反刍性沉思在脑卒中患者自我感受负担与病耻感间的中介作用

Mediating effect of rumination between self-perceived burden and stigma in stroke patients

目的探讨反刍性沉思在脑卒中患者自我感受负担(SPB)与病耻感之间的中介作用, 为临床制订针对性护理干预提供理论依据。方法采用整群抽样法, 选取2022年9月在河南省5所三甲医院神经内科住院的1 126例脑卒中患者为研究对象, 使用一般情况调查表、自我感受负担量表(SPBS)、脑卒中患者病耻感量表(SSS)、简体中文版事件相关反刍性沉思问卷(C-ERRI)对脑卒中患者进行调查。采用Pearson相关分析探讨SPB、反刍性沉思和病耻感的相关性, 采用AMOS 28.0软件建立结构方程模型, 采用Bootstrap法检验中介效应。结果本研究共发放问卷1 126份, 回收有效问卷1 026份, 问卷有效回收率为91.12%(1 026/1 126)。1 026例脑卒中患者SPBS得分为(28.68±8.32)分、SSS得分为(40.53±9.48)分, C-ERRI得分为(25.43±12.62)分。Pearson相关分析结果显示, 脑卒中患者SPB与病耻感、反刍性沉思呈正相关(P<0.01), 反刍性沉思与病耻感呈正相关(P<0.01)。Bootstrap中介效应检验结果显示, 反刍性沉思在脑卒中患者SPB与病耻感之间起部分中介作用, 中介效应占总效应的55.15%。结论脑卒中患者的SPB既能直接影响其病耻感, 又能通过反刍性沉思对病耻感产生间接影响。临床护理工作者应及时评估患者的SPB, 关注反刍性沉思的中介作用, 制订有效的心理干预方案, 实施个性化、针对性的护理措施, 降低患者的病耻感, 提高其治疗依从性和康复依从性。

Objective To explore the mediating effect of rumination between self-perceived burden(SPB)and stigma in stroke patients,so as to provide theoretical basis for the development of targeted nursing interventions in clinical practice.Methods In September 2022,cluster sampling was used to select 1126 stroke patients admitted to Department of Neurology of five Class II Grade A hospitals in Henan Province as subjects.General Information Questionnaire,Self-Perceived Burden Scale(SPBS),Stroke Stigma Scale(SSS),and Chinese Version of Event Related Rumination Inventory(C-ERRI)were used to investigate stroke patients.Pearson correlation analysis was used to explore the correlation between SPB,rumination,and stigma.AMOS 28.0 software was used to establish the structural equation model,and Bootstrap method was used to test the mediating effect.Results A total of 1126 questionnaires were distributed,and 1026 valid questionnaires were collected,with a valid response rate of 91.12%(1026/1126).SPBS score of 1026 stroke patients was(28.68±8.32),the SSS score was(40.53±9.48)and the C-ERRI score was(25.43±12.62).Pearson correlation analysis showed that SPB in stroke patients was positively correlated with stigma and rumination(P<0.01),and rumination was positively correlated with stigma(P<0.01).Bootstrap mediating effect test showed that rumination partially mediated the relationship between SPB and stigma in stroke patients,accounting for 55.15%of the total effect.Conclusions SPB of stroke patients both directly affect stigma and indirectly affect stigma through rumination.Clinical nursing workers should promptly evaluate patients'SPB,pay attention to the mediating role of rumination,develop effective psychological intervention programs,implement personalized and targeted nursing measures,relieve patients'stigma,and improve treatment and rehabilitation compliance.