癌症照料者的心理健康状况及其影响因素研究

发布时间：2018-03-29 04:25

本文选题：住院癌症病人　切入点：照料者　出处：《大连医科大学》2017年硕士论文

【摘要】：目的:描述癌症照料者的心理健康及抑郁状况,归纳并分析影响其心理健康和抑郁状况的因素,以提高照料者的心理健康水平,进而为如何建立有效的干预手段来为癌症病人、家属、照料者提供更好的支持与帮助提供科学理论依据。方法:本研究将一对一的半结构式心理访谈法与问卷评估法相结合,于2015年1月至2015年11月,按照序贯进入的方法选取辽宁省大连市大连医科大学附属第二医院和大连大学附属中山医院肿瘤科的150例接受手术、放化疗的住院癌症病人的主要照料者作为研究对象,分析癌症照料者的心理健康、抑郁状况及其相关影响因素。采用患者一般资料及疾病诊疗情况问卷、照料者基本情况问卷了解患者及其主要照料者的基本人口学因素和疾病诊疗情况,采用症状自评量表(SCL-90),流调中心抑郁水平评定量表(CES-D),社会支持评定量表(SSRS)分别评定照料者的心理健康状况、抑郁状况、社会支持水平。结果:(1)主要对胃肠道癌症、妇科癌症、头颈部癌症、乳腺癌、肺癌为主的150例住院癌症患者的照料者心理健康状况研究发现,癌症照料者的SCL-90总分、各因子分均显著高于中国常模(p=0.000),焦虑因子的阳性检出率居首位(58.7%),其次是人际关系敏感(25.3%)和强迫(21.3%)。癌症照料者的CES-D得分为7.77±6.35分,有抑郁照料者占12.0%(18例)。(2)女性照料者的CES-D(t=3.615,p=0.000)、SCL-90总分(t=㧟2.172,p=0.032)均显著高于男性,且女性人际关系敏感(t=㧟2.430,p=0.017)、焦虑(t=㧟2.530,p=0.013)、抑郁(t=㧟3.304,p=0.001)、恐怖(t=㧟2.202,p=0.030)因子得分均显著高于男性。(3)不同婚姻状况的照料者在CES-D(F=10.308,p=0.000)、SCL-90总分(F=7.935,p=0.001)上差异显著,已婚照料者CES-D、SCL-90总分显著低于未婚、丧偶照料者。癌症照料者的CES-D(F=12.576,p=0.000)、SCL-90(F=9.168,p=0.000)总分存在照料者角色差异,父母显著高于其他角色照料者,其次是配偶。(4)不同经济状况的照料者在CES-D(F=3.779,p=0.012)、SCL-90总分(F=3.336,p=0.021)和焦虑(F=3.611,p=0.015)、抑郁(F=3.009,p=0.032)因子上差异显著,人均月收入≥5000的照料者CES-D、SCL-90总分最低。不同工作状况的照料者在CES-D(F=3.906,p=0.010)、SCL-90总分(F=4.321,p=0.006)和强迫(F=7.803,p=0.000)、焦虑(F=4.243,p=0.007)、恐怖(F=4.850,p=0.003)因子上差异显著,在职照料者的CES-D、SCL-90总分显著低于其他工作状况者。(5)不同自评身体健康状况的照料者在CES-D(F=9.842,p=0.000)、SCL-90总分(F=10.541,p=0.000)上差异显著,自评身体健康状况良好的照料者在躯体化(F=7.617,p=0.001)、强迫(F=6.359,p=0.002)、焦虑(F=6.335,p=0.002)、偏执(F=4.772,p=0.010)、抑郁(F=7.113,p=0.001)因子上均显著低于自评身体健康状况较差或一般者。(6)不同病程的患者,其照料者在CES-D(F=6.272,p=0.001)、SCL-90总分(F=6.653,p=0.000)和强迫(F=2.992,p=0.033)、人际关系敏感(F=3.005,p=0.032)、焦虑(F=3.353,p=0.021)、偏执(F=3.490,p=0.017)、抑郁(F=3.535,p=0.016)、恐怖(F=3.372,p=0.020)因子上均存在显著差异,病程处在3~12个月的患者,其照料者CES-D、SCL-90总分最高。(7)护理不同癌种的患者,其照料者在CES-D(F=3.038,p=0.008)、SCL-90总分(F=3.084,p=0.011)和强迫(F=3.296,p=0.008)、人际关系敏感(F=2.809,p=0.019)、焦虑(F=2.657,p=0.025)、偏执(F=3.556,p=0.005)、抑郁(F=4.163,p=0.001)因子上均存在显著差异,头颈部癌症患者的照料者CES-D、SCL-90总分显著高于其他癌种,其次是肺癌和胃肠道癌症。(8)不同癌症分期的患者,其照料者CES-D(F=4.681,p=0.004)、SCL-90总分(F=2.998,p=0.033)差异显著,Ⅳ期癌症患者的照料者SCL-90总分显著高于其他三类分期。癌症转移患者其照料者的CES-D(t=14.080,p=0.000)、SCL-90总分(t=3.289,p=0.001)显著高于癌症未转移者;有癌痛的患者其照料者的CES-D(t=14.482,p=0.000)、SCL-90总分(t=3.333,p=0.002)显著高于无癌痛者。(9)癌症照料者社会支持总分为39.30±5.42分,显著高于国内常模(t=10.718,p0.01)。癌症照料者的CES-D总分与客观支持(r=㧟0.315)、主观支持(r=㧟0.359)、支持的利用度(r=㧟0.384)、社会支持总分(r=㧟0.463)均呈显著负相关。SCL-90总分与客观支持(r=㧟0.216)、主观支持(r=㧟0.310)、支持的利用度(r=㧟0.234)、社会支持总分(r=㧟0.344)均呈显著负相关。