学龄期白血病患儿及家长的心理健康状况及干预

发布时间：2018-03-03 01:01

本文选题：白血病　切入点：学龄期儿童　出处：《福建医科大学》2011年硕士论文　论文类型：学位论文

【摘要】：目的:(1)通过调查了解学龄期白血病儿童及家长在疾病心理健康状况及疾病的应对方式,探讨其可能的影响因素,为临床实施心理干预提供理论依据。(2)通过调查心理干预后白血病儿童及家长心理转变情况,探讨有效的心理干预策略,以期为指导白血病儿童及家长的身心康复提供有价值的理论依据和决策咨询。方法:采用前瞻性病例-对照研究方法,对60例白血病患儿(白血病初治与强化治疗儿童各30例)、39例非恶性血液病患儿(病例对照组)及52例正常对照组儿童和其家长心理卫生状况进行调查。分别采用儿童焦虑性情绪障碍筛查表(SCARED)、儿童抑郁障碍自评量表(DSRSC)、患病行为问卷调查患儿心理行为状况,SCL-90症状自评量表调查家长的心理卫生状况,医学应对方式量表调查患儿的应对方式,应对方式问卷调查患儿家长的应对方式情况,并搜集患儿及家庭基本信息进行分析,探讨可能的影响因素。通过笑脸卡评价干预组与非干预组白血病儿童入院第1个月的心情变化情况。结果:(1)心理状况量表测评:①SCARED、DSRSC及SCL-90量表测评:白血病初治组白血病强化组病例对照组正常对照组(F=10.317,P0.001;F=11.674,P0.001;F=11.025,P0.001)。②白血病初治组儿童在躯体化/惊恐、广泛性焦虑、分离性焦虑分量表评分均高于病例对照组和正常对照组(P0.05),白血病强化组在分离性焦虑、社交恐惧分量表高于正常对照组(P0.05)。③白血病组患儿在一般疑病、疾病信念、情感压抑、情绪紊乱、易激惹性、情绪状态、疾病确信和Whiteley疑病指数方面得分均高于病例对照组儿童(P0.05)。④白血病组患儿家长有较多的心理问题,在SCL-90量表中,躯体化、抑郁、焦虑三个分量表评分显著高于健康对照组(P0.05),白血病初治组的家长表现出更显著的强迫、抑郁、焦虑症状(P0.05)。(2)应对方式量表测评:①白血病组儿童较病例对照组儿童更多采用回避(P0.05)和放弃(P0.001)方式来应对疾病;与白血病强化组比较,白血病初治组儿童更不愿意面对疾病(P0.05)。②白血病组患儿家长在自责、求助、幻想的消极应对方面高于病例对照组(P0.05)。(3)相关分析显示:白血病组患儿的负性情绪与其面对方式存在负相关关系(P0.05),与放弃方式存在正相关关系(P0.05)。家长的解决问题方式影响家长的心理健康,与其心理问题呈负相关关系(P0.05);自责、幻想和退避消极应对方式与家长的心理问题存在正相关关系(P0.05)。平均住院天数较长和与同伴的交往关系不良的患儿焦虑性情绪障碍表现更为突出,治疗费用拮据和家长对患儿治愈信心不足以及患儿家长的工作不稳定等,可影响家长的社会适应能力,使得其出现更多的负性心理,并影响患儿表现出更明显的抑郁症状。(4)随着时间的推移,两组白血病儿童入院第1个月的心情都有逐渐变好的趋势,但干预组在心理干预的帮助下,较非干预组比较,心情明显改善,且能够面对疾病,而非干预组改善不明显,提示积极心理干预可有效改善白血病儿童及家长心理卫生状况,提高治疗依从性。结论:(1)白血病儿童及家长存在较多的心理问题及消极应对方式,尤其是在最初诊断和治疗阶段。(2)消极应对方式、对治疗的错误认知及治疗费用拮据是影响白血病患儿及家长心理健康的重要因素。(3)有效的心理干预有助于提高患儿的生活质量和改善家长的心身健康。
[Abstract]:Objective: (1) understand the school-age children with leukemia and their parents in coping style mental health status and disease disease through investigation, to explore the influencing factors, and provide a theoretical basis for clinical psychological intervention. (2) through the investigation of psychological intervention after the transformation of leukemia children and family psychology, to explore the psychological intervention strategies for effective, in order to provide valuable theoretical basis and decision-making consultation for physical and mental rehabilitation leukemia children and their parents.
Methods: a prospective case-control study method, 60 cases of children with leukemia (leukemia and strengthening treatment of children 30 cases), 39 cases of non malignant hematological disease patients (case group) and 52 normal children and their parents mental health status were investigated respectively. The anxiety of children barriers to screening table (SCARED), depression self rating scale for children (DSRSC), the prevalence of psychological behavior of children with behavior questionnaire survey, SCL-90 SCL-90 mental health survey of parents, the coping style of Medical Coping Style Questionnaire of children, coping strategies and Coping Style Questionnaire of parents of children, and collect analyze the basic information of children and their families, to explore the possible influencing factors. The face card evaluation of intervention group and non intervention group of leukemia children hospitalized for first months the mood changes.
