社区居民死亡焦虑的现况及影响因素分析

Current Situation and Influencing Factors Toward Death Anxiety in Community Residents

背景中国死亡质量指数远低于世界平均水平,原因之一是在言生讳死的文化传统影响下,大众很少去思考死亡或临终相关问题,导致死亡来临时出现诸多社会问题。死亡被忽视的背后隐藏着大众对死亡不正确的认知、恐惧或焦虑。目的分析社区居民死亡焦虑的现状及影响因素,引导和启发全科医生认识和熟悉个体和群体的死亡焦虑状态。方法2017年5—8月在北京市15家社区卫生服务机构,采取方便抽样的方法对1100例被调查者进行问卷调查。采用一般情况调查表〔内容包括就诊机构、年龄、性别、受教育程度、宗教信仰、月收入、婚姻状况、是否患有慢性病、同一卫生机构就诊次数、对就诊卫生机构满意度、生命威胁事件(如重大疾病、意外事故等)、生命威胁事件发生次数、丧亲经历、死亡咨询、死亡教育、死亡知识储备情况〕和中文版多维死亡焦虑量表(C-MFODS)〔对自己尸体的恐惧(维度一)、对死后未知世界的恐惧(维度二)、对濒死过程的恐惧(维度三)、对失去重要他人的恐惧(维度四)、对早逝的恐惧(维度五)、对其他尸体的恐惧(维度六)、对死后尸体被损坏的恐惧(维度七)〕进行现场调查。C-MFODS总得分影响因素分析采用多元线性回归分析。结果共发放问卷1100份,回收有效问卷1031份,有效回收率为93.73%。1031例患者C-MFODS总得分为(2.30±0.53)分,维度一、维度二、维度三、维度四、维度五、维度六、维度七得分分别为(2.72±0.77)、(2.64±0.75)、(1.95±0.66)、(1.88±0.55)、(2.08±0.71)、(2.18±0.70)、(2.73±0.93)分。多元线性回归分析结果显示,就诊机构、婚姻状况、同一卫生机构就诊次数、生命威胁事件发生次数是C-MFODS总得分的影响因素(P<0.001)。结论 死亡焦虑的主要内容是对濒死过程、丧亲、早逝的恐惧。就诊机构、婚姻状况、同一卫生机构就诊次数、生命威胁事件发生次数是死亡焦虑水平的主要影响因素,提示社区卫生机构为代表的社会支持及家庭支持具有缓解死亡焦虑的重要作用。

Background China's Quality of Death Index score is much lower than the world average level.One of the reasons is that under the cultural tradition of life-and-death taboo,the public rarely think about death or end-of-life related issues,which lead to the emergence of many social issues before death.Misconceptions,fears,or anxiety are hidden within the public neglect for the end-of-life process.Objective To analyze the status quo and influencing factors of death anxiety in community residents,and to guide general practitioners in their understanding and familiarization with the state of death anxiety in individuals and groups.Methods Convenience sampling of 1 100 cases,using survey questionnaires,were conducted in 15 community health clinics in the city of Beijing between May and August 2017.Survey questionnaires were a combination of standard survey and Multidimensional Fear of Death Scale in Chinese language(C-MFODS).The standard survey contained the following information:clinical agency,age,sex,education level,religion,individual monthly income,marital status,whether suffering from chronic illnesses,number of visits to the same health clinic,satisfaction level with the relevant health clinic,life-threatening events(serious illnesses,accidents,etc.),number of life-threatening events,bereavement experience,grief counseling related to death,death education,and knowledge of death.The Chinese version of the Multidimensional Fear of Death Scale(C-MFODS)was conducted on site,containing the following information:fear for the body after death(dimension 1),fear of the unknown(dimension 2),fear of the dying process(dimension 3),fear for significant others(dimension 4),fear of premature death(dimension 5),fear of the dead(dimension 6)and fear of being destroyed(dimension 7).Multivariate linear regression analysis was used to analyze the influencing factors of C-MFODS total score.Results Of 1 100 questionnaires distributed,1 031 valid questionnaires were received.The response rate was 93.73%.The total score of C-MFODS for the 1 031 respondents was 2.30±0.53.The scores of sub-dimensions 1,2,3,4,5,6,and 7 were(2.72±0.77),(2.64±0.75),(1.95±0.66),(1.88±0.55),(2.08±0.71),(2.18±0.70),(2.73±0.93),respectively.Multivariate linear regression analysis(stepwise method)results indicated that the clinical agency,marital status,number of visits to the same health clinic,and the number of life-threatening events were significantly associated with the total scores of C-MFODS(P<0.001).Conclusion Death anxiety is composed mainly of fears for the dying process,bereavement,and premature death.The main influencing factors for death anxiety are clinical agency,marital status,number of visits to the same health clinic,and the number of life-threatening events.This suggests that community health clinics,as a social and family support agency,play an important role in alleviating death anxiety.