(10)多元逐步回归分析结果显示:癌症照料者心理健康状况的主要影响因素包括:照料者的教育水平(b=㧟0.382)、患者是否存在癌痛(b=0.232)、照料者的自评身体健康状况(b=㧟0.209)和主观支持(b=㧟0.184),模型有统计学意义(F=23.14,p=0.000)。二分类多元Logistic回归分析结果显示:影响癌症照料者抑郁状况的因素包括:患者癌症分期(b=2.470)、照料者的自评身体健康状况(b=0.361)和教育水平(b=0.061),模型有统计学意义(c2=44.94,p=0.000)。结论:(1)与中国健康成人相比,癌症照料者的心理健康水平较低。癌症照料者最容易出现的心理问题为:焦虑、人际关系敏感、强迫。抑郁的发生率为10.67%。(2)女性比男性癌症照料者心理健康、抑郁状况更差,易出现人际关系敏感、焦虑和恐怖。(3)已婚照料者的心理健康、抑郁状况明显好于未婚或丧偶者;不同角色照料者的心理健康、抑郁状况以父母照料者为最差,其次是配偶。(4)人均月收入在1000~2999的照料者心理健康、抑郁状况最差;在职照料者的心理健康、抑郁状况最好。(5)自评身体健康状况越好的照料者,其心理健康、抑郁状况越好。(6)病程处在3~12个月、癌种为头颈部癌症、癌症分期为Ⅳ期、癌症已转移或有癌痛的患者,其照料者心理健康、抑郁状况最差。(7)癌症照料者的社会支持情况较好;社会支持水平越高,心理健康状况越好。(8)癌症照料者的心理健康水平随着照料者教育水平、自评身体健康状况、主观支持的不断提高而提高,随着患者癌痛的出现而降低。患者的癌症分期是照料者抑郁产生的危险因素,照料者的自评身体健康状况和教育水平是抑郁产生的保护性因素。
[Abstract]:Objective : To describe the mental health and depression status of patients with cancer care , to sum up and analyze the factors affecting their mental health and depression . ( 2 ) The scores of CES - D ( t = 3.615 , p = 0.000 ) and SCL - 90 ( t = ? 2.172 , p = 0.032 ) were significantly higher than those of men ( t = ? 2.430 , p = 0.000 ) , and the scores of SCL - 90 ( F = 7.935 , p = 0.000 ) , SCL - 90 ( F = 7.935 , p = 0.000 ) , SCL - 90 ( F = 9.168 , p = 0.000 ) were significantly lower than those of male . ( F = 9.168 , p = 0.000 ) . ( 4 ) At CES - D ( F = 3.779 , p = 0.012 ) , SCL - 90 total score ( F = 3.336 , p = 0.021 ) and anxiety ( F = 3.009 , p = 0.032 ) , depression ( F = 3.009 , p = 0.032 ) , depression ( F = 3.009 , p = 0.032 ) , anxiety ( F = 4.243 , p = 0.007 ) , phobia ( F = 4.850 , p = 0.003 ) , CES - D and SCL - 90 scores of the on - the - job caregivers were significantly lower than those of other working conditions . ( 5 ) There was a significant difference from CES - D ( F = 9.842 , p = 0.000 ) and SCL - 90 ( F = 10.541 , p = 0.000 ) among the caregivers of different self - assessment body health conditions . Self - assessment of good health - like caregivers was significantly lower in somatization ( F = 7.617 , p = 0.002 ) , anxiety ( F = 6.335 , p = 0.002 ) , paranoid ( F = 4.772 , p = 0.010 ) , depression ( F = 7.113 , p = 0.001 ) . ( 6 ) In patients with different course of disease , their caregivers had significant differences in CES - D ( F = 6.272 , p = 0.001 ) , SCL - 90 ( F = 6.653 , p = 0.000 ) and obsessive - compulsive ( F = 2.992 , p = 0.033 ) , interpersonal sensitivity ( F = 3.005 , p = 0.021 ) , paranoid ( F = 3.490 , p = 0.021 ) , paranoid ( F = 3.490 , p = 0.021 ) , paranoid ( F = 3.490 , p = 