【作者】 杨琴；

【导师】 殷晓旭；

【作者基本信息】 华中科技大学 ， 公共卫生， 2019， 硕士

【摘要】 目的:分析结核病患者抑郁症状发生情况并探索其影响因素;同时,利用结构方程模型分析家庭功能、疾病认知、医患沟通、结核病相关病耻感与抑郁症状之间的相互关系,并验证病耻感是否作为中介变量发挥中介效应,为制定有效干预措施,改善结核病患者抑郁症状提供实证依据。方法:本研究采用文献研究和小组讨论的方法设计结构化调查问卷,利用多阶段抽样方法选取湖北省三个结核病防治单位作为调查地点,2013年10月1日至2014年3月31日期间对所有前来就诊的结核病患者进行问卷调查,共收集有效问卷1342份。运用多元线性回归分析探索结核病患者抑郁症状的影响因素,利用结构方程模型探究家庭功能、疾病认知、医患沟通、病耻感与患者抑郁症状之间的相互关系,同时对结核病相关病耻感的中介效应进行检验。所有数据分析均使用统计软件SAS9.3和Amos17.0。结果:1、结核病患者抑郁症状现状在1342例结核病患者中,患者抑郁症状量表平均得分为15.86分,标准差为8.19分,抑郁症状发生率为48%。其中,34.58%患者有轻度抑郁症状,13.19%患者有中度及重度抑郁症状。2、结核病患者抑郁症状影响因素多因素分析表明,结核病患者抑郁症状在人口统计学变量如性别、民族和文化程度上具有显著性差异,女性(?=1.13,P=0.0054)、少数民族(?=2.22,P<0.0001)结核病患者出现抑郁症状的可能性更大。相比于小学及以下文化程度的患者,初中(?=-1.25,P=0.0071)、高中及以上(?=-2.54,P=0.0001)患者发生抑郁症状的可能性更小。家庭功能、疾病认知、医患沟通和病耻感与患者抑郁症状得分显著相关,其中,家庭功能、疾病认知和医患沟通均与抑郁症状呈负相关,病耻感与抑郁症状呈正相关。3、结核病相关病耻感对抑郁症状的影响及其中介作用结构方程模型结果显示,结核病相关病耻感对抑郁症状具有显著直接效应,效应值大小为0.219(P<0.001)。此外,结核病相关病耻感部分中介了家庭功能和疾病认知对抑郁症状的影响,中介效应值分别为-0.048(P<0.01)和-0.021(P<0.01),占总效应的比例分别为12.44%和8.86%;结核病相关病耻感完全中介了医患沟通对抑郁症状的影响,中介效应值为-0.028(P<0.01)。结论:抑郁症状在我国结核病患者中普遍存在,良好的家庭功能、疾病认知和医患沟是患者抑郁症状的保护因素,结核病相关病耻感是抑郁症状的危险因素。此外,结核病相关病耻感还作为中介变量在家庭功能、疾病认知和医患沟通影响患者抑郁症状时发挥中介效应。创新和局限性:本研究的创新点在于探讨了家庭功能、疾病认知、医患沟通、病耻感与结核病患者抑郁症状之间的复杂关系,并首次明确了结核病相关病耻感对抑郁症状的影响及其中介效应。本研究主要有以下两点局限性,首先,本研究是横断面研究,尚不能进行因果推论;其次,调查地点仅为湖北省,尚需在更多地区对结核病患者开展调查,验证本研究的调查结果。更多还原

【Abstract】 Objectives: This study aimed to assess the status of depressive symptoms in patients with tuberculosis and to identify the potential influencing factors of depressive symptoms.Meanwhile,we explored the association between family function,knowledge about tuberculosis,doctor-patient communication,tuberculosis-related stigma,and depressive symptoms,and examined the mediating effect of tuberculosis-related stigma.The findings of the research provide empirical evidence for depression interventions among patients with TB.Methods: Structured questionnaire were developed based on comprehensive reviews of literature and an advisory panel.Then three tuberculosis prevention and control institutions were randomly selected in Hubei province using a multistage sampling method.A cross-sectional survey was conducted in the selected tuberculosis prevention and control institutions from October 1,2013 to March 31,2014.Finally,a total of 1342 valid questionnaires were collected.Multiple linear regression method was used to identify the risk factors of depressive symptoms in patients with TB.Structural equation model was used to explore the interrelationships between family function,knowledge about tuberculosis,doctor-patient communication,tuberculosis-related stigma and depressive symptoms,and validate the mediating effect of stigma.All data analyses were performed using statistical software SAS9.3 and Amos 17.0.Results:1.Current status of depressive symptoms among tuberculosis patients.Of the 1,342 tuberculosis patients included in this study,the average score of the Depressive Symptoms Scale was 15.86(standard deviation = 8.19)and the prevalence of depre ssion symptoms was 48%.Of these,34.8% had mild while 13.2% had moderate to severe depressive symptoms.2.Influencing factors of depressive symptoms among tuberculosis patients.Multivariate analysis showed that depressive symptoms in tuberculosis patients had significant differences in socio-demographic characteristics.Female(?=1.13,P=0.0054)and minority(?=2.22,P<0.0001)patients are more likely to have depressive symptoms.Compared to patients with primary education level or below,patients with secondary education level(? =-1.25,P=0.0071),high school education level or above(? =-2.54,P=0.0001)are less likely to have depressive symptoms.In addition,family function,knowledge about tuberculosis,and doctor-patient communication were significantly negatively associated with patients’ depression symptoms,while tuberculosis-related stigma was significantly positively associated with patients’ depression symptoms.3.The effects of stigma on depressive symptoms and the mediating effect of stigma.Results of structural equation model showed that tuberculosis-related stigma had a significant direct effect on depressive symptoms,and the effect value was 0.219(P < 0.001).In addition,stigma partially mediated the effect of family function and knowledge about tuberculosis on depressive symptoms,and the mediating effect value was-0.048(P<0.01)and-0.021(P<0.01),accounted for 12.44% and 8.86% of the total effect,respectively.Stigma fully mediated the effect of doctor-patient communication on depressive symptoms,and the effect value was-0.028(P<0.01).Conclusion: Depressive symptoms are common among rural tuberculosis patients in China.Good family function,knowledge about tuberculosis,and doctor-patient communication are protective factors but tuberculosis-related stigma is a risk factor for depressive symptoms.Moreover,the effect of family function,knowledge about tuberculosis and doctor-patient communication on depressive symptoms can be mediated by tuberculosis-related stigma.Highlights and limitations: To the best of our knowledge,this was the first study to explore the complex interrelationships between family function,knowledge about tuberculosis,doctor-patient communication,tuberculosis-related stigma,and depressive symptoms.In addition,this was the first study to validate the effects of stigma on depressive symptoms and the mediating effect of stigma.There are a few limitations of this study that must be noted.Firstly,as a cross-sectional study,causality cannot be inferred.Secondly,our sample only comprised patients with TB in Hubei province,further studies in other provinces are needed.更多还原