治疗同盟和自尊在经历机械约束的住院精神障碍患者病耻感和胁迫体验间的链式中介作用

The Chain-Mediating Effects of Therapeutic Alliance and Self-Esteem in the Relationship between Stigma and Perceived Coercion in Psychiatric Patients Exposed to Mechanical Restraint during Hospitalization

目的探讨病耻感对经历机械约束的住院精神障碍患者胁迫体验的影响,以及治疗同盟和自尊在其中的作用。方法2021年2-7月,采用胁迫体验问卷、贬低-歧视感知量表、工作同盟量表、自尊量表对武汉市精神卫生中心便利抽取的270名住院期间经历过机械约束的精神障碍患者进行调查。结果患者病耻感和胁迫体验得分分别为(29.62±6.17)分、(66.83±31.63)分。病耻感与胁迫体验呈正相关(P<0.001),病耻感可直接预测胁迫体验,也可通过治疗同盟、自尊及其链式中介作用间接预测胁迫体验。结论降低病耻感、发展积极的治疗同盟、提升自尊是降低经历机械约束精神障碍患者胁迫体验的有效途径。

Objective To explore the relationship between stigma and perceived coercion,and the chain mediating roles of therapeutic alliance and self-esteem among psychiatric patients exposed to mechanical restraint during hospitalization.Methods From February to July 2021,270 psychiatric patients exposed to mechanical restraint during hospitalization in Wuhan Mental Health Center were selected to complete the questionnaires,including Coercion Experience Scale,Perceived Devaluation and Discrimination Scale,Working Alliance Inventory-Short Form Revised and Self-esteem Scale.Results The scores of stigma and perceived coercion for patients exposed to mechanical restraint were(29.62±6.17)and(66.83±31.63),respectively.Stigma was positively correlated with coercion(P<0.001).Stigma not only directly affected perceived coercion,but also indirectly affected perceived coercion through the therapeutic alliance,self-esteem and their chain mediating pathway.Conclusions Lowering stigma,developing positive therapeutic alliances and boosting self-esteem are effective ways to reduce the perceived coercion of psychiatric patients exposed to mechanical restraint.