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

[1]	«中国脑卒中防治报告2021»编写组. «中国脑卒中防治报告2021»概要[J]. 中国脑血管病杂志, 2023, 20(11): 783-793.
	Report on Stroke Prevention and Treatment in China Writing Group. Brief report on stroke prevention and treatment in China, 2021[J]. Chin J Cerebrov Dis, 2023, 20(11): 783-793.
[2]	周丹, 唐维红. 脑卒中患者年龄变化趋势及中青年脑卒中患者危险因素分析[J]. 检验医学与临床, 2019, 16(2): 211-213.
	ZHOU D, TANG W H. The trends of age change in stroke patients and risk factors of young and middle-aged stroke patients[J]. Lab Med Clin, 2019, 16(2): 211-213.
[3]	PUTAALA J. Ischemic stroke in young adults[J]. Continuum (Min-neap Minn), 2020, 26(2): 386-414.
[4]	熊健, 郑国华. 脑卒中患者执行功能的研究进展[J]. 中国康复理论与实践, 2020, 26(7): 797-801. doi: 10.3969/j.issn.1006-9771.2020.07.012
	XIONG J, ZHENG G H. Advance in executive function for post-stroke patients (review)[J]. Chin J Rehabil Theory Pract, 2020, 26(7): 797-801.
[5]	COELHO A, DE BRITO M, BARBOSA A. Caregiver anticipatory grief: phenomenology, assessment and clinical interventions[J]. Curr Opin Support Palliat Care, 2018, 12(1): 52-57. doi: 10.1097/SPC.0000000000000321
[6]	于文华, 陆宇晗, 路潜, 等. 癌症患者主要照顾者预期性悲伤的研究进展[J]. 中华护理杂志, 2018, 53(6): 730-735.
	YU W H, LU Y H, LU Q, et al. Research progress of anticipatory grief in primary caregivers of cancer patients[J]. Chin J Nurs, 2018, 53(6): 730-735.
[7]	王亚菲, 高振清, 柳云, 等. 首发脑卒中患者亲属照顾者预期性悲伤现状及影响因素分析[J]. 中国实用护理杂志, 2023, 39(3): 215-221.
	WANG Y F, GAO Z Q, LIU Y, et al. Current status and influencing factors of anticipatory grief among family caregivers of first stroke patients[J]. Chin J Pract Nurs, 2019, 39(3): 215-221.
[8]	STROEBE M S, FOLKMAN S, HANSSON R O, et al. The prediction of bereavement outcome: Developmentofan integrative risk factor framework[J]. Soc Sci Med, 2006, 63(9): 2440-2451. doi: 10.1016/j.socscimed.2006.06.012
[9]	吴明隆. 结构方程模型-AMOS的操作与应用[M]. 2版. 重庆: 重庆医科大学出版社, 2010: 4-5.
	WU M L. Structural equation Model-AMOS operation and application[M]. 2nd ed. Chongqing: Chongqing Med Unive Press, 2010: 4-5.
[10]	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志, 2018, 51(9): 666-682.
	Chinese Society of Neurology, Cerebrovascular Group, Chinese Society of Neurology. Chinese Guidelines for Diagnosis and Treatment of Acute Ischemic Stroke 2018[J]. Chin J Neurol, 2018, 51(9): 666-682.
[11]	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国脑出血诊治指南(2019)[J]. 中华神经科杂志, 2019, 52(12): 994-1005.
	Chinese Society of Neurology, Cerebrovascular Group, Chinese Society of Neurology. Chinese Guidelines for Diagnosis and Treatment of Cerebral Hemorrhage (2019)[J]. Chin J Neurol, 2019, 52(12): 994-1005.
[12]	中华医学会神经病学分会神经重症协作组. 神经重症监护病房建设中国专家共识[J]. 中华神经科杂志, 2014, 47(4): 269-273.
	Chinese Association of Neurology, Chinese Association of Neurology. Consensus of Chinese Experts on the Construction of Neurological Intensive Care Unit[J]. Chin J Neurol, 2014, 47(4): 269-273.
[13]	THEUT S K, JORDAN L, ROSS L A, et al. Caregiver's anticipatory grief in dementia: a pilot study[J]. Int J Aging Hum Dev, 1991, 33(2): 113-118. pmid: 1955206
[14]	辛大君. 晚期癌症患者及其家属悲伤反应研究[D]. 泸州: 西南医科大学, 2016.
	XIN D J. A study on grief response of advanced cancer patients and their families[D]. Luzhou: Southwest Medical University, 2016.
[15]	王烈, 杨小湜, 侯哲, 等. 护理者负担量表中文版的应用与评价[J]. 中国公共卫生, 2006, 22(8): 970-972.
	WANG L, YANG X S, HOU Z, et al. Application and evaluation of chinese version of Zarit Caregiver Burden interview[J]. Chin J Public Health, 2006, 22(8): 970-972.
[16]	LAZARUS R S, DELONGIS A, FOLKMAN S, et al. Stress and adaptational outcomes. The problem of confounded measures[J]. Am Psychol, 1985, 40(7): 770-785. pmid: 4037513
[17]	解亚宁. 简易应付方式量表信度和效度的初步研究[J]. 中国临床心理学杂志, 1998(2): 114-115.
