基于 Lazarus 应激与应对理论的食管癌照顾者负担、获益感与焦虑抑郁的结构方程模型构建。

The construction of the structural equation model of burden, benefit finding, and anxiety-depression of esophageal cancer caregivers based on Lazarus stress and coping theory.

机构信息

Wuxi School of Medicine, Jiangnan University, Wuxi, China; Department of Anesthesiology and Perioperative Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China.

Wuxi School of Medicine, Jiangnan University, Wuxi, China.

出版信息

Ann Palliat Med. 2021 Jul;10(7):7644-7652. doi: 10.21037/apm-21-1466.

DOI:10.21037/apm-21-1466

PMID:34353052

Abstract

BACKGROUND

A large number of studies have shown that the assignment of long-term care duties brings great pressure and negative emotions to caregivers of cancer patients, and also affects the quality of care. Lazarus and Folkman's stress and coping theory holds that the process of cognition and evaluation of stress is key to the stress response when a stressor acts on individuals. This study is to explore the mediating effect of benefit finding between caregiver burden and anxiety-depression of esophageal cancer caregivers, according to a model hypothesis constructed based on stress and coping theory. The design of this study involved correlation and theoretical testing using a structural equation model.

METHODS

A total of 228 pairs of esophageal cancer patients from 2 tertiary hospitals and their family caregivers were recruited in this study from May 2020 to January 2021. A questionnaire survey was conducted using the general information questionnaire, the caregiver burden inventory (CBI), the benefit finding scale (BFS), and the hospital anxiety and depression scale (HADS).

RESULTS

A good fitting model [chi-square (χ2)/degrees of freedom (df) =2.212, root mean square error of approximation (RMSEA) =0.07, comparative fit index (CFI) =0.976, Tucker-Lewis index (TLI) =0.964, goodness of fit (GFI) =0.954, normed fit index (NFI) =0.957] indicated the mediating effect of benefit finding between caregiver burden and anxiety-depression of esophageal cancer caregivers. A higher level of benefit finding had a negative effect on caregiver burden and anxiety-depression, which reduced the burden and psychological distress of caregivers. The theoretical hypothesis was validated.

CONCLUSIONS

Clinical nurses should pay attention to the benefit finding level of caregivers. For caregivers with low-level of benefit finding, intervention measures should be taken to improve the psychological cognitive level of caregivers, which can ultimately improve the quality of life of patients.

摘要

背景

大量研究表明，长期照护任务给癌症患者的照顾者带来了巨大的压力和负面情绪，也影响了照护质量。拉扎勒斯和福克曼的压力与应对理论认为，当压力源作用于个体时，认知和评估压力的过程是压力反应的关键。本研究依据压力与应对理论构建的模型假设，探讨照顾者负担与食管癌照顾者焦虑抑郁之间的获益寻求的中介效应。本研究设计采用结构方程模型进行相关和理论检验。

方法

本研究于 2020 年 5 月至 2021 年 1 月，从 2 所三级医院选取 228 对食管癌患者及其家庭照顾者进行问卷调查，问卷包括一般资料问卷、照顾者负担量表（CBI）、获益寻求量表（BFS）、医院焦虑抑郁量表（HADS）。

结果

拟合优度较好的模型[卡方自由度比（χ2/df）=2.212，近似误差均方根（RMSEA）=0.07，比较拟合指数（CFI）=0.976，塔克-刘易斯指数（TLI）=0.964，拟合优度指数（GFI）=0.954，归一化拟合指数（NFI）=0.957]表明获益寻求在照顾者负担与食管癌照顾者焦虑抑郁之间起中介作用。较高水平的获益寻求对照顾者负担和焦虑抑郁有负向影响，降低了照顾者的负担和心理困扰。理论假设得到验证。