摘要
糖尿病为西医病名,属中医“消渴”范畴。2010年调查显示我国现有糖尿病患者达9240万例,居全球之首。在不同类型的糖尿病中,2型糖尿病则是发病率最高(超过90%),其并发症或伴发症也非常多,对患者的身心健康和经济负担影响巨大,因此本文以2型糖尿病患者为研究对象。2型糖尿病是一种致病因素复杂的终身性疾病,因此对2型糖尿病的防治除了药物治疗以外,还需要结合非药物的干预措施。中医健康心理学思想已存在有几千年的历史,但没有构成系统的理论体系,其健康心理学思想也散载于中医各类古籍医案中。本文对其进行了初步的梳理,并以中医健康心理学视角研究2型糖尿病非药物干预。
目的
①梳理中医健康心理学理论,为T2DM患者心理、行为及社会特征的研究奠定理论基础；同时开发基于中医健康心理学的T2DM患者研究量表。
②通过调查,掌握2型糖尿病患者的心理特征；分析患病前生活行为与患病后躯体症状之间的关联；研究患病后患者社会支持状况及其社会网络特征,并分析社会因素对T2DM患者身心健康的影响。
③制定基于中医健康心理学视角的干预措施,为预防糖尿病及其并发症的发生、控制疾病的发展以及提高患者生存质量的提供参考。
方法
①文献法：通过文献收集与研究,分析国内外有关2型糖尿病的研究成果,为调查表的制定和后续研究提供参考依据。
②专家咨询法：对糖尿病专家和卫生统计专家进行咨询,借助其专业知识与经验,保证研究质量,提升研究水平。
③问卷调查法：在参考其他相关量表的基础上自编调查量表,以调查2型糖尿病患者的心理、行为及社会特征。
④统计分析方法：主要应用因子分析(包括探索性和验证性因子分析)、结构方程模型以及多元回归分析等统计方法。
结果
①T2DM患者心理障碍现象总体平均发生率为54.7%.在调查的21项心理障碍指标中,主要表现在担忧病情恶化(91.4%)、失眠多梦(90.3%)、恐惧并发症(89.2%)、心情悲伤(80.2%)等,还伴有明显的认知障碍。
②通过探索性因子分析(EFA),将T2DM患者的21个调查指标降维处理为六个因子：“悲”、“忧”、“怒””、“内疚感”、“认知障碍”以及“自暴自弃”等因子,其中18个指标因子负荷大于0.5,六个因子累计方差贡献率为65.71%.
③通过验证性因子分析(CFA),发现T2DM患者身体健康与心理健康状况之间存在显著性相关(P<0.05),相关系数为0.472.
④在调查对象中,有41.0%的调查对象喜欢吃甜食；38.5的人喜欢吃麻辣咸味偏重的食物；22.6%的人不喜欢吃水果蔬菜；喜欢吃零食的群体占28.4%;20.1%的人喜欢吃得过饱；三餐无规律的有8.6%；有19.8%的人在外就餐比较多；中度和重度以上的吸烟者占19.5%；喜好饮酒的人占13.6%；不做家务或很少做的占24.1%；很少体育锻炼的占30.2%,41.7%的人工作中的体力活动很少；有37.0%的日常作息无规律,存在睡眠障碍的有44.2%.
