青少年1型糖尿病患者心理韧性与其身心状况的关系研究

doi:10.3761/j.issn.0254-1769.2022.03.009

摘要/Abstract

摘要：

目的探讨青少年1型糖尿病患者心理韧性现状及与血糖控制、糖尿病痛苦和生活质量的关系。方法采用便利抽样法,选取2019年2月—2020年9月在南京市两所三级甲等医院门诊复诊或病房住院的360例青少年1型糖尿病患者作为调查对象。使用青少年糖尿病优势与韧性量表、5条目糖尿病痛苦量表、中文版简易青少年糖尿病生活质量量表及一般情况调查表调查患者。采用高效液相色谱法测定患者的糖化血红蛋白值。结果青少年1型糖尿病患者心理韧性得分为（40.18±9.27）分,处于中等偏上水平。心理韧性总分与糖化血红蛋白值（r=-0.373,P<0.001）、糖尿病痛苦得分（r=-0.336,P<0.001）呈负相关,与生活质量得分呈正相关（r=0.431,P<0.001）。分层线性回归分析结果显示,控制人口社会学和疾病变量后,心理韧性独立解释患者血糖控制变异的10.0%,对糖尿病痛苦的解释为7.8%,占生活质量变异的17.7%。结论干预患者的心理韧性或可改善其血糖控制、心理状态和生活质量,值得医务工作者关注。

关键词: 青少年, 糖尿病护理, 心理韧性, 血糖控制, 生活质量

Abstract:

Objectives To explore the level of resilience among adolescents with Type 1 diabetes and its association with glycemic control,diabetes distress,and quality of life. Methods A total of 360 adolescents with Type 1 diabetes were recruited from the outpatient and inpatient in Endocrinology departments of 2 public hospitals in Nanjing by convenience sampling method. The data were collected by the Diabetes Strengths and Resilience Measure for Adolescents,the Problem Areas in Diabetes Scale-5,the Short Form of the Chinese version Diabetes Quality of Life for Youth Scale,and the Self-Designed General Information Questionnaire. Results The resilience of adolescents with Type 1 diabetes was 40.18±9.27,which was above the medium level. Resilience was negatively correlated with glycosylated hemoglobin value（r=-0.373,P<0.001） and diabetes distress（r=-0.336,P<0.001）,while it was positively correlated with quality of life（r=0.431,P<0.001）. Hierarchical regression analysis showed that resilience independently explained 10.0% of the variation in glycemic control,7.8% of diabetes distress,and 17.7% of the quality of life,after controlling for demographic and disease variables. Conclusions Interventions that target patients’ resilience may improve their glycemic control,mental health,and quality of life,which should arouse the attention of medical workers.

Key words: Adolescents, Diabetes Care, Resilience, Glycemic Control, Quality of Life

罗丹, 徐晶晶, 王玉冰, 李明子. 青少年1型糖尿病患者心理韧性与其身心状况的关系研究[J]. 中华护理杂志, 2022, 57(3): 306-311.

LUO Dan, XU Jingjing, WANG Yubing, LI Mingzi. Association of resilience with glycemic control,diabetes distress,and quality of life among adolescents with Type 1 diabetes[J]. Chinese Journal of Nursing, 2022, 57(3): 306-311.

图/表 3

表1 青少年1型糖尿病患者的一般资料（n=360）

Table 1 Characteristics of adolescents with Type 1 diabetes（n=360）

表2 青少年1型糖尿病患者心理韧性得分情况

Table 2 Resilience scores of adolescents with Type 1 diabetes

表3 心理韧性与青少年T1D患者健康相关指标关系的分层回归分析结果

Table 3 Hierarchical regression analyses of the association between resilience resilience and health-related indicators in adolescents with T1D

