团体心理干预对终末期肾病患者疾病不确定感、自我感受负担和绝望水平的影响

doi:10.3969/j.issn.1006-3110.2019.12.009

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摘要目的探讨团体心理干预对终末期肾病患者疾病不确定感、自我感受负担、焦虑、抑郁和绝望水平的影响。方法选取2017年1月—2018年3月于新疆医科大学第一附属医院进行治疗的100例终末期肾病患者作为观察对象,随机分为对照组和观察组,每组各50例。对照组给予常规心理干预,观察组给予团体心理干预。分别采用Mishel疾病不确定感量表(Mishel Uncertainty in Illness Scale,MUIS)、自我感受负担量表(Self-perceived Burden Scale,SPBS)、焦虑自评量表(Self-rating Anxiety Scale,SAS)、抑郁自评量表(Self-rating Depression Scale,SDS)和Beck绝望量表(Beck Hopelessness Scale,BHS)评价患者疾病不确定感、自我感受负担、焦虑、抑郁及绝望水平。比较两组患者干预前后MUIS评分、SPBS评分、SAS评分、SDS评分及BHS评分。结果 MUIS评分显示,干预前,两组不明确性(t=0.250,P=0.802)、复杂性(t=0.577,P=0.565)、信息缺乏(t=0.701,P=0.485)、不可预测维度评分(t=1.004,P=0.318)及总分(t=0.308,P=0.759)对比差异无统计学意义。干预后3月,观察组不明确性(t=3.188,P=0.002)、复杂性(t=3.873,P<0.001)、信息缺乏(t=8.681,P<0.001)、不可预测维度评分(t=8.114,P<0.001)及总分(t=7.062,P<0.001)均低于对照组,差异均有统计学意义。SPBS评分显示,干预前,两组患者经济负担(t=0.832,P=0.407)、情感负担(t=0.645,P=0.520)、身体负担评分(t=0.638,P=0.525)及总分(t=0.797,P=0.428)对比差异无统计学意义。干预后3月,观察组情感负担(t=6.893,P<0.001)、身体负担评分(t=8.577,P<0.001)及总分(t=9.378,P<0.001)均低于对照组,差异均有统计学意义,而经济负担评分对比差异无统计学意义(t=0.873,P=0.385)。干预前,两组SAS评分(t=0.349,P=0.728)和SDS评分(t=0.296,P=0.768)对比差异无统计学意义。干预后3月,观察组SAS评分(t=5.812,P<0.001)和SDS评分(t=5.146,P<0.001)均低于对照组,差异均有统计学意义。BHS评分显示,干预前,两组对未来的感觉(t=1.263,P=0.210)、动力的丧失(t=1.512,P=0.134)、对未来的期望评分(t=1.150,P=0.253)及总分(t=0.237,P=0.813)对比差异无统计学意义。干预后3月,观察组对未来的感觉(t=3.900,P<0.001)、动力的丧失(t=5.012,P<0.001)、对未来的期望评分(t=7.987,P<0.001)及总分(t=4.132,P<0.001)均低于对照组,差异均有统计学意义。结论团体心理干预能够减轻终末期肾病患者疾病不确定感和自我感受负担,改善焦虑、抑郁不良情绪,并降低患者绝望水平。

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关键词 ：团体心理干预, 终末期肾病, 疾病不确定感, 自我感受负担, 焦虑, 抑郁, 绝望水平

Abstract：Objective To explore the influences of group-based psychological intervention on uncertainty in illness, self-perceived burden, anxiety, depression and despair level in patients with end stage renal disease (ESRD). Methods One hundred ESRD patients who received therapy in the First Hospital Affiliated to Xinjiang Medical University from January 2017 to March 2018 were selected as the observation subjects. They were randomly divided into the control group and the observation group (each n=50). The control group was given conventional psychological intervention, while the observation group received group-based psychological intervention. Mishel Uncertainty in Illness Scale (MUIS), Self-perceived Burden Scale (SPBS), Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS) and Beck Hopelessness Scale (BHS) were employed to assess uncertainty in illness, self-perceived burden, anxiety, depression and despair level, respectively. Then, scores of MUIS, SPBS, SAS, SDS and BHS were compared between the two groups before and after the intervention. Results Comparison of MUIS scores between the two groups indicated that no statistically significant differences were found in the scores of uncertainty(t=0.250,P=0.802), complexity(t=0.577,P=0.565), lack of information(t=0.701,P=0.485) and unpredictability(t=1.004,P=0.318) and the total scores(t=0.308,P=0.759) before the intervention, but the scores of uncertainty(t=3.188, P=0.002), complexity(t=3.873, P<0.001), lack of information(t=8.681, P<0.001), unpredictability(t=8.114, P<0.001) and the total scores(t=7.062, P<0.001) three months after the intervention were all lower in the observation group than in the control group, with statistically significant differences. Comparison of SPBS scores between the two groups revealed that no statistically significant differences were found in the scores of financial burden(t=0.832,P=0.407), emotional burden(t=0.645,P=0.520), body burden(t=0.638,P=0.525) and the total scores(t=0.797,P=0.428)before the intervention. The scores of emotional burden (t=6.893, P<0.001), body burden (t=8.577, P<0.001) and the total score (t=9.378, P<0.001) three months after the intervention were all lower in the observation group than in the control group, with statistically significant differences. No statistically significant difference was observed in the score of financial burden between the two groups(t=0.873,P=0.385). The scores of SAS (t=0.349, P=0.728) and SDS (t=0.296, P=0.768) before the intervention had no statistically significant differences between the two groups, while the scores of SAS(t=5.812, P<0.001)and SDS (t=5.146, P<0.001)were both lower in the observation group than in the control group, with statistically significant differences. Comparison of BHS scores between the two groups displayed that no statistically significant differences were found in the scores of feelings about the future (t=1.263, P=0.210), loss of motivation(t=1.512,P=0.134), future expectation(t=1.150,P=0.253) and the total score (t=0.237,P=0.813) before the intervention, but the scores of feelings about the future(t=3.900,P<0.001), loss of motivation(t=5.012,P<0.001), future expectation(t=7.987,P<0.001) and the total score(t=4.132, P<0.001) three months after the intervention were all lower in the observation group than in the control group, with statistically significant differences. Conclusions Group-based psychological intervention can alleviate uncertainty in illness and self-perceived burden, improve negative emotions of anxiety and depression, and reduce despair level in patients with ESRD.

Key words： group-based psychological intervention end stage renal disease uncertainty in illness self-perceived burden anxiety depression despair level

收稿日期: 2018-12-26

R395.6

基金资助:新疆维吾尔自治区自然科学基金(2017D01C293)

通讯作者: 李素华,E-mail:lisuhuanh@sina.com。

作者简介: 杨文君(1981-),女,山东临沂人,大学本科,主管护师,研究方向:肾脏病患者健康教育、护理和心理疾病预防。

引用本文:

杨文君, 周梅, 何帆, 李素华. 团体心理干预对终末期肾病患者疾病不确定感、自我感受负担和绝望水平的影响[J]. 实用预防医学, 2019, 26(12): 1441-1445. YANG Wen-jun, ZHOU Mei, HE Fan, LI Su-hua. Influences of group-based psychological intervention on uncertainty in illness, self-perceived burden and despair level in patients with end stage renal disease. , 2019, 26(12): 1441-1445.

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