Schnoll R A, Harlow L L, Stolbach L L, Brandt U
Department of Psychology, University of Rhode Island, Kingston 02881, USA.
Psychooncology. 1998 Mar-Apr;7(2):69-77. doi: 10.1002/(SICI)1099-1611(199803/04)7:2<69::AID-PON286>3.0.CO;2-8.
The present study used structural equation modeling to examine the relationships among disease stage (i.e. Stage II versus Stage IV), age, coping style, and psychological adjustment in 100 women diagnosed with breast cancer. Five separate models were examined: a full model, a mediational model, a demographic-disease model, a coping style model, and a regression model The analyses revealed that the present data best fit the mediational model in which age and stage of disease were not directly associated with psychological adjustment but, instead, were mediated by coping style (chi 2(25) = 45.776, AASR = 0.05, CFI = 0.94). The mediational model accounted for 56% of the variance in psychological adjustment. In particular, the model showed that younger women and women with an earlier disease stage used greater levels of the coping strategy characterized as a fighting spirit and lower levels of the coping strategies characterized as hopelessness/helplessness, anxious preoccupation, and fatalism which, in turn, were related to better psychological adjustment. Overall, these findings may offer an explanation for the conflicting findings regarding the relationship between age, stage of disease, and psychological adjustment to breast cancer by illustrating that coping strategies may be an essential mediating factor; in turn, a mediating model of psychological adaptation may offer useful information for clinicians as they implement interventions designed to improve patients coping efforts.
本研究采用结构方程模型，对100名被诊断为乳腺癌的女性的疾病阶段（即II期与IV期）、年龄、应对方式和心理调适之间的关系进行了研究。研究了五个独立的模型：一个完整模型、一个中介模型、一个人口统计学-疾病模型、一个应对方式模型和一个回归模型。分析结果表明，目前的数据最适合中介模型，在该模型中，年龄和疾病阶段与心理调适没有直接关联，而是通过应对方式起中介作用（卡方(25)=45.776，AASR = 0.05，CFI = 0.94）。中介模型解释了心理调适方差的56%。具体而言，该模型表明，年轻女性和疾病阶段较早的女性更多地采用被视为斗志的应对策略，而较少采用被视为绝望/无助、焦虑关注和宿命论的应对策略，而这些应对策略又与更好的心理调适相关。总体而言，这些发现可能为关于年龄、疾病阶段与乳腺癌心理调适之间关系的相互矛盾的研究结果提供一种解释，即应对策略可能是一个重要的中介因素；反过来，心理适应的中介模型可能为临床医生在实施旨在改善患者应对努力的干预措施时提供有用信息。
