孤独症患儿照护者照护体验的结构方程模型分析

Analysis of structural equation model of care experience of caregivers of children with autism

目的构建并验证照护体验结构方程模型,分析孤独症患儿照护者的照护体验。方法选取2018年3月—2020年6月重庆市大足区人民医院收治的186例孤独症患儿及其主要照护者,采用儿童孤独症评定量表(childhood autism rating scale,CARS)对患儿病情严重程度进行评估,采用Zarit照顾者负担量表(Zarit caregiver burden interview,ZBI)、照顾者积极感受量表(positive aspects of caregiving,PAC)、症状自评量表(self-reporting inventory)(又名90项症状清单,symptom checklist-90,SCL-90)和生活满意度量表(satisfaction with life scale,SWLS)调查照护者负担、积极感受、心理状态和生活满意度,分析各变量间的相关性。根据Kramer’s照顾者适应模型,构建照护体验结构方程模型并进行验证。结果Pearson相关性分析结果表明:患儿病情严重程度、照护者负担、照护者心理状态、照护者积极感受、照护者生活满意度,两两间均具有相关性(均P<0.05)。结构方程模型分析显示:患儿病情严重程度可直接对照护者负担产生正向影响(P<0.05),进而间接对照护者心理状态产生正向影响(P<0.05);患儿病情严重程度可直接对照护者积极感受产生负向影响(P<0.05),进而间接对照护者心理状态产生正向影响、对生活满意度产生负向影响(P<0.05);照护者负担可交叉对照护者积极感受、生活满意度产生负向影响(P<0.05),对照护者心理状态产生正向影响(P<0.05);照护者积极感受可交叉对照护者心理状态产生负向影响(P<0.05),对生活满意度产生正向影响(P<0.05);照护者心理状态可交叉对照护者生活满意度产生负向影响(P<0.05)。结论孤独症患儿照护者的照护体验有消极与积极两方面,均与患儿病情严重程度相关,且照护者积极、消极两方面的主效应较交叉效应更强。

Objective To construct and verify the structural equation model of care experience,and analyze care experience of caregivers of children with autism.Methods A total of 186 children with autism admitted in People’s Hospital of Chongqing Dazu Distrist,Chongqing from March 2018 to June 2020 and their main caregivers were selected.Childhood autism rating scale(CARS)was used to assess the severity of the disease.Zarit caregiver burden interview(ZBI),positive aspects of caregiving(PAC),self-reparting inventory[symptom checklist-90(SCL-90)],and satisfaction with life scale(SWLS)were used to investigate caregivers’burden,positive feeling,mental state,and life satisfaction.The correlations among the variables were analyzed.According to Kramer’s caregiver adaptation model,the structural equation model of care experience was constructed and verified.Results Pearson correlation analysis showed that there were correlations between the severity of the disease,caregiver burden,caregiver’s psychological state,caregiver’s positive feeling,and caregiver’s life satisfaction(P<0.05).Structural equation model analysis showed that the severity of children’s disease had a positive impact on the burden of caregivers directly(P<0.05),and then had a positive impact on the psychological state of caregivers indirectly(P<0.05).The severity of children’s condition had a negative impact on the positive feeling of caregivers directly(P<0.05),and then had a positive impact on the psychological state of caregivers indirectly and a negative impact on life satisfaction(P<0.05).Caregivers’burden had a negative impact on caregivers’positive feeling and life satisfaction(P<0.05),but had a positive impact on caregivers’psychological status(P<0.05).The positive feeling of caregivers had a negative impact on the psychological state of caregivers(P<0.05),but had a positive impact on life satisfaction(P<0.05).The psychological status of caregivers had a negative impact on the life satisfaction of caregivers(P<0.05).Conclusion The caregivers’care experience of autistic children has both negative and positive aspects,which are related to the severity of the disease.The main effect of positive and negative aspects of caregivers is stronger than the cross effect.