⑤通过结构方程模型(SEM)分析发现,“饮食不节”、“不良嗜好”、“运动不足”以及“起居失宜”等四个外生潜变量与糖尿病发病(内生潜变量)存在显著性因果关系(P<0.05),并且通过SEM的拟合度检验可知该模型具有统计学意义：并且测量外生潜变量的15个测量指标,其负荷大多大于0.5(其中只有三个指标负荷小于0.5)；在内生潜变量(糖尿病发病)的4个测量指标则均为显著,且系数均大于0.5,说明生活行为与糖尿病发病存在显著性因果关系。
⑥在获取社会支持方面,本次调查的T2DM患者样本群体中,主观支持得分平均为22.54分(占该项总体的70.4%)；社会客观支持平均为15.55分(占该项总体的70.7%)；对支持的利用度平均为8.10分(占该项总体的67.5%)。该患者群体与国内常模在总社会支持和主观社会支持两方面的差异无统计学意义(P值分别为0.09和0.07),但社会客观支持与支持利用度上存在显著性差异(P=0.00)。
⑦在社会网络特征调查中,调查对象网络规模为16.85人；以四分等级评价,该群体网络关系密度平均为2.65,网络成员职业异质性为1.75,网络相对地位自我评价为2.21,网络成员互动为2.11,网络成员信任为3.14。通过多元回归分析可知,社会网络对T2DM患者的身体健康及心理健康影响的回归模型均具有统计学意义(P值均小于0.05),解释力度(R2)分别为0.117和0.186,说明社会网络回归模型对患者身心健康具有一定解释能力。
讨论
①T2DM患者心理障碍客观存在,并表现为六种类型,应高度重视糖尿病患者心理障碍的干预治疗。
②T2DM患者身心健康存在密切联系,两者相互影响,可互为因果,因此治疗应注重身心同治,以提高疗效。
③不良生活行为与糖尿病发病存在关联,应通过多种渠道,加大健康生活行为的宣传,改变民众不良生活行为和方式,促进个人、家庭以及社会的健康和谐发展。
④提高高危人群糖尿病防范意识,在无症状情况下也不能掉以轻心,坚持定期健康体检,加强自我健康管理能力,早发现、早诊断和早治疗。
⑤完善社会支持网络,改善患者社会支持的主客观体验,提高患者支持利用度,提升糖尿病患者的生活质量。
⑥社会网络对T2DM患者身心健康存在肯定的影响。
Diabetes Mellitus (DM) is a western medicine term of disease or symptom, and corresponds to "xiao ke" in Traditional Chinese medicine (TCM). Now there are nearly 92,400,000 people suffered from DM in China, which is first rank country with those patients in the world. According to proposal of the World Health Organization, DM can be mainly divided into many different types. In those types, T2DM is the most common form of this disease (over 90%), and it hurts the diabetics'mental health as well as body health, and also brings heavy economic burden to the T2DM patients. Therefore, this study takes the T2DM sufferers as the research object. Many factors can potentially beget T2DM. So the control and prevention measures for T2DM should be contained multiple methods, including medicine treatment and non-medicine intervention. This research explores the non-medicine intervention measures for T2DM from the viewpoint of TCM healthy psychology. Though the healthy psychology thought of TCM (HPTCM) has already existed for several thousand years, TCM theory did not constitute the theory system for healthy psychology, and those thought spark spread in many ancient works of TCM.
Objectives
①The research neatens the theory of TCM healthy psychology firstly for the next study of exploring the psychological, behavioral and social characteristics of T2DM Patients, and then makes the questionnaire based on the theory of health psychology of TCM.
②The research analyzes the psychological characteristics, life style and behaviors before suffering DM, and the impacts of their social support and social network characteristics on body-mental health of T2DM Patients.
③The research puts forward some prevention and control interventions for the diabetics based on the HPTCM, and gives some advices for patients to improve their life quality.
Methods
①Literature analysis:Through this method, the paper searches the study literature about T2DM from whole world, and designs the questionnaire.
②Consultation with expert:The researcher consults with specialists of DM and health statistics when the study begins to design the questionnaire and investigates patients.
③Questionnaire:Based on other correlative questionnaire scale, the paper designs its own questionnaire for probing the psychological, behavioral and social characteristics of type 2 diabetic patients.
④Statistics analysis:Including factor analysis (Exploratory Factor Analysis, EFA; Confirmatory Factor Analysis, CFA), Structural Equation Model (SEM) and Multiple Regression, and so on.
