肺癌患者家庭功能与应对方式、抑郁状态的调查与分析
|
摘要
目的：
评估肺癌患者的家庭功能状况,并探讨其影响因素；了解肺癌患者和家属的应对方式,并探讨患者和家属的应对方式与家庭功能的关系；了解肺癌患者的抑郁状态,并探讨患者抑郁状态与其家庭功能的关系,以家庭为切入点寻找提高患者生命质量的合理途径。
方法：
采用问卷和访谈相结合的方法对肺癌患者的家庭进行研究。研究对象为2011年10月至2012年2月在北京市三家三甲医院胸部肿瘤科住院的肺癌患者及其家属,共107个家庭(每个家庭2人)纳入研究。采用一般情况调查表、家庭关怀度指数问卷(APGAR).家庭功能评定量表(FAD)、家庭负担会谈量表(FBS)、医学应对问卷(MCMQ).简明应对方式问卷(SCSQ).自评抑郁量表(SDS)对肺癌患者的家庭功能及其影响因素、患者和家属的应对方式、患者的抑郁状态进行测评,通过问卷收集的全部数据使用SPSS统计软件进行处理。采用质性研究的方法作为辅助和补充,对5个家庭的10位成员进行深度访谈,访谈资料遵循质性研究的原则进行整理和转录,并将定量研究与定性研究获得的数据进行整合。
结果：
1家庭功能评估：应用家庭关怀度指数问卷(APGAR)调查发现肺癌患者主观评价的家庭功能良好,93.5%的肺癌患者主观认为其家庭功能处于良好状态；应用家庭功能评定量表(FAD)对肺癌患者的家庭功能进行多维度评定,发现与功能不良的界值分相比,总体功能得分<界值分,差异有统计学意义(t=-2.745,P<0.05),问题解决、沟通、角色维度得分<界值分,差异有统计学意义(t=一5.715,P<0.01；t=一5.297,P<0.01t=一3.299,P<0.01),情感介入和行为控制维度得分>界值分,差异有统计学意义(t=3.083,P<0.01；t=14.548,P<0.01),情感反应维度得分与界值分差异无统计学意义(t=0.996,P>0.05),提示肺癌患者家庭的总体功能、问题解决、沟通和角色功能未见不良,情感介入和行为控制功能不良,情感反应功能弱化。
2家庭功能的影响因素：家庭人均月收入、家庭负担、患者的年龄、婚龄、文化程度、性别、患者是否为家庭的主要经济来源、患者与家人的亲密程度以及家属的年龄和文化程度均对家庭功能产生影响。
3肺癌患者和家属的应对方式及与家庭功能的关系：肺癌患者回避和屈服应对方式的得分与一般患者人群得分比较,差异有统计学意义(t=12.112,P<0.01；t=9.537,P<0.01),患者家属积极和消极应对方式得分与常模比较,差异有统计学意义(t=3.771,P<0.01: t=-6.200,P<0.01)；相关分析显示应对方式与家庭功能之间存在一定的相关(P<0.05)。
4肺癌患者抑郁状态及与家庭功能的关系：肺癌患者的SDS评分显著高于国内常模(t=8.469,P<0.01),相关分析显示患者的抑郁状态与其家庭功能呈负相关(P<0.05)。
5质性访谈的结果在某些方面对定量研究的结果予以支持。
结论：肺癌患者家庭功能在某些维度存在不良,应在护理工作中有针对性的进行干预；应重视具有不利影响因素的家庭,并给予关注和支持；通过了解家庭功能和应对方式、抑郁状态的互动关系和规律,可尝试对患者及家属的应对方式进行干预,作为改善家庭功能的可行途径；可将家庭功能作为改善患者心理状态的切入点。在对肺癌患者的护理工作中,应将患者的家庭视为护理对象,以家庭功能为切入点,以改善患者的身心健康状态,提高其生命质量。
Objective:
To explore the condition and influence factors of family function of the patients with lung cancer;To explore the coping styles of the patients with lung cancer and their family members;To explore the correlativity among family function and coping styles;To explore the state of depression of the patients with lung cancer;To explore the correlativity among family function and depression.
Methods:
The present study used the mixed methods-combine questionary and interview.The data covered107patients with lung cancer who are in hospital in thoracic tumor department of three A-level hospitals in Beijing from October2011to February2012and their family members. The thesis examines the family function and its influence factors by questionary, APGAR, FAD and FBS; examines the coping styles by MCMQ and SCSQ;examines the depression by SDS.Entire data are statistical analyzed by the software SPSS.Besides,the qualitative study is used as supplementary by interviewing10members from5families.The data are collected and recoded according the rules of qualitative study,then integrate the data from the two parts.
Results:
1Assessment of family function:APGAR shows that the subjective evaluation of family function by patients themselves is good,93.5%patients agree that their family function are in good condition. Multidimensional assessment by FAD shows that the score of GF7the score of AI,BC>boundary,the statistical meaning is significant, there is no statistical meaning between the score of AR and boundary (t=0.996, P>0.05), it means that there is no declination and defect with the function of GF, PS,CM and RL;but the function of Al and BC are declination and defect;the function of AR is weaken.
