应对方式在支气管哮喘患儿父母社会支持与养育压力间的中介作用研究

Mediating Effect of Coping Styles between Social Support and Parenting Stress in Parents of Children with Bronchial Asthma

背景父母的养育压力会直接影响其育儿方式,从而影响患儿的心理健康及疾病转归,故明确应对方式在支气管哮喘(以下简称哮喘)患儿父母社会支持与养育压力间的作用并采取正确的应对方式对改善哮喘患儿疾病转归具有重要意义。目的探讨应对方式在哮喘患儿父母社会支持与养育压力间的中介作用。方法选取2019年5月-2020年9月在广州市红十字会医院和南方医科大学南方医院就诊的哮喘患儿及其父亲或母亲作为研究对象,采用一般资料调查表收集患儿及其父母一般资料,分别采用养育压力短式量表(PSI-SF)、社会支持评定量表(SSRS)、特质应对方式问卷(TCSQ)评估患儿父母养育压力、社会支持及应对方式。哮喘患儿父母PSI-SF及其各维度评分、SSRS及其各维度评分、TCSQ各分量表评分间的相关性分析采用Pearson相关分析;采用Mplus 7.4软件构建结构方程模型及Bootstrap法验证应对方式在哮喘患儿父母社会支持与养育压力间的中介作用。结果本研究共发放295份问卷,回收有效问卷276份,有效回收率为93.56%。哮喘患儿父母PSI-SF评分为(108.36±18.88)分,其中养育压力大者225名(占81.52%),各维度中亲职愁苦评分最高。哮喘患儿父母SSRS及社会支持、支持利用度评分均低于健康儿童父母(P <0.05)。哮喘患儿父母积极应对评分低于健康儿童父母,消极应对评分高于健康儿童父母(P <0.05)。Pearson相关分析结果显示,哮喘患儿父母PSI-SF及其各维度评分与SSRS及其各维度评分、积极应对评分呈负相关,与消极应对评分呈正相关(P <0.05);哮喘患儿父母SSRS及其各维度评分与积极应对评分呈正相关,与消极应对评分呈负相关(P <0.05);哮喘患儿父母PSI-SF评分与其各维度评分间、SSRS评分与其各维度评分间均呈正相关,积极应对评分与消极应对评分呈负相关(P <0.05)。构建的哮喘患儿父母社会支持、应对方式、养育压力中介模型的拟合度指数为χ2/df=4.34,近似误差均方根(RMSEA)=0.041。Bootstrap法检验社会支持→应对方式→养育压力的间接效应占73.12%,其中社会支持→积极应对→养育压力的间接效应占43.58%、社会支持→消极应对→养育压力的间接效应占29.54%,表明应对方式在哮喘患儿父母社会支持和养育压力间的中介效应成立。结论哮喘患儿父母养育压力大、社会支持水平低、更倾向于消极应对,且应对方式在哮喘患儿父母社会支持与养育压力间起部分中介作用,故医护人员应引导哮喘患儿父母采取积极应对方式,以提高其社会支持水平、减轻其养育压力。

Background Parents’parenting stress will directly affect their parenting style,thus affecting children’s mental health and disease outcome.Therefore,it is of great significance to clarify the role of coping styles between social support and parenting stress in parents of children with bronchial asthma(hereinafter reffered to as asthma)and take correct coping styles to improve the disease outcome of children with asthma.Objective To explore the mediating effect of coping styles between social support and parenting stress in parents of children with asthma.Methods Children with asthma and their parents who visited GuangZhou Red Cross Hospital and Southern Hospital of Southern Medical University from May 2019 to September 2020 were selected as the research objects.General data of children and their parents were collected by general data questionnaire,and parenting stress,social support,coping styles were evaluated by Parenting Stress Index-Short Form(PSISF),Social Support Rating Scale(SSRS)and Trait Coping Style Questionnaire(TCSQ).Pearson correlation analysis was used to analyze the correlations of scores of PSI-SF and its each dimension,SSRS and its each dimension,TCSQ’s subscales in parents of asthmatic children;structural equation model was constructed by Mplus 7.4 software and Bootstrap method was used to verify the mediating effect of coping styles between social support and parenting stress in parents of children with asthma.Results Two hundred ninty-five questionnaires were issued in this survey,of which 276 questionnaires were recovered,and the effective recovery rate was 93.56%.The PSI-SF score of parents of asthma children was(108.36±18.88),of which 225(81.52%)had high parenting stress,and the parental distress score was the highest in all dimensions.The scores of SSRS,social support and support utilization of parents of asthma children were lower than those of parents of health children(P<0.05).The positive coping score of parents of asthma children was lower than that of parents of health children,and the negative coping score was higher than that of parents of health children(P<0.05).Pearson correlation analysis showed that the PSI-SF and its each dimension scores of parents of asthma children were negatively correlated with SSRS and its each dimension scores and positive coping score,and positively correlated with negative coping score(P<0.05);the SSRS and its each dimension scores were positively correlated with positive coping score,and negatively correlated with negative coping score(P<0.05);there was a positive correlation between PSI-SF score and its each dimension scores,and between SSRS score and its each dimension scores,and there was a negative correlation between positive coping score and negative coping score(P<0.05).The fitting index of the constructed mediating model of social support,coping styles and parenting stress of parents of asthma children showed that:χ2/df=4.34,root mean square errorof approximation(RMSEA)=0.041.Bootstrap test showed that the indirect effect of social support→coping styles→parenting pressure accounted for 73.12%,of which the indirect effect of social support→positive coping or negative coping→parenting pressure accounted for 43.58%and 29.54%,respectively.It showed that the mediating effect of coping styles between social support and parenting pressure of parents of asthma children was established.Conclusion Parents of asthma children have high parenting stress,low level of social support,and more inclined to negative coping,and coping styles can plays a partial mediating role between social support and parenting stress.Therefore,medical staff should guide parents of asthma children to adopt positive coping style,so as to improve their social support level and reduce their parenting stress.