脑卒中吞咽障碍患者疾病病耻感与主要照顾者负担的关系:家庭复原力和个体复原力的链式中介效应

Relationship between disease stigma and primary caregiver burden in patients with stroke dysphagia:a chain mediating effect of family and individual resilience

目的 分析家庭复原力和个体复原力在脑卒中吞咽障碍患者疾病病耻感和主要照顾者照顾负担之间的中介效应。方法 采用便利抽样法,选择2022年12月—2023年8月于新疆医科大学第一附属医院康复医学科住院的235例脑卒中吞咽障碍患者及其主要照顾者作为研究对象。采用疾病病耻感量表(SSCI)、个体复原力量表(CD-RISC-10)、照顾者负担量表(ZBI)及家庭复原力量表(WFRQ-RCHI)对脑卒中吞咽障碍患者的心理状态、个体复原力及其主要照顾者的照顾负担情况及家庭复原力进行调查。采用Spearman相关分析患者的病耻感状态、个体复原力、主要照顾者负担及家庭复原力的相关性。采用Process V4.1插件中的Model 6和Amos软件构建链式中介模型。结果 脑卒中吞咽障碍患者主要照顾者的ZBI得分为50(42,59)分,处于中度负担水平。患者的SSCI得分为87(72,95)分。Spearman相关分析显示,脑卒中吞咽障碍患者疾病病耻感与照顾者负担呈正相关,与家庭复原力和个体复原力呈负相关,照顾者负担与家庭复原力和个体复原力呈负相关,家庭复原力与个体复原力呈正相关(均P<0.01)。家庭复原力和个体复原力在脑卒中吞咽障碍患者疾病病耻感和照顾者负担中起链式中介效应,占总效应量的69.04%。结论 降低患者疾病病耻感可减轻照顾者负担,同时也可从增强脑卒中吞咽障碍患者的家庭复原力和个体复原力的角度出发,探索减轻脑卒中吞咽障碍患者主要照顾者负担的干预方案。

Objective To analyze the mediating effect of family resilience and individual resilience between disease stigma and primary caregiver burden in patients with stroke dysphagia.Methods From December 2022 to August 2023,convenience sampling was used to select 235 patients with stroke dysphagia and their primary caregivers in the Department of Rehabilitation of the First Affiliated Hospital of Xinjiang Medical University as research subjects.Stigma Scale for Chronic Illness(SSCI),10-item Connor-Davidson Resilience Scale(CD-RISC-10),Zarit Caregiver Burden Interview(ZBI),and the Chinese version of the Revised Walsh Family Resilience Questionnaire(WFRQ-R-CHI)were used to investigate the psychological status,individual resilience,and primary caregiver burden and family resilience of patients with stroke dysphagia.Spearman correlation was used to analyze the correlation between patient stigma,individual resilience,primary caregiver burden, and family resilience. Chain mediating model was constructed using Model 6 from the ProcessV4.1 plugin and Amos software. Results ZBI score of the primary caregiver for patients with stroke dysphagiawas 50 (42,59), which was at a moderate burden level. The patient's SSCI score was 87 (72,95). Spearmancorrelation showed that there was a positive correlation between disease stigma and caregiver burden in patientswith stroke dysphagia, a negative correlation with family and individual resilience, a negative correlationbetween caregiver burden and family and individual resilience, and a positive correlation between family andindividual resilience, with statistically significant differences (all P < 0.01). Family resilience and individualresilience played a chain mediating effect in the disease stigma and caregiver burden of patients with strokedysphagia, accounting for 69.04% of the total effect. Conclusions Reducing the disease stigma of patientscan alleviate the burden on caregivers. Intervention programs to reduce the burden on the primary caregivers ofpatients with stroke dysphagia can also be explored from the perspective of enhancing their family and individualresilience.