亲密关系在妇科癌症患者夫妻支持应对与生活质量间的中介效应研究

doi:10.12114/j.issn.1007-9572.2021.02.070

摘要/Abstract

摘要： 背景夫妻支持应对与妇科癌症患者生活质量有关，但其作用路径尚不明确。目的探究亲密关系在妇科癌症患者夫妻支持应对与生活质量间的作用机制。方法采用便利抽样法，选取2020年5月至2021年2月在中国医科大学附属盛京医院住院治疗的309例妇科癌症患者作为研究对象。采用一般资料调查表调查患者的一般资料，采用夫妻支持应对量表评价压力状态下的夫妻支持应对、中文版Lock-Wallace婚姻（恋爱）关系调适量表评价夫妻亲密关系质量、中文版生存质量测定量表简表（包括生理健康、心理健康、社会关系、环境领域4个维度）评价患者生活质量。结果共发放问卷320份，剔除无效问卷11份，回收有效问卷309份，有效回收率为96.56%。309例患者积极夫妻应对方式得分为（48.2±7.4）分，消极夫妻支持应对方式得分为（8.3±1.4）分，夫妻支持应对量表总得分为（97.9±11.4）分，中文版Lock-Wallace婚姻（恋爱）关系调适量表得分为（90.9±19.7）分，生理健康得分为（41.9±14.1）分，心理健康得分为（49.8±11.9）分，社会关系得分为（50.6±13.4）分，环境领域得分为（47.8±9.9）分。多元线性回归分析结果显示：夫妻支持应对量表总得分、Lock-Wallace婚姻（恋爱）关系调适量表得分与妇科癌症患者生理健康得分相关（P<0.05）；Lock-Wallace婚姻（恋爱）关系调适量表得分与妇科癌症患者心理健康得分相关（P<0.05）；Lock-Wallace婚姻（恋爱）关系调适量表得分与妇科癌症患者社会关系得分相关（P<0.05）；夫妻支持应对量表总得分、Lock-Wallace婚姻（恋爱）关系调适量表得分与妇科癌症患者环境领域得分相关（P<0.05）。结构方程模型结果显示，夫妻支持应对量表总得分直接正向预测中文版Lock-Wallace婚姻（恋爱）关系调适量表得分（β=0.931，P<0.001）；中文版Lock-Wallace婚姻（恋爱）关系调适量表得分直接正向预测中文版生存质量测定量表简表得分（β=0.781，P=0.012）；夫妻支持应对量表总得分对中文版生存质量测定量表简表得分无预测作用（β=0.112，P=0.688）。Bootstrap抽样检验法结果显示（重复抽样5 000次）：亲密关系在夫妻支持应对与生活质量间的中介效应为0.727，占总效应的86.7%。结论妇科癌症患者夫妻支持应对处于较低水平，夫妻亲密关系一般，生活质量较差，通过结构方程模型验证了夫妻支持应对可通过夫妻亲密关系对生活质量有间接预测作用。

关键词: 生殖器肿瘤, 女（雌）性, 妇科癌症, 亲密关系, 夫妻支持应对, 生活质量, 中介效应

Abstract: Background

Dyadic coping are associated with quality of life in gynecologic cancer patients, but the mechanism path of action is still unclear.

Objective

To explore the mechanism of intimate relationship between dyadic coping and quality of life in gynecological cancer patients.

Methods

By using a convenience-sampling method, 309 hospitalized gynecological cancer patients from Shengjing Hospital of China Medical University from May 2020 to February 2021 were selected as the research objects. The general data questionnaire was used to investigate the general data of patients, the Dyadic Coping Inventory was used to assess the dyadic coping under stress. The Chinese version of the Lock-Wallace Marriage (Love) Relationship Adjustment Scale was used to evaluate the quality of intimate relationships between couples, the The Chinese version of the World Health Organization Quality of Life-BREF Scale (including the four dimensions of physical health, mental health, social relations, and environment) was used to examine the quality of life of patients.

