焦虑抑郁和心理弹性对乳腺癌病人创伤后成长的影响
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摘要
[目的]通过构建化疗期乳腺癌病人焦虑抑郁、心理弹性、创伤后成长的关系模型,探讨焦虑、抑郁、心理弹性对创伤后成长的影响。[方法]采用综合医院焦虑抑郁量表、心理弹性量表、创伤后成长量表对224例化疗期乳腺癌病人进行问卷调查,并用相关分析、结构方程建模和简单斜率调节效应分析焦虑抑郁、心理弹性和创伤后成长的关系。[结果]焦虑与心理弹性、创伤后成长呈负相关(r值分别为-0.402,-0.617,P均<0.01),抑郁与心理弹性、创伤后成长呈负相关(r值分别为-0.419,-0.629,P均<0.01);心理弹性与创伤后成长呈正相关(r=0.386,P<0.01);心理弹性在焦虑抑郁和创伤后成长之间发挥部分中介效应(中介效应占总效应的32.12%);心理弹性在焦虑抑郁和创伤后成长间起调节作用,同等的焦虑抑郁情绪,高心理弹性相对中、低心理弹性病人可获得更大的创伤后成长增长率。[结论]化疗期乳腺癌病人焦虑抑郁和心理弹性影响其创伤后成长,应建立基于多学科协作理念的协作机制,进行专业的心理干预降低病人焦虑抑郁情绪,挖掘心理弹性潜能,促进其创伤后成长。
Objective:To construct a relationship model among anxiety,depression,resilience and post-traumatic growth,PTG and explore the effects of anxiety,depression,and resilience on PTG.Methods:A total of 224 patients with breast cancer during chemotherapy were surveyed using the General Hospital Anxiety and Depression Scale,Connor-Davidson Resilience Scale(CD-RISC)and The Posttraumatic Growth Inventory.Correlation analysis,structural equation modeling,and simple slope adjustment effects were used to analyze the relationship among anxiety,depression,resilience and PTG.Results:The study showed that there was a significant negative correlation between anxiety and resilience(r=-0.402,P<0.01),and a significant negative correlation with PTG(r=-0.617,P<0.01);there was a significant negative correlation between depression and resilience(r=-0.419,P<0.01),and there was a significant negative correlation with PTG(r=-0.629,P<0.01);resilience was significantly positively correlated with PTG(r=0.386,P<0.01).Resilience played a partial mediating effect among anxiety,depression and PTG(mediation effect accounts for 32.12% of the total effect).In addition,resilience played a regulatory role between anxiety,depression,and PTG.Faced with the same anxiety and depression,patients with higher resilience could achieve greater PTG rates.Conclusions:Anxiety,depression,and resilience affected their PTG of breast cancer patient during chemotherapy.Coordination mechanism on should be established based on multidisciplinary collaborative concept.Professional psychological intervention should be used to reduce their anxiety and depression,and to explore the potential of resilience and promote their PTG.
Objective:To construct a relationship model among anxiety,depression,resilience and post-traumatic growth,PTG and explore the effects of anxiety,depression,and resilience on PTG.Methods:A total of 224 patients with breast cancer during chemotherapy were surveyed using the General Hospital Anxiety and Depression Scale,Connor-Davidson Resilience Scale(CD-RISC)and The Posttraumatic Growth Inventory.Correlation analysis,structural equation modeling,and simple slope adjustment effects were used to analyze the relationship among anxiety,depression,resilience and PTG.Results:The study showed that there was a significant negative correlation between anxiety and resilience(r=-0.402,P<0.01),and a significant negative correlation with PTG(r=-0.617,P<0.01);there was a significant negative correlation between depression and resilience(r=-0.419,P<0.01),and there was a significant negative correlation with PTG(r=-0.629,P<0.01);resilience was significantly positively correlated with PTG(r=0.386,P<0.01).Resilience played a partial mediating effect among anxiety,depression and PTG(mediation effect accounts for 32.12% of the total effect).In addition,resilience played a regulatory role between anxiety,depression,and PTG.Faced with the same anxiety and depression,patients with higher resilience could achieve greater PTG rates.Conclusions:Anxiety,depression,and resilience affected their PTG of breast cancer patient during chemotherapy.Coordination mechanism on should be established based on multidisciplinary collaborative concept.Professional psychological intervention should be used to reduce their anxiety and depression,and to explore the potential of resilience and promote their PTG.
