Department of Social Work and Social Policy, Renmin University of China, Beijing, China.
Beijing Yizhuang Technology Innovation Company Limited, Beijing, China.
BMC Psychiatry. 2023 Aug 28;23(1):625. doi: 10.1186/s12888-023-05084-1.
Informal caregivers of children with leukemia can be emotionally and psychiatrically vulnerable when facing difficult treatment decisions (e.g., chemotherapy, targeted therapy, radiation, transplantation). A common behavioral manifestation of decisional conflict is the verbalized expression of uncertainty about which medical treatment plan to take. The study aims to examine the associations between decisional conflict, mastery, and depressive symptoms among parental caregivers of children with leukemia in China. It explored the mediating role of mastery in the relationship.
A cross-sectional survey design was adopted. A total of 386 parental caregivers were recruited, and 325 valid questionnaires remained. The mean age of caregivers was 37.7 years, and 61.5% caregivers were female. We used Question Format Decisional Conflict Scale to assess decisional conflict, Pearlin's Mastery Scale to assess mastery, and Center for Epidemiological Studies Depression 10 to assess depressive symptoms. We used mediation analyses to test the mediating effect of mastery.
The total score of decisional conflict scale, along with its dimensions of uncertainty, support, and effective decision were found negatively associated with depressive symptoms. In contrast, the dimension of information and value were not significantly associated with depressive symptoms. Mediation analyses demonstrated the direct effects of overall decisional conflict and uncertainly were fully mediated by mastery, while the direct effect of support and effective decision were partially mediated.
Efforts should be made to alleviate parental caregivers' decisional conflict and enhance sense of mastery. Particular attention should be paid to the psycho-social support to relieve uncertainties and ineffectiveness in decision making.
当面临困难的治疗决策（如化疗、靶向治疗、放疗、移植）时，儿童白血病患者的非专业照护者可能在情绪和心理上很脆弱。决策冲突的一种常见行为表现是对采取哪种医疗治疗方案表示不确定。本研究旨在检验中国儿童白血病患者父母照护者的决策冲突、掌控感和抑郁症状之间的关联，并探讨掌控感在其中的中介作用。
采用横断面调查设计。共招募了 386 名父母照护者，其中 325 份有效问卷。照护者的平均年龄为 37.7 岁，61.5%为女性。我们使用问题格式决策冲突量表评估决策冲突，皮尔林掌控感量表评估掌控感，以及流行病学研究抑郁量表 10 评估抑郁症状。我们使用中介分析来检验掌控感的中介效应。
决策冲突量表的总分及其不确定性、支持和有效决策维度与抑郁症状呈负相关。相比之下，信息和价值维度与抑郁症状没有显著关联。中介分析表明，整体决策冲突和不确定性的直接效应完全由掌控感中介，而支持和有效决策的直接效应部分由掌控感中介。
应努力减轻父母照护者的决策冲突并增强其掌控感。特别需要关注心理社会支持，以缓解决策中的不确定性和无效性。
