难治性继发性甲状旁腺功能亢进血液透析患者心理弹性对创伤后成长的影响:希望的中介作用

Effects of resilience on posttraumatic growth in patients with refractory secondary hyperparathyroidism:the mediating role of hope

目的探讨希望在难治性继发性甲状旁腺功能亢进(rSHPT)患者心理弹性与创伤后成长(PTG)间的中介作用。方法便利抽样法选取2018年9月至2021年9月在中日友好医院接受维持性血液透析治疗的rSHPT患者和非难治性SHPT患者为研究对象,采用中文版Herth希望量表、中文版Connor-Davidson心理弹性量表和创伤后成长评定量表(PTGI)对495例rSHPT患者和1295例非难治性SHPT患者进行问卷调查,按照1∶1倾向性评分匹配(PSM)后2组各436例,比较2组在希望、心理弹性与PTG得分的差异。采用Pearson相关分析对rSHPT组希望、心理弹性与PTG得分总分进行相关性分析。采用回归分析与SPSS Process程序的中介模型Model 4对希望在心理弹性与PTG之间的中介效应进行检验。结果rSHPT患者希望得分(32.16±4.15)分、心理弹性得分(61.22±14.38)分、PTG得分(52.34±18.92)分,低于非难治性SHPT患者的(33.41±2.97)分(t=-5.72,P<0.05)、(63.19±7.25)分(t=-2.77,P<0.05)、(57.95±10.07)分(t=-6.34,P<0.05)。希望、心理弹性与PTG得分之间呈正相关(r=0.671、0.488、0.523,均P<0.01)。回归分析显示,心理弹性可以正向预测PTG(β=0.518,P<0.01);心理弹性可以正向预测希望(β=0.188,P<0.01);心理弹性(β=0.204,P=0.002)和希望(β=1.442,P<0.01)可以正向预测PTG。希望在心理弹性与PTG之间起部分中介作用,中介效应占比为60.23%。结论rSHPT患者的希望、心理弹性与PTG水平总体较低。心理弹性既可以直接影响PTG,也可以通过希望间接影响PTG。医护人员应通过积极的心理干预措施提升rSHPT患者的心理弹性和希望水平促进PTG发生。

Objective To investigate the mediating effect of hope on resilience and post traumatic growth(PTG)in patients with refractory secondary hyperparathyroidism(rSHPT).Methods It was convenient to select rSHPT patients and non-refractory SHPT patients who received maintenance hemodialysis treatment in China-Japan Friendship Hospital from September 2018 to September 2021.Totally 495 patients with rSHPT and 1295 patients with mild secondary hyperparathyroidism(SHPT)were surveyed by the Chinese Version of The Herth Hope Scale,the Chinese version of the Connor-Davidson Resilience Scale and the Post Traumatic Growth Rating Scale(PTGI).After matching according to the 1∶1 Propensity Score Matching(PSM),436 cases were set in each of the two groups.The differences of hope,resilience and PTG scores between the two groups were compared.Pearson correlation analysis was used to analyze the correlation between hope,resilience and total score of PTG in rSHPT group.Regression analysis and SPSS Process mediation Model 4 were used to test the mediating effect of hope on resilience and PTG.Results The hope score(32.16±4.15),psychological resilience score(61.22±14.38),and the PTG score(52.34±18.92)of rSHPT patients was significantly lower than 33.41±2.97(t=-5.72,P<0.05),63.19±7.25(t=-2.77,P<0.05),57.95±10.07(t=-6.34,P<0.05)of SHPT patients.There was a positive correlation between hope,resilience and PTG score(r=0.671,0.488,0.523,all P<0.01).Regression analysis showed that resilience could positively predict PTG(β=0.518,P<0.01).Psychological resilience positively predicted hope(β=0.188,P<0.01).Resilience(β=0.204,P=0.002)and hope(β=1.442,P<0.01)could positively predict PTG.Hope played a partial mediating role in the relationship between resilience and PTG,and the mediating effect accounted for 60.23%.Conclusions rSHPT patients generally had lower levels of hope,resilience and PTG.Resilience can affect PTG directly or indirectly through hope.Medical staff should improve the resilience and hope level of patients with rSHPT through positive psychological intervention measures,so as to enhance the positive promoting effect of psychological resilience on PTG.