Analysis of influencing factors and pathway of post-traumatic growth in parents of children with acute leukemia
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摘要:
目的 明确急性白血病患儿父母创伤后成长的现状及影响因素，并进行路径分析，为改善其创伤后成长水平提供依据。 方法 采用便利抽样法，选取2021年12月—2023年9月中国医科大学附属盛京医院儿科血液病房的244例急性白血病患儿父母为研究对象， 使用一般资料调查表、创伤后应激障碍清单-平民版(PCL-C)、心理弹性量表简表(RS-14)、特质应对方式调查问卷(TCSQ)、创伤后成长评定量表(PTGI)进行调查。进行单因素分析、多元线性回归分析、Pearson相关性分析及路径分析。 结果 急性白血病患儿父母的创伤后成长得分为(53.80±14.87)分。多元线性回归分析显示家庭类型、心理弹性和积极应对方式是创伤后成长的影响因素(P < 0.05)。路径分析显示, 心理弹性和积极应对方式能正向预测创伤后成长(β=0.535、0.259, 均P < 0.001)，创伤后应激障碍通过心理弹性、积极应对方式的单独中介作用及心理弹性-积极应对方式的链式中介作用间接影响创伤后成长(β=-0.189，P=0.001)。 结论 急性白血病患儿父母的创伤后成长水平有待提升。医务人员可针对相关因素(心理弹性和积极应对方式)进行干预，以帮助患儿父母实现高水平的创伤后成长。 Abstract:Objective To investigate the influencing factors and pathways of post-traumatic growth in parents of children with acute leukemia, and to provide the theoretical basis for improving their post-traumatic growth level. Methods Convenience sampling was employed in this study. A total of 244 parents of children with acute leukemia from the Department of Pediatrics at Shengjing Hospital of China Medical University were enrolled as research subjects between December 2021 and September 2023. The general demographic questionnaire, the PTSD checklist-civilian version, the 14-item resilience scale, the trait coping style questionnaire, and the post-traumatic growth Inventory were utilized for data collection. Statistical analysis was performed using univariate analysis, multiple linear regression, Pearson correlation, and path analysis. Results The total post-traumatic growth score of parents of children with acute leukemia was (53.80±14.87) points. The results of multiple linear regression analysis showed that family type, resilience and active coping style were the influencing factors of post-traumatic growth (P < 0.05). Pathway analysis showed that resilience and active coping style could positively predict post-traumatic growth (β=0.535, 0.259, all P < 0.001), post-traumatic stress disorder also affected post-traumatic growth through the independent mediating effect of resilience and active coping style, and the chain mediating effect of resilience and active coping style (β=-0.189, P=0.001). Conclusion The post-traumatic growth level of parents of children with acute leukemia needs to be improved. Medical staff can formulate intervention plans targeting influencing factors (resilience and active coping style) to help parents achieve high levels of post-traumatic growth. -
Key words:
- Acute leukemia /
- Parents /
- Post-traumatic growth /
- Influencing factors /
- Pathway analysis
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图 1 心理弹性与积极应对方式在PTSD与PTG之间的作用路径
Figure 1. The pathways of resilience and active coping style between PTSD and PTG
表 1 研究对象一般资料及AL患儿父母PTG影响因素的单因素分析
Table 1. General information of the study subjects and univariate analysis of PTG influencing factors in parents of AL children
项目 人数(%) PTG得分(x ±s，分) 统计量 P值 患儿性别 0.010a 0.992 男 147(60.25) 53.80±14.34 女 97(39.75) 53.78±15.70 患儿年龄 0.071b 0.932 ≤4岁 81(33.20) 53.83±15.17 ＞4~8岁 78(31.97) 53.32±14.29 ＞8岁 85(34.83) 54.20±15.25 居住地 1.397a 0.164 城市 126(51.64) 55.08±15.11 乡镇 118(48.36) 52.42±14.54 是否独生 -0.952a 0.342 是 140(57.38) 53.01±15.39 否 104(42.62) 54.85±14.13 与患儿关系 -0.814a 0.417 父亲 28(11.48) 51.64±14.19 母亲 216(88.52) 54.07±14.96 父母年龄 0.106b 0.900 18~29岁 14(5.74) 55.21±16.79 30~39岁 157(64.34) 53.52±14.72 ≥40岁 73(29.92) 54.11±14.99 教育程度 1.466b 0.233 初中及以下 102(41.80) 51.91±15.90 高中或中专 46(18.85) 55.74±12.48 大学专科及以上 96(39.35) 54.86±14.70 职业 1.382b 0.249 事业单位或公务员 25(10.25) 59.08±10.55 个体经营 126(51.64) 53.32±15.05 农民 12(4.92) 56.08±20.78 其他 81(33.19) 52.57±14.61 婚姻状况 3.418b 0.034 已婚 224(91.80) 53.40±14.61 离婚 16(6.56) 54.53±17.29 丧偶 4(1.64) 72.75±3.50 家庭类型 5.966b 0.003 扩大 56(22.95) 59.02±14.35 核心 168(68.85) 51.65±14.31 单亲 20(8.20) 57.20±17.21 注：a为t值，b为F值。 
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表 2 变量赋值情况
Table 2. Assignment of variables
变量 赋值方法 居住地 城市=1；乡镇=2 是否独生 是=1；否=2 与患儿关系 父亲=1；母亲=2 父母年龄 18~29岁=1；30~39岁=2；≥40岁=3 教育程度 初中及以下=1；高中或中专=2；大学专科及以上=3 职业 其他=(0，0，0);事业单位或公务员=(1，0，0);个体经营=(0，1，0);农民=(0，0，1) 婚姻状况 已婚=(0，0);离婚=(1，0);丧偶=(0，1) 家庭类型 扩大=(0，0);核心=(1，0);单亲=(0，1) PTSD得分 以实际值赋值 心理弹性得分 以实际值赋值 积极应对方式得分 以实际值赋值
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表 3 AL患儿父母PTG影响因素的多元线性回归分析
Table 3. Multivariate linear regression analysis of PTG influencing factors in parents of AL children
变量 B SE β t值 P值 心理弹性得分 0.483 0.069 0.388 6.983 ＜0.001 积极应对方式得分 0.832 0.165 0.282 5.033 ＜0.001 家庭类型(核心) -5.031 1.682 -0.157 -2.992 0.003 注：R2=0.350，调整R2=0.342，F=43.050，P＜0.001。
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表 4 心理弹性和积极应对方式在PTSD与PTG间的链式中介效应
Table 4. The chain mediating effect of resilience and active coping style between PTSD and PTG
影响路径 标准化系数 95% CI P值 PTSD→心理弹性→PTG -0.123 -0.227~-0.040 0.005 PTSD→积极应对→PTG -0.046 -0.099~-0.010 0.010 PTSD→心理弹性→积极应对→PTG -0.021 -0.049~-0.007 0.002 总间接效应 -0.189 -0.306~-0.092 0.001 直接效应 -0.002 -0.082~0.087 0.956 总效应 -0.191 -0.319~-0.052 0.005
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