痴呆照料者心理健康与应对策略的跨人种研究

Mental health status and coping strategies of dementia patients′ caregivers of diverse ethnicities: a cross-cultural study

目的探讨不同人种痴呆照料者心理健康与其照料过程中的应对策略之间的关系。方法121名痴呆照料者,包括29名美籍华人(CN)、29名美籍非洲人(BK)、32名高加索人(WT)和31名拉丁族裔(LT),所有被试者接受“老年人照料者的预后”问卷调查,内容包括受照料者的认知状况问卷、受照料者的简短生活能力量表和工具性生活能力量表、照料者抑郁量表、照料者健康状况问卷,及照料应对方式问卷。结果BK、WT和LT组照料者以女儿居多;CN组配偶、子女所承担的角色较均衡。照料者抑郁量表评分和健康状况评分组间差异不具显著性。不同种族照料者采取的应对方式不同;接纳现状条目和寻找积极因素条目评分均为BK>WT>LT>CN(P<0.05),增加疾病知识条目评分组间差异无显著性。多元逐步回归分析发现,照料者抑郁体验与照料者和受照料者的基本背景及照料应对方式有关(P<0.01),不同种族照料者抑郁体验相关的应对方式不同。结论不同种族痴呆照料者心理状况与其应对策略有关,抑郁体验相关应对方式具有跨人种差异。有必要探讨适合于不同文化背景的照料者应对策略培训和保健模式,以提高痴呆照料质量和生活质量。

Objective To explore the relationship between the mental health status and coping strategies among the dementia patients＇ caregivers of diverse ethnicities. Methods A survey of questionnaire, including sub-questionnaires related to the perceived living ability and cognitive damage, activities of daily living, instrumental activities of daily living, of the patients, and the mental health, coping strategies, and depression status of the CGs, was conducted among 121 caregivers （CGs） of dementia patients in the US, including 4 ethnicities： Chinese-Americans （CN, n = 29）, African-Americans （BK, n =29）, Caucasians （WT, n =32）, and Latinos （LT, n =31 ）. Results The primary CGs were daughters in the BK, WT, and LT groups, while the spouses, sons, and daughters shared the caregiving role in the CN group. No significant difference in depression status and health status and physical and mental health were detected among the 4 groups （ all P 〈 0.05）. The CGs of different ethnicities origins presented different coping strategies. The subtotal scores of accepting the current situation and seeking for positive profiles were significantly different among the 4 ethnic groups with BK 〉 WT 〉 LT 〉 CN （ all P 〈 0.05 ）. Regression analysis suggested that the CGs＇ depression status was associated with the background characteristics of the CGs and the care receivers and the coping strategies of the CGs were cross-ethnic differences of coping patterns relevant to the CGs＇ depressive experiences. Conclusion Mental health status is associated with the coping strategies among the dementia patients＇ CGs, and there is cross-ethnic difference of coping strategies relevant to the CGs＇ depressive experience. Culturally appropriate training on coping strategies and care service is needed to improve the quality of care and quality of life for the dementia patients and their caregivers.