2The influence factors:it shows that the family income,family burden,age, marriage age,cultural,sex,whether the patient provide main financial support for family, and intimacy between family members,these all are the factors.
3Coping styles and correlativity with family function:comparing score of avoiding and giving up of patients with normal score, the statistical meaning is significant (t=12.112, P<0.01; t=9.537, P<0.01); comparing score of positive and negative of family members with normal score, the statistical meaning is significant (t=3.771, P<0.01; t=-6.200, P<0.01); analysis of correlation shows that there is interaction between coping styles and family function (P<0.05).
4Depression and correlativity with family function:the score of SDS with patients is higher than normal score, the statistical meaning is significant (t=8.469,P<0.01), analysis of correlation shows that there is negative-correlation between depression and family function (P<0.05).
5The data from qualitative study shows agreement with the results of quantitative study in some aspects.
Conclusion:
Some dimensions of family function of patients with lung cancer are declination and defect,nurses should intervent by nursing measures with a purpose;also should pay attention to the families with adverse factors; besides,nurses coule try to help the family to improve the family function by changing their coping styles;and could help the patients to improve their mental health by improving their family function.In our nursing practice,we should take the family as our object,help the patients to improve their quality of life by improve their family function.
评估肺癌患者的家庭功能状况,并探讨其影响因素；了解肺癌患者和家属的应对方式,并探讨患者和家属的应对方式与家庭功能的关系；了解肺癌患者的抑郁状态,并探讨患者抑郁状态与其家庭功能的关系,以家庭为切入点寻找提高患者生命质量的合理途径。
方法：
采用问卷和访谈相结合的方法对肺癌患者的家庭进行研究。研究对象为2011年10月至2012年2月在北京市三家三甲医院胸部肿瘤科住院的肺癌患者及其家属,共107个家庭(每个家庭2人)纳入研究。采用一般情况调查表、家庭关怀度指数问卷(APGAR).家庭功能评定量表(FAD)、家庭负担会谈量表(FBS)、医学应对问卷(MCMQ).简明应对方式问卷(SCSQ).自评抑郁量表(SDS)对肺癌患者的家庭功能及其影响因素、患者和家属的应对方式、患者的抑郁状态进行测评,通过问卷收集的全部数据使用SPSS统计软件进行处理。采用质性研究的方法作为辅助和补充,对5个家庭的10位成员进行深度访谈,访谈资料遵循质性研究的原则进行整理和转录,并将定量研究与定性研究获得的数据进行整合。
结果：
1家庭功能评估：应用家庭关怀度指数问卷(APGAR)调查发现肺癌患者主观评价的家庭功能良好,93.5%的肺癌患者主观认为其家庭功能处于良好状态；应用家庭功能评定量表(FAD)对肺癌患者的家庭功能进行多维度评定,发现与功能不良的界值分相比,总体功能得分<界值分,差异有统计学意义(t=-2.745,P<0.05),问题解决、沟通、角色维度得分<界值分,差异有统计学意义(t=一5.715,P<0.01；t=一5.297,P<0.01t=一3.299,P<0.01),情感介入和行为控制维度得分>界值分,差异有统计学意义(t=3.083,P<0.01；t=14.548,P<0.01),情感反应维度得分与界值分差异无统计学意义(t=0.996,P>0.05),提示肺癌患者家庭的总体功能、问题解决、沟通和角色功能未见不良,情感介入和行为控制功能不良,情感反应功能弱化。
2家庭功能的影响因素：家庭人均月收入、家庭负担、患者的年龄、婚龄、文化程度、性别、患者是否为家庭的主要经济来源、患者与家人的亲密程度以及家属的年龄和文化程度均对家庭功能产生影响。
3肺癌患者和家属的应对方式及与家庭功能的关系：肺癌患者回避和屈服应对方式的得分与一般患者人群得分比较,差异有统计学意义(t=12.112,P<0.01；t=9.537,P<0.01),患者家属积极和消极应对方式得分与常模比较,差异有统计学意义(t=3.771,P<0.01: t=-6.200,P<0.01)；相关分析显示应对方式与家庭功能之间存在一定的相关(P<0.05)。
4肺癌患者抑郁状态及与家庭功能的关系：肺癌患者的SDS评分显著高于国内常模(t=8.469,P<0.01),相关分析显示患者的抑郁状态与其家庭功能呈负相关(P<0.05)。
5质性访谈的结果在某些方面对定量研究的结果予以支持。
结论：肺癌患者家庭功能在某些维度存在不良,应在护理工作中有针对性的进行干预；应重视具有不利影响因素的家庭,并给予关注和支持；通过了解家庭功能和应对方式、抑郁状态的互动关系和规律,可尝试对患者及家属的应对方式进行干预,作为改善家庭功能的可行途径；可将家庭功能作为改善患者心理状态的切入点。在对肺癌患者的护理工作中,应将患者的家庭视为护理对象,以家庭功能为切入点,以改善患者的身心健康状态,提高其生命质量。
Objective:
To explore the condition and influence factors of family function of the patients with lung cancer;To explore the coping styles of the patients with lung cancer and their family members;To explore the correlativity among family function and coping styles;To explore the state of depression of the patients with lung cancer;To explore the correlativity among family function and depression.
