慢性心力衰竭患者和家庭照顾者相依关系对双方正性情绪及积极应对方式的影响

目的:基于主客体互倚模型(APIM)分析慢性心力衰竭(CHF)患者和家庭照顾者的相依关系对双方正性情绪及积极应对方式的影响。方法:本研究为横断面研究。采用便利抽样法,选取2020年1—7月于南京医科大学第一附属医院心内科住院的101对CHF患者及其家庭照顾者作为调查对象。采用自制一般资料调查表、相依关系量表、中文版正负情绪量表和中文版简易应对方式量表对CHF患者及其家庭照顾者进行横断面调查,并建立相依关系对正性情绪及积极应对方式的APIM。结果:在主体效应方面,CHF患者及其家庭照顾者的相依关系均可影响自身的正性情绪(回归系数分别为3.922、3.427;P<0.01)和积极应对方式(回归系数分别为2.936、2.828;P<0.01);在客体效应方面,家庭照顾者的相依关系可影响CHF患者的正性情绪(回归系数为2.744,P<0.01)和积极应对方式(回归系数为2.198,P<0.05)。结论:CHF患者的情绪和应对行为受到自身和家庭照顾者所感知相依关系的正向影响,提示临床工作者应重视CHF家庭照护中相依关系的评估,积极探索以相依关系为焦点的干预方案。     

Psychometric characteristics of the mutuality scale in heart failure patients and caregivers

Background

Higher patient-caregiver mutuality is associated with improved patient and caregiver outcomes, but no studies have tested the psychometric characteristics of the mutuality scale (MS) in heart failure (HF) patient and caregiver population.

罗夏测验自主同一性量表的结构效度研究

目的 探讨罗夏测验自主同一性量表的结构效度.方法 对随机抽取的32例被试者进行罗夏测验并进行自主同一性量表(MOA)记分.采用探索性因素分析法在SPSS11.0上进行统计分析.结果 因素分析抽出3个因子,DA、SI、SA在一个因素上负荷量最大,MC、OE聚为另一个因素,RA、DI在第三个因素上负荷最大.结论 罗夏测验自主同一性量表在中国人群中使用有较好的结构效度.     

Dyadic relational resources and role strain in family caregivers of persons living with dementia at home: A cross-sectional survey

Background

Family caregivers of older persons with dementia face negative impacts such as heightened role strain due to care receivers’ incremental loss of cognitive function. Dyadic relational resources were found to protect caregivers against negative caregiving outcomes while caring for cancer patients, but had not been explored in caregivers of patients with dementia.

Objective

To explore whether the impact of caregiving demand/care receivers’ cognitive functioning on caregiver role strain is moderated by dyadic relational resources.

Design

Cross-sectional correlational survey.

Setting

The neurological clinics of a 3700-bed medical centre, neurological ward, and day care centre affiliated with a regional hospital in northern Taiwan.

Participants

A convenience sample of 219 family caregivers and care receivers with dementia was enrolled, with 197 (90%) completing the study questionnaires.

Method

Data were collected from family caregivers’ self-completed questionnaires from December 2010 to November 2011. We examined the moderating effects of caregiving demand/care receiver dementia severity and dyadic relational resources (mutuality, preparedness and predictability) on caregiving outcome (role strain) using hierarchical multiple regression analyses. Moderating effects were examined according to two- and three-way interaction terms in the regressions. We also explored the simple effect of each independent variable on role strain.

Results

The dyadic relational resources of mutuality and preparedness moderated the effects of caregiving demand on caregivers’ role strain. That is, a high level of mutuality and preparedness protected caregivers from high levels of role strain, even when caregiving demand was high. Another important factor was a high level of predictability, which tended to decrease role strain. Finally, the association between care receiver cognitive functioning and caregiver role strain was influenced by the level of mutuality between caregiver and care receiver. More specifically, high levels of mutuality diminished role strain in caregivers of patients with mild dementia.

Conclusions

Dyadic relational resources may moderate the effects of role strain. These findings suggest that these dyadic relational resources should be enhanced for family caregivers of patients with dementia to ease their caregiving role strain.     

