【作者】 苏普玉；

【导师】 陶芳标； 程晓莉；

【作者基本信息】 安徽医科大学 ， 儿少卫生与妇幼保健学， 2008， 硕士

【摘要】 目的了解安徽省艾滋病流行县父母为艾滋病病毒感染(HIV)/艾滋病患者(AIDS)家庭青少年的心理健康水平,分析其心理卫生问题影响因素;探讨集中参与互动式心理应对能力训练对其心理卫生问题及应对方式的影响。方法从安徽省6个艾滋病综合防治项目县(萧县、利辛、界首、临泉、濉溪、郎溪)方便抽取168个HIV/AIDS家庭(每户父母双方至少有一方HIV检测阳性)的家庭,每个家庭调查1名10～18岁青少年,共调查168名,其中父母一方HIV阳性114名,为HIV单亲阳性家庭组;父母双方HIV均阳性54名,为HIV双亲阳性家庭组。在调查同时,在同村调查1名年龄、性别相同的青少年作为非HIV/AIDS家庭组,共调查了130人。使用症状自评量表(SCL-90)、多维学生生活满意度量表(MSLSS)、自尊量表(SES)、简易应对方式问卷(SCSQ)、家庭支持量表(PSS-Fa)评定青少年心理社会因素,评价三组青少年各项心理卫生状况的差异,分析HIV/AIDS家庭青少年心理卫生的影响因素。从以上5个艾滋病综合防治项目县(萧县、界首、临泉、濉溪、郎溪)的调查对象中根据“知情同意”的原则,抽取51名HIV/AIDS家庭青少年进行为期7天的心理应对能力干预训练,并在训练的过程中进行HIV/AIDS基本知识教育;使用症状自评量表(SCL-90)、简易应对方式问卷(SCSQ)及一般项目进行干预前后调查,评价心理应对能力训练对HIV/AIDS家庭青少年心理行为的干预效果。使用统计产品与服务解决方案(statistical product and service solutions, SPSS)13.0版本进行统计分析。结果三组青少年在性别和年龄上差异无显著性,三组人群具有可比性。SCL-90总分、各因子分HIV双亲阳性家庭组均最高,非HIV/AIDS家庭组均最低,三组间差异均有显著统计学意义(P<0.05)。HIV双亲阳性家庭组青少年心理卫生问题总检出率为27.8%,HIV单亲阳性家庭组为16.7%,非HIV/AIDS家庭组为8.5%,三组总检出率差异有显著统计学意义(χ2=11.457,P=0.003)。HIV双亲阳性家庭组青少年10个因子至少1个因子的因子分在2.0～3.0所占比例为37.0%,HIV单亲阳性家庭组为29.8%,非HIV/AIDS家庭组为19.2%,三组间差异有显著统计学意义(χ2=7.250,P=0.027)。三组目前仍在就读的青少年中,HIV/AIDS家庭青少年MSLSS的总分及5个维度的得分均低于非HIV/AIDS家庭组,HIV双亲阳性家庭组最低,其中在“朋友支持”维度三组间差异有显著统计学意义(P<0.05)。三组青少年自尊、积极应对、消极应对均数及等级分布差异均无显著性(P>0.05)。HIV/AIDS家庭青少年心理卫生问题总检出率为20.2%,年龄越大检出率越高。单因素分析显示,积极应对和消极应对得分与SCL-90各因子得分均显著相关;年龄增大、同学朋友关系疏远、消极应对得分高是HIV/AIDS家庭青少年心理卫生问题的危险因素,积极应对和家庭支持得分高是HIV/AIDS家庭青少年心理卫生问题的保护因素。多因素Logistic回归分析显示,HIV/AIDS家庭青少年心理卫生问题主要受积极应对、消极应对、家庭支持和同学朋友关系影响。对51名HIV/AIDS家庭青少年进行为期7天的心理应对能力训练显示,94.12%的儿童报告喜欢参与互动式心理应对能力训练。健康教育前后51名干预对象对20个HIV/AIDS基本知识平均知晓率分别为61.65%、82.25%,前后差异有显著统计学意义(χ2=107.139,P=0.000);20个条目健康教育后的知晓率均高于教育前。心理卫生问题检出率训练后(9.8%)低于训练前(25.5%),差异有统计学显著性(χ2=4.317,P=0.038);抑郁、焦虑得分训练后,(1.40±0.52/1.39±0.49)低于训练前(1.55±0.50/1.55±0.61),差异有统计学显著性(t=2.056、2.115,P=0.046、0.041);积极应对、消极应对得分训练前后差异均无统计学显著性(P>0.05)。结论HIV/AIDS家庭青少年的心理健康状况不容乐观,全社会应采取积极有效措施保证这类特殊群体的健康成长;改善HIV/AIDS家庭青少年的应对方式,促进家庭成员间的相互支持,改变农村有关艾滋病歧视现象是促进HIV/AIDS家庭青少年心理健康的重要途径;集体参与互动式健康教育对提高青少年HIV/AIDS基本知识具有良好的效果;短期集体参与互动式心理应对能力训练对改善AIDS家庭中儿童心理症状具有一定的效果,尚需进一步探讨长期心理应对能力训练对儿童青少年心理行为的影响。更多还原

