基于交叉滞后分析的脑卒中患者夫妻二元应对与抑郁关系研究

Relationship between dyadic coping and depression in stroke patients and their spouses:a cross-lagged panel analysis

目的探究脑卒中患者夫妻二元应对与抑郁随时间的变化趋势及相互关系,为干预措施的制定提供参考。方法2021年4-12月,便利选取202例脑卒中患者及其配偶照顾者,使用二元应对量表和患者健康问卷抑郁症状群量表在患者病情稳定期(T1)、出院后1个月(T2)和3个月(T3)进行评估,通过交叉滞后分析确定患者夫妻二元应对与抑郁的因果关系。结果脑卒中患者夫妻应对水平随时间发展先上升后下降,而抑郁症状得分随时间发展持续下降,2个变量的变化趋势具有显著的时间效应(均P<0.05),但性别差异不明显。交叉滞后分析显示,患者夫妻的二元应对及抑郁得分存在自回归效应,即自身T1得分可显著影响自身T2得分,自身T2得分可显著影响自身T3得分;患者与配偶二元应对相互预测;患者抑郁正向预测配偶抑郁;配偶抑郁负向预测患者二元应对;患者与配偶二元应对预测自身抑郁(均P<0.05)。结论脑卒中患者夫妻二元应对、抑郁水平和抑郁发生率均呈动态变化。患者夫妻二元应对与抑郁互为因果,相互交织。临床及社区医护人员需实施以家庭为中心的综合性干预方案,以改善患者夫妻的心理状态及应对能力。

Objective To explore the trends and relationships between dyadic coping and depression over time in stroke patients and their spouses,and to provide a reference for the development of interventions.Methods From April 2021 to December 2021,202 stroke patients and their spouses were conveniently selected and assessed by using the Dyadic Coping Inventory and the Patients Health Questionnaire-9 during the stable phase(T1),1 month(T2)and 3 months(T3)after discharge.Then cross-lagged panel model was constructed to determine the relationship between dyadic coping and depression in the spousal dyads.Results The level of dyadic coping in the spousal dyads first increased and then decreased over time,whereas the depression symptom scores consistently decreased over time,and the trends of these two variables had significant time effects(all P<0.05),but the gender differences were not significant.Cross-lagged panel analyses showed that there was an autoregressive effect on the dyadic coping and depression scores of the spousal dyads(namely,their own T1 scores significantly affected their own T2 scores,and their own T2 scores significantly affected their own T3 scores);patient′s and spouse′s dyadic coping cross-predicted each other′s dyadic coping;patient′s depression positively predicted spouse′s depression;spouse′s depression negatively predicted patient′s dyadic coping;patient′s and spouse′s dyadic coping predicted their own depression(all P<0.05).Conclusion Level of dyadic coping and depression and incidence of depression were dynamically changing in stroke patients and their spouses.Dyadic coping and depression were causal and intertwined.Clinical and community healthcare professionals should focus on comprehensive family-centred intervention programs to improve the psychological state and coping ability of couples.