参考文献 26

[1]	中华医学会儿科学分会内分泌遗传代谢学组, 中华儿科杂志编辑委员会. 中国儿童1型糖尿病标准化诊断与治疗专家共识(2020版)[J]. 中华儿科杂志, 2020,58(6):447-454.
	Endocrinology,Genetics and Metabolism Group, Pediatrics Society of Chinese Medical Association, Editorial Committee of Chinese Journal of Pediatrics. Expert consensus on standardized diagnosis and treatment of children with type 1 diabetes in China(2020 Edition)[J]. Chin J Pediatr, 2020,58(6):447-454.
[2]	McGuire HC, Ji L, Kissimova-Skarbek K, et al. Type 1 diabetes mellitus care and education in China:the 3C study of cove-rage,cost,and care in Beijing and Shantou[J]. Diabetes Res Clin Pract, 2017,129:32-42. DOI URL
[3]	Fried L, Chetty T, Cross D, et al. The challenges of being phy-sically active:a qualitative study of young people with type 1 diabetes and their parents[J]. Can J Diabetes, 2021,45(5):421-427. DOI URL
[4]	Morrissey EC, Casey B, Dinneen SF, et al. Diabetes distress in adolescents and young adults living with type 1 diabetes[J]. Can J Diabetes, 2020,44(6):537-540. DOI PMID
[5]	Sisto A, Vicinanza F, Campanozzi LL, et al. Towards a transversal definition of psychological resilience:a literature review[J]. Medicina, 2019,55(11):745. DOI URL
[6]	Yi-Frazier JP, Yaptangco M, Semana S, et al. The association of personal resilience with stress,coping,and diabetes outcomes in adolescents with type 1 diabetes:variable- and person-focused approaches[J]. J Health Psychol, 2015,20(9):1196-1206. DOI PMID
[7]	Vesco AT, Feldman MA, Evans MA, et al. Parent-adolescent dya-dic diabetes distress:associations with A1c and diabetes-related strengths[J]. Fam Syst Health, 2018,36(3):357-367. DOI URL
[8]	Hilliard ME, Hagger V, Hendrieckx C, et al. Strengths,risk factors,and resilient outcomes in adolescents with type 1 dia-betes:results from diabetes miles youth-Australia[J]. Diabetes Care, 2017,40(7):849-855. DOI PMID
[9]	谢勇琼, 高金姣. 自我效能、家庭关怀及应对方式对2型糖尿病足患者心理韧性水平的影响[J]. 临床护理杂志, 2018,17(4):2-4.
	Xie YQ, Gao JJ. The effect of the type 2 diabetic foot patients’ psychological resilience level from self-efficacy,family care and facing coping styles[J]. J Clinic Nurs, 2018,17(4):2-4.
[10]	WHO. Global accelerated action for the health of adolescents(AA-HA!):guidance to support country implementation[M]. Ge-neva:WHO, 2017.
[11]	Hilliard ME, Iturralde E, Weissberg-Benchell J, et al. The Diabetes strengths and resilience measure for adolescents with type 1 diabetes(DSTAR-Teen):validation of a new,brief self-report measure[J]. J Pediatr Psychol, 2017,42(9):995-1005. DOI PMID
[12]	Xu J, Luo D, Zhu M, et al. Translation and its psychometric characteristic of the diabetes strengths and resilience measure among Chinese adolescents with type 1 diabetes[J]. J Pediatr Nurs, 2020,50:e2-e7. DOI URL
[13]	McGuire BE, Morrison TG, Hermanns N, et al. Short-form mea-sures of diabetes-related emotional distress:the Problem Areas in Diabetes Scale(PAID)-5 and PAID-1[J]. Diabetologia, 2010,53(1):66-69. DOI PMID
[14]	Luo D, Xu JJ, Cai X, et al. The effects of family functioning and resilience on self‐management and glycaemic control among youth with type 1 diabetes[J]. J Clin Nurs, 2019,28(23/24):4478-4487. DOI URL
[15]	Wang RH, Lo FS, Chen BH, et al. Short form of the Chinese Version Diabetes Quality of Life for Youth Scale:a psychometric testing in Taiwanese adolescents with type 1 diabetes[J]. Diabetes Care, 2011,34(9):1943-1945. DOI URL
[16]	Brazeau A, Nakhla M, Wright M, et al. Stigma and its association with glycemic control and hypoglycemia in adolescents and young adults with type 1 diabetes:cross-sectional study[J]. J Med Internet Res, 2018,20(4):e151. DOI URL
[17]	Ye ZJ, Qiu HZ, Li PF, et al. Validation and application of the Chinese version of the 10-Item Connor-Davidson Resilience Scale(CD-RISC-10) among parents of children with cancer diagnosis[J]. Eur J Oncol Nurs, 2017,27:36-44. DOI URL
[18]	Hasan I, Chowdhury ABMA, HaqueA I, et al. Changes in glycated hemoglobin,diabetes knowledge,quality of life,and anxiety in children and adolescents with type 1 diabetes attending summer camps:a systematic review and meta‐analysis[J]. Pediatr Diabetes, 2021,22(2):124-131. DOI URL
[19]	Pihlaskari AK, Wiebe DJ, Troxel NR, et al. Perceived peer sup-port and diabetes management from adolescence into early eme-rging adulthood[J]. Health Psychol, 2018,37(11):1055-1058. DOI PMID
[20]	Rawal T, Bhaumik S, Shrivastav R, et al. Kids and diabetes in schools(KiDS) intervention in India:participants’ perspectives[J]. Health Educ J, 2021,80(7):851-860. DOI URL
[21]	彭耘夫, 程广云. 中国传统伦理文化与现代家庭本位建设[J]. 江海学刊, 2019(2):225-230.
	Peng YF, Cheng GY. Chinese traditional ethical culture and modern family orientation construction[J]. Jianghai Academic J, 2019(2):225-230.
[22]	Dubovi I, Levy ST, Levy M, et al. Glycemic control in adolescents with type 1 diabetes:are computerized simulations effective learning tools?[J]. Pediatr Diabetes, 2020,21(2):328-338. DOI PMID
[23]	Lo F, Hsu H, Chen B, et al. Factors affecting health adaptation of Chinese adolescents with type 1 diabetes:a path model testing[J]. J Child Health Care, 2016,20(1):5-16. DOI URL
[24]	Maul S, Giegling I, Fabbri C, et al. Genetics of resilience:implications from genome-wide association studies and candidate genes of the stress response system in posttraumatic stress disorder and depression[J]. Am J Med Genet B Neuropsychiatr Genet, 2020,183(2):77-94. DOI URL
[25]	Hood KK, Iturralde E, Rausch J, et al. Preventing diabetes dis-tress in adolescents with type 1 diabetes:results 1 year after participation in the STePS program[J]. Diabet care, 2018,41(8):1623-1630. DOI URL
[26]	Hilliard ME, Cao VT, Eshtehardi SS, et al. Type 1 doing well:pilot feasibility and acceptability study of a strengths-based mHealth app for parents of adolescents with type 1 diabetes[J]. Diabetes Technol Ther, 2020,22(11):835-845. DOI URL