基于疾病共同感知模型初步考察慢性乙型和丙型肝炎的疾病分期、疾病感知、应对策略与心理发病之间的关系。
Preliminary examination of the relations between disease stage, illness perceptions, coping strategies, and psychological morbidity in chronic hepatitis B and C guided by the Common-Sense Model of Illness.
机构信息
Department of Gastroenterology, Faculty of Medicine, Gazi University, Ankara.
Department of Gastroenterology, Faculty of Medicine, Abant İzzet Baysal University, Bolu.
出版信息
Eur J Gastroenterol Hepatol. 2021 Jun 1;33(6):932-939. doi: 10.1097/MEG.0000000000002131.
BACKGROUND AND AIMS
Chronic viral hepatitis (CVH) has a spectrum from asymptomatic disease to cirrhosis and hepatocellular carcinoma. In our study, we aimed to establish the relations between disease stage, illness perception, coping strategies and psychological morbidity in CVH.
METHODS
A total of 182 patients with chronic hepatitis B (CHB) (n = 136) and chronic hepatitis C (CHC) (n = 46) were enrolled. Illness perceptions were measured with the Brief Illness Perceptions Questionnaire. Coping strategies were measured with the Carver Brief Coping Questionnaire. Anxiety and depression were measured with the Hospital Anxiety and Depression Scale. Relations were evaluated by structural equation modeling (SEM).
RESULTS
In CHB, combining the questionnaire data using SEM resulted in a final model with an excellent fit [χ2 (2) = 0.00, P = 1.000, χ2/N = 0.00, root mean square error of approximation (RMSEA) < 0.001, comparative fit index (CFI) = 1.000, goodness-of-fit index (GFI) = 1.000]. Disease stage had a significant direct influence on illness perceptions (β = 0.23, P = 0.006). Illness perceptions had a significant direct influence on emotional coping strategy, depression and anxiety (β = 0.20, P = 0.019; β = 0.33, P < 0.001; β = 0.59, P < 0.001, respectively). While the use of emotional coping strategies was associated significantly (P = 0.01) with the presence of anxiety, problem-focused coping strategy was associated with depression (P = 0.004). In CHC, SEM resulted in a final model with an excellent fit [χ2 (2) = 0.078, P = 0.962, χ2/N = 0.039, RMSEA<0.001, CFI = 1.000, GFI = 0.999]. Disease stage did not have a significant direct influence on illness perceptions (P > 0.05). Illness perceptions had a significant direct influence on depression and anxiety (β = 0.27, P = 0.023; β = 0.44, P < 0.001, respectively).
CONCLUSION
The psychological consequences of the disease vary depending on the person's perception of illness and coping strategies.
背景与目的
慢性病毒性肝炎（CVH）的病程从无症状疾病到肝硬化和肝细胞癌不等。在本研究中，我们旨在建立 CVH 中疾病阶段、疾病认知、应对策略和心理发病之间的关系。
方法
共纳入 182 例慢性乙型肝炎（CHB）（n=136）和慢性丙型肝炎（CHC）（n=46）患者。采用Brief Illness Perceptions Questionnaire 评估疾病认知，采用 Carver Brief Coping Questionnaire 评估应对策略，采用 Hospital Anxiety and Depression Scale 评估焦虑和抑郁。采用结构方程模型（SEM）评估相关性。
结果
在 CHB 中，使用 SEM 结合问卷调查数据得到了一个拟合度极佳的最终模型[χ2（2）=0.00，P=1.000，χ2/N=0.00，近似误差均方根（RMSEA）<0.001，比较拟合指数（CFI）=1.000，拟合优度指数（GFI）=1.000]。疾病阶段对疾病认知有显著的直接影响（β=0.23，P=0.006）。疾病认知对情绪应对策略、抑郁和焦虑有显著的直接影响（β=0.20，P=0.019；β=0.33，P<0.001；β=0.59，P<0.001）。情绪应对策略与焦虑显著相关（P=0.01），而问题导向应对策略与抑郁显著相关（P=0.004）。在 CHC 中，SEM 得到了一个拟合度极佳的最终模型[χ2（2）=0.078，P=0.962，χ2/N=0.039，RMSEA<0.001，CFI=1.000，GFI=0.999]。疾病阶段对疾病认知没有显著的直接影响（P>0.05）。疾病认知对抑郁和焦虑有显著的直接影响（β=0.27，P=0.023；β=0.44，P<0.001）。
结论
疾病的心理后果取决于个体对疾病的认知和应对策略。
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