妊娠期糖尿病孕妇心理弹性现况及影响因素研究
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摘要
目的了解妊娠期糖尿病(GDM)孕妇的心理弹性现况并探讨其影响因素。方法应用Connor-Davidson心理弹性量表、自行构建的妊娠期糖尿病知信行调查问卷、一般资料调查表对上海市4所医院产科门诊及病房的359名GDM孕妇进行问卷调查。结果GDM孕妇的心理弹性量表得分为69.99±15.03,与知信行得分呈正相关(均P<0.01);医院,孕周,是否使用胰岛素,知识、信念、行为得分是GDM孕妇心理弹性的影响因素(P<0.05,P<0.01),可共同解释总变异量的37.7%。结论 GDM孕妇的心理弹性水平处于中等水平,医院、孕周、是否使用胰岛素、疾病相关知识、信念、行为是其影响因素。应针对GDM孕妇开展规范化血糖管理,重视孕早期及孕晚期、使用胰岛素治疗孕妇的心理健康,提升孕妇疾病相关知识、促进其对疾病积极的信念、改善疾病管理行为,以提高GDM孕妇的心理弹性水平。
Objective To describe the level of resilience among women with gestational diabetes mellitus(GDM) and to explore its related factors.Methods A total of 359 women with GDM were selected from obstetric outpatient clinics of 4 tertiary hospitals in Shanghai and were invited to complete the Connor-Davidson Resilience Scale,self-designed GDM knowledge,attitude,and practice(KAP) questionnaire and demographic data questionnaire.Results The sample scored 69.99 ± 15.03 on resilience,which was positively correlated with the GDM knowledge,attitude,and practice scores respectively(P<0.01 for all).Hospital,gestational age,insulin use,GDM knowledge,attitude,and practice were influencing factors of resilience(P<0.05,P<0.01),which could explain 37.7% of the total variance.Conclusion The resilience of women with GDM was at medium level and affected by hospital,gestational age,insulin use and GDM knowledge,attitude and practice.Standardized blood glucose management should be provided,mental health of women during early or late pregnancy and of those who use insulin should be paid more attention,and their GDM knowledge,attitude and practice should be improved,thus to enhance their resilience.
Objective To describe the level of resilience among women with gestational diabetes mellitus(GDM) and to explore its related factors.Methods A total of 359 women with GDM were selected from obstetric outpatient clinics of 4 tertiary hospitals in Shanghai and were invited to complete the Connor-Davidson Resilience Scale,self-designed GDM knowledge,attitude,and practice(KAP) questionnaire and demographic data questionnaire.Results The sample scored 69.99 ± 15.03 on resilience,which was positively correlated with the GDM knowledge,attitude,and practice scores respectively(P<0.01 for all).Hospital,gestational age,insulin use,GDM knowledge,attitude,and practice were influencing factors of resilience(P<0.05,P<0.01),which could explain 37.7% of the total variance.Conclusion The resilience of women with GDM was at medium level and affected by hospital,gestational age,insulin use and GDM knowledge,attitude and practice.Standardized blood glucose management should be provided,mental health of women during early or late pregnancy and of those who use insulin should be paid more attention,and their GDM knowledge,attitude and practice should be improved,thus to enhance their resilience.
引文
[1]中华医学会妇产科学分会产科学组,围产医学分会妊娠合并糖尿病协作组.妊娠合并糖尿病诊治指南(2014)[J].糖尿病临床,2014,8(11):489-498.
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[3]Bellamy L,Casas J P,Hingorani A D,et al.Type 2 diabetes mellitus after gestational diabetes:a systematic review and meta-analysis[J].Lancet,2009,373(9677):1773-1179.
[4]Parsons J,Sparrow K,Ismail K,et al.Experiences of gestational diabetes and gestational diabetes care:a focus group and interview study[J].BMC Pregnancy Childbirth,2018,18(1):1-12.
