Department of Cardiology, Affiliated Hospital of Yangzhou University, No. 368, Hanjiang Middle Road, Yangzhou, Jiangsu 225000, China.
School of Nursing, Yangzhou University, No. 136, Jiangyang Middle Road, Yangzhou, Jiangsu 225000, China.
Eur J Cardiovasc Nurs. 2023 Sep 5;22(6):638-646. doi: 10.1093/eurjcn/zvad024.
Studies have shown that symptom perception is associated with fear of progression (FOP) in many diseases and regulated by psychological factors. Whether the association also occurs in patients with chronic heart failure (HF) remains unclear, as do the specific mechanisms involved. This study aimed to explore the multiple mediation effects of self-care confidence and mental resilience on the relationship between symptom perception and FOP in Chinese patients with chronic HF.
A cross-sectional study was conducted on 247 patients with chronic HF recruited from two hospitals in Yangzhou, China. The sociodemographic and clinical data and self-reported questionnaires including heart failure somatic perception, fear of progression, self-care confidence, and mental resilience were collected. Data analysis relating to correlations and mediating effects was carried out by SPSS 26.0 and PROCESS v3.3 macro. Fear of progression was positively correlated with symptom perception (r = 0.599, P < 0.01), but negatively correlated with self-care confidence (r = -0.663, P < 0.01), mental resilience-strength (r = -0.521, P < 0.01), and mental resilience-toughness (r = -0.596, P < 0.01). The relationship between symptom perception and FOP was mediated by self-care confidence [effect = 0.095, 95% confidence interval (CI) (0.054-0.142)] and mental resilience-toughness [effect = 0.033, 95% CI (0.006-0.074)], respectively, and together in serial [effect = 0.028, 95% CI (0.011-0.050)]. The proportion of the mediating effect accounting for the total effect was 31.0%.
Self-care confidence and mental resilience-toughness were multiple mediators of the association between symptom perception and FOP in patients with chronic HF. Interventions targeted at strengthening self-care confidence and mental resilience may be beneficial for the reduction of FOP, especially with regard to toughness.
研究表明，在许多疾病中，症状感知与进展恐惧（FOP）有关，并受心理因素调节。在慢性心力衰竭（HF）患者中，这种关联是否存在以及涉及的具体机制尚不清楚。本研究旨在探讨自我护理信心和心理适应力对中国慢性 HF 患者症状感知与 FOP 之间关系的多重中介效应。
对来自中国扬州两家医院的 247 例慢性 HF 患者进行了横断面研究。收集了社会人口统计学和临床数据以及自我报告的问卷，包括心力衰竭躯体感知、进展恐惧、自我护理信心和心理适应力。使用 SPSS 26.0 和 PROCESS v3.3 宏进行了与相关性和中介效应相关的数据分析。进展恐惧与症状感知呈正相关（r = 0.599，P < 0.01），但与自我护理信心（r = -0.663，P < 0.01）、心理适应力-力量（r = -0.521，P < 0.01）和心理适应力-坚韧（r = -0.596，P < 0.01）呈负相关。症状感知与 FOP 之间的关系分别通过自我护理信心[效应=0.095，95%置信区间（CI）（0.054-0.142）]和心理适应力-坚韧[效应=0.033，95%CI（0.006-0.074）]进行中介，并且在序列中共同进行[效应=0.028，95%CI（0.011-0.050）]。中介效应占总效应的比例为 31.0%。
自我护理信心和心理适应力-坚韧是慢性 HF 患者症状感知与 FOP 之间关联的多重中介。针对增强自我护理信心和心理适应力的干预措施可能有助于减少 FOP，特别是坚韧度。
