恶性肿瘤住院患者自杀的影响因素研究

发布时间：2018-09-16 19:48

【摘要】：目的:本研究调查某两所三甲综合医院恶性肿瘤住院患者自杀意念的发生情况,并研究患者社会人口学特征、疾病特征、健康状况、应对风格和感知社会支持对产生自杀意念的影响,通过路径分析即因果模型分析探讨自杀意念的产生与患者健康状况、应对风格以及感知的社会支持三者之间的相关性,为恶性肿瘤住院患者的健康宣教及制定自杀干预措施提供依据基础。方法:研究分两个部分展开,首先调查恶性肿瘤住院患者自杀意念的发生情况,并调查其人口学特征、疾病特征的状况,分析发生自杀意念的影响因素;第二,通过多个量表的调查问卷,分析患者自杀意念的产生与其健康状况、应对风格以及感知的社会支持之间的直接效应、间接效应和总效应的关系。具体方法如下:第一:本研究采用横截面描述性设计,于2016年01月至2016年12月期间在昆明医科大学第二附属医院、温州市中心医院2所两家三级甲等综合医院里进行。采用方便取样法,选取愿意并能自主填表的1000位恶性肿瘤住院患者为研究对象,他们进该研究基于他们对问卷的接受程度,但是由于病情加重和(或)时间不足的原因,有29位患者中途退出。数据工具包括患者一般资料调查问卷、自杀意念自评量表(SIOSS)、简明健康状况调查表(SF-26)、医学应对问卷(MCMQ)及社会支持评定量表(SSRS)进行调查。一般资料的内容主要包括:①一般人口学资料:性别、年龄、婚姻状况、文化程度、居住地、家庭人均收入等;②疾病临床资料:疾病诊断、肿瘤分期、确诊时间、容颜体貌、疾病治疗信心、睡眠状况等;资料运用SPSS22.0进行描述性统计分析、方差分析、Logistic回归分析、相关分析、卡方检验统计分析自杀意念的影响因素。第二:通过调查结果分析和了解自杀意念的发生与患者的健康状况、应对风格以及社会支持关系,资料运用SPSS22.0和AMOS 18.0软件进行统计分析,统计学方法包括t检验、Logistic回归分析、相关分析和路径分析等。结果:①发放调查表是1000份,有29人由于个人原因中途退出,11份问卷内容填写不完整,最终有效问卷940份,108份有自杀意念,恶性肿瘤住院患者的自杀意念发生率为11.48%,29例有自杀计划,21例有过自杀行为。②一般资料单因素分析显示:恶性肿瘤住院患者有自杀意念组和无自杀意念组在居住地、肿瘤分期、确诊时间、容颜体貌改变、治疗信心、睡眠等差异有统计学意义(P0.05)。自杀意念的一般资料Logistics回归分析显示,影响恶性肿瘤住院患者自杀意念的因素有居住地、肿瘤分期、治疗信心、睡眠四个变量。2、关于自杀意念的发生与患者健康状况、医学应对风格以及感知的社会支持的研究分析,有自杀意念组与无自杀意念组比较,前者屈服维度得分比后者高(P0.05),健康状况所得总分以及五个维度评分、社会支持所得总分及三个维度评分均比无自杀意念组低(P0.05)。3、路径分析显示:面对的应对风格对健康状况有直接正向效应(β=0.078,P0.05),对感知社会支持有直接正向效应(β=0.17,P0.01);屈服的应对风格对健康状况有直接负向效应(β=-0.532,P0.01),对社会支持有直接负向效应(β=-0.226,P0.01),对自杀意念有直接正向效应(β=0.315,P0.01);回避的应对风格对社会支持有直接正向效应(β =0_112,P0.01);对健康状况有直接正向效应(β=0.068,P0.05);社会支持对健康状况有直接正向效应(β =0.224,P0.01),对自杀意念有间接负向效应(β=-0.076,P0.01);面对、屈服、回避的应对风格均可以通过健康状况与感知社会支持中的一个变量或者两个变量间接影响自杀意念;社会支持可以通过健康状况中介变量影响自杀意念。以上可见,应对风格中的屈服应对、健康状况对自杀意念既有直接效应又有间接效应;应对风格中的面对应对、回避应对、社会支持对自杀意念有间接效应。结论:1.该两家三级甲等综合医院综合恶性肿瘤住院患者自杀意念比普通人群的发生率高。2.居住地、肿瘤分期、容颜体貌改变、睡眠、预后是否有信心是恶性肿瘤住院患者自杀意念的影响因素,最后经过多因素logistic回归分析,得出恶性肿瘤患者住院患者自杀意念的危险因素为居住地在农村、家庭收入低、疾病治疗没有信心、失眠四个变量。3.面对、屈服、回避的应对风格均可以通过健康状况与感知社会支持中的一个变量或者两个变量间接影响自杀意念;社会支持可以通过健康状况中介变量影响自杀意念。以上可见,应对风格中的屈服应对、健康状况对自杀意念既有直接效应又有间接效应;应对风格中的面对应对、回避应对、社会支持对自杀意念有间接效应。通过路径分析可以得出积极的面对疾病、家属亲戚朋友等对患者较高的支持和关怀、减少病人的疼痛等疾病的不适感为恶性肿瘤住院患者自杀意念的保护因素。
[Abstract]:AIM: To investigate the incidence of suicidal ideation among inpatients with malignant tumors in two tertiary general hospitals, and to investigate the effects of social demographic characteristics, disease characteristics, health status, coping style and perceived social support on suicidal ideation. Path analysis, i.e. causal model, was used to analyze the relationship between suicidal ideation and suicidal ideation. The correlation among health status, coping style and perceived social support provided the basis for health education and suicide intervention of inpatients with malignant tumors. Secondly, the direct, indirect and total effects of suicidal ideation on health status, coping style and perceived social support were analyzed by multiple questionnaires. The face-to-face descriptive design was carried out in two tertiary A general hospitals of the Second Affiliated Hospital of Kunming Medical University and Wenzhou Central Hospital from January 2016 to December 2016. A convenient sampling method was used to select 1000 inpatients with malignant tumors who were willing to fill in the form independently. They entered the study based on their questioning. Data tools included patient general information questionnaire, suicide ideation self-rating scale (SIOSS), concise health status questionnaire (SF-26), medical coping questionnaire (MCMQ) and social support rating scale (SSRS). The main contents include: (1) general demographic data: gender, age, marital status, educational level, residence, family income per capita; and (2) clinical data: disease diagnosis, tumor stage, diagnosis time, facial features, confidence in disease treatment, sleep status; data using SPSS 22.0 for descriptive statistical analysis, variance analysis, Logistic analysis. Regression analysis, correlation analysis and chi-square test were used to analyze the influencing factors of suicide ideation. Secondly, the relationship between suicide ideation and patients'health status, coping style and social support was analyzed by analyzing the results of the survey. The data were analyzed by SPSS22.0 and AMOS 18.0 software. The statistical methods included t test and Logistic regression. Results: 1. 