癌症患者主要照顾亲属的焦虑、抑郁、社会支持状况及相关因素研究
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摘要
癌症不仅给患者的身心健康造成极大的威胁,对于患者亲属也是严重的不良应激事件。在经受亲人患癌症的巨大打击时,他们不但承担着主要的照顾任务、沉重的经济负担,还要努力控制自己的情绪并为患者提供积极的情感支持,这给癌症患者亲属的身心健康带来不利影响。已有文献报道,亲属的社会心理疾病发生率等于或大于癌症患者,在对抗癌症的战役中,癌症患者的亲属被认为是共同受累者。研究显示,癌症患者和亲属的心理健康相互关联,当患者亲属的心身健康出现问题时,不但影响对患者的照顾质量,也会给患者的心理带来不利影响。因此,关注癌症患者亲属的心理健康状况及影响因素,为制定针对性的干预措施提供依据,对于提高亲属的心理健康水平,进而提高对患者的支持水平有着至关重要的作用。
目的:调查住院癌症患者主要照顾亲属的焦虑、抑郁、社会支持状况及相关因素,为制定针对性的干预措施提供依据,以提高癌症患者亲属的心理健康水平,进而提高对患者的支持水平。
方法:以2006年10月至12月在西京医院综合诊疗中心各病区住院治疗的106例连续癌症患者的亲属为调查对象。采用流调用抑郁自评量表(CES-D)、焦虑自评量表(SAS)及社会支持评定量表(SSRS)分别评定亲属的抑郁、焦虑和社会支持。用自编问卷调查患者及亲属的一般情况和患者的疾病信息。
结果:①癌症患者亲属的抑郁自评分均值为18.75±9.06分,高于国内常模,且超过正常范围界值;有抑郁症状者占55.7%,高于国内正常人群;26~50岁年龄组、家庭经济状况差、社会支持利用度低的患者亲属,患者为男性或临床表现症状较多及消化系统癌症患者的亲属抑郁症状发生率显著增高;亲属抑郁影响因素的多元回归分析结果显示:亲属抑郁评分与患者癌症分期、亲属对社会支持的利用度、患者躯体症状和家庭收入状况有线性关系,其中与支持利用度呈负相关,患者躯体症状对亲属抑郁评分影响最大。②癌症患者亲属的焦虑粗评分为33.94±7.09分,高于国内常模,差异有统计学意义;在106例被调查者中,24例的焦虑评分超过了临床截断点,有焦虑症状者占22.6 %,其中23例与抑郁症状共存;影响亲属焦虑状况的单因素分析结果显示:患者的配偶和报告患者躯体症状较多的亲属更易发生焦虑。③癌症患者亲属的社会支持总分为40.54±8.21分,高于国内常模。影响亲属社会支持状况的单因素分析结果显示:>55岁年龄组的亲属主观支持分及支持利用度得分均显著降低;受教育年限>12年的亲属支持利用度得分高于受教育年限短者;干部、职员、知识分子的客观支持分显著高于工人;工人的客观支持和支持利用度得分均较低;医疗费用完全自付的亲属所得的客观支持分显著低于有医疗保险者;亲属的客观支持分在患者的疾病晚期高于早期。④非抑郁组亲属的社会支持分高于抑郁组,支持利用度得分显著增高,有统计学意义;抑郁与社会支持的相关分析显示:社会支持利用度与抑郁状况呈显著负相关。
结论:住院癌症患者的亲属存在较严重的抑郁和焦虑。其心理健康状况不仅受亲属自身社会人口因素的影响,也受患者一般情况及病情的影响。患者的配偶、26～50岁年龄组、家庭经济状况差、对社会支持利用度低的亲属及癌症晚期、躯体症状多的患者的亲属是易发生不良心理应激的高危人群。医务人员应将患者及亲属视为二联体,在治疗癌症患者时,重视对患者亲属心理反应的观察,在对亲属实施心理干预时,应考虑到患者因素所致的影响。医务人员需积极主动地与患者及亲属交谈,注意了解其心理健康状况及影响因素,并采取针对性的干预措施,以提高患者亲属的心理健康水平,进而提高对患者的支持水平。
The diagnosis of cancer has not only a significant impact on the affected patients, but also is a distress for their families. Suffering from the distress that their familiy members with cancer, caregivers have to assume the primary responsibility of caring for the patients ,afford the finacial burden ,actively engage in emotion support for the patients, whilst also attempt to manage their own feeling states.These stress-factors could bring negative impact to the caregivers, physical and mental health. It has been reported that the prevalence of emotional distress in caregivers equaled or exceeded that in cancer patients. Family members have been described as co-sufferers in the battle against cancer. The large number of studies have reported a positive relationship between caregivers’and patients’distress. While the caregivers suffer some physical or psychological distress, the quality of care will be affected ,and will be brought some negative factors for the patiens’mental health.so,paying attention to the mental health of family caregivers and the related factors play an important role in providing a foundation of designing interventions,and then improving the level of mental heath of caregivers and support level for the cancer patients.
