The mediating role of loneliness and social support between stigma and social avoidance in rural breast cancer survivors
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摘要:
目的 探讨农村乳腺癌幸存者病耻感与社交回避之间的关系，分析社会支持的调节作用，为促进社会融合提供理论支撑。 方法 采用便利抽样选取2021年11月—2022年6月蚌埠市2所三甲医院260例农村乳腺癌幸存者为研究对象，采用社会影响量表(SIS)、孤独感量表(UCLA-8)、领悟社会支持量表(PSSS)、社交回避量表对其进行问卷调查，运用Pearson相关性分析及SPSS Process程序进行调节中介检验。 结果 (1) 农村乳腺癌幸存者病耻感、孤独感、社交回避和社会支持得分分别为(63.06±7.33)分、(18.54±4.31)分、(7.48±3.54)分、(58.86±8.78)分；病耻感与孤独感和社交回避呈正相关关系(r=0.563、0.543，均P＜0.001)，孤独感与社交回避呈正相关关系(r=0.536，P＜0.001)。(2)孤独感在病耻感与社交回避间起部分中介作用，中介效应占35%。(3)领悟社会支持在病耻感和孤独感间起调节作用(t=2.533，P=0.012)，且随着社会支持的升高病耻感对孤独感的影响逐渐降低。 结论 病耻感增加了患者不良社交体验，并通过孤独感产生间接影响；而农村患者社会支持相对局限，对减轻孤独感有意义，但不足以调节社交行为。医护人员可以从降低病耻感和孤独感的角度出发，并结合患者情感、认知、生活环境等多方因素制定有效的干预指导措施，促进其社会融合。 Abstract:Objective To explore the relationship between stigma and social avoidance in rural breast cancer survivors, and to analyze the moderating effect of social support in order to provide a theoretical basis for promoting social integration. Methods A total of 260 rural breast cancer survivors were selected by convenience sampling from 2 grade A hospitals in Bengbu City from November 2021 to June 2022. They were administered questionnaires using social impact scale (SIS), loneliness scale (UCLA-8), perceived social support scale (PSSS), and social avoidance scale. Pearson correlation analysis and SPSS Process program were used to mediate the test. Results (1) The scores of stigma, loneliness, social avoidance and social support of rural breast cancer survivors were (63.06±7.33) points, (18.54±4.31) points, (7.48±3.54) points and (58.86±8.78) points.; stigma was positively correlated with loneliness and social avoidance (r=0.563, 0.543, all P < 0.001), and loneliness was positively correlated with social avoidance (r=0.536, P < 0.001). (2) Loneliness partially mediated the relationship between stigma and social avoidance, accounting for 35%. (3) Social support had a moderating effect on the relationship between stigma and loneliness (t=2.533, P=0.012), and the influence of stigma on loneliness gradually decreased as social support increased. Conclusion Stigma increases patients ' negative social experiences and affects them indirectly through loneliness; among rural patients, social support was relatively limited, which was important in alleviating loneliness but could not improve social behavior. From the perspective of reducing stigma and loneliness, medical staff develop effective interventions to promote patients ' social integration by combining emotional, cognitive, environmental and other factors. -
Key words:
- Breast cancer survivors /
- Stigma /
- Loneliness /
- Social avoidance /
- Perceived social support
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图 1 孤独感和社会支持在乳腺癌幸存者病耻感和社交回避关系中的假设模型
Figure 1. A hypothetical model exploring the relationship between stigma, social avoidance, loneliness, and social support in breast cancer survivors
图 2 社会支持在病耻感与孤独感之间的调节效应
Figure 2. The moderating role of social support in the relationship between stigma and loneliness
表 1 260例乳腺癌幸存者一般资料
Table 1. General information for 260 survivors with breast cancer
项目 例数 百分比(%) 项目 例数 百分比(%) 年龄(岁) 肿瘤分期 ＜45 68 26.2 一期 42 16.2 46~55 127 48.8 二期 155 59.6 ＞56 65 25.0 三期 63 24.2 受教育程度 病程(年) 小学及以下 128 49.2 ＜1 107 41.1 初高中 118 45.4 1~2 94 36.2 大学及以上 14 5.4 ＞2 59 22.7 家庭人均月收入(元) 治疗方式 ＜2 500 184 70.8 手术 9 3.5 2 500~5 000 69 26.5 手术+化疗 172 66.1 ＞5 000 7 2.7 手术+放化疗 79 30.4 职业 居住状态 在职 21 8.1 独居 12 4.6 无业 209 80.4 与配偶 81 31.2 自由职业 16 6.1 与子女 23 8.8 退休 14 5.4 与配偶及子女 144 55.4 婚姻状况 并发淋巴水肿 已婚 253 97.3 是 41 15.8 离异或丧偶 7 2.7 否 219 84.2 
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表 2 各变量间相关性分析(r值)
Table 2. Correlation analysis among variables (r value)
项目 社会支持 病耻感 孤独感 社交回避 社会支持 1 病耻感 -0.392 1 孤独感 -0.538 0.563 1 社交回避 -0.315 0.543 0.536 1 注：均P < 0.001。
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表 3 孤独感在乳腺癌患者病耻感和社交回避间的中介效应检验
Table 3. The mediating effect of loneliness on stigma and social avoidance in breast cancer survivors
结果变量 预测变量 整体拟合指数 回归系数显著性 R R2 F β t值 P值 社交回避 病耻感 0.543 0.295 107.739 0.262 10.380 0.001 孤独感 病耻感 0.563 0.317 119.964 0.331 10.953 0.001 社交回避 孤独感 0.610 0.372 76.230 0.170 5.893 0.001 病耻感 0.277 5.643 0.001
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表 4 总效应、直接效应和中介效应分解表
Table 4. Tables for total, direct, and intermediate effects
效应类型 效应值 Boot标准误 Boot CI下限 Boot CI上限 效应占比(%) 直接效应 0.170 0.029 0.114 0.227 65.00 间接效应 0.092 0.020 0.058 0.135 35.00 总效应 0.262 0.025 0.213 0.312
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表 5 有调节的中介效应检验
Table 5. Test for moderated mediating effect
变量 方程1：社交回避 方程2：孤独感 方程3：社交回避 β t值 P值 95% CI β t值 P值 95% CI β t值 P值 95% CI 病耻感 0.351 5.773 < 0.001 0.231~0.471 0.421 8.344 < 0.001 0.321~0.520 孤独感 0.355 5.283 < 0.001 0.222~0.487 社会支持 0.008 0.134 0.894 -0.109~0.125 -0.375 -7.437 < 0.001 -0.474~-0.275 0.013 0.213 0.831 -0.104~0.130 病耻感×社会支持 -0.017 -0.364 0.716 -0.108~0.075 0.109 2.533 0.012 0.024~0.193 孤独感×社会支持 -0.054 -1.112 0.267 -0.150~0.042 R2 0.373 0.450 0.375 F值 37.876a 69.905a 38.315a 注：aP＜0.001。
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