精神科护士人格特征与心理困扰的关系:心理弹性的中介作用

目的 探讨精神科护士人格特征与心理困扰的关系及心理弹性的中介作用。方法 采用大五人格问卷(BFI)、心理弹性量表(CD-RISC 10)和凯斯勒10量表(K10)对192名精神科护士进行问卷调查。 结果 精神科护士K10得分为20.66±5.91,80.7%的精神科护士存在不同程度的心理困扰(K10得分≥16)。K10总分与人格特征中的N维度呈显著正相关(P<0.01),与E维度、C维度、心理弹性呈显著负相关(均P<0.01),心理弹性与E维度、C维度呈显著正相关(均P<0.01),与N维度呈显著负相关(P<0.01)。心理弹性部分中介了神经质与心理困扰的关系,中介效应占总效应的25.4%。 结论 神经质人格与心理弹性是影响精神科护士心理困扰发生的重要因素,心理弹性部分中介了神经质人格对心理困扰的影响。     

Survivors’ understanding of vulnerability and resilience to maternal near-miss obstetric events in Uganda

Objective

To gain an understanding of how obstetric complications affect the lives and livelihoods of survivors.

Methods

A phenomenological study was conducted between April and August 2013 at Mulago Hospital, Kampala, Uganda. Data were collected through in-depth interviews among 36 women admitted with obstetric near miss. The interviews investigated perceptions, lived experiences, and meanings attached to such experiences by survivors. More specifically, the questions explored: self-rated health; anticipated social, sexual, and reproductive health challenges; and mitigating factors.

Results

The identified themes were prior expectations, vulnerability, body and social capital, and resilience. Women were found to approach childbirth with predetermined expectations that influenced their pregnancy and childbirth experience. Fatalism, expectations, and social insecurity markedly contributed to vulnerability. Resilience factors included ability to institute adaptations and to harness body and social capital.

Conclusion

Vulnerabilities and their determinants were found to be inter-related. Individuals’ social capital fluctuates over the acute crisis, necessitating multiple adaptations and coping strategies to reduce vulnerability or increase resilience. Although social and body capital may be mobilized to mitigate the effects of the obstetric crisis, they can either worsen vulnerability or increase resilience.     

Looking for resilience: Understanding the longitudinal trajectories of responses to stress

Taking advantage of two large, population-based, and longitudinal datasets collected after the 1999 floods in Mexico (n = 561) and the September 11, 2001 terrorist attacks in New York (n = 1267), we examined the notion that resilience may be best understood and measured as one member of a set of trajectories that may follow exposure to trauma or severe stress. We hypothesized that resistance, resilience, recovery, relapsing/remitting, delayed dysfunction, and chronic dysfunction trajectories were all possible in the aftermath of major disasters. Semi-parametric group-based modeling yielded the strongest evidence for resistance (no or mild and stable symptoms), resilience (initially moderate or severe symptoms followed by a sharp decrease), recovery (initially moderate or severe symptoms followed by a gradual decrease), and chronic dysfunction (moderate or severe and stable symptoms), as these trajectories were prevalent in both samples. Neither Mexico nor New York showed a relapsing/remitting trajectory, and only New York showed a delayed dysfunction trajectory. Understanding patterns of psychological distress over time may present opportunities for interventions that aim to increase resilience, and decrease more adverse trajectories, after mass traumatic events.     

Nivel de resiliencia y síntomas depresivos en el internado médico en el Perú

IntroductionThe medical intern is susceptible to multiple factors that can lead to depressive symptoms. Resilience is a mechanism that allows them to overcome and counteract this problem. There is limited information about the scope and relationship between these 2 aspects in the population described.ObjectiveTo determine the relationship between the level of resilience and the presence of depressive symptoms during the medical internship in Lima, Peru.Materials and methodsA cross-sectional study was carried out on a representative sample of interns from four hospitals in Lima, Peru. The level of resilience was measured with the Wagnild and Young Abbreviated Resilience Questionnaire, and the presence of depressive symptoms with the abbreviated Zung Self-Rating Depression Scale. A logistic regression model was used to determine statistical relationship.ResultsA total of 202 interns were surveyed (83.5% of the total number of interns). The mean level of resilience was 78.01 ± 11.59, with a high resilience prevalence of 87.1% (n = 176), with the mean prevalence of depressive symptoms being 42.6% (n = 86). An inverse relationship was found between a high level of resilience and the absence of depressive symptoms (OR 13.75; 95% CI 3.9-47.6; P < .05).ConclusionThose with a higher level of resilience had fewer depressive symptoms. Contact with friends, and conformity with the hospital and with staff were associated with a high level of resilience.     

