中青年脑卒中患者疾病不确定感潜在类别分析

Analysis of latent classes of disease uncertainty among young and middle-aged stroke patients

目的探索急性期江苏省中青年脑卒中患者疾病不确定感潜在类别,分析不同类别在人口学及心理困扰的特征差异。方法2023年9月至2024年2月采用便利抽样法选取江苏省苏州市立医院及苏州市相城人民医院的神经内科及神经外科346例急性期江苏省中青年脑卒中住院患者为研究对象,采用一般资料调查表、中文版疾病不确定感量表和凯斯勒心理困扰量表进行调查。应用SPSS 26.0统计学软件进行数据分析,采用Mplus 8.0软件对疾病不确定感进行潜在类别分析,采用logistic回归分析不同疾病不确定感类别的人口学差异,比较不同类别之间心理困扰的差异。结果急性期中青年脑卒中患者疾病不确定感得分为(68.19±14.42)分,心理困扰得分为(28.39±4.39)分。疾病不确定感可分为3个类别:较低水平-不舒适组(55.2%)、中等水平-复杂性组(30.3%)和较高水平-不确定性组(14.5%)。不同文化水平、年龄、工作状态、婚姻状况、居住地、脑卒中类型、发作次数、自理能力、患病前是否为家庭经济的主要来源、家庭可支配月收入的中青年脑卒中患者疾病不确定感类别比较,差异有统计学意义(P<0.05)。单身,卒中2次及以上,自理能力为中、重度,35~<55岁患者更易归于较高水平-不确定性组。不同类别的心理困扰总分及抑郁评分比较,差异有统计学意义(P<0.05)。结论中青年脑卒中患者疾病不确定感有明显的分类特征,不同疾病不确定感类别的脑卒中患者心理困扰存在差异,需从积极心理学视角出发,找出精准干预靶点,以缓解疾病不确定感。

Objective To explore the latent class of disease uncertainty among young and middle-aged acute stroke patients,and to analyze differences in the demographic and psychological distress characteristics of the different classes.Methods A total of 346 young and middle-aged stroke inpatients in the acute phase in the Department of Neurology and Department of Neurosurgery,Suzhou Municipal Hospital and Xiangcheng People’s Hospital in Jiangsu Province were selected by convenience sampling from September 2023 to February 2024,and were investigated by using the General Information Questionnaire,mishel’s uncertainty in illness scale-adult and the 10-item Kessler Psychological Distress Scale.SPSS 26.0 was applied for data analysis,Mplus 8.0 software was used to analyze the potential classes of disease uncertainty,univariate and multicategorical logistic regression was used to analyze the demographic differences among different classes of disease uncertainty,and analysis of variance(ANOVA)was used to compare the differences in psychological distress among different classes.Results Young and middle-aged acute stroke patients had disease uncertainty score(68.19±14.42)and psychological distress score(28.39±4.39).Disease uncertainty among young and middle-aged acute stroke patients can be classified into three classes models:lower level-discomfort class(55.2%),medium level-complexity class(30.3%),and higher level-uncertainty class(14.5%),respectively.The results of multiple logistic regression analysis showed that there were statistically significant differences in different age,employment status,marital status,number of strokes,self-care ability,whether they were the main source of family finances before the disease,and per capita monthly income,the difference was statistically significant(P<0.05).Patients who were single,had two or more strokes,were moderately severe in self-care,and were 35-<55 years old were more likely to be classified in the higher level-uncertainty class. The psychological distress scores for three different classes of disease uncertainty were compared, the difference was statistically significant (P<0.05). Conclusion There are obvious classification characteristics of disease uncertainty in young and middle-aged stroke patients, and there are differences in psychological distress among stroke patients with different disease uncertainty classes. This suggests the need to identify precise targets for intervention from a positive psychology perspective in order to alleviate the uncertainty of the disease.