脊髓损伤患者希望和抑郁在创伤后应激障碍与失能中的中介效应  

Mediating effects of hope and depression on post-traumatic stress disorder and disability in patients with spinal cord injury

作　　者：黄慧 李伦兰 王宗桂[3] 袁昊炜[1] 丁佩佩 凤林生 蔡玉静 HUANG Hui;LI Lunlan;WANG Zonggui;YUAN Haowei;DING Peipei;FENG Linsheng;CAI Yujing(School of Nursing,Anhui Medical University,Hefei 230601,Anhui,China;The First Affiliated Hospital of Anhui Medical University,Hefei 230022,Anhui,China;The Second Affiliated Hospital of Anhui Medical University,Hefei 230601,Anhui,China)

机构地区：[1]安徽医科大学护理学院,安徽合肥230601 [2]安徽医科大学第一附属医院,安徽合肥230022 [3]安徽医科大学第二附属医院,安徽合肥230601

出　　处：《护士进修杂志》2023年第14期1261-1266,共6页Journal of Nurses Training

基　　金：安徽高校自然科学研究项目(编号:KJ2020ZD18);安徽医科大学护理学院研究生青苗培育计划项目(编号:hlqm2021043)。

摘　　要：目的探讨脊髓损伤(SCI)患者希望和抑郁在创伤后应激障碍(PTSD)与失能中的中介作用。方法采用便利抽样法,选取2021年1月-2022年2月收治于安徽医科大学第一附属医院、安徽医科大学第二附属医院和中国科学技术大学附属第一医院的278例SCI患者;采用一般资料调查表、世界卫生组织残疾评定项目(WHO-DAS 2.0)、希望量表(HHI)、抑郁量表(HAMD)和PTSD量表进行问卷调查。结果患者WHO-DAS 2.0得分为(3.40±0.64)分,HHI得分为(2.95±0.46)分,HAMD得分为(1.66±0.42)分,PTSD得分为(1.68±0.87)分;PTSD、希望、抑郁和失能两两呈显著相关(P<0.05);中介模型检验结果显示,PTSD对失能的直接效应不显著,希望和抑郁在PTSD和失能之间的间接效应显著,效应量值为0.1和0.217,效应量为21.7%和47.07%,且希望-抑郁的链式中介作用显著,效应值为0.06,效应量为13.02%。结论SCI患者的PTSD不能直接影响其失能,但可通过希望和抑郁的完全中介作用间接影响失能,提示应关注患者希望和抑郁的心理状态,以减少SCI患者失能的发生。Objective To explore the mediating effect of hope and depression on post-traumatic stress disorder(PTSD)and disability in patients with spinal cord injury(SCI),in order to further reveal theinfluence mechanism of PTSD on patients with disability,and to provide reference for the construction of intervention programs for patients with SCI disability.Methods A total of 278 SCI patients admitted to the First Affiliated Hospital of Anhui Medical University,the Second Affiliated Hospital of Anhui Medical University,and the First Affiliated Hospital of University of Science and Technology of China from January 2021 to February 2022 were investigated by convenience sampling method,which questionnaires were conducted usinggeneral information questionnaire,World Health Organization Disability Assessment Project(WHO-DAS 2.0),Hope Index Scale(HHI),Hamilton Depression Scale(HAMD),and PTSD scale.Results The scores of WHO-DAS 2.0,HHI,HAMD,and PTSD were(3.40±0.64)points,(2.95±0.46)points,(1.66±0.42)points,and(1.68±0.87)points,respectively.Correlation analysis showed that PTSD,hope,depression,and disability were significantly correlated with each other(P<0.05);Mediation model test showed that the direct effect of PTSD on disability was not that significant,and the indirect effect of hope and depression between PTSD and disability was significant,with effect value of 0.1 and 0.217 and effect magnitude of 21.7%and 47.07%,and the chain mediated effect of hope depression was significant,with effect value of 0.06 and effect magnitude of 13.02%.Conclusion PTSD in patients with SCI cannot directly affect their disability,but can indirectly affect disability through the complete mediation effect of hope and depression,suggesting that attention shall be paid to the psychological states of hope and depression in patients so that the occurrence of disability in them can be reduced.

关 键 词：脊髓损伤 创伤后应激障碍 希望 抑郁 失能 中介效应 护理 

分 类 号：R471[医药卫生—护理学] R681.5[医药卫生—临床医学]