【摘要】：目的:本研究調(diào)查某兩所三甲綜合醫(yī)院惡性腫瘤住院患者自殺意念的發(fā)生情況,并研究患者社會(huì)人口學(xué)特征、疾病特征、健康狀況、應(yīng)對(duì)風(fēng)格和感知社會(huì)支持對(duì)產(chǎn)生自殺意念的影響,通過(guò)路徑分析即因果模型分析探討自殺意念的產(chǎn)生與患者健康狀況、應(yīng)對(duì)風(fēng)格以及感知的社會(huì)支持三者之間的相關(guān)性,為惡性腫瘤住院患者的健康宣教及制定自殺干預(yù)措施提供依據(jù)基礎(chǔ)。方法:研究分兩個(gè)部分展開(kāi),首先調(diào)查惡性腫瘤住院患者自殺意念的發(fā)生情況,并調(diào)查其人口學(xué)特征、疾病特征的狀況,分析發(fā)生自殺意念的影響因素;第二,通過(guò)多個(gè)量表的調(diào)查問(wèn)卷,分析患者自殺意念的產(chǎn)生與其健康狀況、應(yīng)對(duì)風(fēng)格以及感知的社會(huì)支持之間的直接效應(yīng)、間接效應(yīng)和總效應(yīng)的關(guān)系。具體方法如下:第一:本研究采用橫截面描述性設(shè)計(jì),于2016年01月至2016年12月期間在昆明醫(yī)科大學(xué)第二附屬醫(yī)院、溫州市中心醫(yī)院2所兩家三級(jí)甲等綜合醫(yī)院里進(jìn)行。采用方便取樣法,選取愿意并能自主填表的1000位惡性腫瘤住院患者為研究對(duì)象,他們進(jìn)該研究基于他們對(duì)問(wèn)卷的接受程度,但是由于病情加重和(或)時(shí)間不足的原因,有29位患者中途退出。數(shù)據(jù)工具包括患者一般資料調(diào)查問(wèn)卷、自殺意念自評(píng)量表(SIOSS)、簡(jiǎn)明健康狀況調(diào)查表(SF-26)、醫(yī)學(xué)應(yīng)對(duì)問(wèn)卷(MCMQ)及社會(huì)支持評(píng)定量表(SSRS)進(jìn)行調(diào)查。一般資料的內(nèi)容主要包括:①一般人口學(xué)資料:性別、年齡、婚姻狀況、文化程度、居住地、家庭人均收入等;②疾病臨床資料:疾病診斷、腫瘤分期、確診時(shí)間、容顏體貌、疾病治療信心、睡眠狀況等;資料運(yùn)用SPSS22.0進(jìn)行描述性統(tǒng)計(jì)分析、方差分析、Logistic回歸分析、相關(guān)分析、卡方檢驗(yàn)統(tǒng)計(jì)分析自殺意念的影響因素。第二:通過(guò)調(diào)查結(jié)果分析和了解自殺意念的發(fā)生與患者的健康狀況、應(yīng)對(duì)風(fēng)格以及社會(huì)支持關(guān)系,資料運(yùn)用SPSS22.0和AMOS 18.0軟件進(jìn)行統(tǒng)計(jì)分析,統(tǒng)計(jì)學(xué)方法包括t檢驗(yàn)、Logistic回歸分析、相關(guān)分析和路徑分析等。結(jié)果:①發(fā)放調(diào)查表是1000份,有29人由于個(gè)人原因中途退出,11份問(wèn)卷內(nèi)容填寫(xiě)不完整,最終有效問(wèn)卷940份,108份有自殺意念,惡性腫瘤住院患者的自殺意念發(fā)生率為11.48%,29例有自殺計(jì)劃,21例有過(guò)自殺行為。②一般資料單因素分析顯示:惡性腫瘤住院患者有自殺意念組和無(wú)自殺意念組在居住地、腫瘤分期、確診時(shí)間、容顏體貌改變、治療信心、睡眠等差異有統(tǒng)計(jì)學(xué)意義(P0.05)。自殺意念的一般資料Logistics回歸分析顯示,影響惡性腫瘤住院患者自殺意念的因素有居住地、腫瘤分期、治療信心、睡眠四個(gè)變量。2、關(guān)于自殺意念的發(fā)生與患者健康狀況、醫(yī)學(xué)應(yīng)對(duì)風(fēng)格以及感知的社會(huì)支持的研究分析,有自殺意念組與無(wú)自殺意念組比較,前者屈服維度得分比后者高(P0.05),健康狀況所得總分以及五個(gè)維度評(píng)分、社會(huì)支持所得總分及三個(gè)維度評(píng)分均比無(wú)自殺意念組低(P0.05)。3、路徑分析顯示:面對(duì)的應(yīng)對(duì)風(fēng)格對(duì)健康狀況有直接正向效應(yīng)(β=0.078,P0.05),對(duì)感知社會(huì)支持有直接正向效應(yīng)(β=0.17,P0.01);屈服的應(yīng)對(duì)風(fēng)格對(duì)健康狀況有直接負(fù)向效應(yīng)(β=-0.532,P0.01),對(duì)社會(huì)支持有直接負(fù)向效應(yīng)(β=-0.226,P0.01),對(duì)自殺意念有直接正向效應(yīng)(β=0.315,P0.01);回避的應(yīng)對(duì)風(fēng)格對(duì)社會(huì)支持有直接正向效應(yīng)(β =0_112,P0.01);對(duì)健康狀況有直接正向效應(yīng)(β=0.068,P0.05);社會(huì)支持對(duì)健康狀況有直接正向效應(yīng)(β =0.224,P0.01),對(duì)自殺意念有間接負(fù)向效應(yīng)(β=-0.076,P0.01);面對(duì)、屈服、回避的應(yīng)對(duì)風(fēng)格均可以通過(guò)健康狀況與感知社會(huì)支持中的一個(gè)變量或者兩個(gè)變量間接影響自殺意念;社會(huì)支持可以通過(guò)健康狀況中介變量影響自殺意念。以上可見(jiàn),應(yīng)對(duì)風(fēng)格中的屈服應(yīng)對(duì)、健康狀況對(duì)自殺意念既有直接效應(yīng)又有間接效應(yīng);應(yīng)對(duì)風(fēng)格中的面對(duì)應(yīng)對(duì)、回避應(yīng)對(duì)、社會(huì)支持對(duì)自殺意念有間接效應(yīng)。結(jié)論:1.該兩家三級(jí)甲等綜合醫(yī)院綜合惡性腫瘤住院患者自殺意念比普通人群的發(fā)生率高。2.居住地、腫瘤分期、容顏體貌改變、睡眠、預(yù)后是否有信心是惡性腫瘤住院患者自殺意念的影響因素,最后經(jīng)過(guò)多因素logistic回歸分析,得出惡性腫瘤患者住院患者自殺意念的危險(xiǎn)因素為居住地在農(nóng)村、家庭收入低、疾病治療沒(méi)有信心、失眠四個(gè)變量。3.面對(duì)、屈服、回避的應(yīng)對(duì)風(fēng)格均可以通過(guò)健康狀況與感知社會(huì)支持中的一個(gè)變量或者兩個(gè)變量間接影響自殺意念;社會(huì)支持可以通過(guò)健康狀況中介變量影響自殺意念。以上可見(jiàn),應(yīng)對(duì)風(fēng)格中的屈服應(yīng)對(duì)、健康狀況對(duì)自殺意念既有直接效應(yīng)又有間接效應(yīng);應(yīng)對(duì)風(fēng)格中的面對(duì)應(yīng)對(duì)、回避應(yīng)對(duì)、社會(huì)支持對(duì)自殺意念有間接效應(yīng)。通過(guò)路徑分析可以得出積極的面對(duì)疾病、家屬親戚朋友等對(duì)患者較高的支持和關(guān)懷、減少病人的疼痛等疾病的不適感為惡性腫瘤住院患者自殺意念的保護(hù)因素。
