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护理学报 ›› 2019, Vol. 26 ›› Issue (3): 73-78.doi: 10.16460/j.issn1008-9969.2019.03.073

• 心理卫生 • 上一篇    

领悟社会支持及应对方式在恶性血液病行造血干细胞移植患者心理弹性与创伤后成长间的中介效应

解文君1, 张帅2, 刘毅1, 张会娟1, 刘贵英1, 王蓓1, 刘洁1, 刘玉秋1, 管伟1   

  1. 1.中国医学科学院血液病医院(血液学研究所),天津 300000;
    2.浙江省人民医院杭州医学院附属人民医院,浙江 杭州 310000
  • 收稿日期:2019-01-15 出版日期:2019-02-10 发布日期:2020-07-08
  • 作者简介:解文君(1980-),女,贵州贵阳人,硕士,副主任护师,护理部副主任。
  • 基金资助:
    协和青年基金护理理论与实践研究中心项目(2017330026)

Perceived Social Support and Coping Style as Mediators between Resilience and Post-traumatic Growth among Patients with Hematopoietic Stem Cell Transplant

XIE Wen-jun1, ZHANG Shuai2, LIU Yi1, ZHANG Hui-juan1, LIU Gui-ying1, WANG Bei1, LIU Jie1, LIU Yu-qiu1, GUAN Wei1   

  1. 1. Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences, Tianjin 300000, China;
    2. Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou 310000,China
  • Received:2019-01-15 Online:2019-02-10 Published:2020-07-08

摘要: 目的 评估恶性血液病行造血干细胞移植患者的创伤后成长水平,探讨恶性血液病造血干细胞移植患者领悟社会支持、应对方式及心理弹性状况与创伤后成长之间的内在关联,明确其中介效应。方法 采用方便抽样方法,于2016年7—12月选取207例造血干细胞移植患者,采用创伤后成长量表、领悟社会支持量表、应对方式量表及心理弹性量表对其进行问卷调查。结果 造血干细胞移植患者创伤后成长总分为(73.31±16.45)分,领悟社会支持总分为(66.51±11.45)分,应对方式总分为(54.75±6.57)分,心理弹性得分为(29.34±7.17)分。造血干细胞移植患者创伤后成长与领悟社会支持、应对方式、心理弹性总分均呈密切正相关(r=0.441~0.551,均P<0.01)。构建中介模型显示,心理弹性对创伤后成长有正向预测作用(β=0.535,P<0.01),应对方式对创伤后成长有正向预测作用(β=0.297,P<0.01),心理弹性对社会支持有正向预测作用(β=0.563,P<0.01),领悟社会支持、应对方式在造血干细胞移植患者心理弹性与创伤后成长间起中介作用。结论 造血干细胞移植患者创伤后成长、社会支持、应对方式、心理弹性得分均处于在中等偏上水平,且创伤后成长与领悟社会支持、应对方式、心理弹性总分均呈密切正相关,领悟社会支持、应对方式在恶性血液病行造血干细胞移植患者心理弹性与创伤后成长间存在中介效应。医护人员可采用积极手段来提高患者心理弹性,增强社会支持力度,引导其采用积极应对方式面对困境,从而培养创伤后成长。

关键词: 造血干细胞移植, 创伤后成长, 领悟社会支持, 应对方式, 心理弹性心理因素, 中介效应

Abstract: Objective To assess post-traumatic growth(PTG)of hematopoietic stem cell transplant (HSCT) patients with hematologic malignancies, to explore its intrinsic relationship with perceived social support, coping style and psychological resilience and to identify the mediating role of perceived social support and coping style. Methods With convenient sampling method, the 207 HSCT patients were selected from July to December 2016 and they were investigated by using the Posttraumatic Growth Inventory(PTGI), Perceived Social Support Scale(PSSS), Medical Coping Modes Questionnaire(MCMQ)and the score of the 10-item Connor-Davidson Resilience Scale(CD-RISC10). Results The total score of PTGI in HSCT patients was 73.31±16.45, and that of PSSS was 66.51±11.45, the total score of MCMQ was 54.75±6.57, and the score of CD-RISC10 29.34±7.17. The scores of PTGI, PSSS, MCMQ and CD-RISC10 of HSCT patients were significantly positively correlated (r=0.441~0.551,all P<0.001). The constructed mediation model showed that resilience (β=0.535, P<0.01) and coping style (β=0.297, P<0.01) had a positively predictive effect on PTG and resilience had had a positively predictive effect on social support (β=0.563,P<0.01). Perceived social support and coping style played a mediating role in the psychological resilience and PTG of HSCT patients. Conclusion Score of PTG, social support, coping style and resilience of HSCT patients is in a mediate or above level. PTG is significantly positively correlated with perceived social support, coping style and resilience. Perceived social support and coping style play a mediating role in the psychological resilience and PTG of HSCT patients. Positive measures are proposed to take to improve patients' psychological resilience and social support, and guide them to adopt a positive coping style to face difficulties, so as to cultivate PTG.

