银屑病患者病耻感及其影响因素作用机制研究

发布时间：2018-03-28 11:02

本文选题：银屑病　切入点：病耻感　出处：《中南大学》2010年博士论文

【摘要】：目的： 1.翻译并修订银屑病耻辱感体验问卷(Feeling of stigmatization of psoriasis FSQ),研究建立适合我国银屑病患者病耻感的测量工具。 2.从社会人口学特征、患病情况等方面研究影响银屑病患者病耻感的主要影响因素。 3.研究生物、心理、社会学因素对银屑病患者生活质量的影响及其可能机制。为临床银屑病患者健康提供理论依据。方法 1.按照量表翻译程序对银屑病耻辱感体验问卷(FSQ)进行汉化,形成FSQ中文版。采用随机抽样法,于2008年10-12月抽取长沙市和常德市共3所医院皮肤科门诊就诊银屑病患者185名,填写中文版FSQ。采用主成分分析、Cattell陡阶检验等方法对FSQ中文版进行修订,形成FSQ中文修订量表。 2.采用随机抽样方法,于2009年1-10月抽取长沙市和常德市共3所医院银屑病住院患者144名,对他们进行问卷调查和疾病严重度评价。问卷调查内容包括一般情况、患病情况、社会支持、医学应对、心理测量和生活质量。测量工具包括社会支持量表、医学应对量表、FSQ中文修订问卷、皮肤病生活质量问卷。疾病严重度评价由医生计算]PASI得分完成。对FSQ中文修订量表进行信效度评价。 3.采用单因素和多元线性回归分析筛选出影响银屑病患者病耻感、医学应对、社会支持和生活质量的因素；探讨疾病严重度、病耻感、医学应对和社会支持对银屑病患者生活质量的影响,并采用结构方程专用分析软件Amos 18作结构方程模型(structural equation modeling,SEM),对它们之间的关系进行路径分析。结果 1.通过汉化和初步因子分析,确定包含4个维度27个条目的FSQ中文修订量表。 2.信度检验：(1)重测信度：各分量表和总量表重测信度在0.747-0.890之间。(2)分半信度：两个分半子量表得分的分半信度(经Spearman-Brown公式校正)系数0.66。(3)Cronbach's a系数：各分量表和总量表a系数在0.73～0.90之间。(4)分量表的一致性：各条目与分量表间的相关系数在0.550～0.852之间；各分量表间的相关系数在0.027～0.254之间；分量表与总量表的相关系数在0.385-0.853之问。 3.效度检验：(1)内容效度：修订量表与源量表的相关系数为0.984,修订量表各维度与源量表相应维度的相关系数在0.843-1之间。(2)结构效度：验证性因子分析结果表明病耻感4因子模型的χ(?)=12.21,df=3, GFI、NFI、RFI、IFI、CFI各项拟合指标显示拟合良好。 4.银屑病患者病耻感平均89.44±16.08分,多元线性回归分析结果显示,皮损出血、瘙痒、有被拒绝经历、皮损暴露等进入回归方程,R2=0.386。 5银屑病患者社会支持总平均得分39.09±10.19,与常模差异无统计学意义。多元线性回归分析结果显示,影响银屑病患者社会支持的因素有：皮损暴露、付费方式、家族史、合并症、疾病严重度、出血,R2=0.489。 6.多元线性回归分析结果显示,影响银屑病患者“回避”应对的因素有：皮损暴露、年龄、家族史、病程、职业,R2=0.404。影响患者“屈服”应对的因素有：被拒绝经历、皮损暴露、职业、瘙痒程度、出血、经济收入,R2=0.414。影响患者“面对”应对的因素有：性别、受教育水平、工作状态、经济收入、家族史、瘙痒程度、病程,R2=0.492。 7.银屑病患者皮肤病生活质量平均11.90±5.79,多元线性回归分析结果显示,影响银屑病患者生活质量的因素有：年龄、受教育水平、经济收入、工作状态、疾病严重度、出血、瘙痒程度、皮损暴露、关节受损、被拒绝经历、合并症,R2=0.696。 8. Pearson相关分析结果显示,银屑病患者病耻感与医学应对、社会支持和生活质量相关,相关系数在0.27～0.62之间。银屑病患者皮肤病生活质量与疾病严重程度、医学应对、社会支持、病耻感相关,相关系数在0.23～0.67之间。 9.结构方程模型(SEM)分析结果显示,病情严重程度对生活质量有直接(正向)效应(β=0.192,P0.01),同时严重度还可通过影响耻辱感、社会支持间接影响生活质量；医学应对方式可通过影响耻辱感或社会支持间接影响生活质量；耻辱感(β=-0.642,P0.01)和社会支持(β=-0.311,P0.01)对生活质量有直接效应。耻辱感、社会支持作为中介变量(mediated variable)调节病情严重程度与生活质量的关系。结论 1.FSQ中文修订量表具有较好的信度和效度。 2.影响银屑病患者病耻感的因素有性别、年龄、受教育水平、工作状态、出血和瘙痒、皮损暴露、有被拒绝的经历。 3.银屑病患者“面对”、“回避”、“屈服”的应对方式均高于常模。 4.年轻和年老、受教育水平低、无工作、经济收入低、病情严重、皮损出血、瘙痒程度、皮损暴露、发病年龄大于45岁、有并发症、有被拒绝的经历是银屑病患者生活质量下降的危险因素。 5.病情严重程度、耻辱感、社会支持、医学应对方式对生活质量存在直接和/或间接效应。 6.耻辱感、社会支持作为中介变量调节病情严重程度与生活质量的关系。
[Abstract]:Objective:
1. translated and revised psoriasis shame experience questionnaire (Feeling of stigmatization of psoriasis FSQ), study the establishment of measurement tools for China's stigma of patients with psoriasis.
2. from the social demographic characteristics, prevalence of effects of main influence factors of stigma of patients with psoriasis.
3. to study the effect of biological, psychological and sociological factors on the quality of life of patients with psoriasis and its possible mechanism, providing a theoretical basis for the health of patients with clinical psoriasis.
Method
1. according to the scale of translation program experience questionnaire of psoriasis (FSQ) finished, shame FSQ Chinese version. Using random sampling, in 2008 10-12 months from Changsha city and Changde city a total of 3 patients with psoriasis in the outpatient department of dermatology in 185 hospitals, fill in the Chinese version of FSQ. using principal component analysis, Cattell test and other steep steps method for revision of the FSQ Chinese version, FSQ Chinese revised scale.
2. random sampling method was adopted in 2009 1-10 months from Changsha city and Changde City, a total of 3 inpatients with psoriasis hospital 144, questionnaire survey and evaluation of the severity of the disease. They survey included general condition, prevalence, social support, medical coping, psychological measurement and measurement tools including the social quality of life. Support scale, medical coping scale, FSQ Chinese revised questionnaire, dermatology life quality questionnaire. The severity of the disease was evaluated by]PASI score. The doctor calculated on FSQ Chinese scale reliability and validity evaluation.
3. by univariate and multivariate linear regression analysis was used to determine the stigma of psoriasis patients, medical coping, social support and quality of life; to investigate the severity of the disease, stigma, coping and social support on quality of life in patients with psoriasis, and using structural equation analysis software Amos 18 special structural equation model (structural equation modeling, SEM), the path analysis of the relationship between them.
Result