[5]American Diabetes Association.Standards of medical care in diabetes-2018[J].Diabetes Care,2018,41(Suppl 1):S1-S159.
[6]雷阳,张静平.中文版Connor-Davidson心理弹性量表在糖尿病患者中的信效度研究[J].中国全科医学,2016,19(10):1188-1193.
[7]张萍,莫霖,李霞,等.认知行为疗法对癌症化疗患儿心理弹性及负性情绪的影响[J].护理学杂志,2018,33(13):60-64.
[8]黄琴,何丽芸,张甜,等.个案管理模式对HIV/AIDS患者心理弹性及自我管理能力的影响[J].护理学杂志,2018,33(5):80-82,88.
[9]吕磊,李佳,李国宏.新护士心理弹性概念框架的构建[J].护理学杂志,2017,32(12):72-75.
[10]Yi J P,Vitaliano P P,Smith R E,et al.The role of resilience on psychological adjustment and physical health in patients with diabetes[J].Br J Health Psychol,2008,13:311-325.
[11]Jaser S S,White L E.Coping and resilience in adolescents with type 1 diabetes[J].Child Care Health Dev,2011,37(3):335-342.
[12]Denisco S.Exploring the relationship between resilience and diabetes outcomes in African Americans[J].J Am Acad Nurse Pract,2011,23(11):602-610.
[13]赵蔓,孙春荣.2型糖尿病患者心理弹性与自我管理行为的关系研究[J].齐鲁护理杂志,2017,23(3):34-36.
[14]Connor K M,Davidson J R T.Development of a new resilience scale:the Connor-Davidson Resilience scale(CD-RISC)[J].Depress Anxiety,2003,18(2):76-82.
[15]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.
[16]于肖楠,张建新.自我韧性量表与Connor-Davidson韧性量表的应用比较[J].心理科学,2007,30(5):1169-1171.
[17]章孟星.妊娠期糖尿病临床护理实践的指南改编研究[D].上海:复旦大学,2018.
[18]潘运,杨桂芳.国外心理韧性的研究述评[J].贵州师范大学学报(社会科学版),2013,2013(2):7-12.
[19]黄昆,许勤,蒋明,等.乳腺癌术后化疗患者心理弹性与焦虑抑郁的相关性研究[J].护理学杂志,2013,28(2):89-91.
[20]Minfeng H.Resilience in chronic disease:the relationship among risk factors,protective factors,adaptive outcomes,and the level of resilience in adults with diabetes[D].Queensland:University of Queensland,2009.
[21]梁海英,陈兢思,赵丹曦,等.妊娠期糖尿病患者心理健康状况的临床调查[J].中国妇幼保健,2008,23(27):3868-3870.
[22]符春花,吴媛,辛若梅,等.三级综合医院ICU护士的心理弹性状况及其影响因素[J].中华全科医学,2018,16(4):663-666.
[23]Bahremand M,Rai A,Alikhani M,et al.Relationship between family functioning and mental health considering the mediating role of resiliency in type 2 diabetes mellitus patients[J].Glob J Health Sci,2014,7(3):254-259.
[24]汪艳阳.糖尿病患者心理弹性的研究进展[J].糖尿病新世界,2017,20(2):195-196.
[25]Yi J P,Vitaliano P P,Smith R E,et al.The role of resilience on psychological adjustment and physical health in patients with diabetes[J].Br J Health Psychol,2008,13(Pt2):311-325.
[26]Utz B,Kolsteren P,De Brouwere V.A snapshot of current gestational diabetes management practices from 26 low-income and lower-middle-income countries[J].Int J Gynaecol Obstet,2016,134(2):145-150.
[2]Metzger B E,Lowe L P,Dyer A R,et al.Hyperglycemia and adverse pregnancy outcomes[J].N Engl J Med,2008,358(19):1991-2002.
[3]Bellamy L,Casas J P,Hingorani A D,et al.Type 2 diabetes mellitus after gestational diabetes:a systematic review and meta-analysis[J].Lancet,2009,373(9677):1773-1179.
