HIV/AIDS病人歧视知觉与心理健康的关系反刍思维的中介作用
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摘要
目的探究反刍思维在歧视知觉和心理健康之间的中介效应,以期为艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)进行有效的心理干预提供理论参考和现实依据。方法采取方便抽样,抽取278名北京市某三甲医院艾滋病门诊的HIV/AIDS病人进行问卷调查,包括一般资料问卷、Berger HIV歧视知觉问卷(BHSS)、反刍思维量表(RRS)、症状自评量表(SCL-90)。结果 HIV/AIDS病人的BHSS、RRS、SCL-90总均分分别为(2.80±0.45)分,(1.95±0.58)分,(1.65±0.46)分。歧视知觉、反刍思维、心理健康三变量两两呈正相关(P<0.05)。SCL-90高分组的负性自我形象得分显著高于低分组(P<0.05),SCL-90高分组的反刍思维总分及各因子分得分显著高于低分组(P<0.01)。HIV/AIDS病人的反刍思维在歧视知觉与心理健康之间起部分中介作用。结论 HIV/AIDS病人心理健康水平较低,存在较高的歧视知觉,倾向于使用反刍思维方式。医务人员应该关注HIV/AIDS病人的思维变化,制定相应的心理干预措施降低其歧视知觉,降低反刍思维水平,进而提高HIV/AIDS病人的心理健康水平。
Objective To explore the mediating effects of rumination between perceived stigma and mental health of HIV/AIDS patients, and provide theoretical basis and reference data for the improvement of HIV/AIDS patients' mental health. Methods 278 HIV/AIDS patients were tested with Berger HIV Stigma Scale(BHSS), Ruminative Responses Scale(RRS) and Symptom Checklist 90(SCL-90) and the general information scale. Results(1) The score of the HIV/AIDS patients' BHSS, BHSS, SCL-90 was 2.80±0.45,1.95±0.58,1.65±0.46.(2) The three variables of stigma, rumination and mental health were positively correlated(P<0.05).(3) The high SCL-90 group' negative self-image and rumination scores were significantly higher than those of the low group(P<0.05, P<0.01).(4) Rumination played a partially mediating role in the relationship between stigma and the mental health of the HIV/AIDS patients. Conclusion HIV/AIDS patients have low mental health, high stigma perception and rumination. Medical staff should pay attention to the thought of HIV/AIDS patients, formulate psychological intervention measures, to reduce their stigma perception and rumination, so as to improve the mental health of them.
Objective To explore the mediating effects of rumination between perceived stigma and mental health of HIV/AIDS patients, and provide theoretical basis and reference data for the improvement of HIV/AIDS patients' mental health. Methods 278 HIV/AIDS patients were tested with Berger HIV Stigma Scale(BHSS), Ruminative Responses Scale(RRS) and Symptom Checklist 90(SCL-90) and the general information scale. Results(1) The score of the HIV/AIDS patients' BHSS, BHSS, SCL-90 was 2.80±0.45,1.95±0.58,1.65±0.46.(2) The three variables of stigma, rumination and mental health were positively correlated(P<0.05).(3) The high SCL-90 group' negative self-image and rumination scores were significantly higher than those of the low group(P<0.05, P<0.01).(4) Rumination played a partially mediating role in the relationship between stigma and the mental health of the HIV/AIDS patients. Conclusion HIV/AIDS patients have low mental health, high stigma perception and rumination. Medical staff should pay attention to the thought of HIV/AIDS patients, formulate psychological intervention measures, to reduce their stigma perception and rumination, so as to improve the mental health of them.
引文
[1] Sanjuán P,Molero F,Fuster MJ,et al.Coping with HIV related stigma and well-being[J].Journal of Happiness Studies,2013,14(2):709-722.
[2] Vami SE,Miller CT,Mccuin T,et al.Disengagement and Engagement Coping with HIV/AIDS Stigma and Psychological Well-Being of People with HIV/AIDS[J].J Soc Clin Psychol,2012,31(2):123-150.
