Structural Equation Model For The Relationship Between Self-perceived Burden And Anxiety/Depression Among Patients With Coronary Heart Disease

Objectives 1.To investigate the status of self-perceived burden(SPB)and the related influencing factors among patients with coronary heart disease(CHD).2.To construct a structural equation model for the relationship between SPB and anxiety/depression among CHD patients,explore the main mediating variables affecting the relationship between them and the path relationship among the variables,to provide reference for clinical targeted intervention.Methods A cross-sectional study of 308 patients with CHD from December 2017 to September 2018 from the department of cardiovascular medicine in two tertiary hospitals in Anhui province,using convenience sampling method.All of the participants were investigated by General Demographic Information Questionnaire,Self-perceived Burden Scale(SPBS),General Self-efficacy Scale(GSES),Medical Coping Modes Questionnaire(MCMQ),Social Support Rating Scale(SSRS)and Hospital Anxiety and Depression Scale(HADS).SPSS 22.0 was used for statistical analysis of the data,multiple linear regression analysis was used to explore the influencing factors of SPB in CHD patients,and AMOS 23.0 was used for construction and validation of the structure equation model.Results 1.The total score of SPB in CHD patients was(27.91±8.07).in addition,no SPB only accounted for 15.9%,mild SPB accounted for 41.9%,moderate SPB accounted for 32.1%,severe SPB accounted for 10.1%.Single factor analysis results showed that the SPB in CHD patients differed significantly according to gender,age,educational level,occupation,residence,per capita monthly household income,payment of medical expenses,the degree of self-care,primary caregiver,type of CHD,angina pectoris grade and number of complications(P<0.05).Multiple linear regression analysis results showed that occupation,residence,per capita monthly household income,the degree of self-care,angina pectoris grade and number of complications were main influencing factors of SPB in CHD patients(adjusted R~2=0.293,F=7.685,P<0.001).2.Structural equation model results showed that the model was well fitted,NC=2.742,RESEA=0.075,GFI=0.955,AGFI=0.908,NFI=0.953,IFI=0.969,CFI=0.969.In the model,the total effect of SPB on anxiety/depression was 0.683,in which the direct effect was 0.345,and the indirect effect through self-efficacy,resignation coping and social support was 0.338.Conclusion 1.Overall,the SPB of patients with CHD is at a mild level,and occupation,residence,per capita monthly household income,the degree of self-care,angina pectoris grade and number of complications are influencing factors of SPB in patients with CHD.Medical staff should pay attention to the SPB of CHD patients in order to improve the mental health of them.2.The structural equation model for the relationship between SPB and anxiety/depression among patients with CHD shows good fit index.The model shows that SPB can directly affect anxiety/depression,and also indirectly affect anxiety/depression through self-efficacy,resignation coping and social support.Self-efficacy,resignation coping and social support are the mediating variables of the relationship between SPB and anxiety/depression.Among them,SPB can indirectly affect resignation coping and social support through self-efficacy,and then act on anxiety/depression,showing that self-efficacy is an important mediating variable.Medical staff can reduce the influence of SPB on anxiety/depression and improve the mental health of CHD patients by intervening mediating variables such as self-efficacy,resignation coping and social support.