Methods:
The present study used the mixed methods-combine questionary and interview.The data covered107patients with lung cancer who are in hospital in thoracic tumor department of three A-level hospitals in Beijing from October2011to February2012and their family members. The thesis examines the family function and its influence factors by questionary, APGAR, FAD and FBS; examines the coping styles by MCMQ and SCSQ;examines the depression by SDS.Entire data are statistical analyzed by the software SPSS.Besides,the qualitative study is used as supplementary by interviewing10members from5families.The data are collected and recoded according the rules of qualitative study,then integrate the data from the two parts.
Results:
1Assessment of family function:APGAR shows that the subjective evaluation of family function by patients themselves is good,93.5%patients agree that their family function are in good condition. Multidimensional assessment by FAD shows that the score of GF
2The influence factors:it shows that the family income,family burden,age, marriage age,cultural,sex,whether the patient provide main financial support for family, and intimacy between family members,these all are the factors.
3Coping styles and correlativity with family function:comparing score of avoiding and giving up of patients with normal score, the statistical meaning is significant (t=12.112, P<0.01; t=9.537, P<0.01); comparing score of positive and negative of family members with normal score, the statistical meaning is significant (t=3.771, P<0.01; t=-6.200, P<0.01); analysis of correlation shows that there is interaction between coping styles and family function (P<0.05).
4Depression and correlativity with family function:the score of SDS with patients is higher than normal score, the statistical meaning is significant (t=8.469,P<0.01), analysis of correlation shows that there is negative-correlation between depression and family function (P<0.05).
5The data from qualitative study shows agreement with the results of quantitative study in some aspects.
Conclusion:
Some dimensions of family function of patients with lung cancer are declination and defect,nurses should intervent by nursing measures with a purpose;also should pay attention to the families with adverse factors; besides,nurses coule try to help the family to improve the family function by changing their coping styles;and could help the patients to improve their mental health by improving their family function.In our nursing practice,we should take the family as our object,help the patients to improve their quality of life by improve their family function.
引文
[1]王长利.肺癌(现代肿瘤临床诊治丛书)[M].北京：科学技术文献出版社,2009：23
[2]Parkin DM,Bray FB,Pisani P.Global cancer statistics,2002[J]. CA Cancer J Clin.2005,55(2): 74-106
[3]支修益.肺癌防治策略高峰论坛[J].中华医学杂志,2005,8(11)：792
[4]Ferlay J,Bray F,Pisani P,et al.GLOBOCAN 2002:Cancer incidence, mortality and prevalence worldwide[M].Version 2.0. IARC Cancer Base No.5. Lyon:IARC Press,2004
[5]Lili T,Janet G,Barry D,et al. Psychosocial oncology in China-Challenges and opportunities [J]. Chinese-German Journal of Clinical Oncology.2009,8(3):123-128
[6]Bowen M.Family therapy in clinical practice[M].New York.Jason Aronson.1978
[7]诺其拉特.佩塞斯蒂安(德)著,李顺伟等译.积极家庭心理治疗[M].国际文化出版公司,1990：47
[8]Murtonen I,Kuisma M,Paunonen M,et al. Family dynamics of families with cancer in Finland[J].Cancer Nurs.1998,21(4):252-258
[9]谷波,刘华英,陈克芳,等.食管癌手术病人生命质量与家庭支持功能研究[J].护士进修杂志,2003,18(8)：686
[10]Olsen EH.The impact of serious illness on family system[J].Postgrad Med.1970,47:172
[11]McWhinney IR.Beyond diagnosis-An approach to the intergration of behavioral science and clinical medicine[J].N Engl J Med.1972,287:84
