Myaskovsky Larissa, Dew Mary Amanda, Switzer Galen E, McNulty Mary L, DiMartini Andrea F, McCurry Kenneth R
Department of Psychiatry, Suite 502 Iroquois Building, 3600 Forbes Avenue, Pittsburgh, PA 15213, USA.
Soc Sci Med. 2005 May;60(10):2321-32. doi: 10.1016/j.socscimed.2004.10.001. Epub 2004 Dec 15.
Although numerous studies have examined coping strategies and quality of life (QOL) among patients with chronic diseases and their family caregivers, no studies have examined the reciprocal effects of patient and caregiver coping strategies on their dyad partner's QOL. Because most people who cope with stressful health experiences do so within the context of interpersonal relationships, it is important to understand the ways in which the two partners' coping strategies may reciprocally affect each other's QOL. Adult lung transplant candidates and their caregivers (N=114 pairs) participated in semi-structured interviews that included measures of QOL and coping with patients' health-related problems. Multivariate, canonical correlation analyses were performed to examine unique patterns of associations between coping and QOL in patient-caregiver dyads. Better patient QOL, across multiple domains, was associated with better caregiver QOL. Multiple elements of patients' coping, including greater use of active coping and emotionally oriented coping were related to generally poorer patient QOL in psychosocial and physical domains. Similarly, caregivers who used more emotionally oriented coping had poorer QOL. There was no statistically reliable relationship between either (a) patient and caregiver use of coping strategies, or (b) caregiver coping and patient QOL. However, patients' coping strategies were important correlates of caregivers' QOL. These findings belie common clinical beliefs that family members' coping responses to patients' health are likely to affect patient well-being. Instead, patients' coping and QOL may be critical for understanding caregiver well-being, especially in the current era in which caregivers are assuming increased responsibility for providing patient care.
尽管众多研究已考察慢性病患者及其家庭照料者的应对策略和生活质量（QOL），但尚无研究考察患者和照料者的应对策略对其二元关系伙伴生活质量的相互影响。由于大多数应对压力性健康经历的人是在人际关系背景下进行的，因此了解双方的应对策略可能相互影响对方生活质量的方式很重要。成年肺移植候选者及其照料者（N = 114对）参与了半结构化访谈，其中包括生活质量测量以及应对患者健康相关问题的内容。进行了多变量典型相关分析，以检验患者 - 照料者二元组中应对与生活质量之间独特的关联模式。多个领域中患者更好的生活质量与照料者更好的生活质量相关。患者应对的多个要素，包括更多地使用积极应对和情感导向应对，在心理社会和身体领域通常与患者较差的生活质量相关。同样，使用更多情感导向应对的照料者生活质量较差。（a）患者和照料者对应对策略的使用，或（b）照料者的应对与患者的生活质量之间均无统计学上可靠的关系。然而，患者的应对策略是照料者生活质量的重要相关因素。这些发现与常见的临床观念相悖，即家庭成员对患者健康的应对反应可能会影响患者的幸福感。相反，患者的应对和生活质量可能对于理解照料者的幸福感至关重要，尤其是在当前这个照料者承担着越来越多患者护理责任的时代。