Objective: To investigate anxiety, depression and social support in caregivers of patients with cancer and the related factors. It would provide the foundation of interventions,and that would improve the level of mental heath of caregivers and the caregivers, surport level for the cancer patients.
Methodes: The study sample consisted of 106 family caregivers of consecutive hospitalized cancer patients at department of comprehensive diagnosis and therapeutic center in Xijing hospital between Octobor and December in 2006 . Depression ,anxiety and social surport were assessed with CES-D, SAS, SSRS respectively.The general condition of the caregivers and disease information of the patients were collected with questionnaires designed by author.
Results:1. The mean depression scores of caregivers on the CES-D was 18.75,it was significantly higher than the normal samples and exceeded the cut off of 16 for clinic depression. 55.7% of caregivers reported CES-D scores which exceed the cut-off. Caregivers aged 26～50 years old, caregivers in lower income level and lower availability of SRSS, caregivers of patients with multiple symptoms,male patients and the patients with cancer in digestive system reported higher prevalence of CESD-defined depression compared with their counterparts. The results from the multiple regression showed that depression in caregivers were related with patients symptom status ,cancer stage, caregivers income level and availability of SSRS.The availability of SSRS was negatively correlated to the level of depression . Patients symptom status were the significantly factors that affect caregivers’depression .
2. The mean level of anxiety scores in caregivers on the SAS was 33.94.Their level of anxiety was significantly higher than normal. In 106 caregivers, 22.6% (24) had been reported that their SAS scores exceeded thresholds for clinical anxiety.There were 23 caregivers with anxiety symptoms also with depression symptoms. The high anxiety index was significantly associated with the caregiver's reported more patients symptoms ,and the spouses of the patients were also at the high risk of anxiety .
3. The mean level of social support scores in caregivers on the SSRS was 40.54.It was higher than normal samples .
Caregivers aged above 50 years-old reported lower level of subjective support scores and lower availability of SRSS. caregivers who received education more than 12 years have higher availability of support than those who received short one ;officials, company staffers, intelligentsias all have significant higher objective support scores than the others ;the caregievers who have to pay for the whole medical-fee get significant lower objective support than the ones who have medicare insurance;the objective support of the caregivers is higher in the later phase of cancer patients than the in earlier phase .
4. The scores of social support in non–depression caregivers were higher than in the depression ones,and availability of social support scores were significantly increased in previous group;the correlation analyse between depression and social support showed :the availability of social support scores correlated negtively with depreession.
Conclusion: A high level of depression and anxiety existed in caregivers of cancer patients.The psychological distress of caregivers was influenced not only by sociodemographics factors of themselves,but also by sociodemographics factors of the patients and patients’state of cacer. Spouses of patients, Caregivers aged 26～50 years old, caregivers in lower income level and lower availability of SRSS, caregivers of patients with multiple symptoms,male patients and the patients with cancer in digestive system are the specific groups at high risk for distressed. Health care personnel should treat the patient and their family members as a‘patient-caregiver dyad’, while the cancer patients were given treatment, the caregivers’distress should be concerned; while health care personnel provide interventions to the caregivers,we should considered of the aspect of patients factors. Health care personnel should actively talk with patients and their caregivers,and be aware of their psychological distress and it’s effected factors and, if necessary, should provide direction interventions,to improve the level of mental health in caregivers,and then to improve the level of surport for patients.
