连带病耻感对精神分裂症患者主要照顾者照顾负担的影响

doi:10.3761/j.issn.0254-1769.2021.02.013

摘要/Abstract

摘要：

目的探讨精神分裂症患者主要照顾者的连带病耻感、社会支持及照顾负担之间的关系。方法采用一般资料问卷、照顾者负担量表、贬低-歧视感知量表、社会支持评定量表,对江苏省某三级甲等医院的455例精神分裂症患者的主要照顾者进行调查。结果连带病耻感可显著正向预测照顾者负担（B=1.592,P<0.001）。连带病耻感对社会支持的预测作用亦显著（B=-1.506,P<0.001）;连带病耻感通过社会支持对精神分裂症患者主要照顾者照顾负担的间接效应显著,其95%置信区间为[0.340~1.076],社会支持的中介效应占总效应的百分比为42.4%。结论护理人员应开展以影响照顾负担的路径为依据的干预策略,降低主要照顾者的连带病耻感水平,提供更多的社会支持,减轻照顾者负担。

关键词: 精神分裂症, 连带病耻感, 社会支持, 照顾者负担, 中介效应, 护理

Abstract:

Objective To explore the relationship between stigma,social support and care burden of primary caregivers of patients with schizophrenia. Methods The primary caregivers of 455 hospitalized patients with schizophrenia were investigated by a self-compiled general information questionnaire,Zairt Caregiver Burden Interview,Perceived Detraction-Discrimination Scale and Social Support Rating Scale. Results Stigma was a significantly positive predictor of caregiver burden（B=1.592,P<0.001）. It was also a significant predictor of social support（B=-1.506,P<0.001）. Stigma had a significantly indirect effect on the burden of care for primary caregivers of schizophrenics through social support,and the 95% confidence interval was[0.340~1.076],which showed that the mediating effect of social support accounts for 42.4% of the total effect. Conclusion Nurses should develop intervention strategies based on pathways that affect the burden of care to reduce the level of stigma of primary caregivers,provide more social support,and reduce the burden on caregivers.

Key words: Schizophrenia, Stigma Attached, Social Support, Burden on Caregivers, Mediating Effect, Nursing Care

刘寿娟, 张燕红, 汤明文, 成荫. 连带病耻感对精神分裂症患者主要照顾者照顾负担的影响[J]. 中华护理杂志, 2021, 56(2): 239-244.

LIU Shoujuan, ZHANG Yanhong, TANG Mingwen, CHENG Yin. The impact of stigma on care burden in primary caregivers of schizophrenics[J]. Chinese Journal of Nursing, 2021, 56(2): 239-244.

图/表 4

Table 1 Correlation analysis of care burden, stigma of associated diseases and social support（r value,n=455）

Table 2 Multiple linear regression analysis of influencing factors of care burden of rimary caregivers（n=455）

Figure 1 Fitting model of mediation of social support

Table 3 Effect analysis of social support as a mediator variable of caregivers' stigma associated with illness on their burden（n=455）

