作者：王冉，邓悦，靳千胜，刘凡，陈璐，王芳

单位：

210008江苏省南京市，南京大学医学院附属鼓楼医院神经外科

Units：

Department of Neurosurgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China

关键词：

脑卒中；疲劳；负性情绪；心理韧性；希望；中介效应

Keywords：

Cerebral stroke; Fatigue; Negative emotions; Resilience; Hope; Mediating effects

CLC：

R 743.33

DOI：

10.12114/j.issn.1008-5971.2024.00.043

Funds：

2022江苏省科技（重点研发计划社会发展）面上项目（BE2022668）；2020年江苏省高层次卫生人才“六个一工程” 拔尖人才项目（LGY2020012）

摘要：

目的　探讨心理韧性和希望在中青年脑卒中患者疲劳与负性情绪间的中介效应。方法　选取2022年 6—12月南京大学医学院附属鼓楼医院收治的中青年脑卒中患者246例为调查对象。使用一般资料调查表、疲劳严重 程度量表（FSS）、医院焦虑抑郁量表（HADS）、心理韧性量表简表（RS-14）、Herth希望量表（HHI）对其进行调 查。各量表总分及维度得分间的相关性分析采用Pearson相关分析，使用AMOS 24.0构建结构方程模型并采用Bootstrap 法检验中介效应的显著性。结果　共发放问卷246份，回收问卷238份，其中有效问卷216份，有效回收率为87.8%。中 青年脑卒中患者FSS总分为（40.0±12.9）分；HADS总分为（12.6±4.5）分，其中焦虑维度得分为（6.2±2.4）分、 抑郁维度得分为（6.4±2.3）分；RS-14总分为（66.9±12.6）分，其中个人能力维度得分为（47.9±9.5）分、积极认 知维度得分为（19.0±3.8）分；HHI总分为（34.7±7.2）分，其中对现实和未来的积极态度维度得分为（11.8±2.3） 分、采取积极的行动维度得分为（11.2±2.5）分、与他人保持亲密的关系维度得分为（11.7±2.7）分。Pearson相关 分析结果显示，FSS总分与HADS总分、焦虑维度得分、抑郁维度得分呈正相关，与RS-14总分、个人能力维度得分、 积极认知维度得分、HHI总分、对现实和未来的积极态度维度得分、采取积极的行动维度得分、与他人保持亲密的关 系维度得分呈负相关（P＜0.05）；HADS总分、焦虑维度得分、抑郁维度得分与RS-14总分、个人能力维度得分、积 极认知维度得分、HHI总分、对现实和未来的积极态度维度得分、采取积极的行动维度得分、与他人保持亲密的关系 维度得分呈负相关（P＜0.05）；RS-14总分、个人能力维度得分、积极认知维度得分与HHI总分、对现实和未来的 积极态度维度得分、采取积极的行动维度得分、与他人保持亲密的关系维度得分呈正相关（P＜0.05）。结构方程模 型显示，心理韧性和希望在中青年脑卒中患者疲劳和负性情绪间的总效应值为0.685〔95%CI（0.597～0.749）〕，直 接效应值为0.228〔95%CI（0.060～0.370）〕，间接效应值为0.457〔95%CI（0.331～0.612）〕，疲劳对负性情绪有 直接正向预测作用（β=0.228，P＜0.01），心理韧性和希望在中青年脑卒中患者疲劳和负性情绪间起部分中介作用 （β=0.457，P＜0.01），占总效应的66.72%。结论　中青年脑卒中患者负性情绪处于中等水平，疲劳对负性情绪有正 向影响，且心理韧性和希望在患者疲劳和负性情绪间具有部分中介效应。

Abstract：

Objective To explore the mediating effects of resilience and hope on fatigue and negative emotions in young and middle-aged stroke patients. Methods A total of 246 young and middle-aged stroke patients admitted to Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from June to December 2022 were selected as the research objects. General Information Questionnaire, Fatigue Severity Scale (FSS) , Hospital Anxiety and Depression Scale (HADS) , 14-Item Resilience Scale (RS-14) and Herth Hope Index (HHI) were used to investigate the patients. Pearson correlation analysis was used to explore the correlation between the total score and dimension score of each scale. AMOS 24.0 was used to construct a structural equation model and Bootstrap method was used to test the significance of the mediating effect. Results A total of 246 questionnaires were distributed, 238 were collected, and 216 were valid, with an effective response rate of 87.8%. In the young and middle-aged stroke patients, the FSS score was (40.0±12.9) ; the total HADS score was (12.6±4.5) , the anxiety dimension score was (6.2±2.4) , and the depression dimension score was (6.4±2.3) ; the total RS-14 score was (66.9±12.6) , the individual ability dimension score was (47.9±9.5) , and the positive cognitive dimension score was (19.0±3.8) ; the total HHI score was (34.7±7.2) , with the positive attitude towards reality and the future dimension score was (11.8±2.3) , the positive action dimension score was (11.2±2.5) , and the maintaining close relationships with others dimension score was (11.7±2.7) . Pearson correlation analysis showed that the total FSS score was positively correlated with the total HADS score, anxiety dimension score, and depression dimension score (P < 0.05) , and negatively correlated with the total RS-14 score, personal ability dimension score, positive cognitive dimension score, total HHI score, positive attitude towards reality and the future dimension score, positive action dimension score, maintaining close relationships with others dimension score (P < 0.05) ; the total HADS score, anxiety dimension score, and depression dimension score were negatively correlated with the total RS- 14 score, personal ability dimension score, positive cognitive dimension score, the total HHI score, positive attitude towards reality and the future dimension score, positive action dimension score, maintaining close relationships with others dimension score (P < 0.05) ; the total RS-14 score, personal ability dimension score, and positive cognitive dimension score were positively correlated with the total HHI score, positive attitude towards reality and the future dimension score, positive action dimension score, maintaining close relationships with others dimension score (P < 0.05) . The structural equation model shows that the total effect value of resilience and hope on fatigue and negative emotions in young and middle-aged stroke patients was 0.685 [95%CI (0.597-0.749) ] , the direct effect value was 0.228 [95%CI (0.060-0.370) ] , and the indirect effect value was 0.457 [95%CI (0.331-0.612) ] , fatigue had a direct positive predictive effect on negative emotions (β=0.228, P < 0.01) , resilience and hope partially mediated the relationship between fatigue and negative emotions in young and middle-aged stroke patients ( β=0.457, P < 0.01) , accounting for 66.72% of the total effect. Conclusion The negative emotion of young and middle-aged stroke patients is at a moderate level, fatigue has a positive impact on negative emotion. Resilience and hope have a partial mediating effect between fatigue and negative emotion of the patients.

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