[12]张秀琴.家庭心理学：基于系统观点的考察[J].青岛大学师范学院学报,2009,26(1)：43-50
[13]曾文星,徐静著.心理治疗：理论与分析[M].北京：北京医科大,中国协和医科大学联合出版社,1994：118-127
[14]Taylor C.Supporting the carers of individuals affected by colorectal cance[J]. Br J Nurs. 2008,17(4):226-230
[15]顾嫒,吕繁.全科医学理论与实践[M].北京：世界图书出版公司,1995：14-15
[16]Kissane DW,McKenzie DP,Forbes A,et al.Psychosocial morbidity associated with patterns of family functioning in palliative care:baseline data from Famliy Focused Grief Therapy controlled trial[J]. Palliat-Med.2003,17(6):527-537
[17]朱希燕,顾潇,张玉芬,等.家庭功能对食管癌住院患者行为方式的影响[J].护理实践与研究,2009,6(5)：12-14
[18]Han KS,Khim SY,Lee SJ,et al. Family functioning and quality of life of the family care-giver in cancer patients[J].Taehan Kanho Hakhoe Chi.2006,36(6):983-991
[19]何雪琳.癌症患者家庭功能与生存质量的相关性研究[J].护理学杂志,2009,24(17)：18-20
[20]Sheila A,Payne BA.Coping with palliative chemotherapy[J]. Journal of Advanced Nursing. 1990,15(3):652-658
[21]Goldberger L,Breznits S.Handbook of stress:theoretical and clinical aspects[M].New York. The Free Press. 1982:778
[22]Halstead MT, Fernsler JL. Coping strategies of long-term cancer survivors[J]. Cancer Nursing. 1974,17(2):94-100
[23]愈磊.应付的理论、研究思路和应用[J].心理科学,1994,2：169-174
[24]姜乾金.浙江淳安小学流行性癔病的心理社会因素探讨[J].中国心理卫生杂志,1990,4：157-174
[25]Broadhead WE,Kaplan BH.Social support and the cancer patient:lmplications for future research and clinical care[J].Cancer,1991:67794-67799
[26]Bloom JR.Social support,accommodation to stress and adjustment to breast cancer[J]. Soc Sci Med. 1982,16(14):1329-1338
[27]穆新华,刘晓红,邓光辉,等.癌症患者心理行为干预的研究与应用[J].解放军护理杂志,2003,20(7)：39-40
[28]赵楠,项春雁.恶性肿瘤患者家庭功能与应对方式调查[J].护理学杂志,2009,24(15)：37-38
[29]刘寒秋.孕妇家庭功能与应对方式的相关性研究[J].实用预防医学2007,14(3)：818-819
[30]唐正芬.家庭动力学特征与青少年应付方式及违法犯罪的相关研究[J].中国儿童保健杂志,2002,10(2)：102-105
[31]张萍华,张桂青,鲁谨.癌症病人抑郁的心理干预研究[J].全科护理,2009,7(1C)：204-207
[32]朱芹,杨默.心理护理对肺癌病人化疗期间生活质量的影响[J].全科护理,2010,8(11A)：2853-2854
[33]Epstein N,Baldwin L,Bishop D.The Mcmaster family assessment device[J]. Journal of Marital and Family Therapy. 1983,9:75-98
[34]Padgett DK. Sociodemographic and disease-related correlates of depressive morbidity among diabetic patients in Zagreb, Croatia[J]. J Nerv Ment Dis.1993,181(2):123-129
[35]Lustman PJ,Penckofer SM,Clouse RE.Recent advances in understanding depression in adults with diabetes[J].Curr Diab Rep.2007,7(2):114-122
[36]崔凤梅,肖红杰,闫玉娟,等.家庭功能调节对慢性乙型肝炎患者抑郁情绪的影响[J].现代临床护理,2009,8(8)：22-24
[37]Dunbar SB,Clark PC,Deaton C,et al.Family education and support interventions in heart failure:A pilot study[J].Nursing Research.2005,54(3):166-186
[38]Minuchin S.Families and family therapy[M].Cambridge:Harvard University Press, 1974:11-15
[39]Miller IW,Ryan CE. The McMaster approach to families:theory, assessment, treatment and research[J].Journal of family therapy.2000,22:168-189
[40]Epstein N,Baldwin L,Bishop D.The Mcmaster family assessment device[J].Journal of Marital and Family Therapy. 1983,9:171-18O
[41]TD Chau,CH Huang,HW Lin,et al.A study on the Apllication of Family APGAR[J].Chinese Journal of Family Medicine.1991,2:73-79
[42]吕繁,顾嫒.家庭APGAR问卷及其临床应用[J].国外医学医院管理分册,1995.2：56-59
[43]苏银花,段功香.家庭功能评定量表及临床应用进展[J].护理研究,2008,22(7)：1794-1796
[44]刘培毅,何幕陶.家庭功能量表(Family Assessment Device,FAD) [J].中国心理卫生杂志,1999,(增刊)：149-151
[45]Sahila Pai,Kapur RK.The burden on the family of a Psychiatric patient:development of a interview schedule[J].Brit J Psychiat.1981,138:332-335
[46]汪向东,王希林,马弘.心理卫生评定量表手册(增订版)[M].北京：中国心理卫生杂志社,1999：194-197
[47]Alicia O,Elizabeth M,Jon N.Three techniques for integratingrating data in mixed methods studies[J].BMJ.2010,341:1147-1150
[48]Ryan CE,Epstein NB,Keitner GI,et al.Evaluating and Treating Families:the McMaster Approach[M].New York.Routledge Taylor & Francis Group.2005.
