耐多药结核病患者心理应激反应影响因素及社会支持调节效应的分析

Influencing factors of psychological stress reaction and moderating effect of social support in patients with multi-drug resistance tuberculosis

目的了解耐多药结核病(MDR-TB)患者的心理应激反应现状及影响因素,并分析社会支持水平在医学应对方式和心理应激反应之间的调节效应。方法本研究为横断面研究。采用便利抽样方法,选取2019年7月—2020年12月于四川大学华西医院结核科住院的273例MDR-TB患者作为研究对象,采用心理应激反应量表(IES-R)、社会支持量表(SSRS)及医学应对方式问卷(MCMQ)对其进行调查。采用χ^(2)检验、t检验进行单因素分析,采用二项Logistic回归分析进行多因素分析,采用PROCESS V 3.3软件进行调节效应分析。结果37.36%(102/273)的MDR-TB患者存在较严重的心理应激反应。Logistic回归分析显示,年龄(OR=1.039,95%CI:1.003~1.076)、婚姻状况(OR=0.136,95%CI:0.024~0.773)、职业(OR=0.057,95%CI:0.011~0.312)、每天饮酒量(OR=28.968,95%CI:2.387~351.609)、社会支持水平(OR=0.927,95%CI:0.866~0.993)及患者面对疾病的屈服心理(OR=2.216,95%CI:1.761~2.788)是MDR-TB患者心理应激反应的独立影响因素。社会支持水平在MDR-TB患者的回避(β=-0.132,P=0.002)、面对(β=-0.068,P=0.038)和心理应激反应间调节效应均显著,高社会支持水平的患者越采用面对或者回避的应对方式,其事件影响量表的得分越低,即心理应激反应越弱。结论医护人员应重视MDR-TB患者出现的心理应激反应,并对其进行针对性心理疏导,增强患者的社会支持水平,提高治疗依从性,从而降低结核复发率。

Objective To understand the current situation and influencing factors of psychological stress reaction in patients with multi-drug resistance tuberculosis(MDR-TB)and to analyze the moderating effect of social support level between medical coping style and psychological stress reaction.Methods This study was a cross-sectional study.Using the convenient sampling method,a total of 273 patients with MDR-TB who were hospitalized in the Tuberculosis Department of West China Hospital,Sichuan University from July 2019 to December 2020 were selected as the research objects.The Impact of Event Scale-Revised(IES-R),Social Support Rating Scale(SSRS)and Medical Coping Modes Questionnaire(MCMQ)were used to investigate them.Theχ^(2) test and t test were used for univariate analysis,binomial logistic regression analysis was used for multivariate analysis and PROCESS V 3.3 software was used for moderating effect analysis.Results A total of 37.36%(102/273)of MDR-TB patients had severe psychological stress reaction.Logistic regression analysis showed that age(OR=1.039,95%CI:1.003-1.076),marital status(OR=0.136,95%CI:0.024-0.773),occupation(OR=0.057,95%CI:0.011-0.312),daily alcohol consumption(OR=28.968,95%CI:2.387-351.609),social support level(OR=0.927,95%CI:0.866-0.993)and patients'yielding psychology in the face of disease(OR=2.216,95%CI:1.761-2.788)were independent factors affecting the psychological stress response of MDR-TB patients.The level of social support had significant moderating effects on avoidance(β=-0.132,P=0.002),confrontation(β=-0.068,P=0.038)and psychological stress in MDR-TB patients.The more the patients with high social support level adopted the coping style of facing or avoiding,the lower the score of the event impact scale,that was,the weaker the psychological stress reaction.Conclusions Medical staff should pay attention to the psychological stress reaction of MDR-TB patients and conduct targeted psychological counseling to enhance social support level of patients and improve treatment compliance,thereby reducing the recurrence rate of tuberculosis.