癌症、良性疾病和非肿瘤手术患者的心理一致感、心理健康和术前医院及手术相关压力感知。
Sense of coherence, mental well-being and perceived preoperative hospital and surgery related stress in surgical patients with malignant, benign, and no neoplasms.
机构信息
Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.
Charité Comprehensive Cancer Center, Charité - Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
出版信息
BMC Psychiatry. 2020 Nov 27;20(1):567. doi: 10.1186/s12888-020-02953-x.
BACKGROUND
This prospective, cross-sectional, observational study examined associations between sense of coherence (SOC), mental well-being, and perceived preoperative hospital and surgery related stress of surgical patients with malignant, benign, and no neoplasms. The objective was to assess a putative association between SOC and preoperative stress, and to test for a statistical mediation by mental well-being.
METHOD
The sample consisted of 4918 patients from diverse surgical fields, of which 945 had malignant neoplasms, 333 benign neoplasms, and 3640 no neoplasms. For each subsample, we conducted simple mediation analyses to test an indirect effect of SOC on preoperative stress mediated by mental well-being. The models were adjusted for age, gender, and essential medical factors.
RESULTS
Patient groups did not differ significantly regarding degrees of SOC and mental well-being (SOC, M [SD]: 12.31 [2.59], 12.02 [2.62], 12.18 [2.57]; mental well-being M [SD]: 59.26 [24.05], 56.89 [22.67], 57.31 [22.87], in patients with malignant, benign, and without neoplasms, respectively). Patients without neoplasms reported significantly lower stress (4.19 [2.86], M [SD]) than those with benign (5.02 [3.03], M [SD]) and malignant neoplasms (4.99 [2.93], M [SD]). In all three mediation models, SOC had significant direct effects on stress, with higher SOC being associated with lower stress (- 0.3170 [0.0407], - 0.3484 [0.0752], - 0.2919 [0.0206]; c' [SE], p < 0.001 in patients with malignant, benign, and without neoplasms, respectively). In patients with malignant neoplasms and without neoplasms, SOC showed small indirect effects on stress that were statistically mediated by well-being. Higher SOC was related to higher well-being, which in turn was related to lower stress. In patients with benign neoplasms, however, no significant indirect effects of SOC were found.
CONCLUSIONS
SOC was directly associated with lower perceived hospital and surgery related stress, over and above the direct and mediation effects of mental well-being. Because the data are cross-sectional, conclusions implying causality cannot be drawn. Nevertheless, they indicate important relationships that can inform treatment approaches to reduce elevated preoperative stress by specifically addressing low SOC.
TRIAL REGISTRATION
clinicaltrials.gov Identifier: NCT01357694 . Registered 18 May 2011.
背景
本前瞻性、横断面、观察性研究考察了癌症患者、良性肿瘤患者和非肿瘤患者的应对感（SOC）、心理健康和术前医院及手术相关压力之间的关联。目的是评估 SOC 与术前压力之间的假定关联，并检验心理健康是否存在统计中介作用。
方法
该样本由来自不同外科领域的 4918 名患者组成，其中 945 名患有恶性肿瘤，333 名患有良性肿瘤，3640 名无肿瘤。对于每个亚组，我们进行简单的中介分析，以检验 SOC 通过心理健康对术前压力的间接效应。模型调整了年龄、性别和基本医疗因素。
结果
各组患者的 SOC 和心理健康程度无显著差异（SOC，M[SD]：12.31[2.59]、12.02[2.62]、12.18[2.57]；心理健康，M[SD]：59.26[24.05]、56.89[22.67]、57.31[22.87]，恶性肿瘤、良性肿瘤和无肿瘤患者）。无肿瘤患者报告的压力明显低于良性肿瘤患者（4.19[2.86]，M[SD]）和恶性肿瘤患者（4.99[2.93]，M[SD]）。在所有三个中介模型中，SOC 对压力均有显著的直接影响，SOC 越高，压力越低（-0.3170[0.0407]、-0.3484[0.0752]、-0.2919[0.0206]；c'[SE]，恶性肿瘤、良性肿瘤和无肿瘤患者的 p 值均<0.001）。在患有恶性肿瘤和无肿瘤的患者中，SOC 对压力的间接效应较小，并且通过心理健康得到统计学上的中介。较高的 SOC 与较高的心理健康相关，而较高的心理健康与较低的压力相关。然而，在患有良性肿瘤的患者中，并未发现 SOC 的显著间接效应。
结论
SOC 与感知到的医院和手术相关压力呈直接相关，超过了心理健康的直接和中介作用。由于数据是横断面的，因此不能得出因果关系的结论。尽管如此，它们表明了重要的关系，可以通过专门针对 SOC 较低的治疗方法来减轻术前升高的压力，为这种治疗方法提供信息。
试验注册
clinicaltrials.gov 标识符：NCT01357694。2011 年 5 月 18 日注册。
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