希望水平在精神分裂症患者病耻感及社会功能缺陷间的中介作用

doi:10.3761/j.issn.1672-9234.2022.07.015

摘要/Abstract

摘要：

目的探讨希望水平在精神分裂症稳定期住院患者病耻感及社会功能缺陷间的中介作用。方法采用便利抽样法选取湖南省某三级医院2021年1月至6月的精神分裂症住院患者为调查对象,采用精神分裂症患者希望量表、贬低-歧视感知量表、社会功能缺陷筛查量表进行问卷调查。结果 217例精神分裂症患者病耻感得分为（29.25±3.40）分,希望得分为（9.41±1.85）分,社会功能缺陷得分为（6.64±3.37）分。希望水平在精神分裂症患者病耻感及社会功能缺陷间存在部分中介作用,效应值为0.243,占总效应38.4%。结论病耻感可通过希望水平间接影响精神分裂症患者社会功能缺陷。在治疗康复中,医务人员和患者家属都应重点关注患者的病耻感及希望水平,加强患者自我肯定训练,促进社会功能恢复,帮助患者回归社会。

关键词: 精神分裂症, 问卷调查, 希望, 病耻感, 社会功能

Abstract:

Objective To explore the mediating role of hope level between stigma and social dysfunction in patients with schizophrenia. Methods The inpatients with schizophrenia in a tertiary hospital in Hunan province from January to June 2021 were selected by convenience sampling. The Schizophrenia Hope Scale（SHS）,Perceived Devaluation-Discrimination Scale（PDD）,and the Social Disability Screening Schedule（SDSS） were used. Results The PDD score of 217 schizophrenic patients was（29.25±3.40）. The SHS score was（9.41±1.85）. The SDSS score was（6.64±3.37）. Hope level had a partial mediating effect between stigma and social dysfunction in schizophrenia patients,accounting for 38.4% of the total effect. Conclusion Stigma can indirectly affect social functioning deficits in patients with schizophrenia through hope levels. During treatment and rehabilitation,both medical staff and patients’ family members should focus on the patient’s stigma and hope level,strengthen the patient’s self-affirmation training,reduce the patient’s social function deficit,and promote the patient’s return to society.

Key words: Schizophrenia, Questionnaires, Hope, Stigma, Social function

向婷婷,蒋小剑,李梅枝,刘娟,王伟月,王礼意. 希望水平在精神分裂症患者病耻感及社会功能缺陷间的中介作用[J]. 中华护理教育, 2022, 19(7): 657-661.

XIANG Ting-ting,JIANG Xiao-jian,LI Mei-zhi,LIU Juan,WANG Wei-yue,WANG Li-yi. The mediating effect of hope level in stigma and social dysfunction in patients with schizophrenia[J]. Chinese Journal of Nursing Education, 2022, 19(7): 657-661.