Key words: hematopoietic stem cell transplantation, post-traumatic growth, perceived social support, coping style, resilience, mediation effect

中图分类号: 

  • R473.55
[1] Joseph S, Wood A.Assessment of Positive Functioning in Clinical Psychology: Theoretical and Practical Issues[J]. Clin Psychol Rev,2010,30(7):830-838.DOI:10.1016/j.cpr.2010.01.002.
[2] Ben-Zur H, Cohen M, Gouzman J.Posttraumatic Growth Moderates the Effects of Posttraumatic Stress Symptoms on Adjustment and Positive Effective Reactions in Digestive System Cancer Patients[J]. Psychol Health Med, 2015,20(6):685-696.DOI:10.1080/13548506.2014.969747.
[3] Sawyer A, Ayers S, Field A P.Posttraumatic Growth and Adjustment Among Individuals with Cancer or HIV/AIDS: A Meta-analysis[J]. Clin Psychol Rev,2010, 30(4):436-447.DOI:10.1016/j.cpr.2010.02.004.
[4] Casellas-Grau A, Font A, Vives J.Positive Psychology Interventions in Breast Cancer. A Systematic Review[J]. Psychooncology, 2014, 23(1):9-19. DOI:10.1002/pon.3353.
[5] Murphy D, Palmer E, Lock R, Busuttil W.Post-traumatic Growth among the UK Veterans Following Treatment for Post-traumatic Stress Disorder[J]. J R Army Med Corps,2017, 163(2):140-145.DOI:10.1136/jramc-2016-000638.
[6] Liu H, Petukhova M V, Sampson N A, et al.Association of DSM-IV Posttraumatic Stress Disorder with Traumatic Experience Type and History in the World Health Organization World Mental Health Surveys[J].JAMA Psychiatry,2017, 74(3):163-167.DOI:10.1001/jamapsychiatry.2016.3783.
[7] Atwoli L, Stein D J, King A, et al.Posttraumatic Stress Disorder Associated with Unexpected Death of a Loved One: Cross-national Findings from the World Mental Health Surveys [J]. Depress Anxiety, 2017, 34(4):315-326.DOI:10.1002/da.22579.
[8] Arikan G, Stopa L, Carnelley K B.The Associations between Adult Attachment, Posttraumatic Symptoms, and Posttraumatic Growth[J].Anxiety Stress Coping,2016, 29(1):1-20. DOI:10.1080/10615806.2015.1009833.
[9] 张之南. 血液病诊断与疗效标准[M].3版.北京:科学出版社,2007:99-220.
[10] Tedeschi R, Calhoun L.The Posttraumatic Growth Inventory: Measuring the Positive Legacy of Trauma[J]. J Trauma Stress, 1996, 9(3):455-471.
[11] 汪际,陈瑶,王艳波,等.创伤后成长评定量表的修订及信效度分析[J].护理学杂志(外科版),2011,26(4):26-28.DOI:10.3870/hlxzz.2011.14.026.
[12] Zimet G, Blumenthal J A, Burg M M, et al.Social Support, Type a Behavior, and Coronary Artery Disease[J]. Psychosom Med, 1987, 49(4):331-340.
[13] 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.
[14] Feifel H I, Strack S, Nagy V T.Coping Strategies and Associated Features of Medically Ill Patients[J]. Psychosom Med, 1987, 49(6):616-625.
[15] 沈晓红,姜乾金.医学应对方式问卷中文版701例测试报告[J].中国行为医学科学,2000,9(1):18. DOI:10.3760/cma.j.issn.1674-6554.2000.01.008.
[16] Connor K M, Davidson J.Development of a New Resilience Scale: the Connor-davidson Resilience Scale (CD-RISC)[J].Depress Anxiety,2003,18(2):76-82.DOI:10.1002/da.10113.
