心理弹性对胃癌根治术患者癌症复发恐惧的作用:领悟社会支持的调节效应

Role of mental resilience in fear of cancer recurrence in patients undergoing radical gastrectomy:An understanding of moderating effects of social support

背景胃癌根治术后患者对癌症复发恐惧(fear of cancer recurrence,FCR)心理将严重影响生活质量.心理弹性能使患者保持良好的心理状态去面对逆境,可能会减轻FCR的影响作用.而良好的社会支持对个人的心理健康具有重要作用,积极的领悟社会支持可通过增强心理弹性的作用而减轻负面情绪.目的探讨心理弹性对胃癌根治术患者FCR的作用以及领悟社会支持在二者间的调节效应.方法选择2018-02/2019-08在我院住院的120例胃癌根治术患者为研究对象,采用汉化版癌症患者恐惧疾病进展简化量表,心理弹性量表以及领悟社会支持量表进行调查,然后统计分析.结果胃癌根治术患者FCR得分42.3分±7.6分.其中,在职患者FCR得分41.8分±7.2分,高于非在职患者FCR得分39.1分±6.9分(P<0.05);医疗负担很重和有一定医疗负担患者FCR得分分别为42.9分±8.2分、42.1分±6.9分,均高于基本无负担患者FCR得分38.9分±7.1分(P<0.05).而胃癌根治术患者一般资料中的其他方面FCR得分(P>0.05).胃癌根治术患者的FCR分与领悟社会支持总分和心理弹性得分均呈负相关(r=-0.144,-0.271,P<0.05),领悟社会支持总分以及各分量表得分与心理弹性均呈正相关(r=0.365,0.348,0.323,0.373,P<0.05).采用分层多元线性回归分析,结果表明对FCR具有负向预测作用(β=-0.236,P<0.01),且领悟社会支持在心理弹性和FCR两者间起到了调节作用(β=-0.182,P<0.01).其中家庭支持(β=-0.164,P=0.003,△R2=0.025),朋友支持(β=-0.175,P=0.001,△R2=0.027),其他支持(β=-0.141,P=0.008,△R2=0.025)均能在心理弹性和FCR间起到调节作用.结论心理弹性对胃癌根治术患者的FCR有直接影响作用;领悟社会支持水平的升高会增强心理弹性对FCR的影响,从而进一步降低FCR水平.

BACKGROUND The fear of cancer recurrence after radical gastrectomy seriously affects the quality of life.Mental resilience can keep patients in a good psychological state to face adversity,which may reduce the impact on fear of cancer recurrence(FCR).However,good social support plays an important role in one’s mental health,and a positive understanding of social support can alleviate negative emotions by enhancing mental resilience.AIM To investigate the effect of psychological resilience on the FCR in patients with radical gastrectomy and to comprehend the regulatory effect of social support on both.METHODS One hundred and twenty patients with radical gastrectomy who were hospitalized at our hospital from February 2018 to August 2019 were selected as the study subjects.The simplified scale of fear of disease progression,psychological resilience scale,and comprehensiveness social support scale of Chinese version of cancer patients were used for investigations.RESULTS FCR score for the overall population was 42.3±7.6.FCR score of active patients(41.8±7.2)was significantly higher than that of non-active patients(39.1±6.9)(P<0.05).FCR scores of patients with heavy medical burden and patients with certain medical burden were(42.9±8.2)and(42.1±6.9),respectively,which were significantly higher than those of patients with no medical burden(38.9±7.1)(P<0.05).However,FCR scores of patients undergoing radical gastrectomy showed no statistically significant difference with regard to other aspects of the general data(P>0.05).FCR score in patients with radical gastrectomy showed a negative correlation with the total score of perceived social support and mental resilience(r=-0.144,-0.271,P<0.05),while the total score of perceived social support and scores of all subscales were positively correlated with mental resilience(r=0.365,0.348,0.323,0.373,P<0.05).Stratified multiple linear regression analysis showed that FCR was a negative predictor(β=-0.236,P<0.01),and that perceived social support mediated the relationship between resilience and FCR(β=-0.182,P<0.01).Family support(β=-0.164,P=0.003,△R2=0.025),friend support(β=-0.175,P=0.001,△R2=0.027),and other support(β=-0.141,P=0.008,△R2=0.025)all had a moderating effect on mental resilience and FCR.CONCLUSION Mental resilience has a direct effect on the FCR in patients with radical gastrectomy.Understanding that increased levels of social support increase the impact of resilience on the FCR can further reduce the FCR.