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
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摘要
目的研究肝癌术后患者创伤后成长与心理弹性及认知评价的相关性,以期为后期进行肝癌术后患者创伤后成长的干预研究提供指导。方法 2016年1-12月,方便抽样法选取在东方肝胆外科医院肝脏外科住院行手术治疗的患者148例为研究对象,采用创伤后成长评定量表(post-traumatic growth inventory,PTGI)、心理弹性量表(Connor Davidson resilience scale,CD-RISC)和认知评价量表对其进行调查分析。结果 148例肝癌术后患者PTGI总分为(66.53±14.98)分,不同文化程度、家庭月收入、肝炎病程、临床分期患者,其PTGI总分的差异均有统计学意义(均P<0.05)。患者的心理弹性得分为(63.63±14.34)分。除PTGI量表中的"与他人关系"和"欣赏生活"维度得分与心理弹性总分及其各维度得分的相关性无统计学意义(均P>0.05)外,患者PTGI总分、新可能性、个人力量维度得分与心理弹性总分及其各维度得分均呈正相关(均P<0.01)。肝癌术后患者PTGI总分及其各维度评分与认知评价量表中的"对疾病结果的不确定感"维度评分均呈负相关(均P<0.01),与"积极评价"维度评分均呈正相关(均P<0.01)。多元回归分析显示,心理弹性、认知评价对PTGI预测显著(均P<0.01)。结论肝癌术后患者心理弹性、认知评价与创伤后成长密切相关,应采取针对性措施促进肝癌术后患者创伤后成长,增进其心理健康。
Objective To study the correlation among psychological resilience,cognitive evaluation and post-traumatic growth in postoperative patients with liver cancer.Methods From January to December 2016, 148 postoperative patients with liver cancer were selected and investigated by post-traumatic growth inventory(PTGI),Connor-Davidson resilience scale(CD-RISC) and cognitive evaluation scale.Results Among 148 pateitns,the total post-traumatic growth score of postoperative patients with liver cancer was 66.53±14.98,which was at the middle level.The total PTGI scores of patients with different educational level,family monthly income,course of hepatitis and clinical stages were significantly different(all P<0.05).The score of psychological resilience was 63.63±14.34.There was no significant correlation among the dimensions of "relation to others" and "enjoy life", total score of psychological resilience and other dimensions(all P>0.05),but there were the positive correlations among PTGI score,new possibility, individual strength score, the total score of resilience and its dimensions(all P<0.01).The total PTGI score in patients with liver cancer after operation were negatively correlated with the dimension scores of "uncertainty about disease outcome" in cognitive assessment scale(all P<0.01),and positively correlated with the dimension scores of "positive evaluation"(all P<0.01).Multivariate regression analysis showed that psychological resilience and cognitive evaluation were significant predictors of PTGI(all P<0.01). Conclusions The psychological resilience and cognitive evaluation of postoperative patients with liver cancer are closely related to post-traumatic growth. Clinically, targeted measures should be taken to promote post-traumatic growth and improve mental health.
Objective To study the correlation among psychological resilience,cognitive evaluation and post-traumatic growth in postoperative patients with liver cancer.Methods From January to December 2016, 148 postoperative patients with liver cancer were selected and investigated by post-traumatic growth inventory(PTGI),Connor-Davidson resilience scale(CD-RISC) and cognitive evaluation scale.Results Among 148 pateitns,the total post-traumatic growth score of postoperative patients with liver cancer was 66.53±14.98,which was at the middle level.The total PTGI scores of patients with different educational level,family monthly income,course of hepatitis and clinical stages were significantly different(all P<0.05).The score of psychological resilience was 63.63±14.34.There was no significant correlation among the dimensions of "relation to others" and "enjoy life", total score of psychological resilience and other dimensions(all P>0.05),but there were the positive correlations among PTGI score,new possibility, individual strength score, the total score of resilience and its dimensions(all P<0.01).The total PTGI score in patients with liver cancer after operation were negatively correlated with the dimension scores of "uncertainty about disease outcome" in cognitive assessment scale(all P<0.01),and positively correlated with the dimension scores of "positive evaluation"(all P<0.01).Multivariate regression analysis showed that psychological resilience and cognitive evaluation were significant predictors of PTGI(all P<0.01). Conclusions The psychological resilience and cognitive evaluation of postoperative patients with liver cancer are closely related to post-traumatic growth. Clinically, targeted measures should be taken to promote post-traumatic growth and improve mental health.
引文
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[2] WAN C,FANG J,YANG Z,et al.Development and validation of a quality of life instrument for patients with liver cancer QOL-LC[J].Am J Clin Oncol ,2010,33(5):448-455.
[3] TEDESCHI R G,CALHOUN L G.The post-traumatic growth inventory measuring the positive legacy of trauma[J].J Trauma Stress,1996,9(3):455-471.
[4] CANN A,CALLHOUN L G,TEDESCHI R G,et al.Assessing post-traumatic cognitive processes:the event related rumination inventory[J].Anxiety Stress Coping,2011,24(2):137-156.
[5] 李玉丽,曹枫林,孔箴,等.高三学生焦虑抑郁情绪与心理弹性的关系[J].中国儿童保健杂志,2010,18(7):586-588.
[6] 于肖楠,张建新.韧性(resilience)——在压力下复原和成长的心理机制[J].心理科学进展,2005,13(5):658-665.
[7] NISHI D,MATSUOKA Y,KIM Y.Posttraumatic growth,posttraumatic stress disorder and resilience of motor vehicle accident survivors[J].Biopsychosoc Med,2010,24(4):4-7.
[8] ZERACH G,SOLOMON Z,COHEN A,et al.PTSD,resilience and posttraumatic growth among exprisoners of war and combat veterans[J].Isr J Psychiatry Relat Sci,2013,50(2):91-99.
[9] 汪际,陈瑶,王艳波,等.创伤后成长评定量表的修订及信效度分析[J].护理学杂志,2011,26(7):26-28.
[10]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.
[11]冯姝.韧性对癌症患者心理压力的作用及其机制研究[D].杭州:浙江大学,2007.
[12]JIM H S,JACOBSEN P B.Posttraumatic stress and posttraumatic growth in cancer survivorship:a review[J].Cancer J,2008,14(6):414-419.
[13]陆靖,史铁英,刘启贵,等.协同护理模式对乳腺癌患者创伤后成长和心理弹性的影响[J].中国实用护理杂志,2015,31(18):1353-1356.
[14]SMITH B W,ZAUTRA A J.Vulnerability and resilience in women with arthritis:test of a two-factor model[J].J Consult Clin Psychol,2008,76(5):799-810.
[15]YI-FRAZIER J P,SMITH R E,VITALIANO P P,et al.A person-focused analysis of resilience resources and coping in diabetes patients[J].Cancer,2005,104(11):2602-2607.
[16]BEN-EZRA M,HAMAMA-RAZ Y,PALGI S,et al.Cognitive appraisal and psychological distress among patients with irritable bowel syndrome [J].Isr J Psychiatry Relat Sci,2015,52(1):54-59.
[17]刘钰,孙玉倩,王凤玲,等.胃肠道恶性肿瘤患者临终阶段创伤后成长与应对方式的研究[J].中国实用护理杂志,2014,30(13):64-66.
[18]BIGATTI S M,STEINER J L,MILLER K D.Cognitive appraisals,coping and depressive symptoms in breast cancer patients[J].Stress Health,2012,28(5):355-361.
[19]MORRIS B A,LEPORE S J,WILSON B,et al.Adopting a survivor identity after cancer in a peer support context [J].J Cancer Surviv,2014,8(3):427-436.