Current status of stigma associated with Alzheimer's disease in primary caregivers and linear regression analysis of influencing factors
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摘要:
目的 探讨阿尔茨海默病(AD)主要照顾者的连带病耻感(AS)现状及影响因素。 方法 便利抽样选取2022年1月—2024年3月上海市第六人民医院AD患者及其主要照顾者177例，采用一般资料表、简易精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)、连带病耻感量表(ASS)、自我效能感量表(SES)、简单应对方式问卷(SCSQ)等进行调查，研究主要照顾者AS现状。运用线性回归分析AD主要照顾者AS影响因素。 结果 AD主要照顾者AS总分(30.34±8.06)分；AS与自我效能感呈负相关关系、与简单应对方式无相关性(r=-0.254、-0.030, P＜0.05、P>0.05)，经相关性分析显示，ASS与SES线性相关(P＜0.05)。AD患者痴呆程度以及主要照顾者与患者共处时间、对患者的病情了解、每月经济收入、民族是AD主要照顾者AS的可疑影响因素(P＜0.05)。线性回归显示，AD患者痴呆程度(β=2.015, P=0.014)、照顾者与患者共处时间(β=2.779, P=0.023)、自我效能感(β=-0.231, P=0.009)是AD主要照顾者AS的影响因素(P＜0.05)。 结论 AD患者主要照顾者存在AS，AD患者痴呆程度、照顾者与患者共处时间、自我效能感为照顾者AS影响因素，应给予AD主要照顾者社会支持，强化心理疏导，提高主要照顾者心理韧性。 Abstract:Objective To explore the current status and influencing factors of comorbidity shame (AS) among primary caregivers of Alzheimer' s disease (AD). Methods Convenience sampling was used to select 177 AD patients and their primary caregivers at the Sixth People' s Hospital of Shanghai from January 2022 to March 2024. General information forms, Mini-Mental Status Examination (MMSE), Montreal Cognitive Assessment Scale (MoCA), Associated Disease Shame Scale (ASS), Self-Efficacy Scale (SES), and Simple Coping Style Questionnaire (SCSQ) were used to investigate the current status of AS among primary caregivers. Use linear regression analysis to identify the influencing factors of primary caregiver AS in AD. Results The total score of AS for the main caregivers of AD was (30.34±8.06) points. The stigma experienced by these caregivers was inversely related to their self-efficacy and simple coping style (r=-0.254, P < 0.05; r=-0.030, P>0.05). Correlation analysis revealed a statistically significant linear relationship between stigma and self-efficacy (P < 0.05). Univariate analysis identified several potential factors influencing stigma among caregivers, including the severity of dementia in AD patients, the duration of caregiving, caregivers' understanding of the patient' s condition, monthly economic income, and nationality (P < 0.05). Further linear regression analysis confirmed that the severity of dementia (β=2.015, P=0.014), the time spent by caregivers with patients (β=2.779, P=0.023), and caregivers' self-efficacy (β=-0.231, P=0.009) were significant predictors of stigma among primary caregivers of AD patients (P < 0.05). Conclusion The main caregiver of AD patients has AS, and the degree of dementia, time spent with the caregiver, and self-efficacy are factors that affect caregiver AS. Social support should be provided to the main caregiver of AD, and psychological counseling should be strengthened to improve their psychological resilience. -
表 1 AD主要照顾者ASS、SES、SCSQ问卷总得分及条目均分得分情况
Table 1. Total and mean scores for the ASS, SES, and SCSQ questionnaires administered to primary caregivers of individuals with AD
