康复锻炼自我效能和疲乏在脊髓损伤患者抑郁和认知功能间的中介作用

Mediating effect of self-efficacy rehabilitation and fatigue between depression and cognitive function in patients with spinal cord injury

目的探讨脊髓损伤患者康复锻炼自我效能和疲乏在抑郁与认知功能之间的中介效应。方法 2018年12月至2020年8月采用一般资料调查问卷、汉密顿抑郁量表、蒙特利尔认知评估量表、康复锻炼自我效能量表、疲乏修订量表对安徽医科大学第一附属医院256例脊髓损伤患者进行问卷调查;采用偏差校正的百分位Bootstrap法检验康复锻炼自我效能和疲乏在抑郁与认知功能的链式中介作用。结果相关分析显示, 抑郁与认知功能(r=-0.146, P<0.01)、康复锻炼自我效能(r=-0.115, P<0.01)呈负相关, 与疲乏呈正相关(r=0.317, P<0.01);康复锻炼自我效能与认知功能呈正相关(r=0.903, P<0.01), 与疲乏呈负相关(r=-0.889, P<0.01);疲乏与认知功能呈负相关(r=-0.217, P<0.01)。中介模型检验表明, 抑郁对认知功能的直接效应显著, 效应值为-0.141, 效应量为50.20%, 康复锻炼自我效能和疲乏在抑郁与认知功能之间的中介作用显著, 效应值为-0.096、-0.026, 效应量为34.1%、9.3%, 且康复锻炼自我效能-疲乏的链式中介作用也显著, 效应值为-0.018, 效应量为6.4%。结论脊髓损伤患者的抑郁不仅直接影响认知功能, 还可分别通过康复锻炼自我效能、疲乏的中介作用, 以及康复锻炼自我效能-疲乏的链式中介作用间接影响认知功能。

Objective To explore the mediating effect of self-efficacy and fatigue between depression and cognitive function in patients with spinal cord injury.Methods General information questionnaire,Hamilton Depression Scale,Montreal Cognitive Scale,Rehabilitation Exercise Self-Efficacy Scale,Fatigue Revised Scale were used to investigate 256 cases of spinal cord injury patients from December 2018 to August 2020.The deviation-corrected percentile Bootstrap method was used to test the chain mediating effect of rehabilitation exercise self-efficacy and fatigue on depression and cognitive function.Results Correlation analysis showed that depression was negatively correlated with cognitive function(r=-0.146,P<0.01),self-efficacy of rehabilitation exercise(r=-0.115,P<0.01),and positively correlated with fatigue(r=0.317,P<0.01),self-efficacy of rehabilitation exercise was positively correlated with cognitive function(r=0.903,P<0.01),and negatively correlated with fatigue(r=-0.889,P<0.01),and fatigue was negatively correlated with cognitive function(r=-0.217,P<0.01).The mediation model test showed that depression had a significant direct effect on cognitive function,with an effect value of-0.141 and an effect size of 50.20%.Self-efficacy of rehabilitation exercise and fatigue had a significant mediating effect between depression and cognitive function.The effect value was-0.096,-0.026,the effect size was 34.1%,9.3%,and the chain mediation effect of rehabilitation exercise self-efficacy-fatigue was also significant,the effect value was-0.018,and the effect size was 6.4%.Conclusions Depression in patients with spinal cord injury not only directly affects cognitive function,but also indirectly affects cognitive function through the mediating effects of self-efficacy of rehabilitation exercise and fatigue,and the chain-type mediating effect of rehabilitation exercise self-efficacy and fatigue.