脑卒中患者病耻感现状及影响因素研究

doi:10.3969/j.issn.1674-490X.2021.06.009

摘要/Abstract

摘要： 目的调查脑卒中患者病耻感现状,探讨脑卒中患者病耻感的影响因素,明确影响因素的作用机制。方法采用定点连续取样法按纳排标准抽取324例住院脑卒中患者,应用脑卒中患者病耻感量表、健康认知评价量表、心理弹性量表简化版、领悟社会支持量表、医学应对方式问卷进行调查。结果脑卒中患者病耻感总分(45.36±11.76)分。脑卒中患者病耻感与负性认知评价、屈服应对方式、回避应对方式呈正相关(P<0.05);与心理弹性、社会支持、面对应对方式呈负相关(P<0.05)。脑卒中患者病耻感影响因素中,负性认知评价总效应值0.023;心理弹性总效应值-0.601;社会支持总效应值-0.234;回避应对方式总效应值为0.110。结论脑卒中患者的病耻感处于中等偏上水平,脑卒中患者病耻感水平不容乐观,应予以重视。脑卒中患者对卒中事件的负性认知评价通过回避应对方式间接正向影响病耻感;心理弹性既可直接负向影响病耻感,又可通过负性认知评价及回避应对方式间接负向影响病耻感,直接影响大于间接影响;社会支持既可直接负向影响病耻感,又可通过负性认知评价及回避应对方式间接负向影响病耻感,直接影响大于间接影响;回避应对方式对病耻感有直接正向影响。

关键词: 脑卒中, 病耻感, 影响因素, 路径分析

Abstract: Objective To investigate the status quo of stigma in stroke patients and explore the influencing factors of stigma in stroke patients, and clarify the mechanism of the influencing factors. Methods A total of 324 inpatients with stroke were selected by fixed point continuous sampling according to the standard of inpatient arrangement. Stroke patients' stigma scale, health cognitive evaluation scale, simplified version of mental resilience scale, perceived social support scale and medical coping style questionnaire were used to investigate. Results The total score of stigma in stroke patients was 45.36±11.76.Stigmatism in stroke patients was positively correlated with negative cognitive evaluation, submission coping style and avoidance coping style. And psychological resilience, social support and coping style were significantly negatively correlated. Among the influencing factors of stigma in stroke patients, the total effect value of negative cognitive evaluation was 0.023;Total effect value of mental resilience -0.601;Total effect value of social support was -0.234;The total effect of avoidance coping style was 0.110.Conclusion The stroke patients' stigma is above the average level, among which the score of self-perception dimension is the highest. The situation of stigma is not optimistic, and medical workers should pay attention to it. The negative cognitive evaluation of stroke events in stroke patients indirectly affected stigma through avoidance coping style; Resilience can affect stigma directly and indirectly through negative cognitive evaluation and avoidance coping style. The direct effect is greater than the indirect effect. Social support not only directly affected stigma, but also indirectly affected stigma through negative cognitive evaluation and avoidance coping style. The direct effect is greater than the indirect effect. Avoidance coping style has a direct positive effect on stigma.

Key words: stroke, stigma, influencing factors, path analysis

中图分类号:

李雪霏,姜媛媛,田帆,井坤娟,曹畅. 脑卒中患者病耻感现状及影响因素研究[J]. 医学研究与教育, 2021, 38(6): 59-68.