Results: (1) mental status scale: SCARED, DSRSC and SCL-90 scale: leukemia Leukemia Group intensive group case control group and normal control group (F=10.317, P0.001; F=11.674, P0.001; F=11.025, P0.001). The group of children leukemia / panic in the body, generalized anxiety. Separation anxiety subscale scores were higher than those of case control group and normal control group (P0.05), leukemia group in strengthening separation anxiety, social phobia subscale is higher than the normal control group (P0.05). The group of children with leukemia in general hypochondria, illness beliefs, emotional depression, mood disorders, irritability, mood state, disease sure and Whiteley index scores were higher than the case of hypochondriasis of children in the control group (P0.05). The group of parents of children with leukemia have more psychological problems, the body in the scale of SCL-90, anxiety, depression, three subscales scores were significantly higher than that of the control group (P 0.05), leukemia group of parents showed significantly greater compulsion, depression, anxiety symptoms (P0.05). (2) coping style scale: the children leukemia group than in case control group of children with more avoidance (P0.05) and (P0.001) give way to deal with the disease; compared with leukemia enhancement. Leukemia children were more reluctant to face the disease (P0.05). The group of parents of children with leukemia in self blame, for help, was higher than the control group negative coping style of fantasy (P0.05). (3) the correlation analysis showed that the negative emotion of patients and the leukemia group face has a negative correlation (P0.05), there is a way the relationship and give way (P0.05). The influence of parents' parents to resolve the problem of mental health was negatively correlated with mental problems (P0.05); self blame, fantasy and withdrawal should be negative and there is a positive correlation between the psychological problems of other type and parents (P0.05). Performance anxiety emotional disorders adverse average hospitalization days longer and with peer relationship were more prominent, treatment cost constraints and parents of the children were cured and lack of confidence in parents of children with unstable, can affect the parents' ability to adapt to society, making it appear more negative psychological, and influence the children show the more obvious depressive symptoms. (4) with the passage of time, the two groups of children with leukemia were first months of mood has gradually become a good trend, but the intervention group in psychological intervention help, compared with the non intervention group, the mood is obviously improved, and able to face the disease, and no obvious improvement in the non intervention group that suggests that positive psychological intervention can effectively improve the mental health status of parents and children with leukemia, improve treatment compliance.
Conclusion: (1) leukemia children and their parents have many psychological problems and negative coping style, especially in the initial diagnosis and treatment stage. (2) negative coping style, wrong cognition and treatment costs of treatment of the constraints factors that influence the mental health of parents of children with leukemia and the weight. (3) effective psychological intervention help to improve the mental health of children and improve the quality of life for parents.

【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R395.6;R733.7

【引证文献】