| 【Objective】To investigate the current situation of psychosocial adaptation in patients with chronic obstructive pulmonary disease(COPD),to understand the influence of general data of COPD patients on their psychosocial adaptation,to analyze the correlation between psychosocial adaptation and stress perception,psychological flexibility and coping style based on stress coping theory,and to verify the intermediary role of psychological flexibility and coping style between stress perception and psychosocial adaptation in COPD patients.The purpose of this study is to provide reference for the intervention program of disease adaptation in patients with COPD in the future.【Methods】This study adopts a cross-sectional study method.A total of 260 with COPD patients who were hospitalized in the respiratory medicine department of three first-class hospitals in Shandong Province were selected by convenience sampling from January to November 2020.The General situation questionnaire,Modified British Medical Reasearch Council Dyspnea(m MRC),Self-Report Psychosocial Adjustment to Illness Scale(PAIS-SR),Chinese version Peceived Stress Scale(CPSS),Acceptance and Action Questionnaire Second Edition(AAQ-Ⅱ),and Medical Coping Modes Questionnaire(MCMQ)were uesd to investigate.SPSS21.0 and AMOS23.0 statistical software were used to analyze the data,including statistical descriptive analysis,independent sample T-test,one-way ANOVA analysis of variance,Pearson correlation analysis,multiple linear stepwise regression analysis and constructing structural equation models.【Results】1.The average score of the total score of psychosocial adaptation in patients with COPD was(60.91 ±16.40),and the average score of each dimension item from high to low was the ability to work(1.72±0.43),entertainment situation(1.68±0.60),sexuality(1.43±0.45),psychological conditions(1.39±0.55),health care(1.33±0.49),exchange of information(1.15±0.60),family relationships(1.02±0.47).2.The results of independent sample T-test and one-way ANOVA showed that there were significant differences in the scores of psychosocial adaptation among COPD patients with age,place of residence,payment system in health care,employment status,living style,family per capita monthly income,number of hospitalizations due to acute attack within one year,pulmonary function grade and degree of dyspnea(P<0.05).3.The average score of the total score of perceived stress in patients with COPD was(33.40±7.77),and76.0% of patients had a high level of perceived stress,in which the highest average score was tension dimension(2.67±0.60),followed by it was the dimension of lose of control(2.10±0.59).The average score of the total score of psychological flexibility in patients with COPD was(27.67±7.14),and the average score of items was(3.95±1.02).The scores of face coping in coping styles for COPD patients was lower than those of general patients(P<0.01),while the scores of avoidance coping and yield coping were higher than those of general patients(P<0.01),the average score of each dimension item from high to low was face(2.21±0.42),avoidance(2.20±0.39)and yield(2.12±0.63).4.The results of correlation analysis showed that the psychosocial adaptation of COPD patients was negatively correlated with perceived stress(r =-0.448),avoidance coping(r =-0.238)and yield coping(r =-0.532)(P < 0.01),and positively correlated with psychological flexibility(r =0.604)and face coping(r = 0.545)(P <0.01).5.Multiple linear stepwise regression analysis showed that psychological flexibility,yield coping,pulmonary function grade,perceived stress,face coping,family per capita monthly income,living style were important predictors of psychosocial adaptation in patients with COPD,which explained 66.1% of the variation of psychosocial adaptation.6.Structural equation model was constructed to analyze the pathway between perceived stress,psychological flexibility,coping style and psychosocial adaptation in patients with COPD,the fitting indexes of the structural equation model were:χ~2=69.447,χ~2/df=1.578,GFI=0.958,AGFI=0.925,NFI=0.943,TLI=0.967,CFI=0.978,IFI=0.979,RFI=0.915,RMSEA=0.049.By themediation test of Bootstrap,the 95% confidence interval of indirect effect of each path did not contain 0,that was psychological flexibility and coping style played a part of the mediating role between perceived stress and psychosocial adaptation respectively,while psychological flexibility and coping style played a chain-mediated role between perceived stress and psychosocial adaptation,and the total mediating effect was 53.0%.【Conclusion】1.The psychosocial adaptation of patients with COPD was at a poor level,which was affected by age,place of residence,payment system in health care,employment status,living style,family per capita monthly income,number of hospitalizations due to acute attack within one year,pulmonary function grade and degree of dyspnea.2.The perceived stress of COPD patients was generally high,the psychological flexibility was at a low level.The coping style of face coping was lower than those of the general patients,and the avoidance and yield coping was higher than those of the general patients,and the patients were more inclined to negative coping.3.The psychosocial adaptation of COPD patients was negatively correlated with perceived stress,avoidance coping and yield coping,and positively correlated with psychological flexibility and face coping.4.Multiple linear stepwise regression analysis showed that sense of loss of control,psychological flexibility,yield,pulmonary function grade,family per capita monthly income and face were important predictors of psychosocial adaptation in patients with COPD.5.The psychological flexibility and coping style of COPD patients played a part of the mediating role between perceived stress and psychosocial adaptation,and psychological flexibility and coping style also played a chain-mediated role between perceived stress and psychosocial adaptation.That was to say perceived stress can not only directly affect psychosocial adaptation,but also indirectly affect psychosocial adaptation through psychological flexibility and coping style. |
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