卒中后失语患者心理一致感评价和影响因素分析

doi:10.3969/j.issn.1673-5765.2024.03.010

摘要/Abstract

摘要： 目的评价卒中后失语患者心理一致感，分析影响卒中后失语患者心理一致感的因素。
方法本研究为前瞻性观察性研究。连续招募2018年12月—2022年12月首都医科大学附属北京天坛医院收治的144例卒中后失语患者，采用一般资料调查问卷收集患者的临床资料，采用中国康复研究中心汉语标准失语症检查法（China rehabilitation research center aphasia examination，CRRCAE）评估失语程度，采用中文版心理一致感量表（sense of coherence-13 scale，SOC-13）、社会支持量表（social support scale，SSRS）、一般自我效能感量表（general self-efficacy scale，GSES）、中文版知觉压力量表（Chinese-version perceived stress scale，CPSS）评估患者的心理一致感、社会支持、自我效能和知觉压力。分析中文版SOC-13总分与SSRS、GSES、CPSS总分的相关性。使用多重线性回归分析影响卒中后失语患者心理一致感水平的因素。
结果卒中后失语患者中文版SOC-13总分为（57.96±12.11）分，心理一致感处于低水平。卒中后失语患者中文版SOC-13总分与SSRS总分（r=0.592，P＜0.05）、GSES总分（r=0.470，P＜0.05）呈正相关，与CPSS总分呈负相关（r=-0.410，P＜0.05）。多重线性回归分析显示，抑郁（β=1.006，P=0.001）、日常生活能力（β=1.124，P=0.003）、CRRCAE评分（β=1.325，P＜0.001）、SSRS总分（β=1.123，P=0.009）、GSES总分（β=0.341，P=0.015）、CPSS总分（β=-0.402，P=0.023）是卒中后失语患者低中文版SOC-13总分的影响因素。
结论卒中后失语患者心理一致感水平偏低。抑郁、日常生活能力、失语程度、社会支持、自我效能、知觉压力是患者心理一致感水平的影响因素。

文章导读： 卒中后失语患者心理一致感水平偏低，且受抑郁、日常生活能力、失语程度、社会支持、自我效能、知觉压力的影响。

关键词: 卒中后失语; 心理一致感; 社会支持; 自我效能; 知觉压力; 因素分析

Abstract: Objective To evaluate the sense of coherence of post-stroke aphasia patients, and analyze the factors affecting the sense of coherence of post-stroke aphasia patients.
Methods This is a prospective observational study. A total of 144 patients with post-stroke aphasia admitted to Beijing Tiantan Hospital, Capital Medical University from December 2018 to December 2022 were continuously recruited. Clinical data of patients were collected by general data questionnaire. The degree of aphasia was evaluated using the China rehabilitation research center aphasia examination (CRRCAE). The Chinese version of the sense of coherence-13 scale (SOC-13), the social support scale (SSRS), the general self-efficacy scale (GSES) and the Chinese-version perceived stress scale (CPSS) were used to evaluate the patients’ sense of coherence, social support, self-efficacy and perceived stress. The correlation between total score of Chinese version of SOC-13 and total score of SSRS, GSES and CPSS was analyzed. Multiple linear regression was used to analyze the factors affecting the level of sense of coherence in post-stroke aphasia patients.
Results The total score of Chinese version of SOC-13 in post-stroke aphasia patients was 57.96±12.11, and the sense of coherence was at a low level. The total score of Chinese version of SOC-13 was positively correlated with the score of SSRS (r=0.592, P<0.05) and GSES (r=0.470, P<0.05), and negatively correlated with the total score of CPSS (r=-0.410, P<0.05). Multiple linear regression analysis showed that depression (β=1.006, P=0.001), ability of daily living (β=1.124, P=0.003), CRRCAE score (β=1.325, P<0.001), SSRS score (β=1.123, P=0.009), GSES score (β=0.341, P=0.015) and CPSS score (β=-0.402, P=0.023) were the influencing factors of low Chinese version of SOC-13 score in post-stroke aphasia patients.
Conclusions The level of sense of coherence is low in post-stroke aphasia patients. Depression, ability of daily living, degree of aphasia, social support, self-efficacy and perceived stress are the factors that affect the level of sense of coherence.

