基于结构方程模型构建肺癌患者心理困扰影响因素模型

Constructing risk prediction model of psychological distress in lung cancer patients based on structural equation model

摘要:

目的：采用结构方程模型构建肺癌患者心理困扰影响因素模型。方法：便利抽取441名住院肺癌患者，采用问卷或量表调查患者的一般资料、心理困扰、病耻感、疾病感知、社会支持、知觉压力、应对方式、正念及自尊，并使用结构方程分析上述因素与心理困扰的关系。结果：基于结构方程模型建立的肺癌患者心理困扰影响因素模型拟合度较好，结果显示：社会支持对心理困扰有直接（β=-0.540，P=0.001）和间接负向（β=-0.003）效应，知觉压力对心理困扰有直接（β=0.181，P=0.001）和间接正向（β=0.004）效应，应对方式对心理困扰有直接正向效应（β=0.114，P=0.005），正念（β=-0.021）与病耻感（β=-0.201）对心理困扰有间接负向效应，文化程度对心理困扰有直接（β=0.147，P=0.003）和间接正向（β=0.026）效应，家庭收入对心理困扰有直接负向（β=-0.105，P=0.027）和间接正向（β=0.108）效应，年龄对心理困扰有直接负向效应（β=-0.101，P=0.019），职业状态对心理困扰有直接正向效应（β=0.094，P=0.032），饮酒史（β=0.031）与肿瘤分期（β=0.031）对心理困扰有间接正向效应。结论：本研究构建出的肺癌患者心理困扰影响因素模型理论可接受，因素的路径分析表明肺癌患者心理困扰受多种因素影响，社会支持、应对方式、知觉压力、正念、病耻感、年龄、家庭收入、文化程度、职业状态、肿瘤分期是肺癌患者心理困扰的重要影响因素。

Abstract:

Objective：To develop the risk prediction model of psychological distress in lung cancer patients by using structural equa－tion model. Methods：A total of 441 hospitalized patients with lung cancer were randomly selected and questionnaires or scales were used to investigate the general information，psychological distress，stigma，illness perception，social support，perceived stress，coping style，mindfulness and self-esteem. Structural equation model was used to analyze the association between those factors and psycho－logical distress. Results：The structural equation model for psychological distress in lung cancer patients had a good fitting degree and its results showed that social support had a direct negative effect（β=-0.540，P=0.001） and an indirect negative effect（β=-0.003） on psychological distress，perceived stress had a direct negative effect（β=0.181，P=0.001） and an indirect negative effect（β=0.004） on psychological distress，coping style had a direct positive effect（β=0.114，P=0.005），mindfulness（β=-0.021） and stigma（β=-0.201） had indirect negative effect on psychological distress，educational level had a direct（β=0.147，P=0.003） and an indirect positive effect（β=0.026） on psychological distress，family income had a direct negative effect（β=-0.105，P=0.027） and an indirect positive effect（β=0.108） on psychological distress，age had a direct negative effect（β=-0.101，P=0.019） on psychological distress，occupational status had a positive effect（β=0.094，P=0.032） on psychological distress，and drinking history（β=0.031） and cancer stage（β=0.031） had an indirect effect on psychological distress. Conclusion：The risk prediction model which was con－structed in the present study is acceptable for patients. Path analysis of all risk factors suggests that the psychological dis－tress of lung cancer patients is influenced by many different factors in different ways and he social support，coping style，mindfulness，stigma，age，family income，educational level，occupational status，drinking history and cancer stage are key predictors