Chew Judith, Haase Anne M, Carpenter John
School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, United Kingdom.
School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, United Kingdom.
Epilepsy Behav. 2017 Jan;66:19-26. doi: 10.1016/j.yebeh.2016.09.039. Epub 2016 Dec 14.
As young people experience added demands from living with epilepsy, which may lead to poor psychosocial adjustment, it is essential to examine mechanisms of change to provide practitioners with knowledge to develop effective interventions. The aim of this study was to examine individual and family-level factors - stress and illness perceptions, coping behaviors and family resilience - that promote or maintain young people's self-esteem.
From November 2013 to August 2014, young people attending a neurology clinic in KK Women's and Children's Hospital, Singapore, participated in a cross-sectional survey (n=152; 13-16years old). Multiple mediation analyses were conducted to evaluate whether these variables mediated the relationship between illness severity (i.e., low, moderate, high) and self-esteem.
Multiple mediation analyses demonstrated that illness severity had a direct effect on young people's self-esteem. Compared to those with moderate illness severity (reference group), young people with low severity had significantly higher self-esteem (c=3.42, p<0.05); while those with high severity had a more negative view of themselves (c=-3.93, p<0.001). Illness severity also had an indirect influence on self-esteem through its effects on mediators, such as perceived stress, illness perceptions and family resilience (D: Total ab=3.46, 95% CI 1.13, 5.71; D: Total ab=-2.80, 95% CI -4.35, -1.30). However, young people's coping levels did not predict their self-esteem, when accounting for the effects of other variables.
The continued presence of seizure occurrences is likely to place greater demands on young people and their families: in turn, increased stress and negative illness perceptions negatively affected family processes that promote resilience. As the mediating effect of these modifiable factors were above and beyond the contributions of illness characteristics and young people's levels of coping, this has implications for developing individual and family interventions aimed to support young people living with epilepsy.
由于年轻人在患有癫痫的情况下会面临更多生活需求，这可能导致心理社会适应不良，因此必须研究变化机制，以便为从业者提供知识，从而制定有效的干预措施。本研究的目的是考察促进或维持年轻人自尊的个体和家庭层面因素——压力和疾病认知、应对行为及家庭复原力。
2013年11月至2014年8月，新加坡KK妇女儿童医院神经科门诊的年轻人参与了一项横断面调查（n = 152；13 - 16岁）。进行了多项中介分析，以评估这些变量是否介导了疾病严重程度（即低、中、高）与自尊之间的关系。
多项中介分析表明，疾病严重程度对年轻人的自尊有直接影响。与疾病严重程度为中度的年轻人（参照组）相比，疾病严重程度低的年轻人自尊显著更高（c = 3.42，p < 0.05）；而疾病严重程度高的年轻人对自己的看法更消极（c = -3.93，p < 0.001）。疾病严重程度还通过其对中介变量（如感知压力、疾病认知和家庭复原力）的影响，对自尊产生间接影响（D：总ab = 3.46，95% CI 1.13，5.71；D：总ab = -2.80，95% CI -4.35，-1.30）。然而，在考虑其他变量的影响时，年轻人的应对水平并不能预测他们的自尊。
癫痫发作的持续存在可能给年轻人及其家庭带来更大的需求：反过来，压力增加和负面的疾病认知会对促进复原力的家庭过程产生负面影响。由于这些可改变因素的中介作用超出了疾病特征和年轻人应对水平的影响，这对制定旨在支持癫痫患者的个体和家庭干预措施具有启示意义。