Results

A total of 320 questionnaires were distributed, 11 invalid questionnaires were excluded, and 309 valid questionnaires were returned, with an effective recovery rate of 96.56%. The average score of positive dyadic coping, negative dyadic coping and total score of dyadic coping for 309 patients were (48.2±7.4) , (8.3±1.4) , and (97.9±11.4) , respectively. The Chinese version of Locke-Wallace Marital (love) Adjustment and Prediction Test's mean score was (90.9±19.7) . The average score for the physical domain, psychological domain, social domain, and environment domain were (41.9±14.1) , (49.8±11.9) , (50.6±13.4) , and (47.8±9.9) , respectively. Multiple linear regression analysis showed that the total score of the Lock-Wallace Marital (love) Adjustment and Prediction Scale were significantly correlated with physical domain scores in gynecologic cancer patients (P<0.05) ; The Lock-Wallace Marital (love) Adjustment and Prediction Scale scores were associated with psychological domain scores in gynecologic cancer patients (P<0.05) ; The Lock-Wallace Marital (love) Adjustment and Prediction Scale scores were associated with social domain scores in gynecologic cancer patients (P<0.05) ; The total score of dyadic coping and Lock-Wallace Marital (love) Adjustment and Prediction Scale were significantly correlated with environment domain scores in gynecologic cancer patients (P<0.05) . The results of Structural Equation Model showed that the total score of dyadic coping positively predicted Lock-Wallace Marital (love) Adjustment and Prediction Scale (β=0.931, P<0.001) , Lock-Wallace Marital (love) Adjustment and Prediction Scale scores positively predicted the World Health Organization Quality of Life-BREF Scale scores (β=0.781, P=0.012) , and the total score of dyadic coping exerted no predictive effect on the World Health Organization Quality of Life-BREF questionnaire scores (β=0.112, P=0.688) .The results of the bootstrap sampling method (5 000 replicates) showed that the mediating effect of intimate relationship on the relationship between dyadic coping and quality of life was 0.727, accounting for 86.7% of the total effect.

Conclusion

Gynecological cancer patients may have a relatively low level of dyadic coping, unsatisfactory intimate relationship, and poorer quality of life. The dyadic coping can indirectly predict the quality of life through intimate relationship was verified by structural equation modeling.

Key words: Genital neoplasms, female, Gynecological cancer, Intimate relationship, Dyadic coping, Quality of life, Mediating effect

中图分类号:

R736.8

叶慧慧,葛莉娜,臧爽,等. 亲密关系在妇科癌症患者夫妻支持应对与生活质量间的中介效应研究[J]. 中国全科医学, 2022, 25(09): 1105-1112. DOI: 10.12114/j.issn.1007-9572.2021.02.070.

YE Huihui, GE Lina, ZANG Shuang, HU Shuang.

Study on the Mediating Effect of Intimate Relationship between Dyadic Coping and Quality of Life in Gynecological Cancer Patients' Couples [J]. Chinese General Practice, 2022, 25(09): 1105-1112.

图/表 3

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项目	积极夫妻支持应对得分	消极夫妻支持应对得分	夫妻支持应对量表总得分	中文版Lock-Wallace婚姻（恋爱）关系调适量表得分	生理健康得分	心理健康得分	社会关系得分	环境领域得分
积极夫妻支持应对得分	1.000	-	-	-	-	-	-	-
消极夫妻支持应对得分	-0.348^a	1.000	-	-	-	-	-	-
夫妻支持应对量表总得分	0.954^a	-0.200^a	1.000	-	-	-	-	-
中文版Lock-Wallace婚姻（恋爱）关系调适量表得分	0.733^a	-0.307^a	0.695^a	1.000	-	-	-	-
生理健康得分	0.499^a	-0.181^a	0.507^a	0.502^a	1.000	-	-	-
心理健康得分	0.415^a	-0.108^*	0.421^a	0.531^a	0.697^a	1.000	-	-
社会关系得分	0.417^a	-0.223^a	0.399^a	0.479^a	0.322^a	0.355^a	1.000	-
环境领域得分	0.668^a	-0.240^a	0.664^a	0.571^a	0.524^a	0.481^a	0.475^a	1.000

