焦虑、认知功能对老年糖尿病患者自我管理行为影响的结构方程模型分析  

Structural equation model analysis of the influence of anxiety and cognitive function on self-management behavior in elderly patients with diabetes mellitus

作　　者：张海鑫 张一方 芦萌 谢芷兰 张纹菱 王宇萍[1] 李晋磊 ZHANG Hai-xin;ZHANG Yi-fang;LU Meng;XIE Zhi-lan;ZHANG Wen-ling;WANG Yu-ping;LI Jin-lei(School of Medicine and Public Health,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100005,China;不详)

机构地区：[1]中国医学科学院北京协和医学院群医学及公共卫生学院,北京100005 [2]石家庄市第八医院

出　　处：《现代预防医学》2024年第7期1284-1289,共6页Modern Preventive Medicine

基　　金：美国中华医学基金会项目(CMB 22-467)。

摘　　要：目的探讨老年糖尿病患者认知功能、焦虑、自我管理行为之间的关系。方法于2021年10月—2022年5月在山东省烟台市蓬莱人民医院内分泌科对60岁及以上老年2型糖尿病患者进行面对面调查,分别采用老年焦虑量表简版(GAI-SF)、蒙特利尔认知评估量表(MoCA)、自设题项评估患者焦虑、认知功能、自我管理重点行为状况。采用结构方程模型进行路径分析及中介效应检验。结果共纳入1319名60岁及以上糖尿病患者,其中110人(8.3%)有焦虑症状,MoCA量表平均得分为(23.89±4.12)分,自我管理行为平均得分为(3.74±1.27)分。结构方程模型分析显示,认知功能在焦虑与自我管理行为之间呈现遮掩作用,焦虑直接对自我管理行为产生正向影响(β=0.127,P=0.019),但又通过对认知功能产生较强的负向影响(β=-0.567,P<0.001)进而对自我管理行为产生一定的负向影响(β=-0.241,P<0.001),从而遮掩了正向影响,故最后焦虑对自我管理行为呈现负向影响(β=-0.115,P<0.001)。结论老年糖尿病患者的焦虑情绪与其自我管理行为负相关,并可通过认知功能对自我管理产生负面影响。Objective To explore the relationship among cognitive function,anxiety,and self-management behavior in elderly patients with diabetes mellitus.Methods A face-to-face survey was conducted among elderly patients with type 2 diabetes mellitus aged 60 and over in the Department of Endocrinology,Penglai People’s Hospital,Yantai city,Shandong Province from October 2021 to May 2022.The Geriatric Anxiety Inventory-Short Form(GAI-SF),the Montreal Cognitive Assessment(MoCA),and self-designed items were used to assess the anxiety,cognitive function,and self-management behaviors of the patients.Path analysis and mediation effect testing were conducted using a structural equation model.Results In total 1319 diabetic patients aged 60 and above were enrolled,of whom 8.3%had anxiety symptoms.The average scores of MoCA scale and self-management behavior were(23.89±4.12)and(3.74±1.27),respectively.Structural equation model analysis showed that cognitive function had a masking effect between anxiety and self-management behavior,and anxiety had a positive effect on self-management behavior directly(β=0.127,P<0.019).However,it also had a strong negative effect on cognitive function(β=-0.567,P<0.001)and then had a negative effect on self-management behavior(β=-0.241,P<0.001).Therefore,anxiety had a negative effect on self-management behavior(β=-0.115,P<0.001).Conclusion The anxiety of elderly patients with diabetes is negatively correlated with their self-management behavior and can have a negative effect on self-management through cognitive function.

关 键 词：糖尿病 焦虑 认知功能 自我管理行为 结构方程模型 

分 类 号：R161.7[医药卫生—公共卫生与预防医学] R587.1