目的:调查住院癌症患者主要照顾亲属的焦虑、抑郁、社会支持状况及相关因素,为制定针对性的干预措施提供依据,以提高癌症患者亲属的心理健康水平,进而提高对患者的支持水平。
方法:以2006年10月至12月在西京医院综合诊疗中心各病区住院治疗的106例连续癌症患者的亲属为调查对象。采用流调用抑郁自评量表(CES-D)、焦虑自评量表(SAS)及社会支持评定量表(SSRS)分别评定亲属的抑郁、焦虑和社会支持。用自编问卷调查患者及亲属的一般情况和患者的疾病信息。
结果:①癌症患者亲属的抑郁自评分均值为18.75±9.06分,高于国内常模,且超过正常范围界值;有抑郁症状者占55.7%,高于国内正常人群;26~50岁年龄组、家庭经济状况差、社会支持利用度低的患者亲属,患者为男性或临床表现症状较多及消化系统癌症患者的亲属抑郁症状发生率显著增高;亲属抑郁影响因素的多元回归分析结果显示:亲属抑郁评分与患者癌症分期、亲属对社会支持的利用度、患者躯体症状和家庭收入状况有线性关系,其中与支持利用度呈负相关,患者躯体症状对亲属抑郁评分影响最大。②癌症患者亲属的焦虑粗评分为33.94±7.09分,高于国内常模,差异有统计学意义;在106例被调查者中,24例的焦虑评分超过了临床截断点,有焦虑症状者占22.6 %,其中23例与抑郁症状共存;影响亲属焦虑状况的单因素分析结果显示:患者的配偶和报告患者躯体症状较多的亲属更易发生焦虑。③癌症患者亲属的社会支持总分为40.54±8.21分,高于国内常模。影响亲属社会支持状况的单因素分析结果显示:>55岁年龄组的亲属主观支持分及支持利用度得分均显著降低;受教育年限>12年的亲属支持利用度得分高于受教育年限短者;干部、职员、知识分子的客观支持分显著高于工人;工人的客观支持和支持利用度得分均较低;医疗费用完全自付的亲属所得的客观支持分显著低于有医疗保险者;亲属的客观支持分在患者的疾病晚期高于早期。④非抑郁组亲属的社会支持分高于抑郁组,支持利用度得分显著增高,有统计学意义;抑郁与社会支持的相关分析显示:社会支持利用度与抑郁状况呈显著负相关。
结论:住院癌症患者的亲属存在较严重的抑郁和焦虑。其心理健康状况不仅受亲属自身社会人口因素的影响,也受患者一般情况及病情的影响。患者的配偶、26～50岁年龄组、家庭经济状况差、对社会支持利用度低的亲属及癌症晚期、躯体症状多的患者的亲属是易发生不良心理应激的高危人群。医务人员应将患者及亲属视为二联体,在治疗癌症患者时,重视对患者亲属心理反应的观察,在对亲属实施心理干预时,应考虑到患者因素所致的影响。医务人员需积极主动地与患者及亲属交谈,注意了解其心理健康状况及影响因素,并采取针对性的干预措施,以提高患者亲属的心理健康水平,进而提高对患者的支持水平。
The diagnosis of cancer has not only a significant impact on the affected patients, but also is a distress for their families. Suffering from the distress that their familiy members with cancer, caregivers have to assume the primary responsibility of caring for the patients ,afford the finacial burden ,actively engage in emotion support for the patients, whilst also attempt to manage their own feeling states.These stress-factors could bring negative impact to the caregivers, physical and mental health. It has been reported that the prevalence of emotional distress in caregivers equaled or exceeded that in cancer patients. Family members have been described as co-sufferers in the battle against cancer. The large number of studies have reported a positive relationship between caregivers’and patients’distress. While the caregivers suffer some physical or psychological distress, the quality of care will be affected ,and will be brought some negative factors for the patiens’mental health.so,paying attention to the mental health of family caregivers and the related factors play an important role in providing a foundation of designing interventions,and then improving the level of mental heath of caregivers and support level for the cancer patients.
Objective: To investigate anxiety, depression and social support in caregivers of patients with cancer and the related factors. It would provide the foundation of interventions,and that would improve the level of mental heath of caregivers and the caregivers, surport level for the cancer patients.
Methodes: The study sample consisted of 106 family caregivers of consecutive hospitalized cancer patients at department of comprehensive diagnosis and therapeutic center in Xijing hospital between Octobor and December in 2006 . Depression ,anxiety and social surport were assessed with CES-D, SAS, SSRS respectively.The general condition of the caregivers and disease information of the patients were collected with questionnaires designed by author.
