Rosen R C, Contrada R J, Gorkin L, Kostis J B
University of Medicine and Dentistry, Robert Wood Johnson Medical School, Piscataway, NJ 08854, USA.
Psychosom Med. 1997 Mar-Apr;59(2):193-200. doi: 10.1097/00006842-199703000-00012.
Few studies have evaluated the determinants of perceived health in patients with chronic illness. The present study was designed to evaluate the role of biomedical, demographic, and psychosocial influences on global subjective health by means of a structural equation modeling approach.
A conceptual model of perceived health was tested in a subsample of patients (N = 146) from the multicenter Studies of Left Ventricular Dysfunction (SOLVD) trial. Domain-specific quality of life constructs (emotional status, social support, and physical functioning), were assessed by means of multiple indicators. These latent (mediating) variables, along with six single-indicator biomedical and background variables, were modeled as predictors of a composite index of perceived health.
A satisfactory fit was obtained for the proposed model, with practical fit indices ranging from .89 to .95. High levels of perceived health were associated with low levels of emotional distress and high levels of physical functioning. Social support was positively correlated with physical functioning and negatively associated with emotional distress. Among the background variables, no direct associations were observed between any of the single-indicator variables and perceived health. Several background variables (eg, age, income, walk-test scores) had indirect effects via associations with the latent variables of physical functioning and emotional distress.
These findings support the use of a structural modeling approach in assessing determinants of perceived health in patients with congestive heart failure. Further research is needed to evaluate the utility of the model in other patient populations.
很少有研究评估慢性病患者自我感知健康的决定因素。本研究旨在通过结构方程建模方法评估生物医学、人口统计学和心理社会因素对整体主观健康的作用。
在多中心左心室功能障碍研究（SOLVD）试验的患者子样本（N = 146）中测试自我感知健康的概念模型。通过多个指标评估特定领域的生活质量结构（情绪状态、社会支持和身体功能）。这些潜在（中介）变量，连同六个单指标生物医学和背景变量，被建模为自我感知健康综合指数的预测因子。
所提出的模型获得了令人满意的拟合度，实际拟合指数范围为0.89至0.95。高水平的自我感知健康与低水平的情绪困扰和高水平的身体功能相关。社会支持与身体功能呈正相关，与情绪困扰呈负相关。在背景变量中，未观察到任何单指标变量与自我感知健康之间存在直接关联。几个背景变量（如年龄、收入、步行测试分数）通过与身体功能和情绪困扰的潜在变量的关联产生间接影响。
这些发现支持使用结构建模方法评估充血性心力衰竭患者自我感知健康的决定因素。需要进一步研究以评估该模型在其他患者群体中的效用。