[49]McPherson CJ,Wilson KG,Murray MA.Feeling like a burden:Exploring the perspectives of patients at the end of life[J].Soc Sci Med.2007,64:417-427
[50]田秀丽,刘化侠,柴士美.晚期癌症患者自我感受负担的研究进展[J].中华护理杂志,2008,43(10)：955-958
[51]Walster E,Berscheid E,Walster G.New directions in equity research[J].Pers Soc Psychol,1973,25:151-176
[52]Walster E, Walster G, Berscheid E.Equity theory and research[M].Boston:Allyn&Bacon. 1978:19-78
[53]Kuijer RG,Buunk BP,Ybema JF.Are equity concerns important in the intimate relationship when one partner of a couple has cancer?[J].Soc Psychol Q.2001,64:267-282
[54]汪凤炎.中国文化心理学[M].广州：暨南大学出版社,2004：33-59
[55]杨国枢.中国人的心理与行为：本土化研究[M].北京：中国人民大学出版社,2004：138-155
[56]刘海丽,王爱平.晚期肺癌病人自我感受负担的研究进展[J].护理研究,2011,25(3A)：565-568
[57]李涛,田晓红.简述家庭治疗中的家庭系统观[J].四川精神卫生,2008,21(4)：255-256
[58]吴红艳,章玉玲,吕茹铃.痛风患者家庭功能与自我管理的调查[J].实用临床医学,2007,8(3)：25-26
[59]何松彬,唐维国.长期生存癌症患者的述情障碍[J].中国心理卫生杂志,2002,16(9)：609-610
[60]张继志.精神医学与心理卫生研究[M].北京：北京出版社,1994：245
[61]付莉.妇科恶性肿瘤患者家庭功能状况调查及影响因素分析.天津医科大学.硕士学位论文.2010
[62]张文颖,崔凤梅,肖红杰,等.慢性乙型肝炎患者家庭功能状况调查研究[J].医学临床研究,2009,4(26)：694-697
[63]池丽萍,辛自强.家庭功能及相关因素的研究[J].心理学探新,2001,21(3)：55-60
[64]王昕,叶兰仙,任建功,等.2型糖尿病患者家庭功能调查与分析[J].中国卫生事业管理,2009,8：577
[65]叶玲.主观幸福感影响因素研究[J].聊城大学学报(社会科学版),2010,2：223-224
[66]熊真真.2型糖尿病慢性并发症病人家庭负担及影响因素研究.四川大学.硕士学位论文.2007
[67]张冬红,王传升,王太枝.家庭教育对老年痴呆患者家庭负担的研究[J].中国误诊学杂志,2006,6(2)：248-249
[68]朱希燕,张玉芬,张海燕,等.食管癌住院患者家庭功能与家庭负担的研究及护理干预[J].护理实践与研究,2009,6(11)：8-10
[69]李淑萍,李海玉.手术患者家庭功能与家庭负担状况的研究[J].实用全科医学,2008,6(5)：539-540
[70]邵文利,邹本乐,史淑萍,等.外科手术患者家庭功能与家庭负担状况的研究[J].护理学杂志,2006,21(24)：1-2
[71]李文杰,王峰,李树秋,等.住院肿瘤患者亲属照顾者主管负担及相关因素[J].山东大学学报,2011,49(4)：146-149
[72]Christopher JL,Margaret F,Raisa BD,et al.Financial and family burden associated with cancer treatment in Ontario,Canada[J].Support Care Cancer.2006,14:1077-1085
[73]吕繁.疾病家庭负担和社会负担研究.中国协和医科大学.博士学位论文.1997
[74]杨红红,吕探云,徐禹静.脑卒中病人居家主要照顾者负荷水平与社会支持度的相关性研究[J].中国实用护理杂志,2005,21(3)：6-9
[75]吴文源,张明园,何燕玲,等.老年痴呆病人照料者的负担及其影响因素研究[J].中国 心理卫生杂志,1995,10(2)：49-52
[76]Subman GD,Tessler RC,Willis G.Living with the mentally ill:factors affecting household complaints[J].Schizophr Bull. 1987;13(4):727-736
[77]范群,刘建华,李学信,等.家庭生活周期与家庭功能的关系[J].江苏预防医学,2001,12(3)：527
[78]Oktay ZS,Walper CA.Breast cancer in the life course:Women experience[M].NY:Spring. 1991:107-115
[79]Feldstein MA,Rait D.Family assessment in an oncology setting[J].Cancer Nursing.1992, 15(3):161-172
[80]Syse A,Tretli S,Kravdal O.The impact of cancer on spouses'labor earnings:A population-based study[J].Cancer.2009,115(18 supp1):4350-4361
[81]杜江,全旭,王黎荔.成都市3所高校退休人员家庭功能现状及影响因素调查[J].预防医学情报杂志,2008,24(5)：330-332
[82]何雪琳.癌症病人家庭功能状况调查分析[J].实用肿瘤学杂志,2009,23(4)：368-369
[83]孙玉枝,寇玉坤,杨利军.812例社区老年人日常生活能力、家庭功能及相关因素调查[J].中国全科医学,2004,7(13)：974-976
[84]Astedt-Kurki P,Lehti K,Tarkka MT,et al.Determinants of perceived health in families of patients with heart disease[J].Adv Nurs.2004,48(2):115-123
[85]黄丽,沈晓红,赵梅,等.癌症病人的应对方式与心身症状[J].中国心理卫生杂志,2000,14(2)：102-104
[86]Inoue S,Saeki T,Mantani T,et a;.Factors related to patient's mental adjustment to breast cancer:patient characteristics and family functioning[J].Support Care Cancer, 2003,11(3): 178-184
[87]穆新华.癌症患者的家庭功能、应付方式评估及其相关研究.第二军医大学.硕士学位论文.2004
