恶性骨肿瘤患者和配偶情绪调节困难与抑郁症状的纵向交互作用及护理启示

doi:10.3761/j.issn.0254-1769.2025.24.003

摘要/Abstract

摘要：

目的基于主客体互倚模型探讨恶性骨肿瘤患者和其配偶情绪调节困难与抑郁症状的纵向相互作用，为降低双方抑郁症状提供依据。方法采用便利抽样法，选择2021年10月—2024年9月徐州市某三级甲等医院骨科收治的188例恶性骨肿瘤患者和其配偶作为调查对象，采用情绪调节状态困难量表、9条目患者健康问卷分别于术后、术后1个月、术后3个月进行调查，采用主客体互倚模型的交叉滞后分析进行统计检验。结果回收有效问卷186份，有效问卷回收率为98.94%。恶性骨肿瘤患者和其配偶情绪调节困难对抑郁症状的主体效应具有显著性，即患者和其配偶的情绪调节困难可以正向预测下一阶段自身的抑郁症状。患者和其配偶抑郁症状对情绪调节困难的主体效应具有显著性，即患者和其配偶的抑郁症状可以正向预测一下阶段自身的情绪调节困难。抑郁症状的客体效应具有显著性，即患者和其配偶的抑郁症状可以正向预测下一阶段对方的抑郁症状。结论恶性骨肿瘤患者和其配偶情绪调节困难与抑郁症状相互作用，临床应同步干预双方情绪调节能力，阻断抑郁症状的相互影响。

关键词: 恶性骨肿瘤, 患者, 配偶, 主客体互倚模型, 情绪调节困难, 抑郁症状, 护理

Abstract:

Objective Guided by the Actor-Partner Interdependence Model（APIM），this longitudinal study examines the dyadic interactions between emotion dysregulation and depressive symptoms in patient-spouse dyadic coping with malignant bone tumors. Methods Convenient sampling method was used to select 188 patients with malignant bone tumors and their spouses admitted to the orthopedic department of a tertiary hospital in Xuzhou City as the study subjects. The State Difficulties in Emotion Regulation Scale and Patient Health Questionnaire-9 were used for investigation at 3 time points：postoperative（T1），1 month（T2） and 3 months after postoperative（T3），respectively. Equivalence test and cross-hysteresis analysis of APIM were used for statistical analysis. Results The study collected 186 valid questionnaires with a high response rate of 98.94%. Longitudinal APIM analyses revealed significant actor and partner effects：both patients’ and spouses’ emotion dysregulation significantly predicted their own subsequent depressive symptoms，while their depressive symptoms also predicted later emotion dysregulation. Significant cross-partner influences emerged，with patients’ depressive symptoms predicting spouses’ subsequent symptoms and vice versa，demonstrating bidirectional interpersonal transmission of distress within couples facing malignant bone tumors. Conclusion This study reveals a bidirectional relationship between emotion dysregulation and depressive symptoms in dyadic coping with malignant bone tumors. These findings highlight the clinical importance of implementing couple-based interventions targeting emotion regulation skills in both patients and spouses，which may effectively disrupt the vicious cycle of mutual symptom reinforcement within these caregiving relationships.

Key words: Malignant Bone Tumor, Patient, Spouse, Actor-Partner Interdependence Model, Emotion Dysregulation, Depressive Symptoms, Nursing Care

李蕊, 宋红, 张春艳, 范晓娟, 王瑶, 耿黎明, 杜颖, 单小天. 恶性骨肿瘤患者和配偶情绪调节困难与抑郁症状的纵向交互作用及护理启示[J]. 中华护理杂志, 2025, 60(24): 2964-2970.

LI Rui, SONG Hong, ZHANG Chunyan, FAN Xiaojuan, WANG Yao, GENG Liming, DU Ying, SHAN Xiaotian. Longitudinal dyadic interactions between emotion dysregulation and depressive symptoms in patients with malignant bone tumors and their spouses[J]. Chinese Journal of Nursing, 2025, 60(24): 2964-2970.

图/表 7

表1 恶性骨肿瘤患者一般资料（n=186）

Table 1 General information of patients with malignant bone tumors（n=186）

表2 恶性骨肿瘤患者配偶的一般资料（n=186）

Table 2 General information of spouses of patients with malignant bone tumors（n=186）

表3 恶性骨肿瘤患者和其配偶情绪调节困难、抑郁症状得分（n=186，分，$\bar{x}±s$）

Table 3 Scores of emotion dysregulation and depressive symptoms in patients with malignant bone tumors and their spouses（n=186，scores，$\bar{x}±s$）

表4 恶性骨肿瘤患者和其配偶情绪调节困难、抑郁症状得分及相关分析（r值，n=186）

Table 4 Scores and bivariate correlations for emotion dysregulation and depressive symptoms in patients with malignant bone tumors and their spouses（r values，n=186）

表5 恶性骨肿瘤患者和其配偶情绪调节困难及抑郁症状3次测量的等价性模型拟合结果

Table 5 Model fit indices for testing measurement invariance of emotion dysregulation and depressive symptoms across 3 time points in malignant bone tumor patients and their spouses

表6 恶性骨肿瘤患者和其配偶情绪调节困难、抑郁症状主客体互倚模型限定后的拟合结果

Table 6 Goodness-of-fit indices for the constrained actor-partner interdependence model（APIM） of emotion dysregulation and depressive symptoms in malignant bone tumor patients and their spouses

图1 恶性骨肿瘤患者和其配偶情绪调节困难、抑郁症状的交叉滞后主客体互倚模型图

Figure 1 Cross-lagged actor-partner interdependence model（APIM） of emotion dysregulation and depressive symptoms in patients with malignant bone tumors and their spouses 1）P<0.01，2）P<0.001。

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