| 0bjectiveThe study was to investigate the status of psychological depression,social su pport and personal coping style in patients with chronic aplastic anemia(CAA),an alyze the correlation between depression and social support and individual coping style and the influencing factors of depression,and explore the effect of cognitive behavior intervention on chronic aplastic patients with depression,in order to pro vide reference for clinical nursing.Methods1.The first part,the method of convenient sampling was used to select the pati ents who were hospitalized in Department of Hematology and Department of tradit ional Chinese medicine in the Affiliated Hospital of Weifang Medical University fr om July 2016 to September 2017,and the patients had been diagnosed as CAA.106cases of CAA patients'social support,personal coping style and depression were investigated by using medical coping scale(MCMQ),self rating Depression Scale(SDS),social support assessment scale(SSRS)and general data questionnaire.The d ata were analyzed by SPSS19.0 software.2.The second part,the 106 patients who participated in the first part of the stu dy(July 2016 to September 2017)were selected as subjects for further interventio n.After the questionnaire was completed,the patients were divided into the control group(53)and the intervention group(53).The control group was given routine n ursing measures,including routine hospitalization and post-discharge routine follow-up guidance.On this basis,the intervention group was given 12 weeks of cognitive behavioral intervention,once a week,30-60 minutes each time,including face-to-fa ce intervention and discharge during hospital stay,telephone or WeChat interventio n.After the intervention,using the mobile phone questionnaire or face-to-face ques tionnaire,the 2 groups of patients were evaluated by MCMQ,SDS and SSRS scal e again.The scores were compared between the day of admission and 12 weeks a fter intervention.All the research subjects were completed in December 2017.The data were analyzed by SPSS19.0 software,and the parameters test was used.Sa mples t test,independent sample t test,non parametric test Wilcoxon paired test,paired chi 2 test and Mann--Whitney U rank sum test were used to compare the changes of patients'depression,social support,and personal coping scores before a nd after cognitive intervention,and to analyze the effect of cognitive behavior inte rvention.Results1.Present status and influencing factors of depression in subjects.(1)The average SDS score of 106 CAA patients was(50.25±11.89)points.Th ere were 58 cases of no depressive symptoms and 48 cases with depressive sympt oms,and the incidence of depression was 45.28%.(2)Single factor analysis showed that there were statistically significant differ ences in gender,educational level,family per capita income,course of illness,me dical payment,self-care ability,the number of hospitalization in the last year,with out bleeding,emergency blood transfusion in the last week(P<0.05).(3)Correlation analysis showed that the incidence of depression was negativel y correlated with objective support,subjective support,support utilization and socia l support total score(r_s=-0.643~-0.783,P<0.01);there was a negative correlation wit h the face and avoidance of personal coping style(r_s=-0.361~-0.407,P<0.01),and n o correlation with yield factor(r_s=-0.155,P>0.05).(4)Multiple linear stepwise regression analysis showed that 6 variables were arranged in order of social support score(?=-0.398),monthly income per capita(?=-0.281),course of disease(?=0.259),educational level(?=-0.214),sex(?=-0.163),and emergency transfusion in the last week(?=0.151).Together,it explained 77.8%of the variance of depression,and the F=62.169 and P<0.001,the test equation w ere statistically significant.2.The status of depression,social support and personal coping status after cogn itive behavioral intervention were investigated.(1)In the control group and the intervention group,the depression,social support and individual coping status were compared before and after intervention:(1)There was no statistically significant difference in depression scores,incidence of depressio n,social support and scores of all dimensions and individual responses to each di mension(P>0.05).(2)The scores of depression and and the incidence of depression w ere lower,the scores of social support increased,In the face of higher score,avoi d and yield to lower scores.and the scores of depression,the incidence of depressi on,social support and the scores of all dimensions,and the scores of individual co ping dimensions before and after intervention were statistically significant(P<0.01).(2)The scores of depression,social support and personal coping between the c ontrol group and the intervention group were compared between the two groups.(1)Before intervention,the intervention group and the control group had no statistically significant differences in depression scores,social support and all dimensions,and personal coping dimensions(P>0.05).(2)After the cognitive behavior,the score of de pression in the intervention group was lower than that of the control group.The so cial support and the scores of each dimension and face coping were higher than t hat of the control group;the scores of avoidance and yield coping were lower tha n those of the control group;the scores of depression,social support and the scor es of all dimensions,and the scores of individual coping dimensions were statistic ally significant(P<0.01).Conclusion1.CAA patients with depression were more common.2.The occurrence of depression was negatively related to the social support sy stem of the patients.The better the social support system was played and used,th e better the patient's mental state was,the lower the incidence of depression or th e severity of the depression.In the daily work,the medical staff should fully und erstand the patient's psychology and provide emotional support for the patients;gui de and encourage their families to provide material support and spiritual support f or the patients,and also help and guide the patients to make good use of family and social support systems to reduce the incidence of depression.3.The occurrence of depression in CAA patients was related to individual copi ng.Positive coping was negatively correlated with depression in CAA patients.In the clinical work,the medical staff should guide the patients to take the positive c oping style of thinking ways and seeking help,but also to guide the patients with the passive coping style to adjust to the positive coping style in time and elimin ate or relieve the depression.4.Cognitive behavior intervention can reduce the incidence of depression and degree of depression in CAA patients,improve the level of social support,promot e the positive coping style of the patients and reduce the application of passive co ping style of avoidance and surrender.Therefore,cognitive behavior intervention c an improve the patient's negative psychology and improve the patient's mental heal th effectively.In the clinical nursing work,the cognitive behavior intervention can be applied to the nursing of the patients with chronic aplastic anemia. |
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