[88]吴文源.行为医学量表手册[M].北京：中华医学音像出版社,2005：223-224
[89]刘浩,李国屏,张丽燕,等.家庭功能对不孕妇女心理健康及治疗态度的影响[J].中国妇幼保健,2008,23(25)：3566-3567
[90]杨红霞,宋国丽,李如萍,等.社会支持家庭功能对产后抑郁情绪的影响[J].护理研究,2009,23(12)：3126-3128
[91]杨丽全,陈金寿,郑建胜,等.老年高血压患者家庭功能与抑郁的对应关系研究[J].护理学杂志,2008,23(9)：66-67
[92]季坚,张华,耿青.老年抑郁状态与家庭功能的多元逐步回归分析[J].护理研究,2007,21(8)：2006-2007
[93]王君梅,姚景鹏.血液透析患者心理状态及家庭支持的调查与分析[J].中国使用护理 杂志,2004,20(1)：63-64
[94]Dunbar S B,Clark P C,Quinn C,et al. Family influences on heart failure self-care and out-comes[J].Cardiovas Nuts.2008,23(4):370
[95]Eric F,Rudi R,Mieke D,et al. Implicit and explicit self-esteem in currently depressed individuals with and without suicidal ideation[J]. Journal of Behavior Therapy and Experimental Psychiatry.2007,38:75-85
[96]蔡小俐.癌症病人抑郁程度与主要照顾者压力负荷的相关性研究[J].护理研究,2011,25(6A)：1423-1424
[2]Parkin DM,Bray FB,Pisani P.Global cancer statistics,2002[J]. CA Cancer J Clin.2005,55(2): 74-106
[3]支修益.肺癌防治策略高峰论坛[J].中华医学杂志,2005,8(11)：792
[4]Ferlay J,Bray F,Pisani P,et al.GLOBOCAN 2002:Cancer incidence, mortality and prevalence worldwide[M].Version 2.0. IARC Cancer Base No.5. Lyon:IARC Press,2004
[5]Lili T,Janet G,Barry D,et al. Psychosocial oncology in China-Challenges and opportunities [J]. Chinese-German Journal of Clinical Oncology.2009,8(3):123-128
[6]Bowen M.Family therapy in clinical practice[M].New York.Jason Aronson.1978
[7]诺其拉特.佩塞斯蒂安(德)著,李顺伟等译.积极家庭心理治疗[M].国际文化出版公司,1990：47
[8]Murtonen I,Kuisma M,Paunonen M,et al. Family dynamics of families with cancer in Finland[J].Cancer Nurs.1998,21(4):252-258
[9]谷波,刘华英,陈克芳,等.食管癌手术病人生命质量与家庭支持功能研究[J].护士进修杂志,2003,18(8)：686
[10]Olsen EH.The impact of serious illness on family system[J].Postgrad Med.1970,47:172
[11]McWhinney IR.Beyond diagnosis-An approach to the intergration of behavioral science and clinical medicine[J].N Engl J Med.1972,287:84
[12]张秀琴.家庭心理学：基于系统观点的考察[J].青岛大学师范学院学报,2009,26(1)：43-50
[13]曾文星,徐静著.心理治疗：理论与分析[M].北京：北京医科大,中国协和医科大学联合出版社,1994：118-127
[14]Taylor C.Supporting the carers of individuals affected by colorectal cance[J]. Br J Nurs. 2008,17(4):226-230
[15]顾嫒,吕繁.全科医学理论与实践[M].北京：世界图书出版公司,1995：14-15
[16]Kissane DW,McKenzie DP,Forbes A,et al.Psychosocial morbidity associated with patterns of family functioning in palliative care:baseline data from Famliy Focused Grief Therapy controlled trial[J]. Palliat-Med.2003,17(6):527-537
[17]朱希燕,顾潇,张玉芬,等.家庭功能对食管癌住院患者行为方式的影响[J].护理实践与研究,2009,6(5)：12-14
[18]Han KS,Khim SY,Lee SJ,et al. Family functioning and quality of life of the family care-giver in cancer patients[J].Taehan Kanho Hakhoe Chi.2006,36(6):983-991
[19]何雪琳.癌症患者家庭功能与生存质量的相关性研究[J].护理学杂志,2009,24(17)：18-20
[20]Sheila A,Payne BA.Coping with palliative chemotherapy[J]. Journal of Advanced Nursing. 1990,15(3):652-658
[21]Goldberger L,Breznits S.Handbook of stress:theoretical and clinical aspects[M].New York. The Free Press. 1982:778
[22]Halstead MT, Fernsler JL. Coping strategies of long-term cancer survivors[J]. Cancer Nursing. 1974,17(2):94-100
[23]愈磊.应付的理论、研究思路和应用[J].心理科学,1994,2：169-174
[24]姜乾金.浙江淳安小学流行性癔病的心理社会因素探讨[J].中国心理卫生杂志,1990,4：157-174
[25]Broadhead WE,Kaplan BH.Social support and the cancer patient:lmplications for future research and clinical care[J].Cancer,1991:67794-67799
