Dew M A, Goycoolea J M, Stukas A A, Switzer G E, Simmons R G, Roth L H, DiMartini A
Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania 15213, USA.
Health Psychol. 1998 Mar;17(2):138-51. doi: 10.1037//0278-6133.17.2.138.
This study examined patterns of change in the physical health and well-being of 133 family caregivers to heart transplant recipients during the 1st year after transplant. Caregivers were assessed at 2, 7, and 12 months after transplant. Cluster analysis was used to identify temporal profiles reflecting unique patterns of change in the direction and nature of caregivers' physical health; their temporal profiles showed either (a) a worsening of general medical condition, with weight gain (14% of the sample); (b) worsening medical condition with weight loss (15%); (c) weight gain with stable medical condition (41%); (d) weight loss with slightly improving medical condition (21%); or (e) worsening health perceptions with relatively little objective evidence of change in medical condition or weight (8%). Subsequent multivariate analyses indicated that caregiver characteristics measured at baseline and reflecting caregiving burden, coping styles, demographics, and health history reliably predicted membership in the pattern-of-health-change groups. Among the findings, caregivers who showed a pattern of medical decline with weight loss had a poorer health history and weaker coping styles (lower mastery and higher use of avoidance coping) than other caregivers. Caregivers who experienced medical decline with weight gain had the greatest levels of caregiver burden. These findings are relevant to the design of interventions to maximize not only caregivers' health, but the health of the family members for whom they provide care.
本研究调查了133名心脏移植受者的家庭照顾者在移植后第1年的身体健康和幸福感变化模式。在移植后2个月、7个月和12个月对照顾者进行评估。采用聚类分析来确定反映照顾者身体健康变化方向和性质的独特模式的时间概况；他们的时间概况显示出以下几种情况：(a) 一般医疗状况恶化，体重增加（占样本的14%）；(b) 医疗状况恶化且体重减轻（15%）；(c) 体重增加且医疗状况稳定（41%）；(d) 体重减轻且医疗状况略有改善（21%）；或(e) 健康认知恶化，但医疗状况或体重变化的客观证据相对较少（8%）。随后的多变量分析表明，在基线时测量的反映照顾负担、应对方式、人口统计学和健康史的照顾者特征能够可靠地预测健康变化模式组的成员资格。研究结果包括，与其他照顾者相比，那些呈现出医疗状况下降且体重减轻模式的照顾者健康史较差，应对方式较弱（掌控力较低，更多地使用回避应对方式）。经历医疗状况下降且体重增加的照顾者照顾负担水平最高。这些发现不仅与旨在最大限度提高照顾者健康水平的干预措施设计相关，也与旨在提高他们所照顾的家庭成员健康水平的干预措施设计相关。