量表 项目 条目数 得分 条目均分 ASS 总分 22 30.34±8.06 1.38±0.37 情感维度 5 9.02±0.29 1.80±0.06 社交行为维度 8 10.15±0.20 1.27±0.03 认知维度 9 11.16±0.16 1.24±0.02 SES 总分 10 29.14±6.90 2.91±0.69 SCSQ 总分 20 34.59±9.75 1.73±0.49 积极维度 13 26.69±0.20 2.05±0.02 消极维度 7 7.89±0.54 1.13±0.08 
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表 2 主要照顾者连带病耻感与自我效能感、简单应对方式相关性分析
Table 2. Associations among illness-related stigma, self-efficacy, and coping styles in primary caregivers
项目 情感维度 社交行为维度 认知维度 连带病耻感总分 自我效能感总分 -0.294a -0.132 -0.193a -0.254a 积极维度 -0.044 -0.069 -0.107 -0.083 消极维度 0.017 0.082 0.094 0.070 简单应对方式总分 -0.025 -0.015 -0.038 -0.030 注：aP＜0.05。
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表 3 影响AD主要照顾者连带病耻感得分分析
Table 3. Analysis of factors associated with stigma scores in primary caregivers of AD patients with pre-existing conditions
项目 例数 连带病耻感总分(x±s，分) 统计量 P值 AD患者情况 性别 1.567a 0.119 男性 69 31.52±8.55 女性 108 29.58±7.68 年龄 -0.454a 0.650 <70岁 103 30.57±8.50 ≥70岁 74 30.01±7.46 婚姻状态 1.487a 0.139 有配偶 148 30.74±8.10 无配偶 29 28.31±7.68 学历 1.297b 0.276 初中及以下 97 29.89±7.90 高中、中专或技校毕业 22 32.91±8.65 专科及以上 58 30.12±8.07 痴呆程度 92.247b 0.001 轻度 43 26.93±5.96 中度 86 31.16±6.93 重度 48 31.92±10.50 主要照顾者情况 性别 0.065a 0.948 男性 61 30.39±8.93 女性 116 30.31±7.61 年龄 -1.087a 0.279 <50岁 58 29.40±7.98 ≥50岁 119 30.80±8.09 婚姻状况 0.420a 0.391 有配偶 157 30.15±7.99 无配偶 20 31.80±8.67 居住情况 1.018b 0.386 独居 7 32.14±7.27 夫妻同住 136 30.17±7.91 和子女或孙辈一起住 24 32.08±9.61 其他 10 27.20±6.12 与患者共处时间 5.443b 0.005 一直住在一起 137 30.17±7.88 不住在一起且≤16 h 33 29.06±7.22 不住在一起且>16 h 7 39.71±10.31 对患者的病情了解 5.816b 0.032 不了解 3 23.67±2.89 部分了解 15 31.33±11.51 非常了解 159 30.37±7.72 子女 1.640b 0.197 无 18 29.89±9.22 1~2个 155 30.21±7.94 ≥3个 4 37.50±4.51 学历 0.303b 0.739 初中及以下 27 31.41±8.40 高中、中专或技校毕业 40 29.90±7.10 专科及以上 110 30.24±8.35 职业状态 -0.791a 0.430 在职 114 29.98±7.96 不在职 63 30.98±8.26 每月经济收入 2.739b 0.045 0~2 500元 4 25.25±5.25 2 500~4 000元 28 33.89±9.17 4 000~7 000元 65 30.18±7.46 ≥7 000元 80 29.48±7.95 经济来源 0.226a 0.069 退休金 102 31.28±8.13 其他 75 29.05±7.83 民族 2.944a 0.017 汉族 169 30.61±8.07 少数民族 8 24.63±5.48 a为t值，b为F值。
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表 4 自变量赋值表
Table 4. Independent variable assignment
自变量 赋值方式 痴呆程度 轻度痴呆=1，中度痴呆=2，重度痴呆=3 与患者共处时间 一直住在一起=1，每周≤16 h=2，每周>16 h=3 对患者的病情了解 不了解=1，部分了解=2，非常了解=3 每月经济收入 0~2 500元=1，2 500~4 000元=2，4 000~7 000元=3，≥7 000元=4 民族 汉族=1，少数民族=2 自我效能感总分 以实际值赋值
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表 5 AD主要照顾者连带病耻感影响因素线性回归分析
Table 5. Linear regression analysis of factors influencing stigma associated with pre-existing conditions among the main caregivers of AD
自变量 B SE β t值 P值 痴呆程度 2.015 0.808 0.180 2.494 0.014 与患者共处时间 2.779 1.207 0.181 2.302 0.023 对患者的病情了解 2.333 1.703 0.108 1.370 0.173 每月经济收入 -0.570 0.736 -0.057 -0.774 0.440 民族 -4.829 2.834 -0.125 -1.704 0.090 自我效能感 -0.231 0.087 -0.197 -2.657 0.009
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