阿尔茨海默病照料者社会支持和积极感受的调节和中介效应分析

发布时间：2018-07-10 13:37

本文选题：阿尔茨海默病 + 照料者负担　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的:本文探讨社会支持是否调节了社区居住的轻度阿尔茨海默病(Alzheimer’s disease,AD)患者因素与照料者负担的关系,以及照料者积极感受是否是患者因素影响照料者负担的中介变量。方法:采用横断面研究,研究对象为太原市2所医院和3个社区确诊的AD患者及其照料者,210对轻度AD患者及其照料者完成问卷调查。照料者主观负担评价包括照料者负担量表(Caregiver Burden Inventory,CBI)、焦虑自评量表(Self-Rating Anxiety Scale,SAS)和抑郁自评量表(Self-Rating Depression Scale,SDS),照料者同时完成了社会支持评定量表(Social Support Rating Scale,SSRS)和照料者积极感受量表(Positive Aspects of Caregiving,PAC)。采用蒙特利尔认知评估量表(Montreal Cognitive Assessment,MoCA)和老年抑郁量表(the Geriatric Depression Scale,GDS)评估AD患者认知功能和抑郁水平。分别采用潜调节结构方程(Latent Moderated Structure Equations,LMS)方法和偏差校正的非参数百分位Bootstrap(Bias-Corrected Percentile Bootstrap)方法分析阿尔茨海默病照料者社会支持、积极感受的调节效应和中介效应。结果:LMS研究结果显示:照料者社会支持与患者认知(γa11=0.147,P0.001)和患者抑郁(γa12=-0.146,P=0.001)的交互项对照料者负担的效应均有统计学意义,低社会支持时,关系均最强,高社会支持时,关系均最弱,说明照料者社会支持调节并缓和了患者认知、患者抑郁与照料者负担的关系;偏差校正的非参数百分位Bootstrap法分析结果显示,照料者积极感受对患者抑郁与照料者负担(=0.197,P=0.006)、照料者焦虑(=0.225,P=0.007)、照料者抑郁(=0.178,P=0.034)的完全中介效应有统计学意义,但照料者积极感受不是患者认知和照料者负担的中介变量;混合效应分析结果显示社会支持对以上中介效应模型前后路径均无调节效应(P 0.05)。结论:本研究初步揭示了阿尔茨海默病患者因素“怎样”以及“何时”作用于照料者负担;由于在高社会支持水平时,阿尔茨海默病患者认知、抑郁与照料者负担的关系均最弱,所以,应该给予低社会支持水平的照料者更多关注,为其提供所需的社会支持,从而降低其负担;另外,患者抑郁减少照料者的积极感受,进而加重照料者负担,因此,需要意识到这些关系监控和管理患者抑郁、照料者积极感受的变化从而减缓照料者负担。
[Abstract]:Objective: to investigate whether social support regulates the relationship between the factors of mild Alzheimer's disease (AD) in community and the burden of carers, and whether the positive feelings of carers are the mediating variables that affect the burden of carers. Methods: a cross-sectional study was carried out in two hospitals and three communities in Taiyuan. A questionnaire survey was carried out among the patients with mild AD and their caregivers. The subjective burden assessment included Caregiver burden scale (CBI), Self-Rating Anxiety scale (SAS) and Self-Rating Depression scale (SDS). The carers also completed the Social support rating scale (SSRS) and the positive Aspects of carers (PAC). The cognitive function and depression level of AD patients were evaluated with the Montreal Cognitive Assessment scale (MCA) and the Depression scale (the). The methods of latent moderated structure equation (LMS) and bias-corrected percentile bootstrap (Bootstrap) were used to analyze the effects of social support, positive perception and mediation of Alzheimer's disease carers. Results the results of the study showed that the interaction between social support and patient cognition (纬 a110.147 P0.001) and depression (纬 a12-0.146 P0. 001) had significant effects on the burden of carers. When the social support was low, the relationship was the strongest, and the relationship between the patients with high social support was the weakest. The results showed that the social support of carers regulated and alleviated the cognition of patients, the relationship between depression and burden of carers, and the nonparametric bootstrap analysis of bias correction showed that, The total mediating effects of depression and carer burden (0.197 P0. 006), carer anxiety (0. 225 P0. 007) and carer depression (0. 178 P0. 034) were positively felt by carers, but positive feelings of carers were not mediating variables of patients' cognition and carers' burden. The results of mixed effect analysis showed that social support had no regulating effect on the path before and after the intermediary effect model (P 0.05). Conclusion: this study preliminarily revealed how and when the factors of Alzheimer's disease affected the burden of carers, because at the high level of social support, the patients with Alzheimer's disease were cognized. The relationship between depression and carers' burden is the weakest, so more attention should be given to caregivers with low level of social support to reduce their burden by providing them with the necessary social support. In addition, depression in patients reduces the positive feelings of carers. Therefore, it is necessary to realize that these relationships monitor and manage the depression of the patient, and the change of positive feelings of the carer reduces the burden of the carer.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R749.16

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