原发性脑肿瘤患者心理弹性潜在类别分析

doi:10.3761/j.issn.0254-1769.2022.19.009

摘要/Abstract

摘要：

目的探索原发性脑肿瘤患者心理弹性的潜在类别,并分析影响不同潜在类别的因素。方法 2020年12月—2021年8月采用方便抽样法选取昆明市某三级甲等医院神经外科237例原发性脑肿瘤住院患者作为调查对象,采用一般资料调查问卷、心理弹性量表简表、医学应对方式问卷及领悟社会支持量表进行问卷调查。对调查对象的心理弹性特征进行潜在类别分析,并通过单因素分析、方差分析和有序多分类Logistic回归分析探索心理弹性潜在类别的影响因素。结果回收有效问卷226份,有效回收率为95.4%。经潜在类别分析,原发性脑肿瘤患者心理弹性分为3个潜在类别,分别是低水平心理弹性组（27.4%）、中水平-高波动心理弹性组（30.1%）、高水平心理弹性组（42.5%）;有序多分类Logistic回归分析结果显示,领悟社会支持量表得分（OR=1.045,P<0.001）、医学应对方式问卷的面对维度得分（OR=1.102,P=0.016）和屈服维度得分（OR=0.865,P=0.013）、农村居住地（OR=0.437,P=0.049）是心理弹性潜在类别的影响因素。结论原发性脑肿瘤患者心理弹性有明显的类别特征,临床工作者应识别不同类别患者的特征及影响因素,采取针对性的干预策略,促进患者心理弹性水平提升。

关键词: 原发性脑肿瘤, 心理弹性, 潜在类别分析, 医学应对方式, 社会支持, 神经外科, 护理

Abstract:

Objective To explore the potential categories and influencing factors of psychological resilience in primary brain tumor patients. Methods A convenient sampling method was used to select 237 primary brain tumor patients hospitalized in the Neurosurgery Department of a tertiary hospital in Kunming,Yunnan Province from December 2020 to August 2021. General information questionnaire,Resilience Scale-14（RS-14）,Medical Coping Modes Questionnaire（MCMQ） and Perceived Social Support Scale（PSSS） were conducted for investigation. Latent class analysis （LCA） was used to explore the potential categories of psychological resilience among patients with primary brain tumor. Single factor analysis,analysis of variance and ordinal and multinomial logistic regression analysis were used to identify the factors associated with the potential categories of psychological resilience. Results A total of 226 returned questionnaires were valid,resulting an effective response rate of 95.4%. Based on the analysis of potential categories,the psychological resilience of patients with primary brain tumor was divided into 3 potential categories,namely low level group （27.4%）,medium-high fluctuation group（30.1%） and high level group（42.5%）. The result of ordinal and multinomial logistic regression analysis showed that the score of PSSS（OR=1.045,P<0.001）,facing dimension（OR=1.102,P=0.016） and yield dimension（OR=0.865,P=0.013） in MCMQ,and rural residence （OR=0.437,P=0.049） were the influencing factors of the potential categories of psychological resilience. Conclusion Patients with primary brain tumor have obvious differences in characteristics by psychological resilience. More awareness and interventions from healthcare providers based on characteristics of different types of patients and influencing factors are needed,in order to promote the psychological resilience.

Key words: Primary Brain Tumor, Psychological Resilience, Potential Category Analysis, Medical Coping Style, Social Support, Neurosurgery, Nursing Care

姚芡芡, 刘丽, 罗艳芳, 蒲树英. 原发性脑肿瘤患者心理弹性潜在类别分析[J]. 中华护理杂志, 2022, 57(19): 2363-2370.

YAO Qianqian, LIU Li, LUO Yanfang, PU Shuying. Analysis of potential categories of psychological resilience in primary brain tumor patients[J]. Chinese Journal of Nursing, 2022, 57(19): 2363-2370.