Results
①Among of all samples,54.7% of the T2DM patients have different mental handicaps. Among all 21 research indicator, those most popular syndromes include:being afraid of illness-exacerbation (91.4%), sleep loss (90.3%), being worry about their complication (89.2%), depression (80.2%), and cognitive handicap, and so on.
②Through the statistical method of exploratory factor analysis (EFA) for the 21 indicators, the study gets six latent factors, including "sadness", "sorrow", "rage", "self guilt", "cognitive handicap", and "abandonment". Among 21 indicators, there are 18 indicators with loading greater than 0.5, and all factors cumulative proportion in ANOVA is 65.71%.
③Through the statistical method of Confirmatory Factor Analysis (CFA), this result shows that there is a significant relationship between body health and mental health of T2DM patients, and its correlation coefficient is 0.472.
④Among of all patients,41.0% of them love sweet foods; 38.5% love salty foods; 22.6% don't like eating fruits or vegetables; 28.4% sock; 20.1% overeat usually; 8.6% are ruleless in meals everyday; 19.8% repast in restaurant usually; 19.5% of them over-smoke; 13.6% drink alcohol heavily; 24.1% don't do some homework; 34.2% of them have no physical exercise; 41.7% have little laboring-activity; 37.0% have ruleless in rest; and 44.2% have sleep handicap.
⑤Through the statistical method of Structural Equation Model (SEM), this result shows that there is a significant relationship between exogenous latent variable (repasting immoderation, bad life habit, sport loss and unsuitable life behavior styles) and DM (endogenous latent variable). The SEM has passed the Goodness of Fit test, and indicates this model has a significant meaning. In this model, most loadings of the 15 measurable exogenous indicators are more than 0.5 (only 3 indicators'are less than 0.5), and the loading of 4 measurable endogenous indicators are more than 0.5. All those results show that there is a significant causality relationship between life behaviors and the onset of DM.
⑥This study gets some patients'social support data. T2DM patients' subjective social support average grade is 22.54 (70.4% of total grade); their objective social support is 15.55 (70.7% of all); the usage degree of social support is 8.10 (67.5% of all).Compared with the common model of social support in our country, there have no statistical differences in general social support (p=0.09) and subjective social support (p=0.07), but there have statistical differences in objective social support and the usage degree of social support (p=0.00)
⑦About sample'social network, their average social network size is 16.85. When graded in four points, their network relation density is 2.65; the heterogeneity of job in their network is 1.75, the relative status of research object is 1.75; communication and intercourse of network member is 2.11; the grade of member trust is 3.14. Applying the multiple regression analysis, this results show that social network has a statistical impact on T2DM patients'body-mental health (P<0.05), and their regression models'R2 are 0.117 and 0.186 respectively. Those data illuminate that social network can improve T2DM patients'body-mental health.
Discussion
①There are six types of psychological handicap in T2DM patients. Therefore, psychological interventions should pay more attentions to those people, and increase the control and treat efficacy.
②There is a close relationship between body health and mental health of T2DM patients, and they can influence each other. So, treating body and mental diseases should be simultaneous, and it can improve the efficacy.
③There is a close relationship between bad life behaviors and the onset of T2DM. Therefore, many measures should be taken, such as broadcasting the healthy life behaviors through many channels, to improve people's health knowledge, alter their bad lifestyle and behaviors, and promote the health and harmony for individuals and his families.
④The high risk people should increase their health knowledge for preventing DM. they must manage their health by themselves and go to hospital for medical check regularly, even though without any obvious symptom. So, DM could be discovered early, diagnosed early, and cured early. Therefore, the effective treat will alleviate the body-mental pain for the patients.
⑤The correlative organization and society should consummate the social support network, ameliorate the patients'experiences of social support, heighten the usage degree of social support, and improve the life quality for the DM patients.
⑥Social network has an active impact on body-mental health for the T2DM patients.
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