生态系统论视角下217例青少年癌症患儿心理危机现状及影响因素分析

Current status of mental crisis in 217 adolescents with cancer from the perspective of ecosystem theory

目的:调查了解青少年癌症患儿心理危机现状,基于生态系统论分析其影响因素,为构建青少年癌症患儿心理危机干预模式提供参考依据。方法:纳入8~18岁青少年癌症患儿及健康青少年,采用DASS-21(depression anxiety stress scale 21)量表现场调查,问卷数据双遍录入后进行分析。从生态系统论的微观、中观、外观、宏观系统分析患儿个体、家庭、环境、疾病等因素的关联度及相互影响,以明确其关键影响因素。结果:调查青少年癌症患儿218人,进入研究分析217人,心理危机检出率为45.6%,其中抑郁检出率(26.7%)高于健康青少年(12.5%),焦虑检出率(45.6%)高于健康青少年(13.5%),压力检出率(24.4%)高于健康青少年(8.5%)。在各影响因素里面,男性抑郁检出率高于女性,独生子女抑郁、压力检出率高于非独生子女,专制型家庭教养患儿抑郁、压力检出率高于民主型家庭教养患儿,首诊及定期随访患儿焦虑检出率高于未定期随访患儿,差异有统计学意义(P<0.05),将P<0.05的变量纳入多因素logistic分析,发现专制型家庭教养方式的青少年癌症患儿发生心理危机风险最高。结论:青少年癌症患儿存在焦虑、抑郁、压力等心理危机,独生子女及专制型家庭患儿表现尤为突出,需要医院、家庭、社会、学校多方位联合,实施预防性干预,为患儿营造良好的生态系统,促进其身心健康。

Objective:To investigate the risk factors of adolescents with cancer and mental crisis status from the perspective of ecosystem theory,and to provide reference for constructing an intervention model of psychological crisis for adolescents with cancer.Methods:Adolescents aged 8-18 with cancer and some healthy children were included in this study,they were investigated on spot with depression anxiety stress scale 21(DASS-21),and the questionnaire data were input twice and analyzed.The correlation degree and mutual influence of individual,family,environment,disease and other factors of children were analyzed from micro,meso,appearance and macro system of ecological system theory,so as to clarify the key influencing factors.Results:The investigation included in 218 adolescents with cancer,and 217 were analyzed.The detection rate of mental crisis was 45.6%,among which the detection rate of depression was 26.7%,the detection rate of anxiety was 45.6%,and the detection rate of stress was 24.4%.They were 12.5%,13.5%,and 8.5%higher than those of health adolescents,respectively.Among the influencing factors,the detection rate of depression in male children was higher than that in female children,the detection rate of depression and stress in one-child children was higher than that in non-only children,the detection rate ofdepression and stress in children raised in authoritarian family was higher than that of children raised in democratic family,and the detection rate of anxiety in children with regular follow-up was higher than that of children not regularly followed up,with s statistical significance(P<0.05).The variables with P<0.05 were included in multivariate logistic analysis,and it was found that adolescents with cancer raised in authoritarian family had the highest risk of mental crisis.Conclusion:Adolescents with cancer have mental crisis such as anxiety,depression and stress,especially the one-child children and the children raised in authoritarian family.It’s necessary for hospitals,families,schools,and the whole society to carry out preventive intervention in order to create a good ecosystem for these children,promoting their physical and mental health.