中青年重症脑卒中患者主要照顾者预期性悲伤影响因素的结构方程模型构建

doi:10.3969/j.issn.1006-9771.2024.04.011

Abstract

Abstract:

Objective To construct a structural equation model to explore the influencing factors of anticipatory grief in the main caregivers of young and middle-aged patients with severe stroke, and to provide a basis for exploring the intervention model of anticipatory grief.

Methods From June, 2022 to June, 2023, a total of 300 main caregivers of young and middle-aged patients with severe stroke in Xiangyang No.1 People's Hospital Affiliated to Hubei University of Medicine were selected. The general information questionnaire, Anticipatory Grief Scale (AGS), Zarit Caregiver Burden Interview (ZBI), Social Support Rating Scale (SSRS) and Simplified Coping Style Questionnaire (SCSQ) were used to investigate the influencing factors. Pearson correlation analysis was used to analyze the correlation among the scores of above scales, and AMOS 25.0 was used for model fitting, path and mediating effect analysis.

Results The scores of AGS, ZBI and SSRS were (88.35±9.02), (42.32±7.41) and (41.52±5.43), respectively. The positive coping style accounted for 39.3% of caregivers, and negative coping style accounted for 60.7%. The score of AGS was positively correlated with the scores of negative coping style in SCSQ (r = 0.357) and ZBI (r = 0.381) (P< 0.01), and negatively correlated with the scores of SSRS (r = -0.436) and positive coping style in SCSQ (r = -0.369) (P < 0.01). The structural equation model showed that the direct effect of caregiver burden on anticipatory grief was significant (effect value was 0.458), and the mediating effect of social support, positive coping and negative coping between caregiver burden and anticipatory grief was significant (effect values were 0.113, 0.061 and 0.060, respectively).

Conclusion The main caregivers of young and middle-aged patients with severe stroke have a high level of anticipatory grief. Each influencing factor has a strong predictive and explanatory function on the anticipatory grief of the main caregivers. Medical staff can formulate targeted intervention measures, to reduce the level of anticipatory grief.

Key words: stroke, young and middle-aged, primary caregiver, anticipatory grief, structural equation model

CLC Number:

R743.3

LIU Xing, ZHOU Yumei, XU Huili, PENG Jianying, XIE Zheshu, XING Limin, ZHAO Jun. Structural equation model of influencing factors of anticipatory grief among main caregivers of young and middle-aged patients with severe stroke[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(4): 454-461.

Figures/Tables 4

Table 1

Comparison of AGS scores of main caregivers of young and middle-aged patients with severe stroke among different characteristics (n = 300)"

项目	n	AGS评分	F/t值	P值	项目	n	AGS评分	F/t值	P值
性别			2.485	0.014	< 1	91	89.49±9.31
男	109	86.65±10.07			1~6	129	88.15±8.06
女	191	89.32±8.24			7~12	31	86.64±9.58
文化程度			2.454	0.088	> 12	49	87.81±10.44
初中或以下	135	88.03±8.37			参与照顾的原因			0.383	0.682
高中或中专	75	90.25±10.34			不得已参与	8	90.50±4.44
大专及以上	90	87.24±8.64			责任和义务	210	88.11±8.99
工作状况			0.388	0.679	自愿且乐意	82	88.76±9.45
在职	173	88.58±8.78			对患者病情知晓情况			0.614	0.606
离职或无业	95	87.71±9.35			不了解	2	86.00±2.83
退休	32	89.03±9.52			了解一些	70	87.19±8.55
家庭人均月收入/元			0.169	0.917	大体了解	153	88.89±9.47
< 2000	65	88.34±8.24			完全了解	75	88.40±8.61
2000~4000	133	88.72±9.50			患者性别			0.059	0.953
4001~6000	99	87.87±8.97			男	223	88.33±9.37
> 6000	3	88.00±8.54			女	77	88.40±8.00
性格自我评定			0.310	0.733	患者患病时长/月			11.126	< 0.001
内向型	93	87.80±9.50			< 1	72	84.49±10.36
外向型	149	88.73±8.61			1~6	129	88.39±7.27
混合型	58	88.26±9.36			7~12	49	88.55±7.94
婚姻状况			1.739	0.159	> 12	50	93.62±9.53
未婚	26	91.50±9.83			患者GCS评分			11.144	< 0.001
已婚	268	88.15±8.91			重度意识障碍	43	94.84±9.74
离异	4	82.50±9.54			中度意识障碍	114	88.34±7.03
丧偶	2	85.50±2.12			轻度意识障碍	22	88.55±7.53
宗教信仰			0.662	0.508	清楚	121	86.02±9.62
有	17	86.94±7.49			患者自理能力			13.350	< 0.001
无	283	88.43±9.11			重度依赖	188	89.42±8.69
身体状况			1.171	0.324	中度依赖	86	88.42±6.92
极差	4	83.75±9.36			轻度依赖	13	86.69±7.06
不好	45	86.20±7.54			完全自理	13	74.08±14.81
一般	180	88.80±9.37			患者因脑卒中住院次数			0.226	0.798
好	64	89.06±8.30			< 5	227	88.36±8.57
非常好	7	86.71±13.77			5~10	66	88.56±9.67
与患者的关系			10.190	< 0.001	> 10	7	86.14±16.46
配偶	168	89.58±8.62			患者医保支付方式			22.867	< 0.001
子女	78	89.14±8.03			职工医保	139	86.73±9.42
父母	31	86.32±7.56			居民医保	137	87.69±7.00
兄弟姐妹	23	79.39±11.58			自费	14	101.21±4.82
参与照顾时长/月			0.934	0.425	其他	10	101.90±7.61

Table 1

Table 2

Table 3

Figure 1

References 31

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项目		评分	AGS评分	ZBI评分	SSRS评分	SCSQ评分
项目		评分	AGS评分	ZBI评分	SSRS评分	积极应对	消极应对
AGS评分		88.35±9.02	1.000	－	－	－	－
ZBI评分		42.32±7.41	0.381^a	1.000	－	－	－
SSRS评分		41.52±5.43	-0.436^a	-0.252^a	1.000	－	－
SCSQ评分	积极应对	13.32±5.67	-0.369^a	-0.203^a	0.167^a	1.000
SCSQ评分	消极应对	16.19±4.25	0.357^a	0.226^a	-0.228^a	-0.185^a	1.000

效应类型	路径	标准化效应值	95%CI
效应类型	路径	标准化效应值	下限	上限
直接效应	照顾者负担→预期性悲伤	0.458	0.192	0.729
间接效应	照顾者负担→消极应对→预期性悲伤	0.060	0.012	0.111
间接效应	照顾者负担→积极应对→预期性悲伤	0.061	0.009	0.126
间接效应	照顾者负担→社会支持→预期性悲伤	0.113	0.025	0.232
总效应	照顾者负担→预期性悲伤	0.693	0.499	0.839

Structural equation model of influencing factors of anticipatory grief among main caregivers of young and middle-aged patients with severe stroke

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