1000 questionnaires were sent out, 29 people quit halfway due to personal reasons, 11 questionnaires were incomplete, and 940 questionnaires were valid, 108 of them had suicidal ideation. The incidence of suicidal ideation in hospitalized patients with malignant tumors was 11.48%, 29 had suicidal plans and 21 had suicidal behaviors. (2) Univariate analysis of general data showed that there were significant differences between the suicidal ideation group and the non-suicidal ideation group (P 0.05). Logistic regression analysis showed that the general data of suicidal ideation affected the inpatients with malignant tumor. The factors of suicidal ideation were residence, tumor stage, treatment confidence and sleep. 2. The incidence of suicidal ideation and patients'health status, medical coping style and perceived social support. Compared with the group without suicidal ideation, the former had higher yield dimension score than the latter (P 0.05). The total score and five-dimension score, social support score and three-dimension score were lower than those without suicidal ideation group (P 0.05). Path analysis showed that coping style had a direct positive effect on health status (beta = 0.078, P 0.05), and had a direct positive effect on perceived social support (beta = 0.17, P 0.01). There was a direct negative effect (beta = - 0.532, P 0.01), a direct negative effect on social support (beta = - 0.226, P 0.01) and a direct positive effect on suicidal ideation (beta = 0.315, P 0.01); avoidance coping style had a direct positive effect on social support (beta = 0.112, P 0.01); there was a direct positive effect on health status (beta = 0.068, P 0.05); social support had a direct positive effect on health; Conditions had direct positive effects (beta = 0.224, P 0.01) and indirect negative effects on suicidal ideation (beta = - 0.076, P 0.01); in the face of surrender, avoidance coping styles could indirectly influence suicidal ideation through one or two variables of health status and perceived social support; social support could influence suicidal ideation through a mediator variable of health status. Suicidal ideation. It can be seen that the coping style of the yielding coping, health status on suicidal ideation has both direct and indirect effects; coping style of the face coping, avoiding coping, social support on suicidal ideation has indirect effects. Conclusion: 1. The two tertiary A general hospital patients with malignant tumor suicidal ideation Bip. Residence, tumor stage, facial changes, sleep, and prognosis confidence are the influencing factors of suicidal ideation of inpatients with malignant tumors. Finally, through multivariate logistic regression analysis, it is concluded that the risk factors of suicidal ideation of inpatients with malignant tumors are residence in rural areas, low family income, illness. Facing, yielding and avoiding coping styles can indirectly influence suicidal ideation through one or two variables of health status and perceived social support; social support can influence suicidal ideation through mediating variables of health status. Health status has both direct and indirect effects on suicidal ideation; coping style has indirect effects on suicidal ideation, avoiding coping and social support has indirect effects on suicidal ideation. It is a protective factor for suicidal ideation in hospitalized patients with malignant tumors.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R73-31

【参考文献】