Xie Chunyan, Li Li, Li Yamin
Clinical Nursing Teaching and Research Section, the Second Xiangya Hospital, Central South University, Changsha, People's Republic of China.
XiangYa Nursing School, Central South University, Changsha, People's Republic of China.
Psychol Res Behav Manag. 2023 Feb 10;16:351-361. doi: 10.2147/PRBM.S401380. eCollection 2023.
Learned helplessness (LH) is an essential psychological factor influencing maintenance haemodialysis (MHD) patients' health behaviour and is closely related to prognosis of the disease. This study aimed to identify potential trajectories of LH in MHD patients and assess their predictive role in self-management.
This study was conducted in strict compliance with national laws, the Declaration of Istanbul, and the Declaration of Helsinki. A total of 347 MHD patients at a blood purification centre in Hunan Province, China, were selected as the study population. Four longitudinal surveys (baseline and second/fourth/sixth month after baseline) were conducted using the General Information Questionnaire for MHD patients, the Chinese version of the Learned Helplessness Scale for MHD patients, and the Self-Management Scale for Haemodialysis. Latent growth mixture model (LGMM) analysis was used to identify LH trajectories, and their predictors were analysed using multinomial logistic regression. The predictive role of LH trajectory on self-management was analysed using linear regression.
This study identified three LH trajectories in MHD patients, named the "high-decreasing group" (57.9%), "low-increasing group" (21.3%), and "low-stability group" (20.7%). The results of the univariate analysis showed that sex (χ=33.777, < 0.001), age (χ=10.605, <0.05), and subjective social status (SSS) (χ=12.43, <0.01) were associated with LH trajectory classes. Multinomial logistic regression further demonstrated that gender, age, and SSS were predictors of different LH trajectories. The intercept and slope of the overall LH trajectory were negatively correlated with self-management (β=-0.273, <0.001; β=-0.234, <0.01).
MHD patients show three different LH trajectories. The initial level and developmental rate of LH can negatively predict future self-management. It is necessary to screen MHD patients' LH and develop targeted interventions for them with different LH trajectories at specific stages.
习得性无助（LH）是影响维持性血液透析（MHD）患者健康行为的重要心理因素，且与疾病预后密切相关。本研究旨在确定MHD患者LH的潜在轨迹，并评估其在自我管理中的预测作用。
本研究严格遵循国家法律、《伊斯坦布尔宣言》和《赫尔辛基宣言》进行。选取中国湖南省某血液净化中心的347例MHD患者作为研究对象。采用MHD患者一般信息问卷、中文版MHD患者习得性无助量表和血液透析自我管理量表进行四次纵向调查（基线及基线后第二/四/六个月）。采用潜在增长混合模型（LGMM）分析确定LH轨迹，并使用多项逻辑回归分析其预测因素。采用线性回归分析LH轨迹对自我管理的预测作用。
本研究确定了MHD患者的三种LH轨迹，分别命名为“高下降组”（57.9%）、“低上升组”（21.3%）和“低稳定组”（20.7%）。单因素分析结果显示，性别（χ=33.777，<0.001）、年龄（χ=10.605，<0.05）和主观社会地位（SSS）（χ=12.43，<0.01）与LH轨迹类别相关。多项逻辑回归进一步表明，性别、年龄和SSS是不同LH轨迹的预测因素。总体LH轨迹的截距和斜率与自我管理呈负相关（β=-0.273，<0.001；β=-0.234，<0.01）。
MHD患者呈现三种不同的LH轨迹。LH的初始水平和发展速度可对未来的自我管理产生负向预测作用。有必要筛查MHD患者的LH，并针对处于特定阶段、具有不同LH轨迹的患者制定有针对性的干预措施。