[17] Campbell-Sills L, Stein M B.Psychometric Analysis and Refinement of the Connor-davidson Resilience Scale (CD-RISC): Validation of a 10-item Measure of Resilience[J].J Trauma Stress,2007,20(6):1019-1028.DOI:10.1002/jts.20271.
[18] Wang L, Shi Z, Zhang Y, et al.Psychometric Properties of the 10-items Connor-davidson Resilience Scale in Chinese Earthquake Victims[J]. Psychiatry Clin Neurosci, 2010,64(5):499-504.DOI:10.1111/j.1440-1819.2010.02130.x.
[19] 段会霞,耿莉,李振.160例消化道恶性肿瘤患者配偶创伤后成长现状及影响因素分析[J].护理学报,2018,25(19):40-44.DOI:10.16460/j.issn1008-9969.2018.19.040.
[20] 吴婷,黄孟秋,侯云霞,等.肺癌化疗患者创伤后成长现状及影响因素分析[J].护理学报,2018,25(14):5-9.DOI:10.16460/j.issn1008-9969.2018.14.005.
[21] Garrido-Hernansaiz H, Alonso-Tapia J.Associations among Resilience, Posttraumatic Growth, Anxiety, and Depression and Their Prediction from Stress in Newly Diagnosed People Living with HIV[J]. Assoc Nurses AIDS Care,2017,28(2):289-294. DOI:10.1016/j.jana.2016.12.005.
[22] Jeon G S, Park S Y, Bernstein K S.Socio-demographic and Psychological Correlates of Posttraumatic Growth among Korean Americans with a History of Traumatic Life Experiences[J]. Arch Psychiatr Nurs,2017,31(3):256-262.DOI: 10.1016/j.apnu.2016.12.002.
[23] Calhoun L G, Tedeschi R G.Handbook of Post-traumatic Growth: Research and Practice[M]. Mahwah N J: Erlbaum,2006.
[24] 俞晓梅,严谨.乳腺癌康复期患者体力活动水平及影响因素分析[J].护理学报,2018,25(10):5-9.DOI:10.16460/j.issn1008-9969.2018.10.005.
[25] Tuncay T, Musabak I.Problem-focused Coping Strategies Predict Posttraumatic Growth in Veterans with Lower-limb Amputations[J]. J Soc Serv Res, 2015, 41(4):466-483.DOI: 10.1080/01488376.2015.1033584.
[26] Wiechman Askay S, Magyar-Russell G.Post-traumatic Growth and Spirituality in Burn Recovery[J]. Int Rev Psychiatry, 2009, 21(6):570-579.DOI:10.3109/09540260903344107.
[27] Murphy P J, Hevey D.The Relationship between Internalised HIV-related Stigma and Posttraumatic Growth[J]. AIDS Behav, 2013, 17(5):1809-1818.DOI:10.1007/s10461-013-0482-4.
[28] Wingo A P, Wrenn G, Pelletier T, et al.Moderating Effects of Resilience on Depression in Individuals with a History of Childhood Abuse or Trauma Exposure[J]. J Affect Disord, 2010, 126(3):411-414. DOI:10.1016/j.jad.2010.04.009.
[29] Heilemann M V, Lee K, Kury F S.Psychometric Properties of the Spanish Version of the Resilience Scale[J]. J Nurs Meas, 2003, 11(1):61-72.
[30] Lim M L, Lim D, Gwee X, et al.Resilience, Stressful Life Events, and Depressive Symptomatology among Older Chinese Adults[J].Aging Ment Health,2015,19(11):1005-1014.DOI:10.1080/13607863.2014.995591.
[31] Southwick S M, Charney D S.Resilience: The Science of Mastering Life's Greatest Challenges[M]. Cambridge: Cambridge University Press,2012.DOI:10.1017/9781108349246.
[32] 周宵,安媛媛,伍新春,等.汶川地震三年半后中学生的感恩对创伤后成长的影响:社会支持的中介作用[J].心理发展与教育,2014,30(1):68-74.
[33] 曾秋霞,何海燕,徐春美,等.领悟性社会支持在急性心肌梗死患者感恩与创伤后成长中的中介作用[J]. 护理学报,2018,25(12):6-10.DOI:10.16460/j.issn1008-9969.2018.12.006.
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