Knowles Simon R, Tribbick Davina, Connell William R, Castle David, Salzberg Michael, Kamm Michael A
Simon R. Knowles, PhD, M(Clin), Faculty of Life and Social Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia; Departments of Gastroenterology and Mental Health, St Vincent's Hospital, Melbourne, Australia; and University of Melbourne, Melbourne, Victoria, Australia. Davina Tribbick, B.Soc Sci Hons, Faculty of Life and Social Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia. William R. Connell, MD, Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia. David Castle, MD, Department of Mental Health, St Vincent's Hospital, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia; and Cardiovascular Research Centre, Australian Catholic University, Melbourne, Victoria, Australia. Michael Salzberg, MBBS, Department of Mental Health, St Vincent's Hospital, Melbourne, Australia; and University of Melbourne, Melbourne, Victoria, Australia. Michael A. Kamm, MD, PhD, Department of Gastroenterology, St Vincent's Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Victoria, Australia; and Imperial College, London, United Kingdom.
J Wound Ostomy Continence Nurs. 2017 Jan/Feb;44(1):69-73. doi: 10.1097/WON.0000000000000295.
PURPOSE: In a previous paper focusing on the common sense model (CSM) for ostomies in people with inflammatory bowel disease, cancer, and diverticular disease, we reported that (1) illness perceptions were directly related to illness status, and both illness perceptions and coping strategies (maladaptive coping) directly influenced anxiety and depression; (2) self-efficacy and emotion-focused coping style ameliorated depression but not anxiety; and (3) time since surgery was associated with improved health status, a reduction in negative illness perceptions, and increased emotional-focused coping. The purpose of this article was to perform a secondary analysis with the addition of a stoma quality-of-life measure. SUBJECTS AND SETTING: One hundred fifty adults with ostomies (54 males, and 96 females; mean age = 44 years) completed an online survey. DESIGN: Descriptive, cross-sectional, questionnaire-based study. METHODS: Participants completed the Health Perceptions Questionnaire, Brief Illness Perceptions Questionnaire, Carver Brief Coping Questionnaire, Stoma Self-efficacy Scale, Hospital Anxiety and Depression Scale, and the Stoma Quality-of-Life Scale. RESULTS: Using structural equation modeling, the final model provided an excellent fit to the data (χ27 = 19.20, P = .37, χ/N = 1.08, Standardized Root Mean Square Residual (SRMR) <0.03, Steiger-Lind Root Mean Square Error of Approximation (RMSEA) <0.03, Goodness of Fit Index (GFI) >0.98). Extending upon our previous paper, self-efficacy, anxiety, and depression were found to have a significant direct influence on stoma-specific quality of life (β= .47, P < .001, β=-.25, P < .001, and β=-.35, P < .001, respectively). CONCLUSIONS: The findings of this secondary analysis extends our previous report by identifying that, consistent with the CSM, illness status, illness perceptions, and coping influence health-related quality of life via self-efficacy, anxiety, and depression. The results suggest that to improve an individual's quality of life, psychological interventions should target the psychological processes underpinning mental illness and also help develop and maintain an individual's self-efficacy in relation to ostomy care.
目的：在之前一篇聚焦于炎症性肠病、癌症和憩室病患者造口术常识模型（CSM）的论文中，我们报告称：（1）疾病认知与疾病状态直接相关，且疾病认知和应对策略（适应不良应对）均直接影响焦虑和抑郁；（2）自我效能感和以情绪为中心的应对方式可改善抑郁，但不能改善焦虑；（3）术后时间与健康状况改善、负面疾病认知减少以及以情绪为中心的应对增加相关。本文的目的是在增加一项造口生活质量测量指标的基础上进行二次分析。 研究对象与研究背景：150名有造口术的成年人（54名男性，96名女性；平均年龄 = 44岁）完成了一项在线调查。 研究设计：基于问卷的描述性横断面研究。 方法：参与者完成了健康认知问卷、简短疾病认知问卷、卡弗简短应对问卷、造口自我效能量表、医院焦虑抑郁量表以及造口生活质量量表。 结果：使用结构方程模型，最终模型与数据拟合良好（χ27 = 19.20，P = 0.37，χ/N = 1.08，标准化均方根残差（SRMR）<0.03，斯泰格 - 林德近似均方根误差（RMSEA）<0.03，拟合优度指数（GFI）>0.98）。在我们之前论文的基础上进一步研究发现，自我效能感、焦虑和抑郁对造口特异性生活质量有显著直接影响（β分别为0.47，P < 0.001；β为 - 0.25，P < 0.001；β为 - 0.35，P < 0.001）。 结论：这项二次分析的结果扩展了我们之前的报告，确定了与常识模型一致的是，疾病状态、疾病认知和应对通过自我效能感、焦虑和抑郁影响与健康相关的生活质量。结果表明，为改善个体生活质量，心理干预应针对精神疾病背后的心理过程，同时帮助个体培养并维持与造口护理相关的自我效能感。
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