心理社会适应在青年脑梗死患者孤独感与疲劳间的中介效应

doi:10.3969/j.issn.1006-9771.2025.05.013

摘要/Abstract

摘要：

目的分析心理社会适应在青年脑梗死患者孤独感与疲劳程度间的中介效应。
方法选取2023年2月至2024年5月衡水市人民医院年龄18~45岁脑梗死患者186例。出院后3个月采用疲劳严重度量表(FSS)、孤独量表(UCLA)、疾病心理社会适应量表(PAIS-SR)进行调查。比较不同特征患者FSS评分，Pearson法分析FSS、UCLA和PAIS-SR评分间的相关性，结构方程模型分析PAIS-SR评分在UCLA评分与FSS评分间的中介效应。
结果共回收有效问卷183份。患者FSS评分为(36.78±7.23)分，UCLA评分为(42.26±9.18)分，PAIS-SR评分为(56.62±13.89)分；不同美国国立卫生院卒中量表评分、Rankin修订量表评分、有无抑郁的青年脑梗死患者间，FSS评分有非常高度显著性差异(F > 3.557, P < 0.001)；FSS评分与UCLA评分(r = 0.740, P < 0.001)、PAIS-SR评分(r = 0.731, P < 0.001)呈正相关，UCLA评分与PAIS-SR评分呈正相关(r = 0.761, P < 0.001)；UCLA评分对FSS评分直接效应显著(效应值为0.348)，PAIS-SR评分在UCLA评分与FSS评分间的中介效应显著(效应值为0.154)。
结论心理社会适应在青年脑梗死患者孤独感与疲劳程度发挥部分中介效应。加强患者心理社会适应调控，有望减少孤独感对疲劳的负性作用。

关键词: 脑梗死, 青年, 疲劳, 心理社会适应, 孤独感, 中介效应

Abstract:

Objective To analyze the mediating effect of psychosocial adaptation on the relationship between loneliness and fatigue in young patients with cerebral infarction.
Methods A total of 186 patients (aged 18 to 45 years) with cerebral infarction in Hengshui People's Hospital from February, 2023 to May, 2024 were selected. They were investigated with Fatigue Severity Scale (FSS), Univesity of California at Los Angels Loneliness Scale (UCLA) and Psychosocial Adaptation to Illness Scale-self-report version (PAIS-SR) three months after discharging. The FSS scores were compared among patients with different characteristics. The correlation between the scores of FSS, UCLA and PAIS-SR was analyzed with Pearson's coefficient. Structural equation modeling was used to analyze the mediating effect of PAIS-SR score on the relationship between scores of FSS and UCLA.
Results A total of 183 valid questionnaires were returned. The FSS score was (36.78±7.23), the UCLA score was (42.26±9.18), and the PAIS-SR score was (56.62±13.89). There were significant differences in FSS scores among patients with different National Institutes of Health Stroke Scale scores, modified Rankin Scale scores and depression status (F > 3.557, P < 0.001). The FSS score was positively correlated with the UCLA score (r = 0.740, P < 0.001) and the PAIS-SR score (r = 0.731, P < 0.001), while the UCLA score was positively correlated with the PAIS-SR score (r = 0.761, P < 0.001). The main effect of UCLA score was significant on FSS score (effect size of 0.348), and the mediating effect of PAIS-SR score between UCLA score and FSS score was significant (effect size of 0.154).
Conclusion Psychosocial adaptation plays a partial mediating role in the relationship between loneliness and fatigue for young patients with cerebral infarction. Improving psychosocial adaptation may relieve the influence of loneliness on fatigue.

Key words: cerebral infarction, youth, fatigue, psychosocial adaptation, loneliness, mediating effect

中图分类号:

R743.32

王心颖, 王晓莉, 鲍双振, 郑岳林, 王勇朝. 心理社会适应在青年脑梗死患者孤独感与疲劳间的中介效应[J]. 《中国康复理论与实践》, 2025, 31(5): 601-606.

WANG Xinying, WANG Xiaoli, BAO Shuangzhen, ZHENG Yuelin, WANG Yongzhao. Mediating effect of psychosocial adaptation on relationship between loneliness and fatigue in young patients with cerebral infarction[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(5): 601-606.

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项目	n	FSS评分	F值	P值	项目	n	FSS评分	F值	P值	项目	n	FSS评分	F值	P值
性别			0.976	0.331	医疗支付方式			0.452	0.637	梗死最大直径/cm			0.828	0.409
男	102	37.3±6.9			医保	145	36.6±6.6			< 5	140	36.5±7.1
女	81	36.2±8.1			商业保险	24	36.8±7.4			≥ 5	43	37.6±6.9
年龄/岁			1.825	0.164	其他	14	38.4±6.0			mRS评分			5.339	< 0.001
< 25	46	35.9±7.3			高血压			1.637	0.103	< 3	127	35.1±6.00
25~< 35	71	36.1±5.9			有	46	38.1±7.3			≥ 3	56	40.5±7.1
35~45	66	38.1±8.3			无	137	36.3±6.1			NIHSS评分			3.647	< 0.001
饮酒史			0.083	0.934	糖尿病			0.996	0.320	2~4	35	32.8±6.3
有	49	36.9±6.6			有	25	38.2±6.3			5~15	148	37.7±7.4
无	134	36.8±7.5			无	158	36.6±8.1			抑郁			3.557	< 0.001
吸烟史			1.375	0.171	高脂血症			1.060	0.291	有	54	39.9±6.4
有	86	37.7±7.9			有	72	37.4±6.3			无	129	35.5±8.0
无	97	36.0±8.9			无	111	36.4±7.1			焦虑			1.729	0.086
文化程度			1.819	0.165	病变部位			0.241	0.867	有	65	38.2±7.5
初中及以下	16	37.2±5.9			额叶	45	37.2±6.0			无	118	36.0±8.2
高中/中专	75	35.6±8.1			顶叶	28	36.7±7.2			家庭月收入/元			1.843	0.067
大专及以上	92	37.7±6.8			基底节	41	37.2±6.5			< 5000	78	38.0±8.3
					其他	69	36.3±5.3			≥ 5000	105	35.9±7.6

自变量	B值	β值	P值	R²值	F值	P值
第一层				0.283	23.108	< 0.001
常量	43.562	-	< 0.001
NIHSS评分	0.218	0.270	< 0.001
mRS评分	0.326	0.251	< 0.001
抑郁	4.739	0.264	< 0.001
第二层				0.376	18.967	< 0.001
常量	19.627	-	< 0.001
NIHSS评分	0.198	0.163	< 0.001
mRS评分	0.272	0.155	< 0.001
抑郁	3.836	0.151	< 0.001
UCLA评分	0.260	0.176	< 0.001
PAIS-SR评分	-0.471	-0.168	< 0.001

指标	χ²值	GFI	AGFI	NFI	RFI	IFI	CFI	RMSEA
拟合结果	108.326	0.957	0.942	0.923	0.932	0.963	0.975	0.006
适配标准	-	> 0.9	> 0.9	> 0.9	> 0.9	> 0.9	> 0.9	< 0.08

效应	路径关系	效应值	效果量(%)
直接效应	孤独感→疲劳	0.348	69.32
中介效应	孤独感→心理社会适应→疲劳	0.154	30.68
总效应	-	0.502	100.00