照顾负担对重性精神疾病患者家庭照顾者生活质量的影响:家庭复原力和压力知觉的链式中介模型

Effect of caregiving burden on quality of life among family caregivers of severe mental illness patients:A chain-mediated model of family resilience and perceived stress

目的:调查重性精神疾病(SMI)患者家庭照顾者的生活质量并基于ABC-X模型探讨SMI家庭照顾者照顾负担对生活质量的影响,以及家庭复原力与压力知觉在其中的作用。方法:便利抽样法选取272名武汉市精神卫生中心的SMI家庭照顾者进行问卷调查。采用一般情况问卷、SF-36健康调查简表、Zairt照顾者负担量表、家庭复原力评定量表和压力知觉量表调查研究对象,运用SPSS 23.0和Mplus软件对数据进行描述分析并构建中介效应模型。结果:家庭照顾者生活质量平均得分为(54.26±16.94)分,照顾负担、家庭复原力、压力知觉平均得分分别为(46.85±15.05)分、(146.33±37.23)分、(33.40±6.03)分。生活质量与照顾负担、压力知觉呈负相关(P<0.01),与家庭复原力呈正相关(P<0.01)。中介效应检验结果显示,照顾负担对生活质量有直接影响(β=-0.412,95%CI:-0.565~-0.259),且家庭复原力(β=-0.098,95%CI:-0.112~-0.074)和压力知觉(β=-0.084,95%CI:-0.104~-0.061)在照顾负担和生活质量间分别起中介作用,家庭复原力、压力知觉的链式中介作用(β=-0.056,95%CI:-0.074~-0.030)也成立。结论:SMI家庭照顾者生活质量水平较正常人群低,照顾负担不仅直接预测SMI家庭照顾者的生活质量,还通过家庭复原力和压力知觉的独立中介作用及二者的链式中介作用影响生活质量。

Objective:To investigate the quality of life of family caregivers of patients with severe mental illness(SMI)and to explore the effect of caregiving burden on the quality of life of SMI family caregivers based on the ABC-X model,and the role of family resilience and perceived stress.Methods:A questionnaire survey was conducted among 272 SMI family caregivers in Wuhan Mental Health Center by convenience sampling method.The basic information questionnaire,Mos 36-item short-form health survey(SF-36),Zairt caregiver burden interview(ZBI),Chinese family resilience assessment scale(C-FRAS),and Chinese version perceived stress scale(CPSS)were used to investigate the subjects.SPSS 23.0 and Mplus 8.3 were used to describe and analyze the data and build a mediating effect model.Results:The average score of family caregivers'quality of life was 54.26±16.94,and the average scores of caregiving burden,family resilience,and perceived stress were 46.85±15.05,146.33±37.23,and 33.40±6.03,respectively(P<0.01).The results of the structural equation model showed that the caregiving burden of SMI family caregivers had a direct effect on the quality of life(β=-0.412,95%CI:-0.565--0.259),and the relationship between them was affected by family resilience(β=-0.098,95%CI:-0.112--0.074)and perceived stress(β=-0.084,95%CI:-0.104--0.061),and the chain mediating effect was statistically significant between family resilience and perceived stress(β=-0.056,95%CI:-0.074--0.030).Conclusion:The quality of life among SMI family caregivers is lower than that of the normal population.Caregiving burden not only directly predicts the quality of life of SMI family caregivers,but also influences the quality of life through the independent mediating effect of family resilience and perceived stress and their chain mediating effect.