[3] 孙燕鸣,李洋,赵月娟,等.北京市HIV感染者及AIDS病人生存质量现状与影响因素[J].中华预防医学杂志,2012,46(6):514-518.
[4] 杨翌,张孔来,李泽荣,等.艾滋病病毒感染者生活质量与相关耻辱的关系[J].中国公共卫生,2005,21(6):675-676.
[5] Courtenay-Quirk C,Wolitski RJ,Parsons JT,et al.Is HIV/AIDS stigma dividing the gay community?Perceptions of HIV-positive men who have sex with men[J].AIDS Education & Prevention,2006,18(1):56-67.
[6] 姜红英,付俊,刘家虹,等.医疗领域内艾滋病病人被歧视现状的定性研究[J].现代预防医学,2010,37(5):867-868.
[7] Van Tam V,Phams A,Thorson A,et al.“It is not that I forget,it's just that I don't want other people to know":barriers to and strategies for adherence to antiretroviral therapy among HIV patients in Northern Vietnam[J].AIDS Care,2011,23(2):139-145.
[8] 李宏,王哲,徐俊杰,等.艾滋病相关歧视与抗HIV病毒药物服药依从性等因素的关联性分析[J].医学研究杂志,2013,42(3):18-20.
[9] Tom D.Effects of perceived discrimination:Rejection and identification as two distinct pathways and their associated effects[D].Doctoral dissertation,the Graduate School of The Ohio State University,2006.
[10] 冯正直,张大均.中国版SCL-90的效度研究[J].第三军医大学学报,2001,23(4):481-483.
[11] 李真,王克荣,绳宇.中文版艾滋病感知歧视量表的信效度研究[J].中华护理杂志,2015,50(7):882-885.
[12] 韩秀,杨宏飞.Nolen-Hoeksema 反刍思维量表在中国的试用[J].中国临床心理学杂志,2009,17 (5):550-551,554.
[13] 温忠麟,张雷,侯杰泰,等.中介效应检验程序及其应用[J].心理学报,2004,36(5):614-620.
[14] 汪向东,王希林,马弘,编著.心理卫生评定量表手册[J].中国心理卫生杂志,1999(增刊):31-35.
[15] Jimeez J,Morales M,Castro E,et al.Levels of felt stigma among a group of people with HIV in Puerto Rico[J].P R Health Sci J,2012,31(2):64-70.
[16] 李真.HIV/AIDS病人感知歧视现状调查及影响因素研究[D].北京:北京协和医学院,2015.
[17] 刘欣欣,谢世平,桑海艳,等.HIV/AIDS病人的心理健康状况及其影响因素[J].中华医院感染学杂志,2014,24(1):136-143.
[18] Herek GM,Mitnick L.AIDS and stigma:A conceptual framework and research agenda[J].AIDS and Public Policy Journal,1998,13(1):36-47.
[19] Swim JK,Hyers LL.Stigma,Social Psychology of[J].International Encyclopedia of the Social & Behavioral Sciences,2001:15112-15115.[Epub ahead of print].
[20] Sanjuán P,Molero F,Fuster MJ,et al.Coping with HIV related stigma and well-being[J].Journal of Happiness Studies,2013,14(2):709-722.
[21] 杨翌,张孔来,李泽荣,等.艾滋病病毒感染者生活质量与相关耻辱的关系[J].中国公共卫生,2005,21(6):675-676.
[22] Papadakis AA,Prince KR,Jones N,et al.Self-regulation,rumination,and vulnerability:To depression in adolescent girls[J].Dev Psychopathol,2006,18(3):815-829.
[23] 来水木,韩秀,杨宏飞.国外反刍思维研究综述[J].应用心理学,2009,15(1):90-95.