参考文献

[1] GBD 2017 DALYS AND HALE COLLABORATORS. Global, regional, and national disability-adjusted life-years(DALYs)for 359 diseases and injuries and healthy life expectancy(HALE)for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017[J]. Lancet, 2018, 392(10159): 1859-1922. DOI: 10.1016/s0140-6736(18)32335-3.
[2] GBD 2016 LIFETIME RISK OF STROKE COLLABORATORS, FEIGIN V L, NGUYEN G, et al. Global, regional, and country-specific lifetime risks of stroke, 1990 and 2016[J]. N Engl J Med, 2018, 379(25): 2429-2437. DOI: 10.1056/nejmoa1804492.
[3] 孙海欣, 王文志. 中国60万人群脑血管病流行病学抽样调查报告[J]. 中国现代神经疾病杂志, 2018, 18(2): 83-88.
[4] SEEMAN M, GOFFMAN E. Stigma: notes on the management of spoiled identity[J]. Am Sociol Rev, 1964, 29(5): 770. DOI: 10.2307/2091442.
[5] SARFO F S, NICHOLS M, QANUNGO S, et al. Stroke-related stigma among west Africans: patterns and predictors[J]. J Neurol Sci, 2017, 375: 270-274. DOI: 10.1016/j.jns.2017.02.018.
[6] DANZL M M, HUNTER E G, CAMPBELL S, et al. “Living with a ball and chain”: the experience of stroke for individuals and their caregivers in rural Appalachian Kentucky[J]. J Rural Health, 2013, 29(4): 368-382. DOI: 10.1111/jrh.12023.
[7] ANDERSON S, WHITFIELD K. Social identity and stroke: ‘they don't make me feel like, there's something wrong with me[J]. Scand J Caring Sci, 2013, 27(4): 820-830. DOI: 10.1111/j.1471-6712.2012.01086.x.
[8] HYMAN M D. The stigma of stroke. Its effects on performance during and after rehabilitation[J]. Geriatrics,1971,26(5): 132-141.
[9] 张真容, 闫冰, 林乾冰, 等. 贵阳市脑卒中病人病耻感与生存质量的调查研究[J]. 全科护理, 2018, 16(8): 897-899.
[10] 万琼红, 赵惠芬, 杨鸿雁. 脑卒中患者病耻感现状调查及其影响因素[J]. 神经病学与神经康复学杂志, 2019, 15(2): 95-101.
[11] 邓翠玉, 卢琦, 赵岳. 社区脑卒中患者病耻感现状及影响因素的研究[J]. 中国实用护理杂志, 2017, 33(14): 1093-1097. DOI: 10.3760/cma.j.issn.1672-7088.2017.14.013.
[12] 查梦培, 王卫亮, 李安奕, 等. 脑出血偏瘫患者病耻感的影响因素[J]. 现代预防医学, 2020, 47(5): 879-882.
[13] 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志, 2018, 51(9): 666-682. DOI: 10.3760/cma.j.issn.1006-7876.2018.09.004.
[14] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病组.中国脑出血诊治指南(2019)[J].中华神经科杂志,2019,52(12):994-1005.DOI:10.3760/cma.j.issn.1006-7876.2019.12.003.
[15] KESSLER T A. The Cognitive Appraisal of Health Scale: development of psychometric evaluation[J]. Res Nurs Health, 1998, 21(1): 73-82. DOI: 10.1002/(sici)1098-240x(199802)21: 173: aid-nur8>3.0.co;2-q.
[16] CONNOR K M, DAVIDSON J R. Development of a new resilience scale: the Connor-Davidson Resilience Scale(CD-RISC)[J]. Depress Anxiety, 2003, 18(2): 76-82. DOI: 10.1002/da.10113.
[17] CAMPBELL-SILLS L, STEIN M B. Psychometric analysis and refinement of the Connor-Davidson Resilience Scale(CD-RISC): Validation of a 10-item measure of resilience[J]. J Trauma Stress, 2007, 20(6): 1019-1028. DOI: 10.1002/jts.20271.
