创伤后应激障碍对急性白血病化疗期患者健康促进行为影响的结构方程模型分析

Structural equation model analysis of the effects of post-traumatic stress disorder on health-promoting behavior in patients with acute leukemia during chemotherapy

目的 采用结构方程模型(structural equation model,SEM)分析急性白血病(acute leukemia,AL)化疗期患者创伤后应激障碍对健康促进行为的多维影响关系。方法 选取浙江大学医学院附属第二医院临平院区2017年1月至2021年12月收治的268例AL患者为研究对象,采用一般资料调查表、创伤后应激障碍自评量表(post-traumatic stress disorder checklist-civilian version, PCL-C)、健康促进生活方式量表Ⅱ(health-promoting lifestyle profileⅡ,HPLP-Ⅱ)、一般自我效能感量表(general self-efficacy scale,GSES)和心理弹性量表(Connor-Davidson resilience scale,CD-RISC)对268例AL患者进行问卷调查。运用Pearson分析法分析自我效能感、心理弹性、创伤后应激障碍与健康促进行为之间的相关关系,并建立SEM。结果 本研究共回收260份有效问卷,有效率97.10%。AL患者化疗期间健康促进行为得分(122.19±13.76)分;文化程度、家庭月收入、工作情况和对康复的期望均是AL患者化疗期间健康促进行为的影响因素(P<0.05);Pearson分析结果显示,AL患者化疗期间健康促进行为与创伤后应激障碍呈负相关,与自我效能感、心理弹性均呈正相关(P<0.05);AL患者化疗期间创伤后应激障碍对健康促进行为的中介效应成立,总间接效应占总效应的42.09%,其中自我效能感占19.93%,心理弹性占15.03%,自我效能感与心理弹性的多重中介效应占7.14%。结论 AL患者化疗期间健康促进行为评分处于中等水平,且自我效能感和心理弹性在创伤后应激障碍与健康促进行为间的多重中介效应成立,证实创伤后应激障碍可通过调节自我效能感和心理弹性水平影响健康促进行为。

Objective Structural equation model(SEM) was used to analyze the multi-dimensional relationship between post-traumatic stress disorder(PTSD) and health-promoting behavior in patients with acute leukemia(AL)during chemotherapy. Methods A total of 268 AL patients admitted to Linping District, the Second Affiliated Hospital Zhejiang University School of Medicine from January 2017 to December 2021 were selected as the research objects. The general information questionnaire, post-traumatic stress disorder checklist-civilian version(PCL-C), health-promoting lifestyle profileⅡ(HPLP-Ⅱ), general self-efficacy scale(GSES) and Connor-Davidson resilience scale(CD-RISC)were used to investigate 268 AL patients. Pearson analysis was used to analyze the correlation between self-efficacy,psychological resilience, PTSD and health-promoting behaviors, and SEM was established. Results A total of 260valid questionnaires were collected in this study, with an effective rate of 97.10%. The score of health-promoting behavior of AL patients during chemotherapy was(122.19±13.76) points. Education level, family monthly income,work status and expectation of rehabilitation were the influencing factors of health promotion behavior in AL patients during chemotherapy(P<0.05). Pearson analysis showed that health-promoting behavior during chemotherapy was negatively correlated with PTSD, and positively correlated with self-efficacy and psychological resilience(P<0.05).The mediating effect of PTSD on health-promoting behaviors in AL patients during chemotherapy was established.The total indirect effect accounted for 42.09% of the total effect, including 19.93% of self-efficacy, 15.03% of psychological resilience, and 7.14% of the multiple mediating effects of self-efficacy and psychological resilience.Conclusion The scores of health-promoting behavior in AL patients during chemotherapy were at a medium level,and the multiple mediating effects of self-efficacy and psychological resilience between PTSD and health-promoting behavior were established. It was confirmed that PTSD can affect health-promoting behavior by regulating self-efficacy and psychological resilience.