精神分裂症家庭照护者心理健康影响因素的结构方程模型分析
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摘要
目的利用结构化方程模型分析精神分裂症家庭照护者心理健康的影响因素,为采取有针对性干预措施提供科学依据。方法在调查精神分裂症患者社会功能缺陷及其家庭照护者家庭功能、社会支持、心理健康现状基础上,采用结构方程模型分析影响照顾者心理健康的因素及其效应指标,主要拟合参数包括比较拟合指数(compare the fitted indices,CFI)、拟合优度指数(goodness of fit index,GFI)、调整后的拟合优度指数(the adjusted goodness of fit index,AGFI)、规范拟合指数(normed fit index,NFI)以及近似误差均方根(approximate error root mean square,RMSEA)。结果照护者心理自评量表总分及躯体化、强迫症状、人际关系敏感、抑郁、焦虑、敌对等维度得分均高于正常人水平(均有P <0. 05)。精神分裂症家庭照护者中仅有19. 0%感到无或很少负担,33. 0%为轻度负担,48. 0%认为负担较重。结构方程模型拟合指数为:X~2(58)=47. 440,P=0. 838,X~2/df=0. 818,主要拟合参数GFI=0. 968、AGFI=0. 943、CFI=1. 000、NFI=0. 973、RMSEA=0. 000,模型拟合效果较好。结论精神分裂症家庭照护者存在严重的心理健康问题,照护负担较重;提升家庭照护者社会支持、家庭关怀,提高患者社会功能是改善其照护负担与心理健康水平的有效途径。
Objective The structural equation model was used to analyze the influencing factors of mental health of family caregivers with schizophrenia,so as to provide scientific basis for targeted intervention measures. Methods On the basis of investigating the social dysfunction of schizophrenia patients and their family function,social support and mental health status,structural equation model was used to analyze the factors affecting mental health of caregivers and their effect indexes,the main fitting parameters included compare the fitted indices( CFI),goodness of fit index( GFI),the adjusted goodness of fit index( AGFI),normed fit index( NFI) and approximate error root mean square( RMSEA). Result The total score of psychological self-rating scale of carers was higher than that of normal people( all P <0. 05). Only 19. 0% of home care providers with schizophrenia felt no or little burden,33. 0% mild burden and 48. 0% heavy burden. Structural equation model fitting index for: X~2( 58) = 47. 440,P =0. 838,X~2/df = 0. 818,the main fitting parameters GFI = 0. 968、AGFI = 0. 943,CFI = 1. 000,NFI =0. 973,RMSEA = 0. 000,model fitting effect was good. The total effects of social support,family care,patient social function and care burden on the mental health of family caregivers were-0. 016,-0. 197,0. 114 and 0. 118,respectively. Conclusions The family caregivers of schizophrenia have serious mental health problems,and the burden of care is heavy. improving social support,family care and social function of patients is an effective way to improve their care burden and mental health level.
Objective The structural equation model was used to analyze the influencing factors of mental health of family caregivers with schizophrenia,so as to provide scientific basis for targeted intervention measures. Methods On the basis of investigating the social dysfunction of schizophrenia patients and their family function,social support and mental health status,structural equation model was used to analyze the factors affecting mental health of caregivers and their effect indexes,the main fitting parameters included compare the fitted indices( CFI),goodness of fit index( GFI),the adjusted goodness of fit index( AGFI),normed fit index( NFI) and approximate error root mean square( RMSEA). Result The total score of psychological self-rating scale of carers was higher than that of normal people( all P <0. 05). Only 19. 0% of home care providers with schizophrenia felt no or little burden,33. 0% mild burden and 48. 0% heavy burden. Structural equation model fitting index for: X~2( 58) = 47. 440,P =0. 838,X~2/df = 0. 818,the main fitting parameters GFI = 0. 968、AGFI = 0. 943,CFI = 1. 000,NFI =0. 973,RMSEA = 0. 000,model fitting effect was good. The total effects of social support,family care,patient social function and care burden on the mental health of family caregivers were-0. 016,-0. 197,0. 114 and 0. 118,respectively. Conclusions The family caregivers of schizophrenia have serious mental health problems,and the burden of care is heavy. improving social support,family care and social function of patients is an effective way to improve their care burden and mental health level.
引文
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[9]孙玉成,于文军,徐文明,等.精神分裂症患者家属心理健康影响因素模型的构建[J].中国临床心理学杂志,2012,20(1):61-64.DOI:10.16128/j.cnki.1005-3611.2012.01.026.Sun YC,Yu WJ,Xu WM,et al.Mental health of family members of patients with schizophrenia factor model explored[J].Chin JClin Psychol,2012,20(1):61-64.DOI:10.16128/j.cnki.1005-3611.2012.01.026.