Key words: Post-stroke aphasia; Sense of coherence; Social support; Self-efficacy; Perceived stress; Factor analysis

中图分类号:

项志颖, 尹志科, 沙丽娟. 卒中后失语患者心理一致感评价和影响因素分析[J]. 中国卒中杂志, 2024, 19(3): 319-325.

XIANG Zhiying, YIN Zhike, SHA Lijuan. Evaluation and Influencing Factors of Sense of Coherence in Post-Stroke Aphasia Patients[J]. Chinese Journal of Stroke, 2024, 19(3): 319-325.

参考文献

[1] GODECKE E，ARMSTRONG E，RAI T，et al. A randomized control trial of intensive aphasia therapy after acute stroke：the very early rehabilitation for speech（VERSE）study[J]. Int J Stroke，2021，16（5）：556-572.
[2] LAURES-GORE J S，FARINA M，MOORE E，et al. Stress and depression scales in aphasia：relation between the aphasia depression rating scale，stroke aphasia depression questionnaire-10，and the perceived stress scale[J]. Top Stroke Rehabil，2017，24（2）：114-118.
[3] SHEHATA G A，EL MISTIKAWI T，RISHA A S，et al. The effect of aphasia upon personality traits，depression and anxiety among stroke patients[J/OL]. J Affect Disord，2015，172：312-314[2023-02-11]. https://doi.org/10.1016/j.jad.2014.10.027.
[4] KRISTOFFERZON M L，ENGSTRÖM M，NILSSON A. Coping mediates the relationship between sense of coherence and mental quality of life in patients with chronic illness：a cross-sectional study[J]. Qual Life Res，2018，27（7）：1855-1863.
[5] DE OLIVEIRA T N，DOS SANTOS I B F，SOUZA G L N，et al. Sense of coherence and dental fear/dental anxiety：a systematic review and meta-analysis[J]. Spec Care Dentist，2022，42（3）：257-265.
[6] 中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志，2018，51（9）：666-682.
Chinese Society of Neurology，Chinese Stroke Society. Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2018[J]. Chin J Neurol，2018，51（9）：666-682.
[7] 李胜利，肖兰，田鸿，等. 汉语标准失语证检查法的编制与常模[J]. 中国康复理论与实践，2000，6（4）：162-164，封三.
LI S L，XIAO L，TIAN H，et al. Introduction to Chinese standard aphasia examination[J]. Chinese Journal of Rehabilitation Theory and Practice，2000，6（4）：162-164，inside back cover.
[8] KWAH L K，DIONG J. National institutes of health stroke scale（NIHSS）[J/OL]. J Physiother，2014，60（1）：61[2023-02-11]. https://doi.org/10.1016/j.jphys.
2013.12.012.
[9] 张作记. 行为医学量表手册[M]. 北京：中华医学电子音像出版社，2005：391-392.
ZHANG Z J. Manual of behavioral medicine scales[M]. Beijing：Chinese Medical Multimedia Press，2005：391-392.
[10] FAVA G A，KELLNER R，MUNARI F，et al. The Hamilton depression rating scale in normals and depressives[J]. Acta Psychiatr Scand，1982，66（1）：26-32.
[11] BUYSSE D J，REYNOLDS C F，3rd，MONK T H，et al. The Pittsburgh sleep quality index：a new instrument for psychiatric practice and research[J]. Psychiatry Res，1989，28（2）：193-213.
[12] 包蕾萍，刘俊升，周颖. 心理一致感量表（SOC-13）的信、效度初步研究[J]. 中国心理卫生杂志，2006，20（5）：299-301.
BAO L P，LIU J S，ZHOU Y. Reliability and validity of sense of coherence-13（SOC-13）[J]. Chinese Mental Health Journal，2006，20（5）：299-301.
[13] 刘永闯，郭丽娜，刘堃. 心理一致感量表在社区老年人群应用的信度和效度[J]. 中华行为医学与脑科学杂志，2016，25（4）：376-379.
LIU Y C，GUO L N，LIU K. Reliability and validity of the Chinese version of sense of coherence scale among the older people[J]. Chinese Journal of Behavioral Medicine and Brain Science，2016，25（4）：376-379.
[14] 汪向东，王希林，马弘. 心理卫生评定量表手册（增订版）[M]. 北京：中国心理卫生杂志社，1999：127-131.