图/表 5

表1 调查对象的一般资料及原发性脑肿瘤患者3个心理弹性潜在类别单因素分析[n=226,例（百分比,%）]

Table 1 The general information of the subjects and single factor analysis of 3 potential categories among primary brain tumor patients[n=226,case（percentage,%）]

表2 原发性脑肿瘤患者心理弹性潜在类别模型拟合指标

Table 2 The potential categories model fit indicators for psychological resilience in primary brain tumor patients

图1 原发性脑肿瘤患者心理弹性潜在类别特征分布

Figure 1 The characteristic distribution of 3 potential categories of psychological resilience in primary brain tumor patients

表3 3个潜在类别原发性脑肿瘤患者医学应对方式问卷、领悟社会支持量表得分比较（分,$\bar{x}±s$）

Table 3 Comparison of scores of Medical Coping Modes Questionnaire and Perceived Social Support Scale among 3 potential categories in primary brain tumor patients（score,$\bar{x}±s$）

表4 原发性脑肿瘤患者心理弹性潜在类别的有序多分类Logistic回归分析

Table 4 Ordinal and multinomial Logistic regression analyses of the potential categories of psychological resilience in primary brain tumor patients

参考文献 26

[1]	李乐之, 路潜. 外科护理学[M]. 6版. 北京: 人民卫生出版社, 2012.
	Li LZ, Lu Q. Surgical nursing[M]. 6th ed. Beijing: People’s Medical Publishing House, 2012.
[2]	郑荣寿, 孙可欣, 张思维, 等. 2015年中国恶性肿瘤流行情况分析[J]. 中华肿瘤杂志, 2019, 41(1):19-28. PMID
	Zheng RS, Sun KX, Zhang SW, et al. Report of cancer epidemiology in China,2015[J]. Chin J Oncol, 2019, 41(1):19-28. DOI PMID
[3]	Gibson AW, Graber JJ. Distinguishing and treating depression,anxiety,adjustment,and post-traumatic stress disorders in brain tumor patients[J]. Ann Palliat Med, 2021, 10(1):875-892. DOI URL
[4]	Masten AS. Resilience in developing systems:progress and pro-mise as the fourth wave rises[J]. Dev Psychopathol, 2007, 19(3):921-930. PMID
[5]	王美新. 颅内肿瘤患者心理弹性的现状调查[J]. 临床护理杂志, 2016, 15(1):10-13.
	Wang MX. The psychological resilience among intracranial tumor patients[J]. J Clin Nurs, 2016, 15(1):10-13.
[6]	王孟成, 邓俏文, 毕向阳, 等. 分类精确性指数Entropy在潜剖面分析中的表现:一项蒙特卡罗模拟研究[J]. 心理学报, 2017, 49(11):1473-1482.
	Wang MC, Deng QW, Bi XY, et al. Performance of the entropy as an index of classification accuracy in latent profile analysis:a Monte Carlo simulation study[J]. Acta Psychol Sin, 2017, 49(11):1473-1482. DOI URL
[7]	Achterhof R, Huntjens RJC, Meewisse ML, et al. Assessing the application of latent class and latent profile analysis for evaluating the construct validity of complex posttraumatic stress dis-order:cautions and limitations[J]. Eur J Psychotraumatol, 2019, 10(1):1-11.
[8]	倪平, 陈京立, 刘娜. 护理研究中量性研究的样本量估计[J]. 中华护理杂志, 2010, 45(4):378-380.
	Ni P, Chen JL, Liu N. The sample size estimation in quantitative nursing research[J]. Chin J Nurs, 2010, 45(4):378-380.
[9]	Wagnild GM. The Resilience Scale user’s guide for the US English version of the Resilience Scale and the 14 Item Resilience Scale(RS14)[M]. Montana: The Resilience Center, 2009.
[10]	倪倩钰, 田俊. 心理弹性量表信度和效度评价及应用[J]. 中国公共卫生, 2013, 29(10):1524-1527.
	Ni QY, Tian J. Evaluation on reliability and validity of 14-Item Resilience Scale[J]. Chin J Public Heal, 2013, 29(10):1524-1527.
[11]	Feifel H, Strack S, Nagy VT. Coping strategies and associated features of medically ill patients[J]. Psychosom Med, 1987, 49(6):616-625. PMID
[12]	沈晓红, 姜乾金. 医学应对方式问卷中文版701例测试报告[J]. 中国行为医学科学, 2000(1):18.
	Shen XH, Jiang QJ. Report on application of Chinese version of MCMQ in 701 patients[J]. Chin J Behav Med Sci, 2000(1):18.