[10]陈丽芬,路孝琴.社区精神分裂症家庭照顾者社会支持研究进展[J].中华全科医学,2016,14(6):1022-1025.DOI:10.16766/j.cnki.issn.1674-4152.2016.06.046.Chen LF,Lu XQ.Advance on community schizophrenia family caregivers'social support[J].Chin J Gen Pract,2016,14(6):1022-1025.DOI:10.16766/j.cnki.issn.1674-4152.2016.06.046.
[11]余华,姜红艳,赵旭东,等.老年期痴呆患者家庭照顾者照顾体验的结构方程模型分析[J].中国心理卫生杂志,2015,29(5):336-342.DOI:10.3969/j.issn.1000-6729.2015.05.007.Yu H,Jiang HY,Zhao XD,et al.A structural equation modeling of caregiving experiences of family caregivers caring for people with dementia[J].Chin Ment Health J,2015,29(5):336-342.DOI:10.3969/j.issn.1000-6729.2015.05.007.
[12]吴洪美,单金凤.社区精神分裂症患者家属生存质量与患者社会功能相关性探析[J].中国卫生标准管理,2018,9(2):76-78.DOI:10.3969/j.issn.1674-9316.2018.02.040.Wu HM,Shan JF.The relationship between the quality of life of the family members of the schizophrenic patients and the social function of the patients[J].China Health Standard Management,2018,9(2):76-78.DOI:10.3969/j.issn.1674-9316.2018.02.040.
[13]王海龙,金洪民,白明,等.社区精神分裂症患者康复期需求与患者家庭负担的关系[J].中国健康心理学杂志,2016,24(7):969-972.DOI:10.13342/j.cnki.cjhp.2016.07.003.Wang HL,Jin HM,Bai M,et al.The needs of schizophrenia patients and family burdens in community:the relationship between needs and the needs of schizophrenia patients and family burdens in community:the relationship between needs and family burdens[J].China J Health Psychol,2016,24(7):969-972.DOI:10.13342/j.cnki.cjhp.2016.07.003.
[14]Sariah AE,Outwater AH,Malima KI.Risk and protective factors for relapse among individuals with schizophrenia:a qualitative study in Dar es Salaam,Tanzania[J].BMC Psychiatry,2014,14:240.DOI:10.1186/s12888-014-0240-9.
[15]李菊芳,范湘鸿,陈传萍,等.精神分裂症患者家庭照料者负担的影响因素及护理对策[J].解放军护理杂志,2010,27(5B):730-732,750.Li JF,Fan XH,Chen CP,et al.Influencing factors of schizophrenia family caregivers'burdens and nursing strategies[J].Nurs JChin PLA,2010,27(5B):730-732,750.
[16]李静,高威,左伟,等.先天性肛门直肠畸形患儿父母生活质量和社会支持研究进展[J].中华疾病控制杂志,2017,21(6):632-634.DOI:10.16462/j.cnki.zhjbkz.2017.06.022.Li J,Gao W,Zuo W,et al.Research progress on quality of life and social support among parents of children with congenital anorectal malformation[J].Chin J Dis Control Prev,2017,21(6):632-634.DOI:10.16462/j.cnki.zhjbkz.2017.06.022.
[2]Chien WT,Chan SW,Morrissey J.The perceived burden among Chinese family caregivers of people with schizophrenia[J].J Clin Nurs,2007,16(6):1151-1161.DOI:10.1111/j.1365-2702.2007.01501.x.
[3]张涵,郭继志,王瑞梅,等.老年慢性病患者心理健康状况及应对方式分析[J].中华疾病控制杂志,2016,20(7):659-662.DOI:10.16462/j.cnki.zhjbkz.2016.07.004.Zhang H,Guo JZ,Wang RM,et al.Analysis of the mental status and coping modes among elderly patients with chronic disease[J].Chin J Dis Control Prev,2016,20(7):659-662.DOI:10.16462/j.cnki.zhjbkz.2016.07.004.
[4]金华,吴文源,张明园.中国正常人SCL-90评定结果的初步分析[J].中国神经精神疾病杂志,1986,12(5):260-263.Jin H,Wu WY,Zhang MY.Preliminary analysis of SCL-90 evaluation results in healthy Chinese[J].Chin J Nerv Ment Dis,1986,12(5):260-263.
[5]Magana SM,García JIR,Hernández MG,et al.Psychological distress among Latino family caregivers of adults with schizophrenia:the roles of burden and stigma[J].Psychiatr Serv,2007,58(3):378-384.DOI:10.1176/ps.2007.58.3.378.
