慢性肝炎患者病耻感及其对交往焦虑、一般自我效能感的影响

Illness-related stigma and its effect on interaction anxiousness and general self-efficacy in outpatients with chronic viral hepatitis

目的调查门诊慢性病毒性肝炎病人的病耻感状况并分析其对病人交往焦虑、一般自我效能感的影响。方法48名乙型（CHB）、41名丙型慢性肝炎（CHC）和29名健康志愿者纳入研究，病例组完成自编慢性肝炎病耻感问卷，3组均完成交往焦虑量表（IAS）、一般自我效能感量表（GSES）和简明应对方式问卷（SCSQ）自评。结果CHB和CHC两组阳性率最高的病耻感题目为求职中被排斥（81．2％，75．6％）、病情保密（72．9％，75．6％）、被社会歧视（66．7％，56．1％）和择偶中被歧视（60．4％，61．0％），阳性率最低为与同病者一起压力最小（35．4％，31．7％）和同病才能理解（33．3％，26．8％），各题目阳性率两组间差异均无统计学意义（P〉0．05）；CHB（2．41±0．45）GSES评分和CHC（2．49±0．60）组问差异无统计学意义，但均低于对照组（2．78±0．52）（F=4．648，P=0．011）；病耻感非正常感进入CHB组IAS回归方程（B=4．861，校正R2=0．106），同病才能理解进入CHC组IAS回归方程（B=6．745，校正R2=0．113）；消极应对分（B=-0．424）、被社会歧视（B=-0．359）和与同病者一起压力最小（B=-0．274）进入CHB组GSES回归方程（校正R2=0．280）。结论慢性肝炎病人存在明显病耻感，并可能是造成病人一般自我效能感下降、交往焦虑程度增加的因素。

Objective To investigate the illness-related stigma in outpatients with chronic viral hepatitis B and C and its effects on interaction anxiousness and general self-efficacy. Methods Forty-eight patients with chronic hepatitis B （CHB）, 41 patients with chronic hepatitis C （CHC） and 29 healthy volunteers were enrolled. Hepatitis-related Stigma Questionnaire （HRSQ） produced by researchers was used to assess stigma in patients of both CHB and CHC. All patients and healthy volunteers were evaluated by Interaction Anxiousness Scale （IAS） , General Self-efficacy Scale （GSES） and Simplified Coping Style Questionnaire （SCSQ）. Results Hepatitis-related stigma was common in both CHB and CHC. The most common positive items and their percentages of CHB and CHC were ＂rejection in job seeking＂ （81.2%, 75.6% ） ,＂ keeping conditions about hepatitis secret＂ （72.9% , 75.6% ）,＂feeling discrimination in society＂ （66.7%, 56. 1% ） and ＂rejection in mate selection＂ （60.4%, 61.0% ） , and the rarest ones and percentages were ＂feeling lowest stress together with patients with the same disease＂ （35.4% ,31.7% ） and ＂being understood only by patients with the same disease＂ （33.3% ,26.8% ）. Differences of positive percentages of any items between CHB and CHC were not statistically significant （P 〉 0.05 ）. One-way ANOVA showed that difference of IAS scores among three groups of participants was not statistically significant;and GSES score of CHB（2.41 ± 0.45 ）was not statistically different from that of CHC （2.49 ± 0.60 ）, but they both were lower than that of healthy control （2.78±0. 52 ） （F= 4. 648, P = 0.011 ）. The multivariate stepwise regression analysis showed that the item ＂feeling much different from others＂ of HRSQ entered the formula of CHB IAS score （ B =4. 861 , adjustment R2 =0. 106） ,and the item ＂being understood only by patients with the same disease＂ of HRSQ entered the formula of CHC IAS score （B = 6. 745, adjustment R2 = 0. 113） ; negative coping dimension score of SCSQ （ B = - 0. 424 ） , the item ＂feeling discrimination in society＂ （ B = - 0.359 ） and ＂feeling lowest stress together with patients with the same disease＂ （ B = - 0. 274） entered the formula of CHB GSES score （adjustment R2 = 0.280）. Conclusion Illness-related stigma is common in outpatients with chronic viral hepatitis, which probably raises patients＇ interaction anxiousness and weakens the general selfefficacy of patients with hepatitis B and C.