[18] YU X N, ZHANG J X. Factor analysis and psychometric evaluation of the connor-Davidson resilience scale(cd-risc)with Chinese people[J]. Soc Behav Pers, 2007, 35(1): 19-30. DOI: 10.2224/sbp.2007.35.1.19.
[19] ZIMET G D, POWELL S S, FARLEY G K, et al. Psychometric characteristics of the multidimensional scale of perceived social support[J]. J Pers Assess, 1990, 55(3/4): 610-617. DOI: 10.1080/00223891.1990.9674095.
[20] 黄丽, 姜乾金, 任蔚红. 应对方式、社会支持与癌症病人心身症状的相关性研究[J]. 中国心理卫生杂志, 1996, 10(4): 160-161.
[21] FEIFEL H, STRACK S, NAGY V T. Coping strategies and associated features of medically ill patients[J]. Psychosom Med, 1987, 49(6): 616-625. DOI: 10.1097/00006842-198711000-00007.
[22] 沈晓红, 姜乾金. 医学应对方式问卷中文版701例测试报告[J]. 中国行为医学科学, 2000(1): 22-24.
[23] 朱敏芳, 周宏珍, 邓瑛瑛, 等. 脑卒中患者病耻感量表的编制及信效度检验[J]. 护理学杂志, 2019, 34(1): 70-73. DOI: 10.3870/j.issn.1001-4152.2019.01.070.
[24] ZHU M, ZHOU H, ZHANG W, et al. The Stroke Stigma Scale: a reliable and valid Stigma measure in patients with stroke[J]. Clin Rehabil, 2019, 33(11): 1800-1809. DOI: 10.1177/0269215519862329.
[25] 张文馨. 基于压力与应对理论对肾移植受者健康相关的生活质量的研究[D]. 北京: 北京中医药大学, 2015:24-25.
[26] 李牧玲. 脑卒中患者病耻感量表广州市常模的构建[D]. 广州: 南方医科大学, 2020:55-56.
[27] 庞丹莉. 湖南省某地区住院脑卒中患者病耻感现状及影响因素研究[D]. 长沙: 湖南师范大学, 2020:14-15.
[28] 杨周, TODD J, 陈红, 等. 威胁性疼痛认知评价对接受应对策略效果的影响[J]. 中国疼痛医学杂志, 2011, 17(10): 611-615.
[29] HERMSEN L A H, VAN DER WOUDEN J C, LEONE S S, et al. The longitudinal association of cognitive appraisals and coping strategies with physical functioning in older adults with joint pain and comorbidity: a cohort study[J]. BMC Geriatr, 2016, 16: 29. DOI: 10.1186/s12877-016-0204-7.
[30] 卢彩霞, 陆丽华. 肝癌术后患者的心理弹性水平及认知评价与创伤后成长的相关性研究[J]. 解放军护理杂志, 2019, 36(2): 37-40,44.
[31] 张敏, 刘智慧, 李晶晶, 等. 首发脑卒中患者的心理弹性水平及其影响因素[J]. 解放军护理杂志, 2019, 36(4): 16-19,61.
[32] 张诗毅, 陈伟菊. 积极心理学在脑卒中病人护理中的应用研究[J]. 护理研究, 2018, 32(13): 2023-2026.
[33] 郭海涛. 乳腺癌患者癌症复发恐惧感现状及影响因素研究[D]. 保定: 河北大学, 2020:24-25.
[34] 王位坐, 季建伟, 庄媛, 等. 中国脑卒中患者群体总体社会支持状况的汇总Meta分析[J]. 公共卫生与预防医学, 2018, 29(2): 80-82.
[35] 姜玲. 宫颈癌根治术患者化疗期病耻感与社会支持相关性分析[J]. 护理实践与研究, 2020, 17(20): 89-91.
[36] STANIUTE M, BROZAITIENE J, BUNEVICIUS R. Effects of social support and stressful life events on health-related quality of life in coronary artery disease patients[J]. J Cardiovasc Nurs, 2013, 28(1): 83-89. DOI: 10.1097/jcn.0b013e318233e69d.
[37] 高兰英, 靳月丽, 王静. 不同造口类型肠造口患者病耻感现状及影响因素分析[J]. 齐鲁护理杂志, 2020, 26(20): 74-76.
[38] MYERS S B, MANNE S L, KISSANE D W, et al. Social-cognitive processes associated with fear of recurrence among women newly diagnosed with gynecological cancers[J]. Gynecol Oncol, 2013, 128(1): 120-127. DOI: 10.1016/j.ygyno.2012.10.014.
[39] 雷花, 李丽莎, 杨梅, 等. 前列腺增生症患者病耻感及应对方式的相关性[J]. 现代临床护理, 2018, 17(12): 7-11.