[2] Vami SE,Miller CT,Mccuin T,et al.Disengagement and Engagement Coping with HIV/AIDS Stigma and Psychological Well-Being of People with HIV/AIDS[J].J Soc Clin Psychol,2012,31(2):123-150.
[3] 孙燕鸣,李洋,赵月娟,等.北京市HIV感染者及AIDS病人生存质量现状与影响因素[J].中华预防医学杂志,2012,46(6):514-518.
[4] 杨翌,张孔来,李泽荣,等.艾滋病病毒感染者生活质量与相关耻辱的关系[J].中国公共卫生,2005,21(6):675-676.
[5] Courtenay-Quirk C,Wolitski RJ,Parsons JT,et al.Is HIV/AIDS stigma dividing the gay community?Perceptions of HIV-positive men who have sex with men[J].AIDS Education & Prevention,2006,18(1):56-67.
[6] 姜红英,付俊,刘家虹,等.医疗领域内艾滋病病人被歧视现状的定性研究[J].现代预防医学,2010,37(5):867-868.
[7] Van Tam V,Phams A,Thorson A,et al.“It is not that I forget,it's just that I don't want other people to know":barriers to and strategies for adherence to antiretroviral therapy among HIV patients in Northern Vietnam[J].AIDS Care,2011,23(2):139-145.
[8] 李宏,王哲,徐俊杰,等.艾滋病相关歧视与抗HIV病毒药物服药依从性等因素的关联性分析[J].医学研究杂志,2013,42(3):18-20.
[9] Tom D.Effects of perceived discrimination:Rejection and identification as two distinct pathways and their associated effects[D].Doctoral dissertation,the Graduate School of The Ohio State University,2006.
[10] 冯正直,张大均.中国版SCL-90的效度研究[J].第三军医大学学报,2001,23(4):481-483.
[11] 李真,王克荣,绳宇.中文版艾滋病感知歧视量表的信效度研究[J].中华护理杂志,2015,50(7):882-885.
[12] 韩秀,杨宏飞.Nolen-Hoeksema 反刍思维量表在中国的试用[J].中国临床心理学杂志,2009,17 (5):550-551,554.
[13] 温忠麟,张雷,侯杰泰,等.中介效应检验程序及其应用[J].心理学报,2004,36(5):614-620.
[14] 汪向东,王希林,马弘,编著.心理卫生评定量表手册[J].中国心理卫生杂志,1999(增刊):31-35.
[15] Jimeez J,Morales M,Castro E,et al.Levels of felt stigma among a group of people with HIV in Puerto Rico[J].P R Health Sci J,2012,31(2):64-70.
[16] 李真.HIV/AIDS病人感知歧视现状调查及影响因素研究[D].北京:北京协和医学院,2015.
[17] 刘欣欣,谢世平,桑海艳,等.HIV/AIDS病人的心理健康状况及其影响因素[J].中华医院感染学杂志,2014,24(1):136-143.
[18] Herek GM,Mitnick L.AIDS and stigma:A conceptual framework and research agenda[J].AIDS and Public Policy Journal,1998,13(1):36-47.
[19] Swim JK,Hyers LL.Stigma,Social Psychology of[J].International Encyclopedia of the Social & Behavioral Sciences,2001:15112-15115.[Epub ahead of print].
[20] Sanjuán P,Molero F,Fuster MJ,et al.Coping with HIV related stigma and well-being[J].Journal of Happiness Studies,2013,14(2):709-722.
[21] 杨翌,张孔来,李泽荣,等.艾滋病病毒感染者生活质量与相关耻辱的关系[J].中国公共卫生,2005,21(6):675-676.
[22] Papadakis AA,Prince KR,Jones N,et al.Self-regulation,rumination,and vulnerability:To depression in adolescent girls[J].Dev Psychopathol,2006,18(3):815-829.
[23] 来水木,韩秀,杨宏飞.国外反刍思维研究综述[J].应用心理学,2009,15(1):90-95.