1. by Sinization and preliminary factor analysis, the Chinese revised scale of FSQ, which contains 4 dimensions and 27 items, is determined.
2. reliability test: (1) the test-retest reliability of each subscale and the test-retest reliability was 0.747-0.890. (2) the split half reliability: two divided half scale split half reliability (after Spearman-Brown correction coefficient formula) 0.66. (3) Cronbach's a factor: all subscales of a coefficient of 0.73 ~ 0.90. (4) the consistency of subscales of each item and subscale of the correlation coefficients among 0.550 ~ 0.852; each subscale of the correlation coefficients among 0.027 ~ 0.254; correlation coefficient of subscales and total scale in 0.385-0.853.
3. validity: (1) the content validity: the correlation coefficient of scale and scale revision was 0.984, correlation coefficient of scale and the dimensions of the corresponding dimension of the source scale revised in 0.843-1. (2) the confirmatory factor analysis showed that the stigma of the 4 factor model of X (=12.21?) df=3, GFI, NFI, RFI, IFI, CFI, the fitting index showed that the fitting is good.
4. the stigma of psoriasis patients was 89.44 + 16.08, multiple linear regression analysis showed that the lesions of bleeding, itching, skin lesions have rejected experience, etc. into the regression equation, R2=0.386.
5 psoriasis patients social support total average score of 39.09 + 10.19, no statistical significance compared with the norm. Multiple linear regression analysis showed that the influencing factors of social support in patients with psoriasis are: skin lesions, payment methods, family history, comorbidity, severity of disease, blood, R2=0.489.
6. multiple linear regression analysis showed that patients with psoriasis "avoidance" response factors: skin lesions, age, family history, course of disease, occupation, R2=0.404. factors influencing patients' coping strategy are: rejection experience, skin lesions, itching degree, occupation, income, hemorrhage, R2=0.414. patients "in the face of" coping factors: gender, education level, work status, income, family history, the degree of itching, course of disease, R2=0.492.
7. patients with psoriasis skin disease quality of life was 11.90 + 5.79, multiple linear regression analysis showed that factors affecting the quality of life of patients with psoriasis are: age, education level, income, work status, disease severity, bleeding, itching, skin exposure, joint damage, rejection experience, complications, R2=0.696.
8. Pearson correlation analysis showed that the stigma of psoriasis patients and medical coping, social support and quality of life in 0.27 ~ 0.62, the correlation coefficient between the patients with psoriasis skin disease. The quality of life and disease severity, medical coping, social support, stigma, correlation coefficient in 0.23 ~ 0.67.
9. structural equation model (SEM) analysis showed that the severity of the disease has a direct effect on the quality of life (positive) (beta =0.192, P0.01), at the same time also can affect the severity of the stigma and the indirect effects of social support on quality of life; medical coping style can affect the sense of shame or social support indirectly affect the quality of life; shame (beta =-0.642, P0.01) and social support (beta =-0.311, P0.01) has a direct effect on the quality of life. A sense of shame, social support as a mediator (mediated variable) adjusts the relationship between disease severity and quality of life.
conclusion
The Chinese revised scale of 1.FSQ has good reliability and validity.
2. factors affecting the stigma of patients with psoriasis include gender, age, education level, work status, bleeding and itching, skin exposure, the experience of being rejected.
3. the patients with psoriasis "face", "avoid", and "yield" are all higher than the norm.
4., young and old, low education level, no job, low income, serious illness, skin lesions, bleeding, itching, skin lesions exposure, age over 45 years old, complications and rejection experience are risk factors for quality of life in psoriasis patients.
5. the severity, stigma, social support, and medical coping styles have direct and / or indirect effects on the quality of life.
6. the sense of stigma, social support as an intermediary variable to regulate the relationship between the severity of the disease and the quality of life.

【学位授予单位】：中南大学
【学位级别】：博士
【学位授予年份】：2010
【分类号】：R758.63

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