[26]Bloom JR.Social support,accommodation to stress and adjustment to breast cancer[J]. Soc Sci Med. 1982,16(14):1329-1338
[27]穆新华,刘晓红,邓光辉,等.癌症患者心理行为干预的研究与应用[J].解放军护理杂志,2003,20(7)：39-40
[28]赵楠,项春雁.恶性肿瘤患者家庭功能与应对方式调查[J].护理学杂志,2009,24(15)：37-38
[29]刘寒秋.孕妇家庭功能与应对方式的相关性研究[J].实用预防医学2007,14(3)：818-819
[30]唐正芬.家庭动力学特征与青少年应付方式及违法犯罪的相关研究[J].中国儿童保健杂志,2002,10(2)：102-105
[31]张萍华,张桂青,鲁谨.癌症病人抑郁的心理干预研究[J].全科护理,2009,7(1C)：204-207
[32]朱芹,杨默.心理护理对肺癌病人化疗期间生活质量的影响[J].全科护理,2010,8(11A)：2853-2854
[33]Epstein N,Baldwin L,Bishop D.The Mcmaster family assessment device[J]. Journal of Marital and Family Therapy. 1983,9:75-98
[34]Padgett DK. Sociodemographic and disease-related correlates of depressive morbidity among diabetic patients in Zagreb, Croatia[J]. J Nerv Ment Dis.1993,181(2):123-129
[35]Lustman PJ,Penckofer SM,Clouse RE.Recent advances in understanding depression in adults with diabetes[J].Curr Diab Rep.2007,7(2):114-122
[36]崔凤梅,肖红杰,闫玉娟,等.家庭功能调节对慢性乙型肝炎患者抑郁情绪的影响[J].现代临床护理,2009,8(8)：22-24
[37]Dunbar SB,Clark PC,Deaton C,et al.Family education and support interventions in heart failure:A pilot study[J].Nursing Research.2005,54(3):166-186
[38]Minuchin S.Families and family therapy[M].Cambridge:Harvard University Press, 1974:11-15
[39]Miller IW,Ryan CE. The McMaster approach to families:theory, assessment, treatment and research[J].Journal of family therapy.2000,22:168-189
[40]Epstein N,Baldwin L,Bishop D.The Mcmaster family assessment device[J].Journal of Marital and Family Therapy. 1983,9:171-18O
[41]TD Chau,CH Huang,HW Lin,et al.A study on the Apllication of Family APGAR[J].Chinese Journal of Family Medicine.1991,2:73-79
[42]吕繁,顾嫒.家庭APGAR问卷及其临床应用[J].国外医学医院管理分册,1995.2：56-59
[43]苏银花,段功香.家庭功能评定量表及临床应用进展[J].护理研究,2008,22(7)：1794-1796
[44]刘培毅,何幕陶.家庭功能量表(Family Assessment Device,FAD) [J].中国心理卫生杂志,1999,(增刊)：149-151
[45]Sahila Pai,Kapur RK.The burden on the family of a Psychiatric patient:development of a interview schedule[J].Brit J Psychiat.1981,138:332-335
[46]汪向东,王希林,马弘.心理卫生评定量表手册(增订版)[M].北京：中国心理卫生杂志社,1999：194-197
[47]Alicia O,Elizabeth M,Jon N.Three techniques for integratingrating data in mixed methods studies[J].BMJ.2010,341:1147-1150
[48]Ryan CE,Epstein NB,Keitner GI,et al.Evaluating and Treating Families:the McMaster Approach[M].New York.Routledge Taylor & Francis Group.2005.
[49]McPherson CJ,Wilson KG,Murray MA.Feeling like a burden:Exploring the perspectives of patients at the end of life[J].Soc Sci Med.2007,64:417-427
[50]田秀丽,刘化侠,柴士美.晚期癌症患者自我感受负担的研究进展[J].中华护理杂志,2008,43(10)：955-958
[51]Walster E,Berscheid E,Walster G.New directions in equity research[J].Pers Soc Psychol,1973,25:151-176
[52]Walster E, Walster G, Berscheid E.Equity theory and research[M].Boston:Allyn&Bacon. 1978:19-78
[53]Kuijer RG,Buunk BP,Ybema JF.Are equity concerns important in the intimate relationship when one partner of a couple has cancer?[J].Soc Psychol Q.2001,64:267-282
[54]汪凤炎.中国文化心理学[M].广州：暨南大学出版社,2004：33-59
[55]杨国枢.中国人的心理与行为：本土化研究[M].北京：中国人民大学出版社,2004：138-155
[56]刘海丽,王爱平.晚期肺癌病人自我感受负担的研究进展[J].护理研究,2011,25(3A)：565-568
[57]李涛,田晓红.简述家庭治疗中的家庭系统观[J].四川精神卫生,2008,21(4)：255-256
