晚期癌症患者创伤后应激障碍、感恩与创伤后成长的关系

Relationships among post traumatic stress disorder, gratitude and posttraumatic growth for terminal cancer patients

目的探讨晚期癌症患者创伤后应激障碍、感恩与创伤后成长三者之间的关系。方法采用自编人口学问卷、创伤后应激障碍检查量表平民版、创伤后成长评定量表和感恩问卷，对119名晚期癌症患者进行测量。结果晚期癌症患者创伤后应激障碍的总分为（34．02±12．49）分，再体验症状群、回避＼麻木症状群和警觉性增高症状群的得分分别是（9．79±3．78）分、（13．85±5．68）分和（10．36±3．80）分；感恩的总分为（29．37±7．48）分；创伤后成长的总分为（51．34±13．57）分，欣赏生活、人际关系和自我认可的得分分别是（8．00±2．99）分、（21．18±5．84）分和（22．16±6.10）分。不同创伤后应激障碍分组间晚期癌症患者创伤后成长差异有统计学意义（F=16．267，P〈0．01）。不同感恩分组间晚期癌症患者创伤后成长差异有统计学意义（F=43．674．P〈0．01）。晚期癌症患者创伤后应激障碍的总分，以及再体验症状群、回避＼麻木症状群和警觉性增高症状群等各维度与创伤后成长总分的相关分别是（r=-0．694，P〈0．01）（r=-0．664，P〈0．01）、（r=-0．671，P〈0．01）、（r=-0．611，P〈0．01）；感恩与创伤后成长总分的相关是（r=0．753，P〈0．01）。创伤后应激障碍与感恩能解释患者创伤后成长66．6％的变异；但是．感恩在创伤后应激障碍和创伤后成长之间的凋节效应不显著，无统计学意义（P〉0．05）。结论感恩和创伤后应激障碍是影响晚期癌症患者创伤后成长的重要因素，但感恩不能调节创伤后应激障碍和创伤后成长之间的关系，故应重视感恩情感的实际临床效果，有针对性地开展感恩教育，而不是盲目追求。

Objective To explore the relationships among post traumatic stress disorder （PTSD）, gratitude and posttraumatie growth （PTG） for terminal cancer patients. Methods Totally 119 advanced cancer patients were investigated with the self-demographic questionnaire, posttraumatic growth inventory （PTGI）, the PTSD cheeklist-civilian version （PCL-C） and the Gratitude Questionnaire-6 （GQ-6）. Results For terminal cancer patients,the total score of PCL-C was 34.02± 12.49.The scores on re-experience, avoidance/numbness, hypervigilance were 9.79±3.78,13.85±5.68,10.36±3.80.The total score of gratitude was 29.37±7.48. The total score of PTG was 51.34±13.57.The scores of life appreciation,personal relationship and self-strength were 8.00±2.99,21.18 ± 5.84,22.16 ± 6.10. The total scores of PTG were significantly statistical significance among different PTSD groups （F= 16.267, P〈0.01 ）and gratitude groups （F= 43.674, P〈0.01 ）.The total scores of PCL-C（ r= -0.694, P〈0.01 ） ,re-experience （ r= -0.664, P〈0.01 ） ,avoidance/numbness （ r=-0.671, P〈0.01）,hypervigilanee （ r=0.753, P〈0.01 ） and gratitude（ r=-0.611, P〈0.01 ） were all correlated with PTG . The total score of PCL-C and gratitude couht explain 66.6% variation of PTG. For the relationship between PTSD and PTG,the moderation effect of gratitude was not significant（P 〉0.05）. Conclusion The gratitude and PTSD were important influence factors for terminal cancer patients＇ PTG,while the moderation effect of gratitude was not significant, so in clinical intervention we should pay more attentions to the actual effects of gratitude, and we should not pursuit gratitude education blindly.