Results:1. The mean depression scores of caregivers on the CES-D was 18.75,it was significantly higher than the normal samples and exceeded the cut off of 16 for clinic depression. 55.7% of caregivers reported CES-D scores which exceed the cut-off. Caregivers aged 26～50 years old, caregivers in lower income level and lower availability of SRSS, caregivers of patients with multiple symptoms,male patients and the patients with cancer in digestive system reported higher prevalence of CESD-defined depression compared with their counterparts. The results from the multiple regression showed that depression in caregivers were related with patients symptom status ,cancer stage, caregivers income level and availability of SSRS.The availability of SSRS was negatively correlated to the level of depression . Patients symptom status were the significantly factors that affect caregivers’depression .
2. The mean level of anxiety scores in caregivers on the SAS was 33.94.Their level of anxiety was significantly higher than normal. In 106 caregivers, 22.6% (24) had been reported that their SAS scores exceeded thresholds for clinical anxiety.There were 23 caregivers with anxiety symptoms also with depression symptoms. The high anxiety index was significantly associated with the caregiver's reported more patients symptoms ,and the spouses of the patients were also at the high risk of anxiety .
3. The mean level of social support scores in caregivers on the SSRS was 40.54.It was higher than normal samples .
Caregivers aged above 50 years-old reported lower level of subjective support scores and lower availability of SRSS. caregivers who received education more than 12 years have higher availability of support than those who received short one ;officials, company staffers, intelligentsias all have significant higher objective support scores than the others ;the caregievers who have to pay for the whole medical-fee get significant lower objective support than the ones who have medicare insurance;the objective support of the caregivers is higher in the later phase of cancer patients than the in earlier phase .
4. The scores of social support in non–depression caregivers were higher than in the depression ones,and availability of social support scores were significantly increased in previous group;the correlation analyse between depression and social support showed :the availability of social support scores correlated negtively with depreession.
Conclusion: A high level of depression and anxiety existed in caregivers of cancer patients.The psychological distress of caregivers was influenced not only by sociodemographics factors of themselves,but also by sociodemographics factors of the patients and patients’state of cacer. Spouses of patients, Caregivers aged 26～50 years old, caregivers in lower income level and lower availability of SRSS, caregivers of patients with multiple symptoms,male patients and the patients with cancer in digestive system are the specific groups at high risk for distressed. Health care personnel should treat the patient and their family members as a‘patient-caregiver dyad’, while the cancer patients were given treatment, the caregivers’distress should be concerned; while health care personnel provide interventions to the caregivers,we should considered of the aspect of patients factors. Health care personnel should actively talk with patients and their caregivers,and be aware of their psychological distress and it’s effected factors and, if necessary, should provide direction interventions,to improve the level of mental health in caregivers,and then to improve the level of surport for patients.
引文
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47. Compas B, Worsham N, Epping-Jordan J,et, al. When Mom or Dad has cancer: markers of psychological distress in cancer patients, spouses and children. Health Psychol, 1994,13(6):507–515.
48. Keitel MA, Zevon MA, Rounds JB, et, al.Spouse adjustment to cancer surgery: distress and coping responses. Surg. Oncol, 1990,43:153–158.
49. Carey,PJ,Oberst MT, McCubbin MA,et al.Appraisal and caregiving burden in family members caring for patients receiving chemotherapy. Oncol. Nurs. Forum, 1991,18 (8):1341–1348.
50. Vess J, Moreland J,Schwebel A. An empirical assessment of the effects of cancer on family role functioning. J. Psychosoc. Oncol, 1985,3(1):1–16.
51. Glasdam S, Jensen AB, Madsen AL, et al. Anxiety and depression in cancer patients’ spouses. Psychooncology, 1996,5 (1):23–29.
52. Lee Walker B. Adjustment of husbands and wives to breast cancer. Cancer Pract, 1997,5:92–98.
53. 姜乾金. 医学心理学. 人民卫生出版社,2002,2:89.
54. 朱志光 , 梁虹 . 现代心身疾病治疗学 . 北京 : 人民军医出版社,2002:193-195.
55. Gloliella ME ,Berkman B ,Robison M. Spirituality and quality of life ingynecologic patients[J ] . Cancer Practice ,1998 ,6 (6) :333 - 338.
56. 汪向东,王希林,马弘.心理卫生评定量表手册(增订版). 北京:中国心理卫生杂志社,1999:127-131.
57. Shelley E,Taylor,著.朱熊兆,姚树桥,王湘,主译.健康心理学.人民卫生出版社,2006:218.
58. Ell K, Nishimoto R, Mantell J,et al.Psychological adaptation to cancer: a comparison among patients, spouses and nonspouses. Fam. Systems Med, 1988,6(3):335-348.