项目	积极夫妻支持应对得分	消极夫妻支持应对得分	夫妻支持应对量表总得分	中文版Lock-Wallace婚姻（恋爱）关系调适量表得分	生理健康得分	心理健康得分	社会关系得分	环境领域得分
积极夫妻支持应对得分	1.000	-	-	-	-	-	-	-
消极夫妻支持应对得分	-0.348^a	1.000	-	-	-	-	-	-
夫妻支持应对量表总得分	0.954^a	-0.200^a	1.000	-	-	-	-	-
中文版Lock-Wallace婚姻（恋爱）关系调适量表得分	0.733^a	-0.307^a	0.695^a	1.000	-	-	-	-
生理健康得分	0.499^a	-0.181^a	0.507^a	0.502^a	1.000	-	-	-
心理健康得分	0.415^a	-0.108^*	0.421^a	0.531^a	0.697^a	1.000	-	-
社会关系得分	0.417^a	-0.223^a	0.399^a	0.479^a	0.322^a	0.355^a	1.000	-
环境领域得分	0.668^a	-0.240^a	0.664^a	0.571^a	0.524^a	0.481^a	0.475^a	1.000

因变量	自变量	B	SE	β	t值	P值
生理健康	常量	-13.975	5.895	-	-2.342	0.020
	夫妻支持应对量表总得分	0.379	0.082	0.306	4.606	<0.001
	Lock-Wallace婚姻（恋爱）关系调适量表得分	0.207	0.048	0.289	4.353	<0.001
心理健康	常量	14.147	5.094	-	2.777	0.006
	夫妻支持应对量表总得分	0.105	0.070	0.101	1.501	0.134
	Lock-Wallace婚姻（恋爱）关系调适量表得分	0.279	0.041	0.461	6.872	<0.001
社会关系	常量	11.901	5.895	-	2.019	0.044
	夫妻支持应对量表总得分	0.149	0.081	0.128	1.839	0.067
	Lock-Wallace婚姻（恋爱）关系调适量表得分	0.265	0.047	0.391	5.629	<0.001
环境领域	常量	-5.913	3.675	-	-1.609	0.109
	夫妻支持应对量表总得分	0.450	0.051	0.516	8.872	<0.001
	Lock-Wallace婚姻（恋爱）关系调适量表得分	0.107	0.029	0.212	3.640	<0.001

因变量	自变量	B	SE	β	t值	P值
生理健康	常量	-13.975	5.895	-	-2.342	0.020
	夫妻支持应对量表总得分	0.379	0.082	0.306	4.606	<0.001
	Lock-Wallace婚姻（恋爱）关系调适量表得分	0.207	0.048	0.289	4.353	<0.001
心理健康	常量	14.147	5.094	-	2.777	0.006
	夫妻支持应对量表总得分	0.105	0.070	0.101	1.501	0.134
	Lock-Wallace婚姻（恋爱）关系调适量表得分	0.279	0.041	0.461	6.872	<0.001
社会关系	常量	11.901	5.895	-	2.019	0.044
	夫妻支持应对量表总得分	0.149	0.081	0.128	1.839	0.067
	Lock-Wallace婚姻（恋爱）关系调适量表得分	0.265	0.047	0.391	5.629	<0.001
环境领域	常量	-5.913	3.675	-	-1.609	0.109
	夫妻支持应对量表总得分	0.450	0.051	0.516	8.872	<0.001
	Lock-Wallace婚姻（恋爱）关系调适量表得分	0.107	0.029	0.212	3.640	<0.001