0.021 ) , anxiety ( F = 3.352 , p = 0.020 ) , respectively . The total score of SCL - 90 ( t = 14.80 , p = 0.000 ) , SCL - 90 score ( t = 3.289 , p = 0.000 ) , SCL - 90 total score ( t = 3.289 , p = 0.000 ) , SCL - 90 total score ( t = 3.333 , p = 0.002 ) were significantly higher than those without cancer . ( 9 ) The total social support of cancer care providers was 39.30 卤 5.42 , which was significantly higher than that of domestic norm ( t = 10.718 , p0.01 ) . There was a significant negative correlation between the total score and objective support ( r = ? 0.315 ) , the subjective support ( r = ? 0.394 ) , the support utilization ( r = ? 0.234 ) and the total social support score ( r = 卤 0.344 ) . The main factors influencing the mental health status of the cancer care providers were as follows : ( b = ? 0.382 ) , the self - assessment body health status ( b = ? 0.209 ) and subjective support ( b = ? 0.184 ) of the caregivers , and the model has statistical significance ( F = 23.14 , p = 0.000 ) . The results of multivariate logistic regression analysis showed that the factors influencing the depressive state of cancer - care providers include the stage of cancer ( b = 2.470 ) , the self - assessment body health status ( b = 0.361 ) and the educational level ( b = 0.061 ) , and the model has statistical significance ( c2 = 44.94 , p = 0.000 ) . Conclusion : ( 1 ) Compared with Chinese healthy adults , the mental health of cancer - care providers is low . The most vulnerable psychological problems of cancer - care providers are anxiety , interpersonal sensitivity and coercion . ( 2 ) The mental health and depression of the caregivers are better than those of male cancer - care providers . ( 5 ) The better the mental health and depression of the caregivers , the better the social support of the caregivers ; the higher the social support level , the better the mental health condition . ( 8 ) The level of mental health of cancer care providers increases with the level of caregivers ' education , self - assessment of physical health and subjective support , and decreases with the occurrence of cancer pain in patients . The cancer stage of the patients is a risk factor for depression of caregivers , and the self - assessment body health status and education level of caregivers are the protective factors of depression .

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：B844

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