精神分裂症患者应对方式的结构

背景 精神分裂症患者面临着许多压力,但他们不恰当的应对方式往往影响着疾病的预后.国外的应对方式问卷由于文化背景差异不完全适用于我国人群;而国内的应对方式量表是在精神病人以外的人群中建立的,是否适合精神病人仍不清楚.本研究旨在探索精神分裂症患者和正常人的应对方式结构是否相同,如存在差异,则应另编制适合患者的问卷.方法 通过文献复习收集了91个应对方式项目.7例精神分裂症患者完成模拟测查,根据反馈意见修改部分项目并补充了1个项目.经专家评阅后修改编辑成92个项目的应对方式问卷初稿.分别在符合入选条件的315名正常人和208例精神分裂症患者中测试.患者的入选条件①≥16岁;②符合中国精神障碍分类与诊断标准第3版(CCMD-3)精神分裂症诊断标准;③住院接受药物治疗1个月或以上;④临床总体印象评定的病情严重程度为"中度有病"或更轻,且阳性和阴性症状量表(PANSS)中"注意障碍"项目得分不超过3分;⑤能够理解题意独立完成问卷并知情同意.正常组入选条件①≥16岁;②无精神病史;③能理解题意独立完成问卷并知情同意.对测试结果采用探索性因子分析比较两组的应对方式结构.经过因子分析删除了共通性或载荷量低的项目,两组总共保留了73个项目.根据研究对象的反馈意见再次修改及合并有关项目,编辑成65个项目的应对方式问卷修改稿.而后在符合同样入选条件的另外287名正常人和219例精神分裂症患者中进行验证,采用验证性因子分析分别确定各自的应对方式结构.同时收集患者的病程、诊断亚型资料,并由3名经过一致性培训的主治医师以上的精神科医师对其中205名患者进行了PANSS评定,分析患者的临床特点与应对方式因子得分之间的关系.结果 正常组的应对方式包括"问题解决指向"、"回避"、"认知调整"、"情绪调节"、"寻找专业支持"和"否认"6个因子;而患者组只有前四个因子,后两个因子的相应项目分散到这四个因子中,没有形成独立的因子.验证性因子分析的结果验证了上述结构.研究对象的年龄、性别以及受教育程度对因子结构均无明显的影响.模型比较的结果说明4因子结构对分裂症患者优于6因子结构.偏执型患者"回避"因子分高于未分型患者;偏执型及未分型患者的"问题解决"和"认知调整"因子分高于其他患者.总病程与"情绪调节"因子分呈正相关;PANSS阳性症状分与"回避"因子分呈正相关.结论 精神分裂症患者应对方式的结构与正常人不同,患者的应对方式缺乏必要的选择性.在此基础上编制适合精神分裂症患者特点的应对方式问卷是必要的.

The factor structure of coping strategies in schizophrenic patients

Background Based on prior research in the field, a preliminary questionnaire was created to compare the coping strategies of schizophrenic patients to those of non-ill community residents. Results of the comparison were subsequently used to develop a questionnaire suitable for use in schizophrenic patients.Methods Ninety-one of the 92 items in the preliminary questionnaire were identified from previous questionnaires, and one additional item was created based on information provided in individual interviews with schizophrenic patients. This questionnaire was administered to 315 community controls and 208 schizophrenic inpatients. Exploratory Factor Analyses to identify the factor structure of coping strategies were independently conducted for controls and patients. Based on these results, a revised 65-item instrument was developed and administered to a new group of 287 controls and 219 schizophrenic inpatients. Confirmatory Factor Analyses (CFA) using Linear Structural Relations (LISREL) were independently conducted for the two groups to confirm their respective factor structures.Results Six coping categories identified in normal controls were problem solving, avoidance, cognitive adjustment, emotional adjustment, seeking special support, and denial. Among schizophrenic patients, however,coping strategies of "seeking special support" and "denial" were not independent of the other four coping categories. Their items were distributed among the others. Results of CFA confirmed this four-category model of coping strategies for schizophrenic patients.Conclusions Coping categories employed by schizophrenic patients were different from those employed by normal community controls. Schizophrenic patients lacked the necessary flexibility of selecting appropriate coping strategies.