肺癌患者疾病感知在症状负担影响抑郁和焦虑症状的中介作用研究

Mediating Role of Disease Perception in Lung Cancer Patients in Symptom Burden Affecting Depression and Anxiety

目的:以疾病自我调节常识模型为理论框架,检验疾病感知在肺癌患者症状影响情绪中的作用。方法:通过问卷调查收集数据,评估某专科医院肺癌患者(n=316)症状负担、疾病感知、焦虑和抑郁。采用结构方程模型检验疾病感知的中介效应。结果:患者自我报告躯体症状发生频率依次为呼吸困难(65.61%)、咳嗽(53.16%)、胸痛(38.92%)和手臂疼痛(38.92%)。17.76%和14.14%的患者存在焦虑和抑郁。抑郁、焦虑评分与症状负担、疾病对生活影响的认知和对疾病的担心呈显著正相关(P<0.01),与对治疗方式的信心呈显著负相关(P<0.01)。数据拟合结果支持链式中介模型:症状负担通过作用于患者对疾病影响生活的认知,进而增加患者对疾病的担心,从而加重焦虑、抑郁(焦虑:链式中介效应0.031,P=0.001,抑郁:链式中介效应0.027,P=0.002)。结论:肺癌患者症状对情绪的影响中,疾病多维感知起到重要的中介作用。应充分重视患者疾病体验和对情绪的催化作用,积极对症治疗以缓解症状负担。并通过健康教育和心理干预帮助患者重塑重大疾病下的应对策略和生活方式,减少负面情绪困扰。

Objective:Based on common sense model of illness self-regulation,this study examines the mediating effects of illness perception in the symptoms affecting emotion among lung cancer patients.Methods:A questionnaire survey was used to assess patients'symptom burden,illness perception,anxiety and depression among lung cancer patients(n=316)in a specialized hospital.A structural equation model was used to examine the mediating effects of illness perception.Results:Patients'most frequently self-reported physical symptoms were dyspnea(65.61%),cough(53.16%),chest pain(38.92%)and arm pain(38.92%).17.76%and 14.14%of patients had anxiety and depression.Depression and anxiety were significantly positively correlated to symptom burden,perception of the impact of illness on life,and the concern about the disease(P<0.01),and negatively correlated to confidence in treatment(P<0.01).The serial mediation model indicated good fit to the data:symptom burden was associated with greater concern about the disease by increasing the patient's perception of impact of the disease on their lives,thus aggravating elevates their anxiety and depression(anxiety:serial mediating effect=0.031,P=0.001;depression:serial mediating effect=0.027,P=0.002).Conclusion:Multidimensional illness perception mediates the impact of physical symptom on emotion among lung cancer patients.Full attention should be paid to the patient's disease experience and the catalytic effect on emotion,and active symptom treatment should be taken to alleviate the symptom burden.Through health education and psychological intervention,it helps patients with major illnesses reshape their coping strategies and lifestyles and reduce negative emotion.