	XIE Y N. A preliminary study on the reliability and validity of simple coping style Scale[J]. Chin J Clin Psychol, 1998(2): 114-115.
[18]	肖水源. «社会支持评定量表»的理论基础与研究应用[J]. 临床精神医学杂志, 1994, 4(2): 98-100.
	XIAO S Y. The theoretical basis and research application of Social Support Rating Scale[J]. J Clin Psych, 1994, 4(2): 98-100. doi: 10.1002/(ISSN)1097-4679
[19]	候春慧. 首发青壮年脑卒中患者配偶照顾者准备度与成人依恋的相关性[J]. 国际医药卫生导报, 2021, 27(5): 748-751.
	HOU C H. Relationship between spouse caregiver readiness and adult attachment in first-episode young adult stroke patients[J]. Int Med Health Guid News, 2021, 27(5): 748-751.
[20]	易梦思, 刘方, 张焱, 等. 中青年脑卒中患者疾病进展恐惧现状及影响因素[J]. 现代预防医学, 2022, 49(13) :2481-2485, 2491.
	YI M S, LIU F, ZHANG Y, et al. Current situation and influencing factors of fear of disease progression in young and middle-aged stroke patients[J]. Mod Prev Med, 2019, 49(13): 2481-2485, 2491.
[21]	刘晶晶, 滕艳华. 晚期肺癌患者配偶恐惧疾病进展与预期性悲伤的相关性研究[J]. 护理管理杂志, 2021, 21(7): 511-514.
	LIU J J, TENG Y H. Correlation between fear of disease progression and anticipatory grief in spouse patients with advanced lung cancer[J]. J Nurs Admin, 2019, 21(7): 511-514.
[22]	LYONS K S, LEE C S. The theory of dyadic illness management[J]. J Family Nurs, 2018, 24(1) : 8-28.
[23]	CARO C C, COSTA J D, DA CRUZ D M C. Burden and quality of life of family caregivers of stroke patients[J]. Occup Ther Health Care, 2018, 32(2): 154-171. doi: 10.1080/07380577.2018.1449046 pmid: 29578827
[24]	李棪臻, 王海芳, 蔡建政, 等. 基于全周期需求的缺血性脑卒中偏瘫患者支持性照护信息平台的构建与应用研究[J]. 中国实用护理杂志, 2022, 38(9): 667-674.
	LI Y Z, WANG H F, CAI J Z, et al. Construction and application of a supportive care information platform for ischemic stroke patients with hemiplegia based on full-cycle needs[J]. Chin J Pract Nurs, 2022, 38(9): 667-674.
[25]	王云龙, 刘玉敬, 于颖, 等. 二元应对在脑卒中偏瘫患者配偶照顾负担与负性情绪间的中介效应[J]. 护理学杂志, 2023, 38(24): 19-22, 36.
	WANG Y L, LIU Y J, YU Y, et al. The mediating effect of dual coping between care burden and negative emotions in spouses of stroke patients with hemiplegia[J]. J Nurs Sci, 2023, 38(24): 19-22, 36.
[26]	岳洁, 刘艳, 李玉, 等. 国内脑卒中患者主要照顾者照顾负担水平及影响因素的系统评价[J]. 中国疗养医学, 2022, 31(8): 818-823. doi: 10.13517/j.cnki.ccm.2022.08.008
	YUE J, LIU Y, LI Y, et al. A systematic evaluation of caregiving burden level and influencing factors of primary caregivers of stroke patients in China[J]. Chin J Conval Med, 2022, 31(8): 818-823. doi: 10.13517/j.cnki.ccm.2022.08.008
[27]	朱金凤, 蔡卫新, 陶子荣, 等. 中青年出血性脑卒中患者康复运动依从性现状及其影响因素分析[J]. 中华护理杂志, 2023, 58(5): 580-586. doi: 10.3761/j.issn.0254-1769.2023.05.010
	ZHU J F, CAI W X, TAO Z R, et al. Analysis of rehabilitation exercise compliance and its infuencing factors in young and middle-aged patientswith hemorrhagic stroke[J]. Chin J Nurs, 2023, 58(5): 580-586.
[28]	梁津, 李鸿艳. 脑卒中主要照顾者身心健康研究进展[J]. 循证护理, 2021, 7(7): 906-910.
	LIANG J, LI H Y. Research progress on physical and mental health of primary caregivers of stroke[J]. Chin Evid-Based Nurs, 2021, 7(7): 906-910.
[29]	AKOSILE C O, BANJO T O, OKOYE E C, et al. Informal caregiving burden and perceived social support in an acute stroke care facility[J]. Health Qual Life Outcomes, 2018, 16(1): 57-65. doi: 10.1186/s12955-018-0885-z
[30]	HAN Y, LIU Y, ZHANG X, et al. Chinese family care givers of stroke survivors: determinants of caregiving burden within the first six months[J]. Clin Nurs, 2017, 26(23/24): 4558-4566. doi: 10.1111/jocn.2017.26.issue-23pt24
[31]	韩旭, 朱冉君, 臧舒婷, 等. 首发中青年脑卒中患者家属心理弹性及影响因素分析[J]. 临床心身疾病杂志, 2021, 27(4): 89-93.
	HAN X, ZHU R J, ZANG S T, et al. Analysis of psychological resilience and its influencing factors in family members of young and middle-aged patients with first-episode stroke[J]. J Clin Psych Dis, 2021, 27(4): 89-93.

