The Effect Of Marital Satisfaction On Depression In Breast Cancer Patients And Self-Help Intervention Study

Objective:This study aims to understand the current status of depression in breast cancer patients,and analyze the impact and mechanism of marital satisfaction on depression in breast cancer patients.On this basis,we explored the effect of Cognitive Behavioral Therapy(CBT)self-help intervention focusing on marital relationship in reducing depression of breast cancer patients,with a view to providing new ideas for clinical psychological nursing.Methods:In this study,we used convenience sampling method to select203 breast cancer patients from a hospital at Shijiazhuang city for questionnaire survey,including General Information Questionnaire,ENRICH Marital Satisfaction Scale(EMS),Support in Intimate Relationships Rating Scale(SIRRS),Patient Health Questionnaire-9(PHQ-9).One-way analysis of variance,independent sample t test,Pearson correlation,multiple stepwise regression analysis,structural equation model and mediation effect analysis were used to identify the influencing factors and interaction of depression in breast cancer patients.Fifty breast cancer patients mild/moderate depression and low marital satisfaction were approached using the convenience sampling method.They were divided into intervention group(25 cases)and waiting-list group(25 cases).Patients in the waiting-list group were given routine nursing care,and those in the intervention group were provided with 3-month CBT-based self-help intervention in addition to routine nursing care.EMS、SIRRS and PHQ-9 scores were collected at T1(baseline),T2(post-intervention)and T3(6-months follow-up),using t-test,χ~2 test,and repeated measures analysis of variance to evaluate the effect of the intervention.Results:1 Impact and mechanism of marital satisfaction on depression in breast cancer patients1.1 Survey results of depression,marital satisfaction and spousal support in breast cancer patientsThe incidence of depression in 203 breast cancer patients included in the study was 51.23%,the EMS score was 37.61±7.94,and SIRRS score was54.53±17.26.1.2 Influencing factors of depression in breast cancer patientsUnivariate analysis results showed that education level,tumor stage,and radiotherapy/chemotherapy were influencing factors of depression in breast cancer patients(P<0.01).Pearson correlation analysis results showed that depression was significantly correlated with marital satisfaction and spouse support in breast cancer patients(P<0.01);Taking the above factors as independent variables and depression as the dependent variable into the multiple stepwise regression equation,the results indicated tumor stage,marital satisfaction and spousal support were the main influencing factors of depression in breast cancer patients,which can explain the variation of the dependent variable of 31.3%(P<0.01).The results suggest that tumor stage,marriage satisfaction and spousal support are important factors influencing depression in breast cancer patients.1.3 Mediating role of spousal support in marriage satisfaction and depression of breast cancer patientsUsing the structural equation model to construct a model of influencing factors of depression in breast cancer patients,the model fitting index wasχ~2/df=2.203<5,RMSEA=0.077<0.08,NFI=0.967>0.9,CFI=0.946>0.9,suggesting fitting good.The Bootstrap method was further used to test the mediating effect.The results showed that the total effect,direct effect,and indirect effect of marriage satisfaction on depression were-0.48、-0.36 and-0.10(P<0.01).It could account for 21.59%of the total effect.The above results suggest that tumor stage,marital satisfaction and spouse support are important factors on depression in breast cancer patients,and marital satisfaction could indirectly affect depression through spouse support.2 Self-help intervention effect of CBT on depression in breast cancer patientsThe results of repeated measures analysis of variance showed that there was an interaction effect between the time and group of EMS,SIRRS,and PHQ-9 scores(P<0.01).The simple effect test showed that,fixed time factors,there was no statistical difference in the scores of the intervention group and the waiting-list group at T1(P>0.01);the EMS and SIRRS scores of the intervention group were higher than that of the waiting-list group at T2、T3(P<0.01),The PHQ-9 score was lower than the waiting-list group at T2、T3(P<0.01).Fixed group factors,the EMS and SIRRS scores of the intervention and waiting groups showed an upward trend over time(P<0.01),while the PHQ-9 scale scores showed a downward trend over time(P<0.01).The above results suggest that CBT-based self-help intervention could effectively reduce depression in breast cancer patients,improve marital satisfaction,and enhance spouse support.Conclusion:Tumor stage,marital satisfaction and spouse support are important factors for depression in breast cancer patients,and marital satisfaction can indirectly affect depression through spouse support.CBT-based self-help intervention focusing on marital relationship can effectively ameliorate depression in breast cancer patients.