住院患者心理应激反应及影响因素关系的模型构建

目的建立住院患者心理应激反应及其影响因素关系的结构方程模型，对住院患者的应激过程进行全面整体的研究。方法采取分层、随机、整群抽样方法，使用相应问卷调查782例住院患者的应激源、应对方式、自我效能、社会支持、人格和心理应激反应。结果直接关系的检验进入回归方程的变量为：医院应激（β=0．357）、社会支持（β=-0．109）、病程（β=0．106）、经济状况（β=-0．120）、自我效能（r=-0．315）、神经质（β=0．388）、内外向（β=-0．153）、回避（β=0．095）、屈服（β=0．370），均P〈0．01。医院应激与回避、屈服、神经质3个中介因素存在显著性相关（r=0．125、0．140、0．223，均P〈0．01），自我效能与回避、屈服、社会支持、神经质、内外向5个中介因素存在显著性相关（r=0．113、-0．102、0．189、-0．192、0．196，均P〈0．01）。自我效能对各原因变量（神经质、内外向、屈服、社会支持）的口值下降，但仍然显著。由此建立的应激结构方程模型拟合较好，进入结构方程模型的中介变量为：医院应激、社会支持、病程、经济、自我效能、神经质、内外向、回避。自我效能是一个重要的中介变量；医院应激可直接和间接作用于心理反应。结论可以通过加强正面影响因素如自我效能，削弱负面影响因素如神经质、消极应对方式等措施，降低或缓冲患者心理应激强度，提高患者心理健康水平。

Construction of A Model for the Psychological Stress Response and Its Influencing Factors of Inpatients

Objective To construct an equation model for the relationship of the psychological stress response and its influencing tactors of inpatients. Methods A total of 782 inpatients were recruited into the study by using a stratified-random-cluster method, and were asked to fill out a series of questionnaires assessing hospital stressor, coping style, self-efficacy, social support, personality, and stressful mental response. Results Variables entering regression equation through direct tests and exerting significant effects were hospital stress（β=0. 357）, social support （β=- 0. 109）, course of disease （β= 0. 106）, economic status （β=- 0. 120）, self-efficacy （r= --0. 315）, neuroticism （β=0. 388）, introversion-extraversion （β=-0. 153）, avoidance （β=0. 095）, and resignation（β=0. 370）. Hospital stress was significantly correlated with such three mediators as avoidance, resignation, and neuroticism （r= 0. 125,0. 140,0. 223, P〈0.01 for all）, and self-efficacy was also significantly correlated with such other five intermediary factors as avoidance, resignation, social support, neuroticism, and introversion-extraversion （r = 0.113, - 0. 102,0. 189, -- 0. 192, 0. 196, P〈0.01 for all）. Linear regression analysis showed that the β coefficients dropped in all causatives variables of self-efficacy. The final model showed good fit indexes. Such intermediary variables as hospital stress, social support, course of disease, economic status, self-efficacy, neuroticism, introversion-extraversion and avoidance finally entered the model. Self-efficacy was an important mediator, and hospital stress could influence patients＇ mental status directly and indirectly. Conclusion The psychological health of inpatients can be improved by enhancing positive mediate factors, such as self-efficacy, and reducing such negative factors as avoidance coping style, and neuroticism, etc.