[13]	Zimet GD, Dahlem NW, Zimet SG, et al. The multidimensional scale of perceived social support[J]. J Pers Assess, 1988, 52(1):30-41. DOI URL
[14]	王孟成. 潜变量建模与Mplus应用-基础篇[M]. 重庆: 重庆大学出版社, 2014.
	Wang MC. Latent variable modeling using Mplus[M]. Chong-qing: Chongqing University Press, 2014.
[15]	王安妮, 张雯, 姚抒予, 等. 失独者心理弹性的潜在类别及其抑郁差异比较[J]. 中国临床心理学杂志, 2016, 24(1):139-143.
	Wang AN, Zhang W, Yao SY, et al. Latent classes of resi-lience and their depression difference of only-child loss people[J]. Chin J Clin Psychol, 2016, 24(1):139-143.
[16]	Henry M, Cohen SR, Lee V, et al. The Meaning-Making intervention(MMi) appears to increase meaning in life in advanced ovarian cancer:a randomized controlled pilot study[J]. Psychooncology, 2010, 19(12):1340-1347. DOI URL
[17]	Li C, Lu H, Qin W, et al. Resilience and its predictors among Chinese liver cancer patients undergoing transarterial che-moembolization[J]. Cancer Nurs, 2019, 42(5):e1-e9.
[18]	吴小婷, 章新琼, 王秋萍, 等. 癌症患者心理弹性干预的研究进展[J]. 中华护理杂志, 2017, 52(3):316-320.
	Wu XT, Zhang XQ, Wang QP, et al. Research progress of psychological resilience intervention in cancer patients[J]. Chin J Nurs, 2017, 52(3):316-320.
[19]	王全兰, 李惠萍, 胡少华, 等. 癌症患者心理韧性潜在类别与主观幸福感的关系[J]. 中国健康心理学杂志, 2020, 28(11):1617-1623.
	Wang QL, Li HP, Hu SH, et al. Relationship between resilience and subjective well-being in cancer patients:based on latent profile analysis[J]. China J Heal Psychol, 2020, 28(11):1617-1623.
[20]	孙博玮, 傅荣, 褚红, 等. 144例多发性骨髓瘤患者心理弹性现状及影响因素分析[J]. 护理学报, 2019, 26(10):38-43.
	Sun BW, Fu R, Chu H, et al. Current status of psychological resilience in patients with multiple myeloma and its influence factors:a 144-case study[J]. J Nurs China, 2019, 26(10):38-43.
[21]	王营营, 吴云, 李惠萍, 等. 造血干细胞移植患者心理韧性的潜在类别及应对方式研究[J]. 现代临床护理, 2021, 20(2):1-7.
	Wang YY, Wu Y, Li HP, et al. Resilience and coping styles of patients undergoing hematopoietic stem cell transplantation:a latent profile analysis[J]. Mod Clin Nurs, 2021, 20(2):1-7.
[22]	刘莉莉, 林平, 赵振娟. 自我效能、社会支持及应对方式对急性心肌梗死患者心理弹性影响的路径分析[J]. 中华护理杂志, 2016, 51(1):21-25.
	Liu LL, Lin P, Zhao ZJ. A path analysis of impacts of self-efficacy,social support and coping style on resilience in acute myocardial infarction patients[J]. Chin J Nurs, 2016, 51(1):21-25.
[23]	石跃, 武曌, 杜红娣, 等. 基于焦点解决模式改善初次诊断肿瘤患者情绪及应对方式的应用研究[J]. 癌症进展, 2021, 19(23):2461-2465.
	Shi Y, Wu Z, Du HD, et al. Focused solution model in improving emotion and coping style of cancer patients with initial diagnosis[J]. Oncol Prog, 2021, 19(23):2461-2465.
[24]	赵丹丹, 赵明. 肝癌部分切除术患者心理弹性与社会支持、应对方式的相关性[J]. 中国健康心理学杂志, 2021, 29(11):1665-1669.
	Zhao DD, Zhao M. Correlation between psychological resilie-nce and social support,coping styles in patients undergoing partial hepatectomy[J]. China J Heal Psychol, 2021, 29(11):1665-1669.
[25]	Wallston B, Alagna S, DeVellis B, et al. Social support and physical health[J]. Heal Psychol, 1983, 2(4):367-391.
[26]	闫蓓, 郝莉鹏, 高玉堂, 等. 社区新发乳腺癌患者综合社会支持健康管理应用以及效果评估[J]. 中华肿瘤防治杂志, 2018, 25(1):1-7.
	Yan B, Hao LP, Gao YT, et al. Assessment of the comprehensive social support on health management of breast cancer patients in the community[J]. Chin J Cancer Prev Treat, 2018, 25(1):1-7.