先天性小耳畸形患者心理弹性问题、相关因素及其干预对策研究

发布时间：2018-05-24 11:21

本文选题：先天性小耳畸形 + 心理弹性　；参考：《北京协和医学院》2011年博士论文

【摘要】：研究背景先天性小耳畸形是整形外科最为常见的颅面先天缺陷之一,以往的研究大都关注患者的临床外科治疗,手术方式的改进、软骨组织工程基础研究等层面,或仅对小耳畸形患者的社会心理缺陷进行研究,但是部分小耳畸形患者适应良好,这与近年来心理学研究热点“心理弹性”密切相关,这一现象目前尚缺乏关注。对于先天缺陷带来的一系列心理影响,小耳畸形患者能否积极应对和调整,心态如何,这关系到小耳畸形患者手术能否顺利进行,也关系到小耳畸形患者长期的生理心理健康稳定发展。因此,针对小耳畸形患者心理弹性问题开展系统研究,对于预防和改善小耳畸形患者身心健康问题,促进小耳畸形患者身心健康具有重要意义。研究目的掌握来院就诊的先天性小耳畸形患者的适应现状及心理弹性存在问题；分析影响小耳畸形患者心理弹性的相关危险因素；利用定量研究构建先天性小耳畸形患者的心理弹性结构模型,并结合国内外非自愿手术小耳畸形患者心理健康的干预措施,为有针对性地制定适合于小耳畸形患者心理弹性危险因素的干预对策及改善其心理弹性提供科学依据。研究方法 1.通过对随机抽取250例小耳畸形患者对其访谈并进行适应结果四类量表问卷调查,初步了解小耳畸形患者心理弹性适应结果的现状,对各个量表测量学特征进行检验,了解小耳畸形心理弹性适应结果的基本情况,为确立本研究的基本假设提供现实依据。 2.采用胡月琴和甘怡群等人编制的《青少年心理弹性量表》心理弹性问卷,通过对161名小耳畸形患者的调查,运用探索性因素分析和验证性因素分析等手段探索小耳畸形患者心理弹性的结构,并初步构建小耳畸形患者的心理弹性模型。 3.本研究在获得心理弹性以及相关因素的数据之后,通过分析它们之间的因果关系,确定三类指标：一是能够有效预测心理弹性的前因变量,二是能够代表心理弹性状况的五个维度变量,三是表示心理弹性降低后果的结果变量。将这三类变量的测查问卷进行计算机化,从而建立起小耳畸形患者心理弹性降低的预警系统。结合国内外对小耳畸形患者的心理健康问题的干预策略,制定适合于小耳畸形患者心理弹性危险因素的干预对策以改善其心理弹性,促进其以后的身心健康发展。主要结果 1.小耳畸形患者适应结果问卷调查结果： (1)先天性小耳畸形患者心理健康状况及适应状况总体上未手术组小耳畸形患者的心理健康状况及适应结果较手术组差,表现在心理幸福感量表、身体自尊量表、生活满意量表等因子得分均显著低于手术组,且出现阳性症状的比例较高。小耳畸形患者普遍存在着身体吸引力评价较低、主观幸福感得分低、求助倾向弱、压力调节较差等心理。不同出生地来源下,小耳畸形患者的心理弹性状况有差异,其中,农村小耳畸形患者适应结果低于城市小耳畸形患者。 (2)先天性小耳畸形患者心理弹性调查结果及影响因素影响小耳畸形患者心理健康的因素主要包括以下几个方面：①社会环境因素：如生活事件和心理社会应激、社会支持、社会文化适应、老师同学支持、人际协助、小耳畸形外耳再造手术事件应激等；②家庭因素：如父母及亲属的支持；③个体因素：性别、情绪控制、积极认知、目标专注应对方式等。其中,心理社会应激、家庭支持、外耳再造事件等社会因素是影响小耳畸形患者心理健康的重要因素。 2.小耳畸形患者心理弹性模型构建及预警机制初探：将患者的心理弹性各因素进行回归分析,结合结构方程模型,得出初步公式。同时总结分析文献报道已有的干预措施。以往干预对象主要是战争、创伤、家庭暴力、地震、虐待、慢性病等引起的儿童心理问题。所有心理干预分为预防和治疗干预两类,主要干预措施有：心理综合干预、团体疗法、认知行为疗法、证言疗法、叙事暴露疗法、支持性咨询服务、家庭支持及疗法等等,其中,综合干预是最常用的干预方法。评价心理干预效果的研究大部分为观察性研究,且存在很多方法学上的局限性。绝大多数研究均肯定了已开展的心理干预对非自愿手术小耳畸形患者心理健康有积极的促进作用。研究结论先天性小耳畸形患者的适应状况总体上未手术组较手术组差,且不同出生地下小耳畸形患者的心理弹性各有其特点,小耳畸形患者的心理健康受到社会因素、家庭因素、个体因素及手术因素的综合影响,因此采用综合性的心理干预措施有助于达到更好的干预效果。结合先天性小耳畸形患者心理健康问题的总体特点及现有的关于非自愿手术小耳畸形患者心理干预的证据,提出一套针对先天性小耳畸形患者心理问题的综合干预模式,即采取综合性的以预防为主的干预措施,从社会、学校家庭医院及小耳畸形患者个体三个层面,重点针对影响小耳畸形患者心理弹性的主要因素,通过多种干预方式减少小耳畸形患者的社会心理应激、改善其社会支持、提高小耳畸形患者心理弹性等,从而改善小耳畸形患者心理健康水平。此外,家长老师医生还应结合拒绝手术的小耳畸形患者心理问题的特殊性,开展一些有针对性的心理干预。
[Abstract]:Research background
Congenital microtia is one of the most common congenital craniofacial defects in plastic surgery. Most of the previous studies have paid attention to the clinical surgical treatment, the improvement of the mode of operation, the basic research of cartilage tissue engineering, or the social psychological defects of the patients with small ear deformities, but some patients with small ear deformities are well adapted. This is closely related to psychological elasticity in recent years. This phenomenon is still lack of attention. For a series of psychological effects of congenital defects, whether the patients with small ear deformities can actively respond and adjust their mental attitude is related to the smooth operation of the small ear deformities and the length of the patients with small ear deformities. The physiological and psychological health of the period is stable and stable. Therefore, systematic research on the psychological elasticity of the patients with microtia is of great significance in preventing and improving the physical and mental health of the patients with small ear deformities and promoting the physical and mental health of the patients with small ear deformities.
research objective
To master the adaptation status and psychological elasticity of the patients with congenital microtia in the hospital, analyze the related risk factors of the psychological elasticity of the patients with small ear malformation, construct the mental elastic structure model of the patients with congenital microtia, and combine the mental health of the patients with the involuntary operation of the small ear malformation at home and abroad. The intervention measures of Kang provide a scientific basis for formulating the intervention strategies suitable for the psychological elastic risk factors of the patients with small ear malformation and improving their mental resilience.
research method
1. in order to establish the basic situation of the results of the psychological resilience of the microtia, the basic situation of the psychological resilience of the small ear deformities was examined and the basic situation of the psychosoelastic adaptation of the small ear deformities. The hypothesis provides a realistic basis.
2. the psychological resilience questionnaire of Hu Yueqin and Gan Yiqun was used to explore the psychological elasticity of the patients with small ear malformation by means of exploratory factor analysis and confirmatory factor analysis, and the psychological elastic model of the patients with small ear deformities was constructed by means of exploratory factor analysis and confirmatory factor analysis.
