社区慢性病共病老年患者心理困扰的潜在类别分析

doi:10.3761/j.issn.0254-1769.2023.22.012

摘要/Abstract

摘要：

目的探索社区慢性病共病老年患者心理困扰的潜在类别，分析不同特征的老年患者述情障碍的差异。方法 2022年11月—2023年3月，采用便利抽样法选取江苏省6个地级市中城市和农村685例慢性病共病老年患者为调查对象，采用一般资料调查表、抑郁-焦虑-压力量表和多伦多述情障碍量表进行调查。结果最终共调查662例慢性病共病老年患者，心理困扰总分为30.00（16.00，52.00）分。心理困扰表现为4种不同潜在类别，分别命名为压力-抑郁型（19.9%）、低困扰型（26.0%）、压力-焦虑型（23.4%）和整体高困扰型（30.7%）。不同心理困扰类别的社区慢性病共病老年患者在年龄、婚姻状况、居住状态、疾病经济压力、1年内急性事件和自觉健康状况方面的比较，差异具有统计学意义（P<0.05）。4个潜在类别述情障碍得分的比较，差异有统计学意义（F=136.544，P<0.001）。结论慢性病共病老年患者心理困扰具有明显的分类特征，不同心理困扰类别的老年患者述情障碍存在差异。医护人员应重点关注压力-抑郁型和整体高困扰型老年患者的述情障碍，根据不同类别慢性病共病老年患者采取针对性的干预措施以减轻其心理困扰。

关键词: 慢性病共病, 心理困扰, 述情障碍, 潜在类别分析, 老年护理

Abstract:

Objective To explore latent class of psychological distress among the elderly with multiple chronic conditions in the community and to analyze differences in demographic and alexithymia characteristics across class. Methods A total of 685 urban and rural elderly with chronic disease co-morbidities in 6 prefecture-level cities in Jiangsu Province were selected for the study using the General Information Questionnaire，the Depression Anxiety and Stress Scales-21，and the Toronto Alexithymia scale from November 2022 to March 2023 using a convenience sampling method. Results A total of 662 older adults with multiple chronic conditions were finally investigated with a total psychological distress score 30.00（16.00，52.00）. Psychological distress manifested itself in 4 different potential categories named “stress-depressive”（19.9%），“low distress”（26.0%），“stress-anxiety”（23.4%），and “overall high distress”（30.7%）. The comparison of the different psychological distress categories with respect to age group，marital status，residential status，financial stress of illness，acute events within 1 year，and self-perceived health status showed statistically significant differences（P<0.05）. The comparison of alexithymia scores for the 4 potential categories showed statistically significant differences（F=136.544，P<0.001）. Conclusion Psychological distress in older adults with multiple chronic diseases has distinct categorical features，and alexithymia varies across different categories of psychological distress. Healthcare professionals can adopt targeted interventions according to different categories of chronic disease co-morbidities in order to reduce their psychological distress，and at the same time they should focus on older adults with the alexithymia of “stress-depressive” and “overall high distress”.

Key words: Multiple Chronic Conditions, Psychological Distress, Alexithymia, Latent Class Analysis, Geriatric Nursing

尚彬, 罗彩凤, 吕妃, 吴静, 邵校, 李倩. 社区慢性病共病老年患者心理困扰的潜在类别分析[J]. 中华护理杂志, 2023, 58(22): 2768-2776.

SHANG Bin, LUO Caifeng, LÜ Fei, WU Jing, SHAO Xiao, LI Qian. Latent class analysis of psychological distress among older adults with multiple chronic conditions in communities[J]. Chinese Journal of Nursing, 2023, 58(22): 2768-2776.

图/表 5

表1 慢性病共病老年患者心理困扰潜在类别分析各模型拟合指标

Table 1 ndicators of the fit of each model for the analysis of latent class of psychological distress in older adults with multiple chronic diseases

图1 慢性病共病老年患者心理困扰4个潜在类别的条件概率分布情况注：A为焦虑条目；D为抑郁条目；S为压力条目。

Figure 1 Conditional probability distribution of 4 latent classes of psychological distress in older adults with multiple chronic conditions

表2 不同人口学特征慢性病共病老年患者心理困扰类别比较[n=662，例（百分比，%）]

Table 2 Comparison of classes of psychological distress among older adults with multiple chronic conditions by demographic characteristics[n=662，case（percentage，%）]

表3 慢性病共病老年患者心理困扰类别的多分类Logistic回归（n=662）

Table 3 Multicategory logistic regression of factors influencing psychological distress categories in older adults with multiple chronic conditions（n=662）

表4 不同心理困扰类别慢性病共病老年患者述情障碍得分比较（分，$\bar{x} \pm s$）

Table 4 Comparison of scores for alexithymia in older adults with multiple chronic conditions across psychological distress categories（score，$\bar{x} \pm s$）

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