至少要提前 10 min 漱口，之后才能自测心理疲劳。研究还发现，性别会影响唾液皮质醇水平随时间的变化，女性的皮质醇水平高于男性（Nakajima et al., 2012）。Montero-López et al.（2018）发现，月经周期阶段会增强实验室诱发心理压力时的皮质醇反应。另一项研究则发现，健康女性的基础皮质醇水平不受月经周期影响（Wilson, Lorenz & Heiman, 2018）。这些性别效应并不是唾液皮质醇评估心理疲劳的主要局限，但会使检测更加复杂，因为评估工具需要按性别专门校准。总体上，尚无证据把该方法与执行功能，尤其是抑制功能，下降联系起来，而研究显示，抑制功能下降是个体心理疲劳的重要表现（Guo et al., 2018）。 ### 扫视眼动 近年来，扫视眼动特征逐渐用于识别阿尔茨海默病（AD）和帕金森病等神经退行性疾病相关的认知缺陷（Anderson & MacAskill, 2013；Opwonya et al., 2021）。扫视眼动是眼睛从一点快速移动到另一点的运动（Purves et al., 2001a）。扫视对注意视觉环境有基础作用。例如，我们在过马路前需要通过扫视迅速观察环境，也要借此识别环境中的突然变化，避开危险（Purves et al., 2001b）。反射性扫视由刺激驱动，涉及自下而上的加工；自主扫视由目标驱动，需要较高级的皮层功能才能执行（Mulligan, Stevenson & Cormack, 2013；Goffart, 2009；Walker et al., 2000）。自主扫视涉及自上而下的加工，容易受自然衰老影响，稳定性较低。因此，个体从成年步入老年，或患上影响高级皮层脑区的疾病，例如偏头痛和 Tourette 综合征时，自主扫视会逐渐退化（LeVasseur et al., 2001；Filippopulos et al., 2021；Bafna & Hansen, 2021；Chen et al., 2021；Chen & Machado, 2016）。 扫视眼动与额叶神经活动有关，而额叶是最受心理疲劳影响的脑区（Ishii, Tanaka & Watanabe, 2014；Purves et al., 2001b），因此用扫视眼动检测心理疲劳很可能具有较高的可靠性和效度（Yamada & Kobayashi, 2018）。如前所述，心理疲劳者的额叶过度激活，导致无法抑制反应（Gantois et al., 2020；Guo et al., 2018；Jaydari Fard, Tahmasebi Boroujeni & Lavender, 2019）。抑制反应因而可以作为评估心理疲劳的标志。“反向扫视任务”旨在评估个体抑制反射性扫视、转而产生自主扫视的能力，见图 1。该任务需要高度执行控制，已被证明能够可靠评估抑制反应等执行功能（Chehrehnegar et al., 2021）。 #### 图 1：反向扫视任务一次试次的示例时间线 （A）参与者注视中央点。（B）注视点消失的同时，扫视信号出现在外周视野。（C）参与者向信号相反方向作出正确的反向扫视。 EOG 等多种生理测量工具可用于评估扫视眼动特征。EOG 更常用于测量扫视和注视，其方法是分析眼动在眼周皮肤产生的电信号（Wang et al., 2019）。电极可依据眼睛朝向或背离正负电极方向运动时的肌肉运动量，检测眼球方向变化（Jia & Tyler, 2019）。与把电极按传统方法放置在眼周相比，把电极放在前额只需较少电极，受面部活动的干扰也较少，因而被认为最适合测量与疲劳有关的眼动，见图 2（Zhang et al., 2015；Zheng & Lu, 2017；Heo, Yoon & Park, 2017）。前额电极还可集成到头带和帽子等多种可穿戴设备中，从而方便使用（Heo, Yoon & Park, 2017）。 #### 图 2：测量眼动时的传统电极放置方式 （A）新提出的 EOG 电极放置方式；（B）传统前额 EOG 电极放置方式。红色圆圈表示负电极，绿色圆圈表示正电极，黑色圆圈表示接地电极。垂直（V）和水平（H）电极分别用于检测垂直和水平扫视。 研究者还开发了红外眼动追踪等其他工具，用于追踪扫视眼动。随着技术进步，红外传感器不久后或许能够集成到网络摄像头、手机摄像头甚至监控摄像头中。红外传感器可以检测各方向的扫视，例如水平和垂直扫视，不过已有研究表明，水平扫视足以检测心理疲劳（Jia & Tyler, 2019）。心理疲劳者会呈现特定的眼动指标模式，包括扫视潜伏期延长、眨眼频率增加和瞳孔扩张范围缩小（Yamada & Kobayashi, 2018；Bafna, Bækgaard & Hansen, 2021；Zargari et al., 2018）。