[6]Porr B,Mc Cabe L,di Prodi P,et al.How feedback inhibition shapes spike-timing-dependent plasticity and its implications for recent Schizophrenia models[J].Neural Netw,2011,24(6):560-567.DOI:10.1016/j.neunet.2011.03.004.
[7]黄智辉,杨立群.抑郁症患者的家庭功能和对照料者生活质量的影响[J].中国现代医药杂志,2011,13(10):42-44.Huang ZH,Yang LQ.Family functioning in patients with depression and quality of life of caregivers[J].Mod Med J China,2011,13(10):42-44.
[8]陈宇薇.精神分裂症住院患者家庭负担与社会支持的相关性分析[J].白求恩医学杂志,2016,14(3):282-283.DOI:10.16485/j.issn.2095-7858.2016.03.007.Chen YW.Correlation analysis of the family burden of schizophrenia patients and social support in hospital[J].Journal of Bethune Medical Science,2016,14(3):282-283.DOI:10.16485/j.issn.2095-7858.2016.03.007.
[9]孙玉成,于文军,徐文明,等.精神分裂症患者家属心理健康影响因素模型的构建[J].中国临床心理学杂志,2012,20(1):61-64.DOI:10.16128/j.cnki.1005-3611.2012.01.026.Sun YC,Yu WJ,Xu WM,et al.Mental health of family members of patients with schizophrenia factor model explored[J].Chin JClin Psychol,2012,20(1):61-64.DOI:10.16128/j.cnki.1005-3611.2012.01.026.
[10]陈丽芬,路孝琴.社区精神分裂症家庭照顾者社会支持研究进展[J].中华全科医学,2016,14(6):1022-1025.DOI:10.16766/j.cnki.issn.1674-4152.2016.06.046.Chen LF,Lu XQ.Advance on community schizophrenia family caregivers'social support[J].Chin J Gen Pract,2016,14(6):1022-1025.DOI:10.16766/j.cnki.issn.1674-4152.2016.06.046.
[11]余华,姜红艳,赵旭东,等.老年期痴呆患者家庭照顾者照顾体验的结构方程模型分析[J].中国心理卫生杂志,2015,29(5):336-342.DOI:10.3969/j.issn.1000-6729.2015.05.007.Yu H,Jiang HY,Zhao XD,et al.A structural equation modeling of caregiving experiences of family caregivers caring for people with dementia[J].Chin Ment Health J,2015,29(5):336-342.DOI:10.3969/j.issn.1000-6729.2015.05.007.
[12]吴洪美,单金凤.社区精神分裂症患者家属生存质量与患者社会功能相关性探析[J].中国卫生标准管理,2018,9(2):76-78.DOI:10.3969/j.issn.1674-9316.2018.02.040.Wu HM,Shan JF.The relationship between the quality of life of the family members of the schizophrenic patients and the social function of the patients[J].China Health Standard Management,2018,9(2):76-78.DOI:10.3969/j.issn.1674-9316.2018.02.040.
[13]王海龙,金洪民,白明,等.社区精神分裂症患者康复期需求与患者家庭负担的关系[J].中国健康心理学杂志,2016,24(7):969-972.DOI:10.13342/j.cnki.cjhp.2016.07.003.Wang HL,Jin HM,Bai M,et al.The needs of schizophrenia patients and family burdens in community:the relationship between needs and the needs of schizophrenia patients and family burdens in community:the relationship between needs and family burdens[J].China J Health Psychol,2016,24(7):969-972.DOI:10.13342/j.cnki.cjhp.2016.07.003.
[14]Sariah AE,Outwater AH,Malima KI.Risk and protective factors for relapse among individuals with schizophrenia:a qualitative study in Dar es Salaam,Tanzania[J].BMC Psychiatry,2014,14:240.DOI:10.1186/s12888-014-0240-9.
[15]李菊芳,范湘鸿,陈传萍,等.精神分裂症患者家庭照料者负担的影响因素及护理对策[J].解放军护理杂志,2010,27(5B):730-732,750.Li JF,Fan XH,Chen CP,et al.Influencing factors of schizophrenia family caregivers'burdens and nursing strategies[J].Nurs JChin PLA,2010,27(5B):730-732,750.
[16]李静,高威,左伟,等.先天性肛门直肠畸形患儿父母生活质量和社会支持研究进展[J].中华疾病控制杂志,2017,21(6):632-634.DOI:10.16462/j.cnki.zhjbkz.2017.06.022.Li J,Gao W,Zuo W,et al.Research progress on quality of life and social support among parents of children with congenital anorectal malformation[J].Chin J Dis Control Prev,2017,21(6):632-634.DOI:10.16462/j.cnki.zhjbkz.2017.06.022.
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