Kurlowicz L H
School of Nursing, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia 19104-6096, USA.
Nurs Res. 1998 Jul-Aug;47(4):219-26. doi: 10.1097/00006199-199807000-00007.
Decline in functional ability as a consequence of medical illness or surgery has been associated with the development of depressive symptoms in older patients. Little is known about the influence of psychological variables on the relationship between postoperative functional ability and depressive symptoms in older adults. Inclusion of perceived self-efficacy in a theoretical model of the relationship of functional ability and depressive symptoms would extend knowledge and inform health care providers about specific risk factors for the development of postoperative depressive symptoms in older elective surgery patients.
The purpose of this longitudinal study was to test a theoretical path model of the effects of perceived self-efficacy and functional ability on depressive symptoms in older adults after major elective surgery.
Seventy-six older adult inpatients (60% women; mean age = 72.3 years, SD = 5.06) who had undergone elective total hip replacement surgery participated in a face-to-face interview 4 to 5 days after surgery (Time 1) and a telephone interview 6 weeks after surgery (Time 2). Perceived self-efficacy was measured by the Self-Efficacy Expectation Scale, functional ability by the Functional Status Index, and depressive symptoms by the Geriatric Depression Scale.
Path analysis revealed that Time 1 perceived self-efficacy had a direct, negative effect on Time 2 depressive symptoms. Time 1 perceived self-efficacy also had an indirect effect on Time 2 depressive symptoms through its positive effect on Time 2 functional ability.
The findings suggest that interventions to enhance older patients' perceived self-efficacy while hospitalized after elective total hip replacement surgery may enhance functional ability, which in turn may decrease the likelihood of depressive symptoms postoperatively.
因疾病或手术导致的功能能力下降与老年患者抑郁症状的发生有关。关于心理变量对老年患者术后功能能力与抑郁症状之间关系的影响，人们了解甚少。将自我效能感纳入功能能力与抑郁症状关系的理论模型中，将拓展相关知识，并为医疗保健提供者提供有关老年择期手术患者术后抑郁症状发生的特定风险因素的信息。
本纵向研究的目的是检验一个理论路径模型，该模型探讨自我效能感和功能能力对老年患者大择期手术后抑郁症状的影响。
76名接受择期全髋关节置换手术的老年住院患者（60%为女性；平均年龄 = 72.3岁，标准差 = 5.06）在术后4至5天（时间1）接受了面对面访谈，并在术后6周（时间2）接受了电话访谈。自我效能感通过自我效能期望量表进行测量，功能能力通过功能状态指数进行测量，抑郁症状通过老年抑郁量表进行测量。
路径分析显示，时间1的自我效能感对时间2的抑郁症状有直接的负面影响。时间1的自我效能感还通过其对时间2功能能力的积极影响，对时间2的抑郁症状产生间接影响。
研究结果表明，在择期全髋关节置换手术后住院期间，采取干预措施提高老年患者的自我效能感，可能会增强其功能能力，进而降低术后出现抑郁症状的可能性。