WANG X D，WANG X L，MA H. Rating scales for mental health（updated edition）[M]. Beijing：Chinese Mental Health Journal，1999：127-131.
[15] SCHWARZER R，ARISTI B. Optimistic self-beliefs：assessment of general perceived self-efficacy in thirteen cultures[J]. World Psychology，1997，3（1/2）：177-190.
[16] 王才康，胡中锋，刘勇. 一般自我效能感量表的信度和效度研究[J]. 应用心理学，2001，7（1）：37-40.
WANG C K，HU Z F，LIU Y. Evidences for reliability and validity of the Chinese version of general self-efficacy scale[J]. Chin J Appl Psych，2001，7（1）：37-40.
[17] 杨廷忠，黄汉腾. 社会转型中城市居民心理压力的流行病学研究[J]. 中华流行病学杂志，2003，24（9）：760-764.
YANG T Z，HUANG H T. An epidemiological study on stress among urban residents in social transition period[J]. Chin J Epidemiol，2003，24（9）：760-764.
[18] 王爱霞，刘延锦，郭园丽，等. 心理一致感在脑卒中患者心理压力与抑郁间的中介作用[J]. 中华现代护理杂志，2018，24（18）：2118-2122.
WANG A X，LIU Y M，GUO Y L，et al. Mediating effects of sense of coherence between mental stress and depression in stroke patients[J]. Chinese Journal of Modern Nursing，2018，24（18）：2118-2122.
[19] 谭琳，陈丽，王延芬，等. 缺血性脑卒中患者心理一致感与反刍性沉思、家庭关怀度的关系研究[J]. 护理管理杂志，2021，21（11）：774-779.
TAN L，CHEN L，WANG Y F，et al. Study on the correlation among ischemic stroke patients’ sense of coherence，ruminant meditation and family care[J]. Journal of Nursing Administration，2021，21（11）：774-779.
[20] SHEPPARD S M，SEBASTIAN R. Diagnosing and managing post-stroke aphasia[J]. Expert Rev Neurother，2021，21（2）：221-234.
[21] 刘艳，毛善平，朱华风，等. 卒中后失语患者心理障碍影响因素及情欲顺势心理治疗[J]. 中国健康心理学杂志，2013，21（11）：1653-1655.
LIU Y，MAO S P，ZHU H F，et al. Influencing factors of psychological disorders of patients with aphasia after stroke and lust of homeopathic therapy[J]. China Journal of Health Psychology，2013，21（11）：1653-1655.
[22] 蔡亮. 不同心理一致感个体压力情境下的情绪反应特点及面孔情绪识别研究[D]. 重庆：西南大学，2012.
CAI L. Study on emotional response characteristics and facial emotion recognition of individuals with different sense of coherence under stress[D]. Chongqing：Southwest University，2012.
[23] SUNDBERG K，NILSSON M，PETERSSON L M，et al. The sense of coherence scale in a clinical nursing perspective：a scoping review[J]. J Clin Nurs，2022，31（11/12）：1428-1439.
[24] ZAMANIAN H，AMINI-TEHRANI M，JALALI Z，et al. Stigma and quality of life in women with breast cancer：mediation and moderation model of social support，sense of coherence，and coping strategies
[J/OL]. Front Psychol，2022，13：657992[2023-02-11]. https://doi.org/10.3389/fpsyg.2022.657992.
[25] TSILIGIANNI I，SIFAKI-PISTOLLA D，GERGIANAKI I，et al. Associations of sense of coherence and self-efficacy with health status and disease severity in COPD[J/OL]. NPJ Prim Care Respir Med，2020，30（1）：27[2023-02-11].
https://doi.org/10.1038/s41533-020-0183-1.
[26] MOLERO JURADO M D M，PÉREZ-FUENTES M D C，OROPESA RUIZ N F，et al. Self-efficacy and emotional intelligence as predictors of perceived stress in nursing professionals[J/OL]. Medicina（Kaunas），2019，55（6）：237[2023-02-11].
https://doi.org/10.3390/medicina55060237.
[27] GUO L N，LIU Y J，MCCALLUM J，et al. Perceived stress and depression amongst older stroke patients：sense of coherence as a mediator[J/OL]. Arch Gerontol Geriatr，2018，79：164-170[2023-02-11]. https://doi.org/10.1016/j.archger.2018.08.010.