这些特征的出现，是因为心理疲劳会造成反应抑制缺陷，并降低信息加工速度。可穿戴透明眼部检测系统是一种利用扫视检测心理疲劳的健康监测技术（Sampei et al., 2016）。该设备根据眼睛反射的光测量瞳孔运动和眨眼，光线由染料敏化光伏电池检测。同一研究还使用美国国家航空航天局任务负荷指数（NASA-TLX）验证该设备；NASA-TLX 是一种自评问卷，用于评估个体对导致心理疲劳的心理负荷的估计。不过，这项验证研究的样本只有五名受试者，其中两名受试者的瞳孔运动、眨眼与心理负荷之间没有报告相关性（De Vries et al., 2004）。因此，仍需进一步研究，确定与其他心理疲劳指标高度相关的具体扫视眼动特征。 近期许多研究尝试通过智能手机摄像头和监控装置，在临床环境以外追踪扫视眼动（Lai et al., 2020；Ansari, Kasprowski & Obetkal, 2021）。借助卷积神经网络的基于外观的视线估计，已能从面部图像和桌面摄像头画面中准确解码扫视眼动（Ansari, Kasprowski & Obetkal, 2021）。该模型推进了通过扫视检测心理疲劳的方法，使个体能够在日常活动过程中接受心理疲劳检测。与前述其他方法相比，它提高了动态扫视眼动心理疲劳检测的准确性和便利性。今后仍需开展重复和验证研究，以其他心理疲劳指标验证这些扫视眼动特征；所得数据将有助于把该检测方法集成到现代健康监测技术中。 ## 结论 本文综述并比较了现有心理疲劳检测技术，旨在为今后的技术发展和验证提供依据。研究显示，心理疲劳主要影响视觉皮层和额叶皮层。高压职业、工作时间过长、贫困和工作紧张等环境因素会使个体产生心理疲劳。抑制功能缺陷是较好的心理疲劳指标，可用于早期检测。反向扫视任务能够评估抑制功能，因此有望用于客观检测心理疲劳。本文讨论的每种检测方法都有各自的优点、缺点和集成到健康监测技术中的可行性，汇总见表 3。部分评估工具缺少效度证据且存在其他不足；未来研究应验证能够评估扫视眼动、唾液皮质醇等心理疲劳生物标志的检测工具，以便对心理疲劳作出可靠评估。目前仍应结合多种评估方法，准确检测个体的心理疲劳。 ### 表 3：各种心理疲劳检测方法的优缺点 | 检测方法 | 优点 | 缺点 | | --- | --- | --- | | 自评问卷 | 有多种简短问卷；可靠性经过检验；容易施测；便于获取。 | 无法反映心理疲劳每时每刻的波动；主观且不能避免作答偏差；可能无法准确反映人在特定时刻的认知状态。 | | 注意网络任务 | 涵盖注意的三个基本方面：警觉、定向和执行控制。 | 测验时间长（25–30 min）；存在练习效应；主要用于认知评估和推断；注意网络过于复杂，无法通过单项任务评估。 | | EEG | Theta 波被认为是可靠的心理疲劳主要生物标志；alpha 波被认为是可靠的次级生物标志。 | 需要实验室环境以降低信号噪声；无法在个体执行认知要求较高的任务时准确检测心理疲劳。 | | 心率变异性 | 容易集成到智能设备；属于非自主生物标志。 | 混杂变量过多；可靠性低。 | | 皮质醇水平 | 可与智能疲劳手机等健康监测技术结合使用。 | 缺少证据支持唾液皮质醇与心理疲劳之间的联系；唾液样本容易污染。 | | 扫视眼动 | 反映与心理疲劳有关的脑活动；扫视任务简单、快速；可以测量自主和非自主反应；可通过 EOG 或红外线检测；能集成到智能手机、网络摄像头和录像设备等健康监测技术中。 | 与心理疲劳有关的扫视眼动特征，其效度证据有限。 | ## 补充信息与声明 ### 利益冲突 作者声明不存在利益冲突。 ### 作者贡献 Kaveena Kunasegaran 构思并设计实验、实施实验、分析数据、制作图和/或表、撰写或审阅论文草稿，并批准最终稿。 Ahamed Miflah Hussain Ismail 分析数据、撰写或审阅论文草稿，并批准最终稿。 Shamala Ramasamy 分析数据、撰写或审阅论文草稿，并批准最终稿。 Justin Vijay Gnanou 分析数据、撰写或审阅论文草稿，并批准最终稿。 Brinnell Annette Caszo 分析数据、撰写或审阅论文草稿，并批准最终稿。 Po Ling Chen 构思并设计实验、分析数据、撰写或审阅论文草稿，并批准最终稿。 ### 数据可用性 作者提供了以下数据可用性信息： 本研究不涉及原始数据或代码。 ## 参考文献（保留原文） - Acharya et al. 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