59. Schumacher K,Dodd M,Paul S.The stress process in family caregivers of persons receiving chemotherapy. Res. Nurs. Health, 1993,16 (6):395–404.
60. Mellon S,Northouse LL,Weiss LK. A population-based study of the quality of life of cancer survivors and their family caregivers.Cancer Nurs, 2006,29(2):120-31; quiz 132-3.
61. Baider L, Koch U, Esacson R, et al.Prospective study of cancer patients and their spouses: the weakness of marital strength. Psychooncology, 1998,7(1):49–56.
62. Lalos A, Eisemann M. Social interaction and support related to mood and locus of control in cervical and endometrial cancer patients and their spouses. Support Care Cancer, 1999,7(2):75–78.
63. Baider L, De-Nour A. Psychological distress of cancer couples: a levelling effect. New Trends Exp. Clin. Psychiat, 1999,15 (4):197–203.
64. Douglass L. Reciprocal support in the context of cancer: perspectives of the patient and spouse. Oncol. Nurs. Forum, 1997,24 (9):1529–1536.
65. Derdiarian AK. Effects of information on recently diagnosed cancer patients’ and spouses’ satisfaction with care. Cancer Nurs, 1989,12 (5):285–292.
66. Radloff LS.The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1977; 3 (1); 385-401.
67. 张明园主编. 精神科评定量表手册. 第2 版. 长沙:湖南科学技术出版社,1993.35-42
68. 张作记. 行为医学量表手册. 中国行为医学科学杂志,2001,10:124-125.
69. Tatsuo Akechi, Nobuya Akizuki, Masako Okamura, et al. Psychologicaldistress experienced by families of cancer patients:preliminary findings from psychiatric consultation of a cancer center hospital〔J〕. Japanese Journal of Clinical Oncology, 2006 36(5):329-332.
70. 张明园,任福民,樊斌,等.正常人群中的抑郁症状的调查和CES-D的应用〔J〕.中华神经精神杂志,1987,20(2):67-71.
71. Andershed B, Ternestedt BM. Involvement of relatives in the care of the dying in different care cultures: involvement in the dark or in the light? Cancer Nurs, 1998; 21: 106–116。
72. Henderson S. Neurosis and the social environment [M] . New York :Academic Press ,1981 :29 - 52.
73. Herman-Stahl, Mindy, Petersen, Anne C. The protective role of coping and social resources for depressive symptoms among young adolescents.Journal of Youth and Adolescence, 1996,25(6):733-753.
74. 张理义,崔庶,高柏良,等.某些消化道癌的发生与生长激素、行为类型及社会支持的关系研究.中国行为科学, 1996,5(1): 25.
75. 栾荣生,刘东磊,阳定宇,等.社会支持与社会功能及其影响因素的人群研究.中国心理卫生杂志,1999,13(5): 290-291.
76. 刘霞. 肾移植患者社会支持状况的调查分析与护理对策. 中华护理杂志,2006,41(9):854-857.
77. 吴彩芹,芦 宁,井晓红,等.老年喉癌病人抑郁及社会支持状况研究.护理研究 ,2006 ,20(9A):2282-2283.
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44. Morse S , Fife B. Coping with a partner's cancer: adjustment at four stages of the illness trajectory. Oncol. Nurs. Forum 1998,25 (4):751–760.
45. Ptaceck J,Ptaceck J, Dodge K. Coping with breast cancer from the perspectives of husbands and wives. Psychosoc. Oncol, 1994, 12:47–72.
46. Given CW, Stommel M, Given B, et al. The influence of cancer patients’ symptoms and functional states on patients’ depression and familycaregivers’ reaction and depression. Health Psychol,1993,12(4):277–285.
47. Compas B, Worsham N, Epping-Jordan J,et, al. When Mom or Dad has cancer: markers of psychological distress in cancer patients, spouses and children. Health Psychol, 1994,13(6):507–515.
48. Keitel MA, Zevon MA, Rounds JB, et, al.Spouse adjustment to cancer surgery: distress and coping responses. Surg. Oncol, 1990,43:153–158.
49. Carey,PJ,Oberst MT, McCubbin MA,et al.Appraisal and caregiving burden in family members caring for patients receiving chemotherapy. Oncol. Nurs. Forum, 1991,18 (8):1341–1348.
