York University, Toronto, ON, Canada.
Hospital for Sick Children, Toronto, ON, Canada.
Pain. 2018 Feb;159(2):314-330. doi: 10.1097/j.pain.0000000000001092.
This article, based on 2 companion studies, presents an in-depth analysis of preschoolers coping with vaccination pain. Study 1 used an autoregressive cross-lagged path model to investigate the dynamic and reciprocal relationships between young children's coping responses (how they cope with pain and distress) and coping outcomes (pain behaviors) at the preschool vaccination. Expanding on this analysis, study 2 then modeled preschool coping responses and outcomes using both caregiver and child variables from the child's 12-month vaccination (n = 548), preschool vaccination (n = 302), and a preschool psychological assessment (n = 172). Summarizing over the 5 path models and post hoc analyses over the 2 studies, novel transactional and longitudinal pathways predicting preschooler coping responses and outcomes were elucidated. Our research has provided empirical support for the need to differentiate between coping responses and coping outcomes: 2 different, yet interrelated, components of "coping." Among our key findings, the results suggest that a preschooler's ability to cope is a powerful tool to reduce pain-related distress but must be maintained throughout the appointment; caregiver behavior and poorer pain regulation from the 12-month vaccination appointment predicted forward to preschool coping responses and/or outcomes; robust concurrent relationships exist between caregiver behaviors and both child coping responses and outcomes, and finally, caregiver behaviors during vaccinations are not only critical to both child pain coping responses and outcomes in the short- and long-term but also show relationships to broader child cognitive abilities as well.
这篇文章基于两项配套研究，深入分析了幼儿应对疫苗接种疼痛的情况。研究 1 使用自回归交叉滞后路径模型，探讨了幼儿应对方式（应对疼痛和不适的方式）与疫苗接种时的应对结果（疼痛行为）之间的动态和相互关系。在此分析的基础上，研究 2 进一步使用儿童 12 个月疫苗接种（n=548）、幼儿园疫苗接种（n=302）和幼儿园心理评估（n=172）的 caregiver和儿童变量，对幼儿园应对方式和结果进行建模。对这 5 个路径模型进行总结，并对这两项研究进行事后分析，揭示了预测幼儿应对方式和结果的新的交互和纵向途径。我们的研究为需要区分应对方式和应对结果提供了实证支持：这是“应对”的两个不同但相互关联的组成部分。在我们的主要发现中，结果表明，幼儿的应对能力是减轻与疼痛相关的痛苦的有力工具，但必须在整个预约过程中保持；12 个月疫苗接种预约时的 caregiver 行为和较差的疼痛调节能力预示着幼儿在幼儿园的应对方式和结果； caregiver 行为与儿童的应对方式和结果之间存在强大的同期关系，最后，接种疫苗时 caregiver 的行为不仅对儿童的短期和长期疼痛应对方式和结果至关重要，而且还与更广泛的儿童认知能力有关。