参考文献 29

[1]	Chou KR . Caregiver burden:a concept analysis[J]. J Pediatr Nurs, 2000,15(6):398-407.
[2]	曾繁丽, 刘鹏程, 蒋鹏 , 等. 1218例严重精神障碍患者监护人照顾负担现状及影响因素的调查分析[J]. 中华护理杂志, 2019,54(1):95-99.
	Zeng FL, Liu PC, Jiang P , et al. Investigation and analysis on the factors related to the nursing burden of caregivers of 1218 patients with severe mental disorders[J]. Chin J Nurs, 2019,54(1):95-99.
[3]	王璟, 王自盼, 岳树锦 , 等. 大肠癌患者家庭照顾者照顾负担水平及其相关因素的系统评价[J]. 中国护理管理, 2020,20(1):85-92.
	Wang J, Wang ZP, Yue SJ , et al. Care burden level of family caregivers of patients with colorectal cancer and its associated factors:a systematic review[J]. Chin Nurs Manag, 2020,20(1):85-92.
[4]	Karidi MV, Vassilopoulou D, Savvidou E , et al. Bipolar disorder and self-stigma:a comparison with schizophrenia[J]. J Affect Disord, 2015,184:209-215.
[5]	Kvaale EP, Haslam N, Gottdiener WH . The ‘side effects' of medicalization:a meta-analytic review of how biogenetic explanations affect stigma[J]. Clin Psychol Rev, 2013,33(6):782-794.
[6]	王日香, 董婷婷 . 阿尔茨海默病患者家庭照顾者连带病耻感现状及其与照顾者负担的关系[J]. 中国护理管理, 2019,19(3):345-349.
	Wang RX, Dong TT . Shame among family caregivers of patients with Alzheimer's Disease and its relationship with caregiver burden[J]. Chin Nurs Manag, 2019,19(3):345-349.
[7]	张翀旎, 黄闻, 李淑娟 , 等. 青少年精神分裂症病人照顾者家庭疾病负担现状与社会支持相关性研究[J]. 护理研究, 2020,34(2):192-196.
	Zhang CN, Huang W, Li SJ , et al. Study on correlation between status of family disease burden and peceived social support among caregivers of adolescents with schizophrenia[J]. Chin Nurs Res, 2020,34(2):192-196.
[8]	姜钊, 张子旬, 王锋 , 等. 精神分裂症家属照护负担与社会支持相关性分析[J]. 中国卫生事业管理, 2019,36(10):781-783.
	Jiang Z, Zhang ZX, Wang F , et al. Analyzing the relationship between the family members' burden of care for schizophrenia and social support[J]. Chin Heal Serv Manag, 2019,36(10):781-783.
[9]	栾贝贝, 王维利, 朱宇 , 等. 基于压力与应对理论的癌症照顾者干预性研究现状[J]. 实用医学杂志, 2016,32(8):1356-1358.
	Luan BB, Wang WL, Zhu Y , et al. Research status of cancer caregiver intervention based on stress and coping theory[J]. Practical Medicine, 2016,32(8):1356-1358.
[10]	王烈, 杨小湜, 侯哲 , 等. 护理者负担量表中文版的应用与评价[J]. 中国公共卫生, 2006,22(8):970-972.
	Wang L, Yang XS, Hou Z , et al. Application and evaluation of Chinese version of zarit caregiver burden interview[J]. Chin J Public Heal, 2006,22(8):970-972.
[11]	Link BG, Cullen FT, Struening E , et al. A modified labeling theory approach to mental disorders:an empirical assessment[J]. Am Sociol Rev, 1989,54(3):400.
[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 on stigma and drug compliance in patients with schizophrenia[D]. Beijing:Peking Union Medical College, 2008.
[13]	董佳, 周郁秋, 孙玉静 . 精神分裂症照顾者病耻感测量工具及影响因素研究进展[J]. 中国健康心理学杂志, 2018,26(3):476-480.
	Dong J, Zhou YQ, Sun YJ . Study on the measurement tools of stigma and its influencing factors of schizophrenia caregivers[J]. China J Heal Psychol, 2018,26(3):476-480.
[14]	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, 2016: 384-387.
	Zhang MY, He YL. Psychiatric rating scale manual[M]. Changsha: Hunan Science and Technology Press, 2016: 384-387.
[15]	于文军, 胡纪泽, 李兰兰 . 照顾负担、应对方式和心理健康:对精神分裂症患者家属的追踪研究[J]. 中国临床心理学杂志, 2019,27(5):1031-1035.
