维持性血液透析患者主要照顾者的照顾负担及其与心理弹性、社会支持的相关性分析

Care burden of primary caregivers of maintenance hemodialysis patients and its correlation with psychological resilience and social support

目的分析维持性血液透析(MHD)患者主要照顾者的照顾负担及其与心理弹性、社会支持的相关性。方法采用便利抽样法,选取2020年1月—2021年12月驻马店市中心医院收治的97例MHD患者及97名主要照顾者为研究对象,采用Zarit照顾者负担量表(ZBI)、心理弹性量表(CD-RISC)、社会支持评定量表(SSRS)对研究对象进行调查,采用Pearson相关分析探讨MHD患者主要照顾者的照顾负担、心理弹性、社会支持的关系。采用PROCESS宏程序中的模型4进行中介模型检验,中介效应显著性检验采用Bootstrap分析法。本研究共发放问卷97份,回收有效问卷为97份,有效回收率为100.00%。结果不同年龄、有无其他参与照顾工作者、总照顾时间、每天照顾时间、心理弹性、社会支持的MHD患者主要照顾者ZBI得分比较,差异均有统计学意义(P<0.05)。MHD患者主要照顾者的ZBI总分为(42.39±10.61)分,其中,1.03%(1/97)的主要照顾者无或极轻负担、44.33%(43/97)有轻度负担、50.52%(49/97)有中度负担、4.12%(4/97)有重度负担;MHD患者主要照顾者的CD-RISC总分为(53.09±5.69)分,其中,79.38%(77/97)的主要照顾者为低心理弹性水平、20.62%(20/97)的主要照顾者为中心理弹性水平;MHD患者主要照顾者的SSRS总分为(30.33±7.19)分,其中,21.65%(21/97)的主要照顾者为低社会支持水平、76.29%(74/97)的主要照顾者为中社会支持水平、2.06%(2/97)的主要照顾者为高社会支持水平。MHD患者主要照顾者的照顾负担与心理弹性呈负相关、与社会支持呈负相关;心理弹性与社会支持呈正相关(P<0.05)。社会支持正向预测心理弹性、负向预测照顾负担(P<0.05);心理弹性负向预测照顾负担(P<0.05)。构建的中介模型(因变量为照顾负担;自变量为社会支持;中介变量为心理弹性)中介效应显著。结果显示,间接效应占总效应的79.23%,直接效应占总效应的20.77%。结论MHD患者主要照顾者存在中度照顾负担,而社会支持可直接影响照顾负担,还可通过心理弹性的中介作用间接影响照顾负担。

Objective To explore the care burden of the primary caregivers of maintenance hemodialysis(MHD)patients and its correlation with psychological resilience and social support.Methods From January 2020 to December 2021,97 MHD patients and 97 primary caregivers admitted to Zhumadian Central Hospital were selected by convenient sampling.The subjects were investigated with the Zarit Caregiver Burden Interview(ZBI),Connor-Davidson Resilience Scale(CD-RISC)and Social Support Rating Scale(SSRS).Pearson correlation analysis was used to explore the correlation between the care burden,psychological resilience and social support of the main caregivers of MHD patients.Model 4 in the PROCESS macro program was used to test the intermediary model,and the significance of the intermediary effect was tested by Bootstrap analysis.A total of 97 questionnaires were distributed,and the effective recovery rate was 100.00%.Results There were statistically significant differences in the ZBI scores of MHD patients'main caregivers with different ages,with or without other care workers,total care time,daily care time,psychological resilience and social support(P<0.05).The total ZBI score of the main caregivers of MHD patients was(42.39±10.61),of which 1.03%(1/97)had no or very mild burden,44.33%(43/97)had mild burden,50.52%(49/97)had moderate burden,and 4.12%(4/97)had severe burden.The total score of CD-RISC of the main caregivers of MHD patients was(53.09±5.69),of which 79.38%(77/97)of the main caregivers had low-level resilience,and 20.62%(20/97)of the main caregivers had medium-level resilience.The total SSRS score of the main caregivers of MHD patients was(30.33±7.19),of which 21.65%(21/97)of the main caregivers had low-level social support,76.29%(74/97)of the main caregivers had medium-level social support,and 2.06%(2/97)of the main caregivers had high-level social support.The care burden of the main caregivers of MHD patients was negatively correlated with psychological resilience and social support,and psychological resilience was positively correlated with social support(P<0.05).Social support positively predicted psychological resilience and negatively predicted care burden(P<0.05).Psychological resilience negatively predicted care burden(P<0.05).The intermediary model(dependent variable was care burden;independent variable was social support;intermediary variable was psychological resilience)had a significant intermediary effect.The indirect effect accounted for 79.23%of the total effect,and the direct effect accounted for 20.77%of the total effect.Conclusions The main caregivers of MHD patients have moderate care burden,and social support can directly affect the care burden,and also indirectly affect the care burden through the mediation of psychological resilience.