[Abstract]:AIM: To investigate the incidence of suicidal ideation among inpatients with malignant tumors in two tertiary general hospitals, and to investigate the effects of social demographic characteristics, disease characteristics, health status, coping style and perceived social support on suicidal ideation. Path analysis, i.e. causal model, was used to analyze the relationship between suicidal ideation and suicidal ideation. The correlation among health status, coping style and perceived social support provided the basis for health education and suicide intervention of inpatients with malignant tumors. Secondly, the direct, indirect and total effects of suicidal ideation on health status, coping style and perceived social support were analyzed by multiple questionnaires. The face-to-face descriptive design was carried out in two tertiary A general hospitals of the Second Affiliated Hospital of Kunming Medical University and Wenzhou Central Hospital from January 2016 to December 2016. A convenient sampling method was used to select 1000 inpatients with malignant tumors who were willing to fill in the form independently. They entered the study based on their questioning. Data tools included patient general information questionnaire, suicide ideation self-rating scale (SIOSS), concise health status questionnaire (SF-26), medical coping questionnaire (MCMQ) and social support rating scale (SSRS). The main contents include: (1) general demographic data: gender, age, marital status, educational level, residence, family income per capita; and (2) clinical data: disease diagnosis, tumor stage, diagnosis time, facial features, confidence in disease treatment, sleep status; data using SPSS 22.0 for descriptive statistical analysis, variance analysis, Logistic analysis. Regression analysis, correlation analysis and chi-square test were used to analyze the influencing factors of suicide ideation. Secondly, the relationship between suicide ideation and patients'health status, coping style and social support was analyzed by analyzing the results of the survey. The data were analyzed by SPSS22.0 and AMOS 18.0 software. The statistical methods included t test and Logistic regression. Results: 1. 1000 questionnaires were sent out, 29 people quit halfway due to personal reasons, 11 questionnaires were incomplete, and 940 questionnaires were valid, 108 of them had suicidal ideation. The incidence of suicidal ideation in hospitalized patients with malignant tumors was 11.48%, 29 had suicidal plans and 21 had suicidal behaviors. (2) Univariate analysis of general data showed that there were significant differences between the suicidal ideation group and the non-suicidal ideation group (P 0.05). Logistic regression analysis showed that the general data of suicidal ideation affected the inpatients with malignant tumor. The factors of suicidal ideation were residence, tumor stage, treatment confidence and sleep. 