50. Vess J, Moreland J,Schwebel A. An empirical assessment of the effects of cancer on family role functioning. J. Psychosoc. Oncol, 1985,3(1):1–16.
51. Glasdam S, Jensen AB, Madsen AL, et al. Anxiety and depression in cancer patients’ spouses. Psychooncology, 1996,5 (1):23–29.
52. Lee Walker B. Adjustment of husbands and wives to breast cancer. Cancer Pract, 1997,5:92–98.
53. 姜乾金. 医学心理学. 人民卫生出版社,2002,2:89.
54. 朱志光 , 梁虹 . 现代心身疾病治疗学 . 北京 : 人民军医出版社,2002:193-195.
55. Gloliella ME ,Berkman B ,Robison M. Spirituality and quality of life ingynecologic patients[J ] . Cancer Practice ,1998 ,6 (6) :333 - 338.
56. 汪向东,王希林,马弘.心理卫生评定量表手册(增订版). 北京:中国心理卫生杂志社,1999:127-131.
57. Shelley E,Taylor,著.朱熊兆,姚树桥,王湘,主译.健康心理学.人民卫生出版社,2006:218.
58. Ell K, Nishimoto R, Mantell J,et al.Psychological adaptation to cancer: a comparison among patients, spouses and nonspouses. Fam. Systems Med, 1988,6(3):335-348.
59. Schumacher K,Dodd M,Paul S.The stress process in family caregivers of persons receiving chemotherapy. Res. Nurs. Health, 1993,16 (6):395–404.
60. Mellon S,Northouse LL,Weiss LK. A population-based study of the quality of life of cancer survivors and their family caregivers.Cancer Nurs, 2006,29(2):120-31; quiz 132-3.
61. Baider L, Koch U, Esacson R, et al.Prospective study of cancer patients and their spouses: the weakness of marital strength. Psychooncology, 1998,7(1):49–56.
62. Lalos A, Eisemann M. Social interaction and support related to mood and locus of control in cervical and endometrial cancer patients and their spouses. Support Care Cancer, 1999,7(2):75–78.
63. Baider L, De-Nour A. Psychological distress of cancer couples: a levelling effect. New Trends Exp. Clin. Psychiat, 1999,15 (4):197–203.
64. Douglass L. Reciprocal support in the context of cancer: perspectives of the patient and spouse. Oncol. Nurs. Forum, 1997,24 (9):1529–1536.
65. Derdiarian AK. Effects of information on recently diagnosed cancer patients’ and spouses’ satisfaction with care. Cancer Nurs, 1989,12 (5):285–292.
66. Radloff LS.The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1977; 3 (1); 385-401.
67. 张明园主编. 精神科评定量表手册. 第2 版. 长沙:湖南科学技术出版社,1993.35-42
68. 张作记. 行为医学量表手册. 中国行为医学科学杂志,2001,10:124-125.
69. Tatsuo Akechi, Nobuya Akizuki, Masako Okamura, et al. Psychologicaldistress experienced by families of cancer patients:preliminary findings from psychiatric consultation of a cancer center hospital〔J〕. Japanese Journal of Clinical Oncology, 2006 36(5):329-332.
70. 张明园,任福民,樊斌,等.正常人群中的抑郁症状的调查和CES-D的应用〔J〕.中华神经精神杂志,1987,20(2):67-71.
71. Andershed B, Ternestedt BM. Involvement of relatives in the care of the dying in different care cultures: involvement in the dark or in the light? Cancer Nurs, 1998; 21: 106–116。
72. Henderson S. Neurosis and the social environment [M] . New York :Academic Press ,1981 :29 - 52.
73. Herman-Stahl, Mindy, Petersen, Anne C. The protective role of coping and social resources for depressive symptoms among young adolescents.Journal of Youth and Adolescence, 1996,25(6):733-753.
74. 张理义,崔庶,高柏良,等.某些消化道癌的发生与生长激素、行为类型及社会支持的关系研究.中国行为科学, 1996,5(1): 25.
75. 栾荣生,刘东磊,阳定宇,等.社会支持与社会功能及其影响因素的人群研究.中国心理卫生杂志,1999,13(5): 290-291.
76. 刘霞. 肾移植患者社会支持状况的调查分析与护理对策. 中华护理杂志,2006,41(9):854-857.
77. 吴彩芹,芦 宁,井晓红,等.老年喉癌病人抑郁及社会支持状况研究.护理研究 ,2006 ,20(9A):2282-2283.