社交焦虑、病耻感在精神分裂症患者正念、认知中链式中介路径研究

Study of Chain-mediating Pathway,Social Anxiety and Stigma in Mindfulness and Cognition in Schizophrenia Patients

目的研究社交焦虑、病耻感在精神分裂症(SP)患者正念、认知中链式中介路径。方法选取2022年9月—2023年9月收治的SP 87例,采用一般资料调查问卷、精神疾病病耻感量表、交往焦虑量表、正念注意觉知量表、韦氏成人智力测试对其展开问卷调查,采用Pearson和结构方程模型分析社交焦虑、病耻感、正念、认知间的关系。结果不同性别、年龄、病程、受教育层次、体质量指数、疾病分型SP患者智商值比较差异无统计学意义(P>0.05)。Pearson相关分析显示,SP患者病耻感与社交焦虑呈正相关,正念与社交焦虑、病耻感呈负相关,认知与社交焦虑、病耻感呈负相关,认知与正念呈正相关(P<0.01)。结构方程模型拟合指数χ^(2)/df=4.935,RMSEA=0.051,TLI=0.963,CFI=0.977,NFI=0.952;Bootstrap程序检验显示,正念对认知有直接效应,也可通过社交焦虑、病耻感的平行中介效应或社交焦虑→病耻感链式中介效应间接起正向效应。结论临床在SP患者认知功能康复治疗中,应重视正念干预在不同作用路径之间的效应,并以路径为依据,采取合适方式提高患者认知功能。

Objective To investigate the chain-mediating pathway of social anxiety and stigma in mindfulness and cognition in patients with schizophrenia(SP).Methods A total of 87 SP patients admitted from September 2022 to September 2023 were selected and investigated by general data questionnaire,Internalized Stigma of Mental Illness scale(ISMI),social anxiety scale,Mindfulness Attention Awareness Scale and Wechsler Adult Intelligence Scale.Pearson and structural equation model were used to analyze the relationships among social anxiety,stigma,mindfulness and cognition.Results There was no significant difference in intelligence quotient among SP patients with different age,sex,course of disease,level of education,body mass index and disease type(P>0.05).Pearson correlation analysis showed that stigma was positively correlated with social anxiety(P<0.01),that mindfulness was negatively correlated with social anxiety and stigma(P<0.01),that cognition was negatively correlated with social anxiety and stigma(P<0.01),and that cognition was positively correlated with mindfulness in SP patients(P<0.01).Structural equation model showed fitting indexχ^(2)/df=4.935,RMSEA=0.051,TLI=0.963,CFI=0.977,NFI=0.952.Bootstrap program showed that mindfulness had a direct effect on cognition,and also had an indirect positive effect through the parallel mediating effect of social anxiety and stigma or the chain-mediating effect of social anxiety and stigma.Conclusion In the clinical rehabilitation of SP patients,we should pay attention to the effects of mindfulness intervention in different action pathways,and take appropriate approaches to improve the cognitive function of patients according to the pathway.