2. The incidence of suicidal ideation and patients'health status, medical coping style and perceived social support. Compared with the group without suicidal ideation, the former had higher yield dimension score than the latter (P 0.05). The total score and five-dimension score, social support score and three-dimension score were lower than those without suicidal ideation group (P 0.05). Path analysis showed that coping style had a direct positive effect on health status (beta = 0.078, P 0.05), and had a direct positive effect on perceived social support (beta = 0.17, P 0.01). There was a direct negative effect (beta = - 0.532, P 0.01), a direct negative effect on social support (beta = - 0.226, P 0.01) and a direct positive effect on suicidal ideation (beta = 0.315, P 0.01); avoidance coping style had a direct positive effect on social support (beta = 0.112, P 0.01); there was a direct positive effect on health status (beta = 0.068, P 0.05); social support had a direct positive effect on health; Conditions had direct positive effects (beta = 0.224, P 0.01) and indirect negative effects on suicidal ideation (beta = - 0.076, P 0.01); in the face of surrender, avoidance coping styles could indirectly influence suicidal ideation through one or two variables of health status and perceived social support; social support could influence suicidal ideation through a mediator variable of health status. Suicidal ideation. It can be seen that the coping style of the yielding coping, health status on suicidal ideation has both direct and indirect effects; coping style of the face coping, avoiding coping, social support on suicidal ideation has indirect effects. Conclusion: 1. The two tertiary A general hospital patients with malignant tumor suicidal ideation Bip. Residence, tumor stage, facial changes, sleep, and prognosis confidence are the influencing factors of suicidal ideation of inpatients with malignant tumors. Finally, through multivariate logistic regression analysis, it is concluded that the risk factors of suicidal ideation of inpatients with malignant tumors are residence in rural areas, low family income, illness. Facing, yielding and avoiding coping styles can indirectly influence suicidal ideation through one or two variables of health status and perceived social support; social support can influence suicidal ideation through mediating variables of health status. Health status has both direct and indirect effects on suicidal ideation; coping style has indirect effects on suicidal ideation, avoiding coping and social support has indirect effects on suicidal ideation. It is a protective factor for suicidal ideation in hospitalized patients with malignant tumors.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R73-31

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