【Abstract】 Objectives To study the psychological well-being and influence factors of mental health among adolescents living with HIV-positive parents in rural of Anhui province. Then to explore the influence of participating and interconvertible mental coping effectiveness training targeting those adolescents.Methods The investigation was involving 298 adolescents from 10 to 18 years old, including 54 adolescents living with both parents suffering from HIV or AIDS, 114 adolescents living with one parent was HIV infected and other 130 adolescents from normal families. Only one adolescent was studied peer family. All participants completed an anonymous questionnaire. Psychological health, satisfaction on life, self-esteem and coping style were evaluated by SCL-90, Multidimensional Students’Life Satisfaction Scale, Self-esteem Scale and Simplified Coping Style Questionnaire. We assessment the psychological well-being among the three groups, and analyzed the influence factors of mental health among them. 51 adolescents living with HIV-positive parents were selected to carry out mental coping effectiveness training. At the beginning and end of the intervention, 51 participants were estimated their knowledge of HIV/AIDS, mental health and coping style. AIDS awareness was evaluated by self-organized AIDS knowledge. Mental health and coping style were evaluated by SCL-90 and Simplified Coping Style Questionnaire. We estimated the efficacy of the intervention on those adolescents.Results The total score and 10 factors of the SCL-90 in the adolescents living in family suffering from HIV or AIDS was higher than the adolescents from normal families and those scores in the adolescents living with both parents suffering from HIV/AIDS were the highest. Those scores were significant different in the three different subjects (P<0.05). There were 27.8% of the adolescents living with both HIV-positive parents had the total score of the SCL-90 more than 160 or at lest one of the 10 factors’score more than 3. The detected rate of the adolescents living with one HIV-positive parent was 16.7%, higher than the adolescents from normal families (8.5%) and with significant difference (χ2=11.457,P=0.003). 37.0% of the adolescents living with both HIV-positive parents, were having one or more factor’score between 2.0 and 3.0, compared to the rate (29.8%) of adolescents living with one HIV-positive parent. The rate was higher than the adolescents from normal families (19.2%) and with significant difference (χ2=14.583, P=0.005). Among the students from normal families, the total score and the 5 dimensionalities’score of the MSLSS were lower than those adolescents of parents suffering from AIDS or HIV. In the friend dimensionality, the score of the adolescents from normal families was significantly higher than the adolescents of parents infected HIV. The scores of the self-esteem, positive coping style and negative coping style were not significantly different in the three different subjects.20.2% of the adolescents got the total score of the SCL-90 more than 160 or at lest one of the 10 factors’score more than 3, and the proportion became higher with the increase of aged. The scores of positive and negative cooping style were significantly related with the respective score of 10 factors of SCL-90. The higher score of positive cooping style and family support were protective factors for mental health of adolescents. While higher age, the estranged relationship with schoolmates or friends and the higher score of negative cooping style were risk factors for their mental health. Multinomial Logistic analysis showed that positive cooping style, negative cooping style, family support and relationship with schoolmates or friends were the main influential factors of mental health of adolescents in HIV/AIDS family.94.12% of the adolescents in those study subjects enjoyed taking part in the participating and interconvertible mental coping training. After a seven-day mental coping training, the average rate of understanding about those HIV/AIDS knowledge increased from 61.25% (baseline) to 82.25% and with significant difference (χ2=107.139, P=0.000). The percentage of each knowledge to be answered correctly increased. The percentage of those adolescents who having mental symptom (the total score of the SCL-90 more than 160 or at lest one of the 9 factor’score more than 3) reduced from 25.5% (baseline) to 9.8% and with significant difference (χ2=4.317, P=0.038). The 9 factor’s score of SCL-90 were all lower after intervention, the factor of depression and anxiety were much lower and with significant difference (1.40±0.52/1.55±0.50, 1.39±0.49/1.55±0.61, P=0.046\0.041). The score of positive coping style became higher, negative coping style became lower after intervention, but not with significant difference (P>0.05).Conclusions The psychological status of the adolescents living in family suffering from HIV/AIDS indicated unoptimistic situation. Improving the cooping style of adolescents in AIDS family, promoting the mutual support of family members, changing the discrimination against AIDS in rural area are the importance approach to advancing the mental health of adolescents whose parents infected HIV. The participating and interconvertible health education is propitious to improve the knowledge of HIV/AIDS in adolescents. Short-term mental coping training can reduce mental symptom of those adolescents living in family suffering from HIV/AIDS.更多还原