引文
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[15] 中国抗癌协会乳腺癌专业委员会.中国抗癌协会乳腺癌诊治指南与规范(2017年版)[J].中国癌症杂志,2017,27(9):695-759.
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[17] MULLER D,JUDD C M,YZERBYT V Y.When moderation is mediated and mediation is moderated[J].J Pers Soc Psychol,2005,89(6):852-863.
[2] 国家癌症中心.2018年全国最新癌症报告[EB/OL].[2018-03-27].http://www.360doc.com/content/18/0327/11/4485830_740565648.shtml.
[3] 中国抗癌协会肿瘤心理学专业委员会.中国肿瘤心理治疗指南[M].北京:人民卫生出版社,2017:78-79.
[4] 朱金富,林贤浩.《医学心理学》[M].北京:中国医药科技出版社,2016:1.
[5] TEDESCHI R G,CANN A,TAKU K,et al.The posttraumatic growth inventory:a revision integrating existential and spiritual change[J].Journal of Traumatic Stress,2017,30(1):11-18.
[6] American Psychology Association.The road to resilience:what is resilience?[EB/OL].[2012-08-18].http://www.apa.org/helpcenter/road-resilience.aspx.2011.
[7] 孙振球.医学统计学[M].3版.北京:人民卫生出版社,2010:480.
[8] YU X,ZHANG J.Factor analysis and psychometric evaluation of the Connor-Davidson Resilience Scale (CD-RISC) with Chinese people[J].Social Behavior and Personality:an International Journal,2007,35(1):19-30.
[9] 董璐,胡雁,徐国会,等.中文版创伤后成长量表应用于乳腺癌患者的信效度分析[J].护理学杂志,2013,28(22):21-23.
[10] PODSAKOFF P M,MACKENZIE S B,LEE J Y,et al.Common method biases in behavioral research:a critical review of the literature and recommended remedies[J].J Appl Psychol,2003,88(5):879-903.
[11] YU Nancy Xiaonan,CHEN Lihua,YE Zhi,et al.Impacts of making sense of adversity on depression,posttraumatic stress disorder,and posttraumatic growth among a sample of mainly newly diagnosed HIV-positive Chinese young homosexual men:the mediating role of resilience[J].AIDS Care,2017,29(1):79-85.
[12] KOUTROULI N,ANAGNOSTOPOULOS F,GRIVA F,et al.Exploring the relationship between posttraumatic growth,cognitive processing,psychological distress,and social constraints in a sample of breast cancer patients[J].Women Health,2016,56(6):650-667.
[13] WITTMANN V,LáTOS M,HORVáTH Z,et al.What contributes to long-term quality of life in breast cancer patients who are undergoing surgery?results of a multidimensional study[J].Qual Life Res,2017,26(8):2189-2199.
[14] KENNE SARENMALM E,M?RTENSSON L B,ANDERSSON B A,et al.Mindfulness and its efficacy for psychological and biological responses in women with breast cancer[J].Cancer Medicine,2017,6(5):1108-1122.
[15] 中国抗癌协会乳腺癌专业委员会.中国抗癌协会乳腺癌诊治指南与规范(2017年版)[J].中国癌症杂志,2017,27(9):695-759.
[16] 袁平.有氧运动联合延续性护理对乳腺癌病人创伤后成长和心理弹性的影响[J].护理研究,2017,31(21):2617-2619.
[17] MULLER D,JUDD C M,YZERBYT V Y.When moderation is mediated and mediation is moderated[J].J Pers Soc Psychol,2005,89(6):852-863.