3. after analyzing the data of psychological resilience and related factors, by analyzing the causal relationship between them, three kinds of indicators are determined: one is the antecedent variable that can effectively predict the psychological elasticity, the two is the five dimension variables that can represent the mental resilience, and the three is the result variable that shows the consequences of the psychological resilience. This is the three In order to improve the psychological resilience of the patients with microtia, the psychological resilience of the patients with microtia and the psychological resilience of small ear deformities can be improved. Physical and mental health development.
Main results
1. the results of questionnaire survey of patients with microtia.
(1) mental health status and adaptation of patients with congenital microtia
In general, the mental health status and adaptation results of the patients with small ear malformation were lower than those in the operation group. The scores of factors such as mental well-being scale, body self-esteem scale and life satisfaction scale were significantly lower than those in the operation group, and the proportion of positive symptoms was higher. The score of subjective well-being was low, the tendency of help seeking was weak, and the pressure regulation was poor. The psychological elasticity of the patients with small ear malformation was different from the sources of different birthplaces, and the results of the rural small ear malformation were lower than those of the urban small ear deformity.
(2) investigation results and influencing factors of resilience in patients with congenital microtia
The factors that affect the mental health of the patients with microtia mainly include the following aspects: (1) social environmental factors, such as life events and psychosocial stress, social support, social and cultural adaptation, teachers and students' support, interpersonal assistance, small ear deformity and external ear reconstruction, etc.; and family factors such as support from parents and relatives; 3. Individual factors: gender, emotional control, positive cognition, and target focused coping style. Among them, social factors such as psychosocial stress, family support and external ear reconstruction are important factors affecting the mental health of patients with small ear malformation.
Construction of mental resilience model and early warning mechanism for 2. patients with microtia:
The psychological resilience of the patients was analyzed by regression analysis, combined with the structural equation model, and a preliminary formula was obtained. At the same time, the existing intervention measures were summarized and analyzed. The previous subjects were mainly the psychological problems of children, such as war, trauma, domestic violence, earthquake, maltreatment, chronic disease and so on. All psychological interventions were divided into prevention and treatment. The main intervention measures include psychological comprehensive intervention, group therapy, cognitive behavioral therapy, testimony therapy, narrative exposure therapy, supportive counseling service, family support and therapy, etc., in which comprehensive intervention is the most commonly used intervention. Most of the studies on psychological intervention results are observational, and there are many methodological studies. Most of the studies affirmed that psychological intervention has a positive effect on mental health of patients with involuntary microtia.
research conclusion
The conditions of the patients with congenital microtia were generally worse than those in the operation group, and the mental resilience of the patients with different subterranean microtia had their own characteristics. The psychological health of the patients with small ear malformation was influenced by social factors, family factors, individual factors and surgical factors, so the comprehensive psychological intervention measures were adopted. It helps to achieve better intervention.
Combined with the general characteristics of the mental health problems of the patients with congenital microtia and the existing evidence about the psychological intervention of the patients with involuntary microtia, a set of comprehensive intervention models for the psychological problems of the patients with congenital microtia are put forward, that is to adopt a comprehensive preventive intervention, from the society and the school family hospital. And the individual three levels of the patients with small ear malformation, focusing on the main factors affecting the mental resilience of the patients with microtia, reducing the social psychological stress of the patients with small ear deformities through various intervention methods, improving their social support and improving the mental resilience of the patients with small ear deformities, so as to improve the mental health level of the patients with microtia. In addition, parents Teachers and doctors should also carry out some specific psychological interventions in combination with the particularity of psychological problems of patients with microtia who refuse to operate.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2011
【分类号】：R764

【引证文献】