心理一致感在疾病侵扰与中青年维持性血液透析患者失志综合征间的中介作用分析

Analysis of mediating role of sense of coherence in the relationship between illness intrusiveness and demoralization syndrome among young and middle-aged maintenance hemodialysis patients

目的探讨心理一致感、疾病侵扰对中青年维持性血液透析(maintenance hemodialysis,MHD)患者失志综合征的影响,检验心理一致感在疾病侵扰与中青年MHD患者失志综合征间的中介效应。方法采用便利抽样法,2022年3月—2023年3月选取绍兴地区某三级医院215例中青年MHD患者作为调查对象。采用一般资料调查表、中文版失志综合征量表Ⅱ、中文版疾病生活干扰评估量表、中文版心理一致感量表对其进行调查。结果最终回收有效问卷203份,有效问卷回收率为94.4%。203例中青年MHD患者失志综合征、疾病侵扰、心理一致感得分分别为(13.64±4.68)分、(44.05±13.05)分、(49.80±14.75)分。心理一致感对中青年MHD患者失志综合征具有负向影响(P<0.001),疾病侵扰对中青年MHD患者失志综合征具有正向影响(P<0.001)。心理一致感在疾病侵扰与中青年MHD患者失志综合征中起部分中介效应(β=0.52,P<0.001),中介效应占总效应的60.5%。结论心理一致感、疾病侵扰对中青年MHD患者失志综合征有影响,疾病侵扰水平可通过影响中青年MHD患者的心理一致感水平进而影响其失志综合征程度。护理管理者可通过采取能够降低疾病对中青年MHD患者侵扰程度、提升中青年MHD患者心理一致感水平的有效措施,减轻失志综合征对中青年MHD患者造成的不利影响。

Objective To explore the impact of sense of coherence(SOC)and illness intrusiveness on the demoralization syndrome among young and middle-aged patients undergoing maintenance hemodialysis(MHD),and to test the mediating effect of SOC between illness intrusiveness and demoralization syndrome in this disease population.Methods Using convenience sampling,a total of 215 young and middle-aged MHD patients from a tertiary hospital in Shaoxing were investigated by the general information questionnaire,Chinses version of Demoralization Scale-Ⅱ,Illness Intrusiveness Rating Scale,and Sense of Coherence-13 from March 2022 to March 2023.Results A total of 203 valid questionnaires were collected,with a recovery rate of 94.4%.The scores of demoralization syndrome,illness intrusiveness,and SOC among the 203 young and middle-aged MHD patients were(13.64±4.68),(44.05±13.05),and(49.80±14.75),respectively.SOC had a negative impact on demoralization syndrome in young and middle-aged MHD patients(P<0.001),while illness intrusiveness had a positive impact on demoraliza-tion syndrome(P<0.001).SOC partially mediated the relationship between illness intrusiveness and demoralization syndrome in young and middle-aged MHD patients(β=0.52,P<0.001),accounting for 60.5%of the total effect.Conclusion SOC and illness intrusiveness have impacts on the demoralization syndrome in young and middle-aged MHD patients.The level of illness intrusiveness can influence the level of demoralization syndrome by affecting the level of SOC.Nursing managers can adopt effective measures to reduce the degree of illness intrusiveness and enhance the SOC of young and middle-aged MHD patients,thereby reducing the adverse impact of demoralization syndrome on this patient group.