精神分裂症家庭照护者心理健康影响因素的结构方程模型分析

Structural equation model analysis of mental health influencing factors in family caregivers of schizophrenic patients

目的利用结构化方程模型分析精神分裂症家庭照护者心理健康的影响因素,为采取有针对性干预措施提供科学依据。方法在调查精神分裂症患者社会功能缺陷及其家庭照护者家庭功能、社会支持、心理健康现状基础上,采用结构方程模型分析影响照顾者心理健康的因素及其效应指标,主要拟合参数包括比较拟合指数(compare the fitted indices,CFI)、拟合优度指数(goodness of fit index,GFI)、调整后的拟合优度指数(the adjusted goodness of fit index,AGFI)、规范拟合指数(normed fit index,NFI)以及近似误差均方根(approximate error root mean square,RMSEA)。结果照护者心理自评量表总分及躯体化、强迫症状、人际关系敏感、抑郁、焦虑、敌对等维度得分均高于正常人水平(均有P <0. 05)。精神分裂症家庭照护者中仅有19. 0%感到无或很少负担,33. 0%为轻度负担,48. 0%认为负担较重。结构方程模型拟合指数为:X^2(58)=47. 440,P=0. 838,X^2/df=0. 818,主要拟合参数GFI=0. 968、AGFI=0. 943、CFI=1. 000、NFI=0. 973、RMSEA=0. 000,模型拟合效果较好。结论精神分裂症家庭照护者存在严重的心理健康问题,照护负担较重;提升家庭照护者社会支持、家庭关怀,提高患者社会功能是改善其照护负担与心理健康水平的有效途径。

Objective The structural equation model was used to analyze the influencing factors of mental health of family caregivers with schizophrenia,so as to provide scientific basis for targeted intervention measures. Methods On the basis of investigating the social dysfunction of schizophrenia patients and their family function,social support and mental health status,structural equation model was used to analyze the factors affecting mental health of caregivers and their effect indexes,the main fitting parameters included compare the fitted indices( CFI),goodness of fit index( GFI),the adjusted goodness of fit index( AGFI),normed fit index( NFI) and approximate error root mean square( RMSEA). Result The total score of psychological self-rating scale of carers was higher than that of normal people( all P <0. 05). Only 19. 0% of home care providers with schizophrenia felt no or little burden,33. 0% mild burden and 48. 0% heavy burden. Structural equation model fitting index for: χ^2( 58) = 47. 440,P =0. 838,χ^2/df = 0. 818,the main fitting parameters GFI = 0. 968、AGFI = 0. 943,CFI = 1. 000,NFI =0. 973,RMSEA = 0. 000,model fitting effect was good. The total effects of social support,family care,patient social function and care burden on the mental health of family caregivers were-0. 016,-0. 197,0. 114 and 0. 118,respectively. Conclusions The family caregivers of schizophrenia have serious mental health problems,and the burden of care is heavy. improving social support,family care and social function of patients is an effective way to improve their care burden and mental health level.