精神分裂症与轻性精神障碍患者一级亲属心理韧性、应对方式的对照研究

目的 探讨精神分裂症与轻性精神障碍患者一级亲属心理韧性与应对方式的相关性.方法 对精神分裂症及轻性精神障碍（抑郁症、焦虑症、强迫症、恐惧症、躯体形式障碍及神经衰弱）患者的94名一级亲属分为精神分裂症组（重性组）（n=45）和轻性精神障碍组（轻性组）（n=49）.两组采用心理韧性量表（RSA）、简易应对方式问卷（SCSQ）进行问卷调查,并进行比较分析.结果 轻性组与重性组心理韧性评分,社会能力[（22.67±4.59）分、（20.76±4.09）分,P＜0.05]、家庭凝聚力[（25.41±4.34）分,（22.60±4.90）分,P＜0.01]、社会资源[（25.35±4.27）分,（23.24±4.16）分,P＜0.05]及总分[（129.22±12.89）分,（122.60±14.54）分,P＜0.05]均高于重性组;两组简易应对方式评分,积极应对分轻性组高于重性组[（27.45±5.22）分,（23.36±6.46）分,P＜0.05];消极应对分低于重性组[（9.92±3.08）分,（11.64±4.36）分,P＜0.05],总分也高于重性组[（36.72±5.26）分,（34.41±5.61）分,P＜0.05];两组除轻性组自我的知觉与消极应对无相关外,心理韧性与积极应对呈正相关（r=0.238～ 0.434,P＜0.01或P＜0.05）,与消极应对呈负相关（r=-0.274～0.401,P＜0.01或P＜0.05）.结论 轻性精神障碍患者一级亲属心理韧性高于重性组,面对逆境时多采取积极应对方式,两组心理韧性与应对方式有相关性.     

临床新护士心理弹性对职业倦怠影响的研究

目的 探讨临床新护士心理弹性对职业倦怠影响的研究,为减轻临床新护士职业倦怠提供心理干预依据。方法 对480 名临床新护士进行心理弹性问卷和职业倦怠量表调查,以多元线性回归进行分析。结果 临床新护士心理弹性均分1.89±0.86 分,职业倦怠均分3.83±0.96 分;心理弹性总分和各维度与职业倦怠总分及各维度显著负相关;心理弹性可以负向预测职业倦怠。结论 临床新护士心理弹性处于较低水平,职业倦怠感处于较高水平,心理弹性三因素能有效预测临床新护士的职业倦怠,提升临床新护士的心理弹性可以降低其职业倦怠。     

Distinctive hippocampal and amygdalar cytoarchitectural changes underlie specific patterns of behavioral disruption following stress exposure in an animal model of PTSD

Alterations in cytoarchitecture and molecular signaling have been observed in adaptive and maladaptive responses to stress and presumably underlie the physiological and behavioral changes observed. The relationship between behavioral responses to stress exposure and changes in cytoarchitecture of subregions of the hippocampus and amygdala was investigated in an animal model of PTSD.Behaviors in elevated plus-maze and acoustic startle response tests were assessed in rats 7 days after exposure to predator scent stress. Brains were harvested 24 h later. Neurons from CA1, CA3, and dentate gyrus subregions and basolateral amygdala were reconstructed and subjected to Sholl analysis and spine density estimation. Glucocorticoid receptor, brain-derived neurotrophic factor, phospho-NR1-Ser-889, phospho-GluR1-Ser-845, phospho-calcium/calmodulin dependent protein kinase II-Thy-286, post-synaptic density protein 95 and phospho-CREB-Ser-133 were evaluated in the hippocampus. Data were analyzed by retrospective classification of individual rats into three behavioral response groups.The extent and distribution of changes in the morphology of hippocampal and amygdalar dendrites was significantly associated with stress-induced behavioral response classification. Extreme (PTSD-like) behavioral disruption was associated with extensive neuronal retraction in the hippocampus and proliferation in the amygdala. Neither structure displayed such changes in minimal behavioral responders. Partial behavioral response was associated with identical changes in the hippocampus only. Patterns of change in requisite molecular signaling genes and endophenotypic markers corresponded to the structural and behavioral responses. The extent and distribution of changes in the cytoarchitecture of hippocampal and amygdalar subregions is directly related to the pattern of behavioral response of the individual to stress exposure.     

影响孤独症儿童母亲抑郁的相关因素

目的探讨孤独症儿童母亲的复原力、应对方式、社会支持对抑郁的影响。方法采用抑郁自评量表、复原力量表、简易应对方式问卷和社会支持评定量表对76名孤独症儿童母亲进行调查。结果①孤独症儿童母亲抑郁得分高于全国常模;②孤独症儿童母亲的抑郁与复原力、社会支持、积极应对方式间存在显著负相关,与消极应对方式呈正相关;③复原力、消极应对和积极应对3因子能显著预测抑郁(R2=0.563,F=30.901,P<0.001)。结论复原力和积极应对方式可有效减少孤独症儿童母亲抑郁的发生。