[4]Parsons J,Sparrow K,Ismail K,et al.Experiences of gestational diabetes and gestational diabetes care:a focus group and interview study[J].BMC Pregnancy Childbirth,2018,18(1):1-12.
[5]American Diabetes Association.Standards of medical care in diabetes-2018[J].Diabetes Care,2018,41(Suppl 1):S1-S159.
[6]雷阳,张静平.中文版Connor-Davidson心理弹性量表在糖尿病患者中的信效度研究[J].中国全科医学,2016,19(10):1188-1193.
[7]张萍,莫霖,李霞,等.认知行为疗法对癌症化疗患儿心理弹性及负性情绪的影响[J].护理学杂志,2018,33(13):60-64.
[8]黄琴,何丽芸,张甜,等.个案管理模式对HIV/AIDS患者心理弹性及自我管理能力的影响[J].护理学杂志,2018,33(5):80-82,88.
[9]吕磊,李佳,李国宏.新护士心理弹性概念框架的构建[J].护理学杂志,2017,32(12):72-75.
[10]Yi J P,Vitaliano P P,Smith R E,et al.The role of resilience on psychological adjustment and physical health in patients with diabetes[J].Br J Health Psychol,2008,13:311-325.
[11]Jaser S S,White L E.Coping and resilience in adolescents with type 1 diabetes[J].Child Care Health Dev,2011,37(3):335-342.
[12]Denisco S.Exploring the relationship between resilience and diabetes outcomes in African Americans[J].J Am Acad Nurse Pract,2011,23(11):602-610.
[13]赵蔓,孙春荣.2型糖尿病患者心理弹性与自我管理行为的关系研究[J].齐鲁护理杂志,2017,23(3):34-36.
[14]Connor K M,Davidson J R T.Development of a new resilience scale:the Connor-Davidson Resilience scale(CD-RISC)[J].Depress Anxiety,2003,18(2):76-82.
[15]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.
[16]于肖楠,张建新.自我韧性量表与Connor-Davidson韧性量表的应用比较[J].心理科学,2007,30(5):1169-1171.
[17]章孟星.妊娠期糖尿病临床护理实践的指南改编研究[D].上海:复旦大学,2018.
[18]潘运,杨桂芳.国外心理韧性的研究述评[J].贵州师范大学学报(社会科学版),2013,2013(2):7-12.
[19]黄昆,许勤,蒋明,等.乳腺癌术后化疗患者心理弹性与焦虑抑郁的相关性研究[J].护理学杂志,2013,28(2):89-91.
[20]Minfeng H.Resilience in chronic disease:the relationship among risk factors,protective factors,adaptive outcomes,and the level of resilience in adults with diabetes[D].Queensland:University of Queensland,2009.
[21]梁海英,陈兢思,赵丹曦,等.妊娠期糖尿病患者心理健康状况的临床调查[J].中国妇幼保健,2008,23(27):3868-3870.
[22]符春花,吴媛,辛若梅,等.三级综合医院ICU护士的心理弹性状况及其影响因素[J].中华全科医学,2018,16(4):663-666.
[23]Bahremand M,Rai A,Alikhani M,et al.Relationship between family functioning and mental health considering the mediating role of resiliency in type 2 diabetes mellitus patients[J].Glob J Health Sci,2014,7(3):254-259.
[24]汪艳阳.糖尿病患者心理弹性的研究进展[J].糖尿病新世界,2017,20(2):195-196.
[25]Yi J P,Vitaliano P P,Smith R E,et al.The role of resilience on psychological adjustment and physical health in patients with diabetes[J].Br J Health Psychol,2008,13(Pt2):311-325.
[26]Utz B,Kolsteren P,De Brouwere V.A snapshot of current gestational diabetes management practices from 26 low-income and lower-middle-income countries[J].Int J Gynaecol Obstet,2016,134(2):145-150.