[58]吴红艳,章玉玲,吕茹铃.痛风患者家庭功能与自我管理的调查[J].实用临床医学,2007,8(3)：25-26
[59]何松彬,唐维国.长期生存癌症患者的述情障碍[J].中国心理卫生杂志,2002,16(9)：609-610
[60]张继志.精神医学与心理卫生研究[M].北京：北京出版社,1994：245
[61]付莉.妇科恶性肿瘤患者家庭功能状况调查及影响因素分析.天津医科大学.硕士学位论文.2010
[62]张文颖,崔凤梅,肖红杰,等.慢性乙型肝炎患者家庭功能状况调查研究[J].医学临床研究,2009,4(26)：694-697
[63]池丽萍,辛自强.家庭功能及相关因素的研究[J].心理学探新,2001,21(3)：55-60
[64]王昕,叶兰仙,任建功,等.2型糖尿病患者家庭功能调查与分析[J].中国卫生事业管理,2009,8：577
[65]叶玲.主观幸福感影响因素研究[J].聊城大学学报(社会科学版),2010,2：223-224
[66]熊真真.2型糖尿病慢性并发症病人家庭负担及影响因素研究.四川大学.硕士学位论文.2007
[67]张冬红,王传升,王太枝.家庭教育对老年痴呆患者家庭负担的研究[J].中国误诊学杂志,2006,6(2)：248-249
[68]朱希燕,张玉芬,张海燕,等.食管癌住院患者家庭功能与家庭负担的研究及护理干预[J].护理实践与研究,2009,6(11)：8-10
[69]李淑萍,李海玉.手术患者家庭功能与家庭负担状况的研究[J].实用全科医学,2008,6(5)：539-540
[70]邵文利,邹本乐,史淑萍,等.外科手术患者家庭功能与家庭负担状况的研究[J].护理学杂志,2006,21(24)：1-2
[71]李文杰,王峰,李树秋,等.住院肿瘤患者亲属照顾者主管负担及相关因素[J].山东大学学报,2011,49(4)：146-149
[72]Christopher JL,Margaret F,Raisa BD,et al.Financial and family burden associated with cancer treatment in Ontario,Canada[J].Support Care Cancer.2006,14:1077-1085
[73]吕繁.疾病家庭负担和社会负担研究.中国协和医科大学.博士学位论文.1997
[74]杨红红,吕探云,徐禹静.脑卒中病人居家主要照顾者负荷水平与社会支持度的相关性研究[J].中国实用护理杂志,2005,21(3)：6-9
[75]吴文源,张明园,何燕玲,等.老年痴呆病人照料者的负担及其影响因素研究[J].中国 心理卫生杂志,1995,10(2)：49-52
[76]Subman GD,Tessler RC,Willis G.Living with the mentally ill:factors affecting household complaints[J].Schizophr Bull. 1987;13(4):727-736
[77]范群,刘建华,李学信,等.家庭生活周期与家庭功能的关系[J].江苏预防医学,2001,12(3)：527
[78]Oktay ZS,Walper CA.Breast cancer in the life course:Women experience[M].NY:Spring. 1991:107-115
[79]Feldstein MA,Rait D.Family assessment in an oncology setting[J].Cancer Nursing.1992, 15(3):161-172
[80]Syse A,Tretli S,Kravdal O.The impact of cancer on spouses'labor earnings:A population-based study[J].Cancer.2009,115(18 supp1):4350-4361
[81]杜江,全旭,王黎荔.成都市3所高校退休人员家庭功能现状及影响因素调查[J].预防医学情报杂志,2008,24(5)：330-332
[82]何雪琳.癌症病人家庭功能状况调查分析[J].实用肿瘤学杂志,2009,23(4)：368-369
[83]孙玉枝,寇玉坤,杨利军.812例社区老年人日常生活能力、家庭功能及相关因素调查[J].中国全科医学,2004,7(13)：974-976
[84]Astedt-Kurki P,Lehti K,Tarkka MT,et al.Determinants of perceived health in families of patients with heart disease[J].Adv Nurs.2004,48(2):115-123
[85]黄丽,沈晓红,赵梅,等.癌症病人的应对方式与心身症状[J].中国心理卫生杂志,2000,14(2)：102-104
[86]Inoue S,Saeki T,Mantani T,et a;.Factors related to patient's mental adjustment to breast cancer:patient characteristics and family functioning[J].Support Care Cancer, 2003,11(3): 178-184
[87]穆新华.癌症患者的家庭功能、应付方式评估及其相关研究.第二军医大学.硕士学位论文.2004
[88]吴文源.行为医学量表手册[M].北京：中华医学音像出版社,2005：223-224
[89]刘浩,李国屏,张丽燕,等.家庭功能对不孕妇女心理健康及治疗态度的影响[J].中国妇幼保健,2008,23(25)：3566-3567
[90]杨红霞,宋国丽,李如萍,等.社会支持家庭功能对产后抑郁情绪的影响[J].护理研究,2009,23(12)：3126-3128
[91]杨丽全,陈金寿,郑建胜,等.老年高血压患者家庭功能与抑郁的对应关系研究[J].护理学杂志,2008,23(9)：66-67
[92]季坚,张华,耿青.老年抑郁状态与家庭功能的多元逐步回归分析[J].护理研究,2007,21(8)：2006-2007
[93]王君梅,姚景鹏.血液透析患者心理状态及家庭支持的调查与分析[J].中国使用护理 杂志,2004,20(1)：63-64
[94]Dunbar S B,Clark P C,Quinn C,et al. Family influences on heart failure self-care and out-comes[J].Cardiovas Nuts.2008,23(4):370
[95]Eric F,Rudi R,Mieke D,et al. Implicit and explicit self-esteem in currently depressed individuals with and without suicidal ideation[J]. Journal of Behavior Therapy and Experimental Psychiatry.2007,38:75-85
[96]蔡小俐.癌症病人抑郁程度与主要照顾者压力负荷的相关性研究[J].护理研究,2011,25(6A)：1423-1424