卒中后老年人群心理痛苦及影响因素结构方程模型构建

Study on the construction of structural equation model of psychological distress and its influencing factors in elderly people after stroke

目的了解卒中后老年人群心理痛苦现状,明确卒中后老年人群心理痛苦影响因素及作用机制。方法定点连续取样,按纳排标准抽取230例住院老年脑卒中患者,应用脑卒中患者心理痛苦温度计、健康认知评价量表、心理弹性量表简版、领悟社会支持量表、医学应对方式问卷进行问卷调查。用SPSS 25.0软件包建立数据库,用AMOS 25.0软件进行统计分析,构建心理痛苦影响因素结构方程模型。结果老年脑卒中患者心理痛苦总分(3.02±2.04)分。心理痛苦影响因素中,心理弹性总效应值-0.663,其中直接效应值-0.365;社会支持总效应值-0.033,均为间接效应;认知评价和应对方式在心理弹性与心理痛苦以及社会支持与心理痛苦之间起中介作用。结论老年脑卒中患者的心理痛苦处于中等水平,医务工作者应予以重视。心理弹性对心理痛苦的影响既有直接作用,又可通过认知评价及应对方式间接影响,且呈负向影响;社会支持只能通过认知评价及应对方式间接影响心理痛苦,社会支持通过认知评价及回避应对方式间接正向影响心理痛苦,通过认知评价及屈服应对方式间接负向影响心理痛苦。

Objective To understand the current situation of psychological distress in the elderly after stroke and identify the influencing factors and mechanisms of psychological distress in the elderly after stroke.Methods A fixed-point consecutive sampling was used to select 230 hospitalised elderly stroke patients according to the nativity criterion,and the questionnaire survey was carried out by applying the psychological Distress Thermometer(DT),the Cognitive Appraisal of Health Scale(CAHS),10-item Connor-Davidson Resilience Scale(CD-RISC-10),the Perceived Social Support Scale(PSSS),and the Medical Coping Modes Questionnaire(MCMQ)for the stroke patients.The SPSS 25.0 software package was used to establish the database,and AMOS 25.0 software was adopted for statistical analysis to construct the structural equation model of factors affecting psychological distress.Results The total psychological distress score of elderly stroke patients was 3.02±2.04.Among the influencing factors of psychological distress,the total effect value of psychological resilience was-0.663,of which the direct effect value was-0.365.The total effect value of social support was-0.033,all of which were indirect effects.Cognitive evaluation and coping style play a mediating role between psychological resilience and psychological distress and between social support and psychological distress.Conclusion The psychological distress of elderly stroke patients is at a moderate level,and medical workers should pay attention to it.The effect of psychological resilience on psychological distress is both direct and indirect through cognitive appraisal and coping,and is negative.Social support can only indirectly affect psychological distress through cognitive appraisal and coping,and social support positively affects psychological distress indirectly through cognitive appraisal and avoidance coping,and negatively affects psychological distress indirectly through cognitive appraisal and submission coping.