老年慢性病患者的社会隔离与社会支持在病耻感与服药依从性间的链式中介作用

Serial mediating effect of social isolation and social support on self-stigma and medication adherence in elderly patients with chronic diseases

目的 研究老年慢性病患者的病耻感、社会隔离、社会支持和服药依从性的纵向变化,并分析病耻感与服药依从性的关系及社会隔离和社会支持的链式中介作用。方法本研究于2022年7月和2023年7月,对湖南省邵阳市区430名老年慢性病患者进行了纵向研究,采用SPSS PROCESS 4.1(模型6)检验病耻感通过社会隔离和社会支持影响服药依从性的链式中介作用。结果 从基线到随访,老年慢性病患者病耻感从(26.0±11.2)分增加至(30.0±8.4)分,社会隔离从(1.8±1.3)分增加至(2.4±1.7)分,社会支持从(26.6±6.2)分减少至(23.7±9.2)分,服药依从性从(6.7±1.2)分减少至(5.8±1.6)分,(均P<0.001)。社会隔离和社会支持在病耻感和服药依从性之间存在链式中介作用(总效应c=-0.055,95%CI-0.064~-0.047;直接效应c'=-0.023,95%CI-0.031~-0.015;总间接效应ab=-0.032,95%CI-0.039~-0.025)。结论 随时间的变化,老年慢性病患者的社会支持和服药依从性下降,病耻感和社会隔离上升。病耻感和服药依从性之间存在显著关联,且社会隔离和社会支持在病耻感和服药依从性之间具有链式中介作用。

Objective To investigate the longitudinal changes in self-stigma,social isolation,social support,and medication adherence among elderly patients with chronic diseases and to analyze the relationship between self-stigma and medication adherence,as well as the mediating roles of social isolation and social support.Methods A longitudinal study was conducted between July 2022 and July 2023 on 430 elderly patients with chronic diseases in Shaoyang city,Hunan Province,using PROCESS macro version 4.1,Model 6,to test the chained mediating effect of social isolation and social support on the relationship between self-stigma and medication adherence.Results Between baseline and follow-up,an increase in self-stigma was observed in elderly patients with chronic diseases,from(26.0±11.2)points to(30.0±8.4)points,alongside an increase in social isolation from(1.8±1.3)points to(2.4±1.7)points.Conversely,social support decreased from(26.6±6.2)points to(23.7±9.2)points,as well as medication adherence,from(6.7±1.2)points to(5.8±1.6)points(all P<0.001).The analysis revealed a chained and partial mediating role of social isolation and social support between self-stigma and medication adherence,with a total effect(c)of-0.055(95%CI-0.064 to-0.047),a direct effect(c')of-0.023(95%CI-0.031 to-0.015),and a total indirect effect(ab)of-0.032(95%CI-0.039 to-0.025).Conclusion Over time,a significant decrease is observed in social support and medication adherence among elderly patients with chronic diseases,while self-stigma and social isolation significantly increased.A significant association is observed between self-stigma and medication adherence,with social isolation and social support acting as sequential mediators in this relationship.