	Yu WJ, Hu JZ, Li LL . Caregiver burden,coping styles and mental health:a longitudinal study of primary caregivers of schizophrenia patients[J]. Chin J Clin Psychol, 2019,27(5):1031-1035.
[16]	王霞, 徐蓉, 杨敏 . 精神分裂症患者主要照顾者负担的研究进展[J]. 护理学杂志, 2015,30(7):95-99.
	Wang X, Xu R, Yang M . The caregiving burden of caregivers of patients with schizophrenia:a literature review[J]. J Nurs Sci, 2015,30(7):95-99.
[17]	Grover S, Avasthi A, Singh A , et al. Stigma experienced by caregivers of patients with severe mental disorders:a nationwide multicentric study[J]. Int J Soc Psychiatry, 2017,63(5):407-417.
[18]	Li J, Guo YB, Huang YG , et al. Stigma and discrimination experienced by people with schizophrenia living in the community in Guangzhou,China[J]. Psychiatry Res, 2017,255:225-231.
[19]	司天梅, 于欣 . 难治性精神分裂症的研究进展[J]. 中华精神科杂志, 2018,51(3):157-162.
	Si TM, Yu X . Advances in research on refractory schizophrenia[J]. Chin J Psychiatry, 2018,51(3):157-162.
[20]	Caqueo-Urízar A, Urzúa A, Habib J , et al. Relationships between social stigma,stigma experience and self-stigma and impaired quality of life in schizophrenia across three Latin-American countries[J]. Eur Arch Psychiatry Clin Neurosci, 2019.
[21]	Dockery L, Jeffery D, Schauman O , et al. Stigma-and non-stigma-related treatment barriers to mental healthcare reported by service users and caregivers[J]. Psychiatry Res, 2015,228(3):612-619.
[22]	王星星, 施忠英 . 精神分裂症患者幻听症状管理的研究进展[J]. 中华护理杂志, 2018,53(11):1395-1398.
	Wang XX, Shi ZY . Research progress of auditory hallucination symptom management in schizophrenics[J]. Chin J Nurs, 2018,53(11):1395-1398.
[23]	Bademli K, Duman ZÇ . Effects of a family-to-family support program on the mental health and coping strategies of caregivers of adults with mental illness:a randomized controlled study[J]. Arch Psychiatr Nurs, 2014,28(6):392-398.
[24]	谭晓林, 文丽, 杨冰香 , 等. 团体自我肯定训练对精神分裂症患者病耻感的干预效果研究[J]. 中华护理杂志, 2018,53(10):1168-1173.
	Tan XL, Wen L, Yang BX , et al. Effects of a group self-assertiveness training intervention on stigma of patients with schizophrenia[J]. Chin J Nurs, 2018,53(10):1168-1173.
[25]	焦杰, 郎爽, 罗志芹 , 等. 晚期癌症患者主要照顾者创伤后成长与心理弹性社会支持的相关性研究[J]. 护士进修杂志, 2020,35(2):149-152.
	Jiao J, Lang S, Luo ZQ , et al. A study on the relationship between post-traumatic growth and psychosocial support for primary caregivers of patients with advanced cancer[J]. J Nurses Train, 2020,35(2):149-152.
[26]	娄燕, 陈雪萍, 陈佳佳 , 等. 成年心智障碍者家庭照顾者的照顾负担及影响因素研究[J]. 中华护理教育, 2019,16(3):219-224.
	Lou Y, Chen XP, Chen JJ , et al. Caregivers' burden of caring for adults with mental disabilities[J]. Chin J Nurs Educ, 2019,16(3):219-224.
[27]	赵俭, 李从红, 毕翠云 . 精神分裂症患者在日间康复中心的体验研究[J]. 中华护理杂志, 2018,53(11):1298-1302.
	Zhao J, Li CH, Bi CY . The rehabilitation experiences of schizophrenia patients in day care centers[J]. Chin J Nurs, 2018,53(11):1298-1302.
[28]	严芳, 姚丰菊, 李拴荣 , 等. 同伴支持在社区精神分裂症患者中的应用[J]. 中华护理杂志, 2019,54(10):1545-1550.
	Yan F, Yao FJ, Li SR , et al. Application of peer support in community mental health services to patients with schizophrenia[J]. Chin J Nurs, 2019,54(10):1545-1550.
[29]	杨琼花, 肖云, 何娜 , 等. 微信提醒照顾者对社区精神分裂症患者服药依从性的影响[J]. 中华护理教育, 2019,16(6):479-480.
	Yang QH, Xiao Y, He N , et al. WeChat reminds caregivers of the impact on medication compliance in communities with schizophrenia[J]. Chin J Nurs Educ, 2019,16(6):479-480.