客体关系量表在精神疾病疗效评估中的应用

目的探讨客体关系自主同一性量表（mutuality of autonomy scale,MOA）在评估精神疾病疗效中的作用。方法符合入组标准的32例分裂症（偏执型）、30例抑郁症（单相）,两组患者治疗前后经罗夏测验、MOA量表、PANSS量表（阳性症状与阴性症状量表）、汉密尔顿抑郁量表评分。结果罗夏自主同一性量表与PANSS及汉密尔顿量表之间均有较好的相关;分裂症在高客体关系水平上差异显著,抑郁症在高、低客体关系水平上差异均显著;治疗前后,分裂症组的SA（分离、自主的相似活动）是显著升高,抑郁症SI（分离、自主的相互作用）显著升高,而DI（毁灭性不平衡）显著降低,这些指标或许可作为评估分裂症及抑郁症疗效的标志。结论客体关系自主同一性量表（MOA）部分指标能有效地评估精神疾病疗效。     

照顾者相依关系的研究进展

本文明确了照顾者相依关系的概念,介绍照顾者相依关系的主要测量工具并分析其影响因素及对照顾者的影响,阐述照顾者相依关系的干预措施,以期为更好地开展相关研究提供参考依据。     

Social justice and social responsibility: towards a value-base for global public health

Public health and social justice have been seen as one and the same thing, in that public health is - of its very nature - socially just. In this paper, the relationship between public health and social justice is explored through reflecting upon the definitions of the two. Work being undertaken in Scotland in relation to prison health shows that public health action can be intended to have a socially just consequence. However it is not always possible to show that social justice was always the intended outcome of a public health action, as economic intentions can often result in similar public health intervention. In seeking to set out a values base for Global Public Health, the reflection allows two overarching values to be proposed: equality and mutuality.     

积极感受在脑卒中主要照顾者相依关系与照顾负担的中介效果

目的 探讨积极感受在脑卒中主要照顾者照顾负担与相依关系的中介作用,为提高主要照顾者身心健康提供理论参考。方法 采取便利抽样法抽取神经内科病区194例住院脑卒中主要照顾者为研究对象,采用一般资料调查表、积极感受量表、相依关系量表和照顾负担量表对主要照顾者进行调查。结果 主要照顾者照顾负担得分为（36.96±14.56）分、积极感受得分为（31.06±8.73）分、相依关系得分为（32.95±14.47）分。积极感受与相依关系呈正相关（r=0.50,P<0.01）,与照顾负担得分呈负相关（r=-0.20,P<0.01）,相依关系与照顾负担呈负相关（r=-0.59,P<0.01）。Bootstrap法进一步验证了积极感受的中介效应。结论 积极感受是脑卒中照顾者照顾负担与相依关系间的部分中介变量。医护人员对照顾者应多加关注,了解其在照顾过程中的积极感受及与患者的相依关系水平,及时给予干预,进一步缓解其感知的照顾负担,提高照顾者的生活质量,促进脑卒中患者主要照顾者的身心健康。     

Caregiving in heart failure: Relationship quality is associated with caregiver benefit finding and caregiver burden

Objective

To determine whether relationship quality is associated with caregiver benefit or burden and how depression influences these associations.

Background

Caregivers influence outcomes of patients with heart failure (HF). Relationship quality, caregiver benefit and burden are key factors in the caregiving experience.

Methods

Nineteen caregivers of HF outpatients completed measures of relationship quality, caregiver benefit, burden and depression. Associations were assessed using Pearson's correlations.

Results

Relationship quality was positively associated with caregiver benefit (r = 0.45, P = 0.05) and negatively associated with burden (r = −0.80, P < 0.0001) and depression (r = −0.77, P = 0.0001). Relationship quality and burden remained associated after controlling for depression.

Conclusions

In this exploratory study, relationship quality was positively associated with caregiver benefit and negatively associated with burden. Future studies are needed to further understand these key caregiving factors, which may lead to opportunities to help caregivers see benefits and reduce burden.     

The relationship between perceived mutuality and bulimic symptoms, depression, and therapeutic change in group

This pilot study examined (a) the effectiveness of short-term group relational therapy (RT) in comparison to short-term group cognitive-behavioral therapy (CBT), and (b) the relationship between perceived mutuality (PM) in relationships and severity of bulimic and depressive symptoms in women with bulimia nervosa (BN). Fifteen women ages 20-54 diagnosed with BN (n=11) or binge-eating disorder (BED, n=4) were randomly assigned to a 16-week manualized RT or CBT group. The following measures were administered at baseline, at 8 and 16 weeks, and at 6th- and 12th-month follow-ups: Eating Disorders Inventory-2 (EDI-2), Hamilton Depression Rating Scale (HDRS), Beck Depression Inventory (BDI), and the Mutual Psychological Development Questionnaire (MPDQ). A series of mixed design analyses of variance (ANOVA) were computed to examine group therapy effectiveness and outcomes related to PM and symptom severity. Both group RT and CBT treatment conditions showed significant improvement in reducing binge eating, vomiting, and depression at end of treatment and across follow-up assessment times. Low levels of PM with father at baseline were associated with high levels of bulimic and depressive symptoms across assessment times, whereas low PM with mother was only associated with high levels of depression. Pilot study findings supported the idea that group work focused primarily on PM and relational factors can be effective in treating women with bulimic and depressive symptoms. Findings also suggest that relationships with fathers play an important role in recovery.