生活质量在脑卒中偏瘫患者二元应对与焦虑抑郁间的中介效应

Mediating effect of quality of life in hemiplegic stroke patients dyadic coping,anxiety and depression

目的 调查并讨论脑卒中偏瘫患者与其配偶在面对偏瘫情况时的二元应对水平现状。然后,基于主-客体互倚模型的方法来探讨生活质量在脑卒中偏瘫患者的二元应对水平对焦虑抑郁的中介作用。方法 调查患者的一般资料,并根据二元应对量表、HAMA、HAMD、婚姻调适量表、脑卒中专用生活质量量表对2020年10月—2021年8月619对住院脑卒中偏瘫患者其配偶进行相关的问卷调查,然后采用SPSS23.0统计学软件对所得数据进行多元分层回归分析以及Spearman相关性分析;并基于主-客体互倚模型,分析生活质量在脑卒中偏瘫患者二元应对水平对焦虑抑郁的中介作用。结果 619对患者及配偶当中,双方二元应对均低于平均水平的为243对,双方二元应对处于平均水平为226对,双方二元应对均高于平均水平的为150对。脑卒中偏瘫患者的生活质量与患者二元应对、患者婚姻的调试水平、配偶的二元应对水平、配偶婚姻调试水平呈正相关的关系(r=0.456、0.492、0.442、0.433,P<0.05);与患者焦虑、抑郁呈负相关的关系(r=-0.734、-0.860,P<0.05)。生活质量在患者二元应对水平对患者的焦虑、抑郁中介效应占比17.55%、23.20%;在配偶二元应对水平对患者的焦虑、抑郁的中介效应占比为38.21%、44.12%。结论 脑卒中偏瘫患者的二元应对水平中等;生活质量与患者二元应对、患者婚姻调试、配偶二元应对、配偶婚姻调试水平呈正相关关系;与患者焦虑、抑郁呈负相关关系。生活质量在患者二元应对水平对患者的焦虑、抑郁的影响中起到了部分的中介作用。在临床护理工作中,引导患者和配偶积极二元应对,为改善患者生活质量,开展新的健康教育奠定基础。

Objective To investigate the current situation of dichotomous coping level when facing the hemiplegic situation between stroke hemiplegic patients and their spouses,and to explore the mediating role of quality of life in the dichotomous coping level of stroke hemiplegic patients'anxiety and depression based on the subject-object reciprocity model.Methods A general information questionnaire,binary coping scale,HAMA,HAMD,marital adjustment scale,and stroke-specific quality of life scale were used to survey 619 pairs of hospitalized stroke hemiplegic patients and their spouses from October 2020 to August 2021,and SPSS23.0 was used to perform multivariate hierarchical regression analysis on the obtained data,and Spearman correlation analysis.To analyze the mediating role of quality of life in the dichotomous coping level of stroke hemiplegic patients on anxiety and depression based on the subject-object reciprocity model.Results The number of cases in which both binary coping of 619 pairs of patients and spouses were below average was 243,the number of cases in which both binary coping were at the average level was 226,and the number of cases in which both binary coping were above average was 150.The quality of life of hemiplegic patients with stroke was positively correlated with the patient's binary coping,the patient's level of marital debugging,the spouse's level of binary coping,and the spouse's level of marital debugging(r=0.456,0.492,0.442,0.433,P<0.05);and negatively correlated with the patient's anxiety and depression relationship(r=-0.734,-0.860,P<0.05).Quality of life was 17.55%,23.20%in the mediating effect of patient's binary coping level on patient's anxiety and depression;38.21%,44.12%in the mediating effect of spouse's binary coping level on patient's anxiety and depression.Conclusion Stroke hemiplegic patients'binary coping level is in the middle level;quality of life is positively correlated with patients'binary coping,patients'marital debugging level,spouses'binary coping level,and spouses'marital debugging level;and it is negatively correlated with patients'anxiety and depression.Quality of life played a partial mediating role in the effect of patient binary coping level on patient anxiety and depression.In clinical nursing,guiding patients and spouses to positive binary coping lays the foundation for improving patients'quality of life and developing new health education.