大五人格在患者攻击性与医患信任间的中介作用研究

Mediation Effect of Big Five Personality Traits between Patient Aggression and Doctor-patient Trust

背景近年来,医患冲突加剧、医患信任危机的状况时有发生,国内外学者从不同层面对医患关系的重要性、医患信任的影响因素等问题进行了探究,但目前对患者攻击性、患者人格对医患信任是否有影响及影响的路径尚不清楚。目的探讨患者攻击性、医患信任、大五人格间的关系以及患者大五人格在这二者间的中介作用。方法2017年12月-2018年2月,采用方便抽样法选取深圳市第一人民医院、深圳市中医院、深圳市光明新区人民医院、深圳市罗湖区人民医院、深圳市第七人民医院、深圳市福田区妇幼保健院、深圳市第四人民医院、广东省中医院8家医院患者,采用中文大学生版Buss-Perry攻击性量表(CC-BPAQ)、维克森林医师信任量表中文版(C-WFPTS)、中国版10项目大五人格量表(TIPI-C)进行调查。采用Mann-WhitneyU检验比较不同性别患者的攻击性、医患信任及大五人格间的差异性,采用Spearman秩相关分析患者的攻击性、医患信任及大五人格间的相关性,采用AMOS20.0软件拟合中介模型,采用Bootstrap程序分析中介效应。结果共发放问卷500份,回收有效问卷384份,有效回收率为76.8%。男性患者CC-BPAQ总分、身体攻击、冲动维度得分高于女性(P<0.05)。不同性别患者CC-BPAQ敌意、易怒维度得分、C-WFPTS总分、仁爱、技术能力维度得分、TIPI-C外向性、宜人性、尽责性、情绪稳定性、开放性维度得分比较,差异均无统计学意义(P>0.05)。患者CC-BPAQ总分与C-WFPTS总分(rs=-0.173)及TIPI-C外向性(rs=-0.185)、宜人性(rs=-0.296)、尽责性(rs=-0.237)、情绪稳定性(rs=-0.422)、开放性维度得分(rs=-0.140)均呈负相关(P<0.05),C-WFPTS总分与TIPI-C宜人性(rs=0.207)、情绪稳定性维度得分(rs=0.211)呈正相关(P<0.05)。患者攻击性对医患信任的间接效应的估计值为-0.33〔95%CI(-0.92,-0.09)〕,大五人格在患者攻击性和医患信任间起到完全中介作用。结论患者攻击性以大五人格为中介对医患信任有预测作用,而人格特质是患者对医师信任的保护性因素,能够预防攻击性特质高的患者暴力伤医等攻击性行为,同时能够有效提高患者的医师信任水平。

Background In recent years,the intensification of doctor-patient conflict and the crisis of doctor-patient trust have occurred from time to time.Scholars at home and abroad have explored the importance of doctor-patient relationship and the influencing factors of doctor-patient trust from different levels.However,it is unclear whether aggression and personality of patients have an impact on doctor-patient trust.Objective To explore the relationship among aggression of patients, doctor-patient trust and big five personality traits,and big five personality traits' mediator role in patient aggression and doctorpatient trust.Methods By convenience sampling,patients were extracted from Shenzhen First People's Hospital,Shenzhen Traditional Chinese Medicine Hospital,Shenzhen Guangming New District People's Hospital,Shenzhen Luohu Hospital Group Luohu People's Hospital,Shenzhen Seventh People's Hospital,Women & Children Health Institute Futian,Shenzhen, Shenzhen Fourth People's Hospital,Guangdong Provincial Hospital of Traditional Chinese Medicine from December 2017 to February 2018.The Chinese College Students' version of Buss-Perry Aggression Questionnaire(CC-BPAQ),Chinese version of the Wake Forest Physician Trust Scale(C-WFPTS) and Ten-Item Personality Inventory in China(TIPI-C) were used for investigation.The Mann-Whitney U test was used to compare the differences in aggression,trust in doctors,and big five personality traits among patients by sex.Spearman rank correlation analysis was used to analyze the correlation between patient aggression,doctor-patient trust and big five personality traits.The mediation model was fitted using AMOS 20.0 software, and the mediation effect was analyzed using the Bootstrap program.Results A total of 500 questionnaires were distributed and 384 responsive ones were returned,achieving a response rate of 76.8%.The CC-BPAQ total score,physical aggression and impulsive subscale scores in male patients were higher than those in female patients(P<0.05).Sex-specific differences in the hostility and anger subscale scores of CC-BPAQ,C-WFPTS total score,and the scores of its benevolence,and technical ability dimensions,the subscale scores of extroversion,agreeableness,conscientiousness,neuroticism,and openness of TIPI-C in the patients were not significant(P>0.05).The CC-BPAQ total score was negatively correlated with C-WFPTS total score (rs=-0.173),subscale scores of extroversion(rs=-0.185),agreeableness(rs=-0.296),conscientiousness(rs=-0.237), neuroticism(rs=-0.422),and openness(rs=-0.140)of the TIPI-C(P<0.05).The C-WFPTS total score showed a positive correlation with the subscale scores of agreeableness(rs=0.207),and neuroticism(rs=0.211)of the TIPI-C(P<0.05).The estimated indirect effect of patient aggression on trust in physician was -0.33〔95%CI(-0.92,-0.09)〕.The big five personality traits played a complete mediator role between patient aggression and doctor-patient trust.Conclusion Patient aggression predicted doctor-patient trust via the mediating role of the TIPI-C.Appropriate personality traits are the protective factors for doctor-patient trust.They can prevent patients with high aggressive traits from engaging in aggressive behavior such as violence against doctors,and can effectively improve the level of patient's trust in physicians.