| Background:With the simultaneous increase of incidence rate and survival rate of malignant tumors in children in recent years,although the number of disease-free survivors has increased rapidly,the psychological trauma caused by diagnosis,treatment and rehabilitation of the malignant tumor has not been alleviated.Whether it is facing a long-term hospitalization after illness,invasive procedures such as bone marrow aspiration during treatment,or side effects of drugs such as vomiting and loss of hair,are serious negative experiences and stress events for children with malignant tumors,which make children prone to psychosocial maladjustment.At present,previous studies have explored the influencing factors of the psychosocial adaptation of children with malignant tumors,but the interaction between the factors has not been clarified,and there is a lack of applied research on the Promoting Resilience in Stress Management.Objectives:1.To investigate the current situation of psychosocial adaptation in adolescents with malignant tumor and analyze its influencing factors,and to clarify the interaction between these factors based on Self-Regulation Shift Theory.2.To explore the effects of Promoting Resilience in Stress Management on psychosocial adaptation in adolescents with malignant tumor,so as to provide new clinical strategies for children and their families to better face the disease.Methods:1.Cross-sectional study: the convenience sampling method was adopted to select adolescents with malignant tumor admitted to the Department of Oncology and Hematology of Children’s Hospital of Chongqing Medical University from June 2019 to May 2020.The self-made general information questionnaire,Simplified Coping Style Questionnaire,Social Support Questionnaire,General Self-Efficacy Scale,Post-traumatic Growth Inventory,the 21-item Depression-Anxiety-Stress Scale and Conners’ Parent Symptom Questionnaire were used to investigate all participants in order to examine the status of psychosocial adaptation in adolescents with malignant tumor.And after screening the main influencing factors through single factor analysis,multiple linear regression analysis and correlation analysis,structural equation model was constructed to clarify the interaction between the main factors.2.Randomized controlled trial: a total of 103 adolescents with malignant tumor who attended the Department of Oncology and Hematology of Children’s Hospital of Chongqing Medical University from July 2020 to January 2021 were selected and randomly divided into the experimental group(51 cases)and control group(52 cases).The control group was given the routine psychological care,while the experimental group was given intervention of the Promoting Resilience in Stress Management based on the scheme of the control group.The psychological resilience and psychosocial adaptation of the two groups were evaluated with the 10-item Connor Davidson Resilience Scale,21-item DepressionAnxiety-Stress Scale and Conners’ Parent Symptom Questionnaire before the intervention,the forth week of intervention an the eighth week of intervention.Results:1.Current situation and influencing factors of psychosocial adaptation in adolescents with malignant tumors(1)The results showed that the total detection of negative emotion was 54.47%(195/358),of which the detection rate of depression,anxiety and stress were 33.80%,47.21% and 23.18%,respectively.In depression dimension,mild depression was the main cause(60 cases).There were 85 cases with moderate anxiety and the number of adolescents with mild stress was equal to that with moderate stress,and both were 38 cases.In the area of behavior problems,the median score of the learning problem dimension was the highest,which was 0.75.Comparing the scores of each dimension of behavior problems with the Chinese urban norm of Conners’ Parent Symptom Questionnaire,the results showed that the total detection rate of behavior problems was 12.85%.And the detection rates of conduct problems,learning problems,psychosomatic disorders and impulsive-hyperactive were 5.03%,4.19%,7.26% and 3.35%,respectively.(2)The results of univariate analysis showed that the personality,coping style,disease stage,family upbringing and average monthly household income were the influencing factors of negative emotion in adolescents with malignant tumor(all P<0.05),and gender,personality and disease stage could significant impact the scores of behavior problems in adolescents with malignant tumor(all P<0.05).(3)The results of multiple linear regression analysis indicated that coping style,disease stage,family upbringing and average monthly household income were predictors of negative emotion(P<0.05),and gender,coping style and disease stage could predict the scores of behavior problems in adolescents with malignant tumor(P<0.05).(4)The results of spearman correlation analysis showed that both of the scores of affirmation and support dimension and company and intimacy dimension were negatively correlated with the scores of every dimension of negative emotion and behavior problem.And the score of satisfaction dimension was negatively correlated with the scores of depression dimension,anxiety dimension,stress dimension,conduct problems dimension and learning problems dimension.The score of conflict and punishment dimension was positively correlated with depression dimension,stress dimension,conduct problems dimension,learning problems dimension and impulsive-hyperactive dimension.Additionally,the score of self-efficacy was negatively correlated with the score of every dimension of negative emotion and behavior problem.In post-traumatic growth,the scores of relationship with others dimension,new possibility dimension,personal strength enhancement dimension and appreciation of life dimension were negatively correlated with the score of every dimension of negative emotion and behavior problem.And the score of mental change dimension was negatively correlated with the scores of depression dimension,stress dimension,conduct problems dimension,learning problems dimension and impulsive-hyperactive dimension.(5)The paths of structural equation model demonstrated that disease stage and average monthly household income could directly influence the negative emotion in adolescents with malignant tumor,meaning that the score of negative emotion of adolescents whose average monthly household income is less than 3000 yuan or who is in diagnosis stage is lower than that of adolescents with average monthly household income of3000 to 5000 yuan or who is in rehabilitation stage.In addition,social support,self-efficacy and post-traumatic growth could directly and negatively predict the scores of negative emotion and behavior problems,and social support could also influence negative emotion and behavior problems through self-efficacy or post-traumatic growth.However,coping style could only indirectly affect the negative emotion and behavior problems in adolescents with malignant tumor through self-efficacy or post-traumatic growth.Moreover,the chain mediating effects of self-efficacy and post-traumatic growth were confirmed by Bootstrap test.2.The study on Promoting Resilience in Stress Management based on skills(1)The scores of psychological resilience in the experimental group were significantly higher than those in the control group at the 8th week(P<0.05).And the scores of all dimensions of negative emotion and behavior problems in experimental group were significant lower than those in control group(all P<0.05).(2)In the experimental group,the scores of psychological resilience in the forth and eighth week were higher than the score before intervention(both P<0.05).And the score of psychological resilience in the eighth week was significant higher than that in the forth week(P<0.05).(3)In the experimental group,there were statistically significant differences between the scores of depression,anxiety,stress,conduct problems,learning problems and impulsive-hyperactive dimension before intervention than those in the forth week of intervention(all P<0.05),and the scores of all dimensions of negative emotion and behavior problems in the eighth week of intervention were lower than those before intervention(all P<0.05).In addition,there were statistically significant differences between the scores of depression,anxiety,stress,conduct problems,learning problems and impulsive-hyperactive dimension in the forth week of intervention and those in the eighth week(all P<0.01).Conclusion:1.The manifestations of psychosocial maladjustment,such as melancholy,nervous,bad temper and being easy to quarrel,are common in adolescents with malignant tumor.The main factors of psychosocial adaptation includes disease stage,average monthly household income,coping style of children,social support,self-efficacy and post-traumatic growth.Therefore,the clinical medical staff should formulate corresponding intervention according to the influencing factors,in order to prevent or reduce the occurrence of psychosocial maladjustment in adolescents with malignant tumor.2.As a skill-based psychosocial intervention,Promoting Resilience in Stress Management can effectively improve the psychological resilience of adolescents with malignant tumor and promote the level of psychosocial adaptation. |
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