Arpin K, Fitch M, Browne G B, Corey P
Graduate Department of Nursing, Faculty of Nursing, University of Toronto, Ontario, Canada.
J Clin Epidemiol. 1990;43(4):373-83. doi: 10.1016/0895-4356(90)90123-7.
This study estimated the prevalence of poor adjustment and family dysfunction among three chronically ill clinic patient populations and assessed the biological, situational, social and psychological variables which most explained poor adjustment. Recently referred subjects were approached and 216 chronically ill subjects (from oncology, rheumatology and gastroenterology clinics) completed a Meaning of Illness Questionnaire, the McMaster Family Assessment Device, and the Psychosocial Adjustment to Illness Self-report Scale. In addition, information describing their biological, disease and socioeconomic status was obtained from the clinic record. Respondents were generally representative of other new referrals to the clinics (ineligible for the subsequent trial) in disease characteristics but uniformly came from a more advantaged socioeconomic situation and were better adjusted to illness. Subjects from the three clinics were comparable on meaning, family function and adjustment variables. The proportion of subjects with family dysfunction was 30% and with poor adjustment to illness was 36%, high by community standards. Nevertheless, healthy family functioning and high levels of positive adjustment to chronic illness prevailed and were remarkably similar across clinic settings. Severity or type of disease was not related to adjustment outcomes nor to the level of observed disability. Rather, as hypothesized, meaning given the illness, followed by family function, and disability variables combined to explain 57% of the variance in adjustment outcomes. An intervention designed to improve family function and the meaning given illness was judged suitable.
本研究估计了三类慢性病门诊患者群体中适应不良和家庭功能障碍的患病率，并评估了最能解释适应不良的生物学、情境、社会和心理变量。研究人员联系了近期转诊的受试者，216名慢性病患者（来自肿瘤学、风湿病学和胃肠病学诊所）完成了《疾病意义问卷》《麦克马斯特家庭评估工具》以及《疾病心理社会适应自我报告量表》。此外，从临床记录中获取了描述他们生物学、疾病和社会经济状况的信息。在疾病特征方面，受访者总体上代表了诊所其他新转诊患者（无资格参加后续试验），但他们均来自社会经济状况更优越的群体，并且对疾病的适应情况更好。来自三个诊所的受试者在疾病意义、家庭功能和适应变量方面具有可比性。家庭功能障碍患者的比例为30%，疾病适应不良患者的比例为36%，按社区标准来看偏高。然而，健康的家庭功能和对慢性病的高度积极适应情况普遍存在，并且在各诊所环境中非常相似。疾病的严重程度或类型与适应结果以及观察到的残疾水平均无关。相反，正如所假设的那样，赋予疾病的意义、其次是家庭功能以及残疾变量共同解释了适应结果中57%的变异。一项旨在改善家庭功能和赋予疾病的意义的干预措施被认为是合适的。
