A Study Of The Factors Influencing The Demoralization In Patients With Parkinson’s Disease Based On The Stress And Coping Model

Objectives Through questionnaire survey,to understand the demoralization status of patients with Parkinson’s Disease(PD),identify its influencing factors,build a structural equation model of the influencing factors of PD patients based on stress and coping mode,and analyze the action path and effect of the main influencing factors.To provide the basis for medical staff to carry out targeted mental health guidance.Methods From January 2022 to February 2023,283 inpatients with PD were selected from three comprehensive Class ⅲ Grade A hospitals in Lanzhou according to the inclusion and exclusion criteria.The general information questionnaire,Chinese version of Demoralization Scale(DS-MV),modified H-Y rating Scale,Brief Cognitive Impairment Questionnaire(BIPQ),Perceived Social Support Scale(PSSS),ConnorDavidson Resilience Scale(CD-RISC)and Medical Coping Modes Questionnaire(MCMQ)were used to investigate the current situation and influencing factors of demoralization in PD patients.SPSS26.0 statistical software was used to analyze the data.Count data were described by frequency(n)and percentage(%),and measurement data were described by mean plus or minus standard deviation.Independent sample ttest,one-way analysis of variance and non-parametric Krusakal-Wallis H test were used to compare the differences in general demographic data between different groups.The correlation of the influencing factors was compared by Pearson correlation analysis.Multiple linear regression was used to explore the influencing factors of demoralization in PD patients.Based on the theory of stress and coping model,AMOS 26.0 software was used to construct the structural equation model of influencing factors of demoralization in PD patients.The overall fitness and internal structural fitness indexes were used for fitness test,the maximum likelihood method was used for parameter estimation,and the MI index was used for correction.To clarify the effect path of each influencing factor on demoralization in PD patients,and to analyze the effect of each influencing factor on demoralization in PD patients by path coefficient.Results(1)Current situation of demoralization in PD patients The score of demoralization in PD patients was(37.40±20.42)points,and the average score of each dimension item from high to low was(1.96±1.08)for depression,(1.59±1.04)for emotional insecurity,(1.50±0.86)for failure,and(1.40±0.98)for meaninglessness.The helplessness score was(1.31±0.96).The demoralization was mild or less in 49 cases,accounting for 17.3%;188 cases were moderate,accounting for 66.4%;46 cases were severe,accounting for 16.3%.2.Influencing factors of demoralization in PD patients(1)Univariate analysis of general data: there were differences in the demoralization scores among patients with different nationalities,religious beliefs,education levels,marital status,working status,personal monthly income,course of disease,medication and disease severity,and the differences were statistically significant(P<0.05).(2)Correlation analysis The demoralization of PD patients was significantly negatively correlated with the total score of resilience,strength dimension,tenacity dimension,optimism dimension,total score of perceived social support,family support dimension,friend support dimension,other support dimension and confrontation coping(P < 0.01),and was significantly positively correlated with cognitive evaluation,resignation coping and avoidance coping(P < 0.01).(3)Multiple linear regression analysis: resignation coping,avoidance coping,resilience,cognitive evaluation,social support and medication finally entered the regression equation,which together explained 78.1% of the total variation of demoralization in PD patients.(4)The path and effect of influencing factors of demoralization in PD patients:cognitive evaluation of PD patients had a direct positive effect on demoralization,and it could also have an indirect positive effect on demoralization through avoidance coping style and resignation coping style,with a total effect size of 0.339.Resilience could not only directly affect demoralization,but also indirectly affect demoralization through cognitive evaluation,resignation coping and avoidance coping.The total effect was-0.614.Social support could affect demoralization in PD patients not only directly,but also through avoidance coping,and the total effect size was-0.200.Yielding coping and avoidance coping had direct positive effects on demoralization in PD patients,and the total effect sizes were 0.356 and 0.222,respectively.Conclusions1.PD patients are a group of high demoralization,medical staff should pay attention to this situation.2.Medication,cognitive evaluation,social support,resilience,resignation coping and avoidance coping were the independent influencing factors of demoralization in PD patients.3.Resilience is an important influencing factor of demoralization in PD patients,directly or indirectly through cognitive evaluation,avoidance coping and resignation coping.The second is resignation coping,which directly affects the demoralization of PD patients.Cognitive evaluation and social support can also directly or indirectly affect the level of demoralization through different coping styles.Avoidance coping directly affects the demoralization in PD patients.4.Health management strategies aimed at reducing demoralization in PD patients should focus on the differences in medication,psychological resilience,social support,cognitive evaluation and coping style of patients.Positive psychological intervention strategies should be adopted to improve the level of psychological resilience of patients as the key,help patients to correctly understand the disease through health education and make full use of social support networks.Strengthen the emotional support for patients and improve their coping style,so as to reduce the level of demoralization.