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参考文献 21

[1]	国家卫生健康委办公厅. 精神障碍诊疗规范(2020年版)[EB/OL]. (2020-12-08). http://www.nhc.gov.cn/yzygj/s7653p/202012/a1c4397dbf504-e1393b3d2f6c263d782.shtml .
[2]	Wong YLI, Kong DX, Tu LF, et al. “My bitterness is deeper than the ocean”:understanding internalized stigma from the perspectives of persons with schizophrenia and their family caregivers[J]. Int J Ment Health Syst, 2018, 12(1):14.
[3]	Charlson FJ, Baxter AJ, Cheng HG,et al. The burden of mental,neurological,and substance use disorders in China and India:a systematic analysis of community representative epidemiological studies[J]. Lancet, 2016, 388(10042):376-389. doi: S0140-6736(16)30590-6 pmid: 27209143
[4]	朱叶, 方菁, 张蓓,等. 精神分裂症社会认知功能缺陷的功能影像研究[J]. 中国临床心理学杂志, 2014, 22(2):232-239.
	Zhu Y, Fang J, Zhang B,et al. Functional neuroimaging of social cognition in schizophrenia[J]. Chin J Clin Psychol, 2014, 22(2):232-239.
[5]	顾鑫萍, 李玲. 精神分裂症病人病耻感影响因素及干预的研究进展[J]. 护理研究, 2019, 33(24):4285-4289.
	Gu XP, Li L. Research progress on influencing factors and intervention measures of stigma in patients with schizophrenia[J]. Chin Nurs Res, 2019, 33(24):4285-4289.
[6]	汤明文, 张燕红, 刘寿娟. 425例住院缓解期精神分裂症患者病耻感现状及影响因素分析[J]. 护理学报, 2019, 26(14):43-47.
	Tang MW, Zhang YH, Liu SJ. Stigma of inpatients with schizo-phrenia at remission phase and its influence factors:a 425-case study[J]. J Nurs China, 2019, 26(14):43-47.
[7]	夏婷婷, 王淑云, 杨富国,等. 肠造口患者造口压力及希望水平与自我管理的相关性研究[J]. 护理学报, 2018, 25(18):8-11.
	Xia TT, Wang SY, Yang FG,et al. Association of stoma pressure with hope level and self-management among colostomy patients[J]. J Nurs China, 2018, 25(18):8-11.
[8]	毛英莹, 刘东玮, 孟丽娜,等. 精神分裂症患者病耻感对孤独感的影响:心理弹性与希望的链式中介作用[J]. 中国卫生事业管理, 2020, 37(11):844-847.
	Mao YY, Liu DW, Meng LN,et al. Studying on the influence of stigma on loneliness of patients with schizophrenia based on the chain mediating role of resilience and hope[J]. Chin Health Serv Manag, 2020, 37(11):844-847.
[9]	Choe K. Development and preliminary testing of the Schizoph-renia Hope Scale,a brief scale to measure hope in people with schizophrenia[J]. Int J Nurs Stud, 2014, 51(6):927-933. doi: 10.1016/j.ijnurstu.2013.10.018
[10]	王伟梁, 周郁秋, 柴囡楠,等. 精神分裂症患者希望量表中文版的心理测量学评价[J]. 中国心理卫生杂志, 2018, 32(12):982-985.
	Wang WL, Zhou YQ, Chai NN,et al. Psychometric properties of the Chinese version of the Schizophrenia Hope Scale[J]. Chin Ment Health J, 2018, 32(12):982-985.
[11]	Link BG, Phelan JC, Bresnahan M,et al. Public conceptions of mental illness:labels,causes,dangerousness,and social distance[J]. Am J Public Health, 1999, 89(9):1328-1333. doi: 10.2105/ajph.89.9.1328 pmid: 10474548
[12]	徐晖. 精神分裂症患者病耻感及其与服药依从性关系的研究[D]. 北京: 中国协和医科大学,2008.
	Xu H. A study of stigma of people with schizophrenia and rela-tionships with medication compliance[D]. Beijing: Peking Union Medical College,2008.
[13]	张明园, 何燕玲. 精神科评定量表手册[M]. 长沙: 湖南科学技术出版社,2015.
	Zhang MY, He YL. Handbook of psychiatric rating scale[M]. Changsha: Hunan Science & Technology Press,2015.
[14]	田茜, 孙敏. 工作形塑在新入职护士双元工作压力与隐性缺勤间的中介效应[J]. 中华护理教育, 2021, 18(6):539-543.
	Tian Q, Sun M. Mediating effects of job crafting on working stressor and presenteeism of new nurses[J]. Chin J Nurs Educ, 2021, 18(6):539-543.
[15]	董佳, 周郁秋, 孙玉静. 青年精神分裂症病人病耻感与自尊、心理弹性相关性及其影响因素[J]. 护理研究, 2018, 32(20):3189-3192.
	Dong J, Zhou YQ, Sun YJ. Stigma,self-esteem and mental resilience in young patients with schizophrenics and their influencing factors[J]. Chin Nurs Res, 2018, 32(20):3189-3192.
[16]	任雪英, 陈琳霞, 何红娟,等. 精神分裂症患者希望水平现状及影响因素研究[J]. 中国护理管理, 2015, 15(11):1398-1401.
	Ren XY, Chen LX, He HJ,et al. The status and influencing factors of hope in patients with schizophrenia[J]. Chin Nurs Manag, 2015, 15(11):1398-1401.
[17]	谢穗峰, 赵延宇, 付美华. 长期住院精神分裂症患者社会功能缺陷调查及危险因素分析[J]. 中国实用医药, 2019, 14(31):19-21.
	Xie SF, Zhao YY, Fu MH. Investigation on social function deficits in long-term inpatients with schizophrenia and their risk factors analysis[J]. China Pract Med, 2019, 14(31):19-21.
[18]	Mashiach-Eizenberg M, Hasson-Ohayon I, Yanos PT,et al. Internalized stigma and quality of life among persons with severe mental illness:the mediating roles of self-esteem and hope[J]. Psychiatry Res, 2013, 208(1):15-20. doi: 10.1016/j.psychres.2013.03.013
[19]	徐晖, 李栓荣, 李峥. 精神疾病患者歧视感知状况及应对方式的研究[J]. 中国全科医学, 2012, 15(28):3281-3283.
	Xu H, Li SR, Li Z. Perceived stigma and coping orientation of people with mental illnesses[J]. Chin Gen Pract, 2012, 15(28):3281-3283.
[20]	Galin S, Heruti I, Barak N,et al. Hope and self-efficacy are associated with better satisfaction with life in people with ALS[J]. Amyotroph Lateral Scler Frontotemporal Degener, 2018, 19(7/8):611-618. doi: 10.1080/21678421.2018.1476546
[21]	Oles SK, Fukui S, Rand KL,et al. The relationship between hope and patient activation in consumers with schizophrenia:results from longitudinal analysis[J]. Psychiatry Res, 2015, 228(3):272-276. doi: 10.1016/j.psychres.2015.05.100