病耻感对中青年维持性血液透析患者心理痛苦的影响

doi:10.3761/j.issn.0254-1769.2022.21.004

摘要/Abstract

摘要：

目的探讨自尊在中青年维持性血液透析患者病耻感与心理痛苦之间的中介效应，以及家庭亲密度在其中的调节效应。方法采用便利抽样法，利用病耻感量表、自尊量表、家庭亲密度量表及心理痛苦温度计于2021年6月—12月对福建省福州市、莆田市4所三级甲等医院382例中青年维持性血液透析患者进行调查，应用SPSS 26.0软件进行相关分析，运用PROCESS宏程序中的Model 4进行中介效应分析和Model 58进行调节效应分析。结果中青年维持性血液透析患者心理痛苦检出率为59.7%，病耻感、自尊、家庭亲密度、心理痛苦之间存在两两相关关系（均P<0.001）。自尊在病耻感与心理痛苦间起部分中介作用（β=-0.22，t=-3.85，P<0.001），家庭亲密度调节了这一中介过程的前半路径（β=0.19，t=5.08，P<0.001），高的家庭亲密度会减弱病耻感对自尊的影响，反之，则增强。结论中青年维持性血液透析患者病耻感不仅能直接正向预测心理痛苦，还能通过自尊对其产生间接的影响，家庭亲密度调节了这一过程。可采取叙事家庭疗法降低患者病耻感，提高家庭亲密度，保护自尊，减轻心理痛苦。

关键词: 慢性肾脏疾病, 维持性血液透析, 病耻感, 自尊, 家庭亲密度, 心理痛苦, 护理

Abstract:

Objective To explore the mediating effect of self-esteem on the relationship between stigma and psychological distress in young and middle-aged maintenance hemodialysis patients，and the moderating effect of family cohesion. Methods The Stigma Scale，Self-esteem Scale，Family Cohesion Scale and Psychological Pain Thermometer were used to investigate 382 young and middle-aged maintenance hemodialysis patients from 4 hospitals in Fuzhou and Putian by convenience sampling from June to December，2021. The correlation analysis was carried out by SPSS 26.0 software. Model 4 in PROCESS macro program was used to analyze the mediating effect and Model 58 was used to analyze the moderating effect. Results The detection rate of psychological distress was 59.7% in young and middle-aged maintenance hemodialysis patients. There were significant correlations among stigma，self-esteem，family cohesion and psychological distress（P<0.001）. Self-esteem partially mediated the relationship between stigma and psychological distress（β=-0.22，t=-3.85，P<0.001），and family cohesion moderated the mediating effect（β=0.19，t=5.08，P<0.001）. High family cohesion weakened the effect of stigma on self-esteem，and vice versa. Conclusion Stigma is not only a direct positive predictor of psychological distress，but also has an indirect effect on psychological distress through self-esteem，and family cohesion moderates this process. Narrative family therapy can be used to reduce stigma，improve family cohesion，protect patients’ self-esteem and alleviate the psychological pain of young and middle-aged maintenance hemodialysis patients.

Key words: Chronic Kidney Disease, Maintenance Hemodialysis, Stigma, Self-Esteem, Family Cohesion, Psychological Distress, Nursing Care

何丽芳, 李倩倩, 甘香. 病耻感对中青年维持性血液透析患者心理痛苦的影响[J]. 中华护理杂志, 2022, 57(21): 2585-2591.

HE Lifang, LI Qianqian, GAN Xiang. Influence of stigma on psychological distress among young and middle-aged maintenance hemodialysis patients[J]. Chinese Journal of Nursing, 2022, 57(21): 2585-2591.

图/表 6

表1 中青年维持性血液透析患者病耻感、自尊、家庭亲密度、心理痛苦温度计各量表得分和百分制分数（分，$\bar{x} \pm s$s，n=382）

Table 1 The average scores of stigma, self-esteem, family cohesion，psychological pain thermometer and their hundred-mark scores in young and middle-aged maintenance hemodialysis patients（score，$\bar{x} \pm s$，n=382）

表2 中青年维持性血液透析患者病耻感、自尊、家庭亲密度、心理痛苦变量间相关分析（n=382，r 值）

Table 2 Correlation analysis of stigma，self-esteem， family intimacy and psychological pain in young and middle-aged maintenance hemodialysis patients （n=382，r valure）

表3 自尊在病耻感与心理痛苦间的中介作用检验（n=382）

Table 3 Test of the mediating effect of self-esteem on stigma and psychological distress（n=382）

表4 家庭亲密度对中介模型的调节作用检验（n=382）

Table 4 Test of moderating effect of family cohesion on the mediating model（n=382）

图1 自尊的中介作用及家庭亲密度的调节作用模型图

Figure 1 The mediating role of self-esteem and the moderating role of family cohesion 1）P<0.01;2）P<0.05。

图2 家庭亲密度在病耻感与自尊之间的调节作用

Figure 2 The moderating role of family cohesion between stigma and self-esteem

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