Ormel J, Kempen G I, Penninx B W, Brilman E I, Beekman A T, van Sonderen E
Northern Centre for Health Care Research, University of Groningen, The Netherlands.
Psychol Med. 1997 Sep;27(5):1065-77. doi: 10.1017/s0033291797005321.
This study describes the differences in psychological distress, disability and psychosocial resources between types of major medical conditions and sensory impairments (collectively denoted as CMCs); and tests whether disability and psychosocial resources mediate CMC-specific mental health effects.
Data were obtained from a population-based, cross-sectional survey of 5078 non-institutionalized, late middle-aged and older Dutch persons. The predictors were 16 types of CMCs, including all major chronic medical diseases as well as impairment of hearing, vision, and cognition. The outcomes were assessed in terms of psychological distress as measured by the Hospital Anxiety and Depression Scale. Two aspects of disability were measured (namely, physical and role functioning) and also three psychosocial resources (namely, mastery, self-efficacy and social support).
Level of psychological distress varied across type of CMC. Hearing impairment, neurological disease, vision impairment, and lung and heart disease had particularly strong associations with distress. The level of distress in patients with hearing impairment was 0.45 standard deviation higher than in those without hearing impairment (adjusted for demographics and all other CMCs). Roughly similar patterns of association were found between type of CMC and disability, and also, but to a lesser extent, mastery and self-efficacy. Stepwise multiple regression revealed that type of CMC accounted for 9% of the variance in distress initially, but this fell to 1% after the variance due to disability, mastery and self-efficacy was taken out. Social support was not a mediator. Disability and psychosocial resources accounted for 13% and 14% of the variance in distress, respectively.
These results support the conventional wisdom that it is not the nature of the condition that determines psychological distress, but instead the severity of the disability and loss of psychological resources associated with the condition on the one hand and the psychological characteristics of the patient on the other.
本研究描述了主要医疗状况和感官障碍类型（统称为慢性身心疾病）之间在心理困扰、残疾和心理社会资源方面的差异；并测试残疾和心理社会资源是否介导了特定慢性身心疾病对心理健康的影响。
数据来自对5078名非机构化的荷兰中老年人群进行的基于人群的横断面调查。预测因素为16种慢性身心疾病类型，包括所有主要的慢性内科疾病以及听力、视力和认知障碍。通过医院焦虑抑郁量表测量心理困扰来评估结果。测量了残疾的两个方面（即身体功能和角色功能）以及三种心理社会资源（即掌控感、自我效能感和社会支持）。
心理困扰水平因慢性身心疾病类型而异。听力障碍、神经系统疾病、视力障碍以及肺部和心脏疾病与困扰的关联尤为强烈。听力障碍患者的困扰水平比无听力障碍患者高0.45个标准差（根据人口统计学和所有其他慢性身心疾病进行调整）。在慢性身心疾病类型与残疾之间发现了大致相似的关联模式，掌控感和自我效能感方面的关联模式也相似，但程度较小。逐步多元回归显示，慢性身心疾病类型最初占困扰方差的9%，但在去除因残疾、掌控感和自我效能感导致的方差后，这一比例降至1%。社会支持不是中介因素。残疾和心理社会资源分别占困扰方差的13%和14%。
这些结果支持了传统观点，即决定心理困扰的不是疾病本身的性质，而是一方面与疾病相关的残疾严重程度和心理资源丧失，另一方面是患者的心理特征。