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

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 4

References 31

Related Articles 15

Metrics

Comments

Recommended 0

[1]	ZHENG Jianling, LIU Huilin, ZHU Lin, GU Bin, YAN Ruxiu, ZHAO Qi, SONG Luping. Effect of early intelligent assisted walking under suspension protection on motor and walking function for stroke patients [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(4): 431-436.
[2]	SU Zhaoyin, KANG Weihan, LIU Yatao, LÜ Yuan, Michael NERLICH. Relationship between physical activity levels and stroke risk among middle-aged and older adults in China based on CHARLS data [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(4): 449-453.
[3]	CHEN Yuanyue, LI Jiabin, KUAI Feng, PENG Lili, XIANG Jie. Immediate effect of multi-chancel functional electrical stimulation combined with task-oriented training on brain functional network in stroke patients with upper limb hemiplegia [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(4): 462-467.
[4]	WEI Chen, WANG Zixian, LI Shufan, WANG Peng, JIA Shuqi, TIAN Ying. Effect of mirror therapy on upper extremity motor function and activities of daily living in stroke patients: a meta-analysis [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(3): 281-291.
[5]	LIU Huan, HAN Xue, SONG Jianing, LOU Xiaole, XU Lei. Effect of robotic training under position limitation on upper limbs in patients with shoulder subluxation after stroke [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(3): 303-309.
[6]	YU Chunyang, LIU Ran, ZHAO Yishuang, GUO Shuai, ZHOU Ya'nan, LI Li, ZHANG Hao. Effect of virtual reality treadmill training on balance and gait in stroke patients [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(3): 310-315.
[7]	HUANG Xing, CHANG Jingling, ZHANG Zihan, LI Ying. Characteristics of event-related potential and frequency on working memory of post-stroke aphasia [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(3): 316-325.
[8]	LIANG Ming, WEI Zhen, Zuhere·ROUZI , LI Jinxian. Effect of Passy-Muir speaking valve on swallowing biomechanics of dysphagia in stroke patientst after tracheotomy [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(3): 326-332.
[9]	GAO Ling, CHU Fengming, JIA Fan, CHEN Jie, ZHANG Ming. Effect of brain-computer interface based on visual, auditory and motor feedback combined with transcranial direct current stimulation on upper limb function in stroke patients [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(2): 202-209.
[10]	GONG Xiang, WANG Menghuan, WU Cunshu, CHEN Junwen, XIAO Yue, YANG Yun, SUN Wanting, LU Jun, XU Guangxu. Effect of galvanic vestibular stimulation on stroke patients with lateropulsion [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(2): 210-216.
[11]	LI Fang, LIU Huizhen, MEI Liping, ZHANG Tong, ZHANG Haojie, LI Bingjie, ZHAO Jun. Related factors of post-stroke depression in patients with cerebral infarction during hospitalization in rehabilitation department [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(2): 217-222.
[12]	ZHANG Minglan, ZHANG Lingling, WANG Lisha, LIU Li, GAO Run, RAO Jiang, LIU Wan, XIA Zi'an, ZHANG Chuanwen, CHENG Xinxin. Impact of autonomic nerve function on motor function in patients with post-stroke depression [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(2): 223-231.
[13]	LIN Na, GAO Hanlu, LU Huiping, CHEN Yanqing, ZHENG Junfan, CHEN Shurong. Effect of virtual reality on upper limb function after stroke: a study of diffusion tensor imaging [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 61-67.
[14]	WANG Haoyi, SHI Yawei, LU Jun, XU Guangxu. Impact of subjective vertical perception impairment on function in stroke patients: a retrospective study [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 68-73.
[15]	CHEN Junwen, CHEN Qian, CHEN Cheng, LI Shuyue, LIU Lingling, WU Cunshu, GONG Xiang, LU Jun, XU Guangxu. Effect of modified Baduanjin exercise on cardiopulmonary function, motor function and activities of daily living for stroke patients [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 74-80.