健康与遗传心理学研究室知识库

 甲状腺癌是内分泌系统最常见的恶性肿瘤，近年来的发病率在许多国家地区都呈逐年上升的趋势，是增长速度最快的恶性肿瘤之一。本研究以甲状腺癌术后人群为研究对象，运用心理灵活性的理论对其焦虑抑郁状态进行研究。目的：研究心理灵活性各维度与焦虑、抑郁的关系，并由此探寻对甲状腺癌术后患者进行心理干预的有效途径。方法：整群选取某医院核医学门诊2013年8月4日至2013年11月25日就诊的184人，施测接纳与行动问卷第二版（AAQ-Ⅱ）、认知融合问卷（CFQ）、生命意义量表（MLQ）、焦虑自评量表（SAS）、抑郁自评量表（SDS），回收有效问卷157份。用SPSS19.0对数据进行描述性统计、独立样本t检验、方差分析，Pearson相关分析及多元回归分析。 研究得到以下结果： 第一， 经验性回避和焦虑分别在婚姻状况上差异显著（F=8.059、4.563，p<0.001、p<0.05），离异组得分均显著高于未婚组和已婚组。 第二， 焦虑、抑郁、经验性回避和认知融合在睡眠情况上差异显著（t=-6.565～1.318，p<0.05），且睡眠不好组的各项得分均显著高于睡眠良好组。 第三， 在病程调查上，运用曼惠特尼U检验发现认知融合在发现时间上差异显著（z=-1.984，p<0.05），焦虑、认知融合在手术时间上差异显著（p<0.05），均为1年以上的得分高于1年及以内的得分。 第四， 甲状腺癌术后患者的焦虑粗分为（32.38±6.99）分，显著高于常模（z=72.28，p<0.01）；抑郁粗分为（34.73±7.87）分，显著高于常模（z=2.25,p<0.05）。 第五， 经验性回避、认知融合分别与焦虑、抑郁呈显著正相关（r=0.288～0.471，p<0.01）；生命意义感与焦虑、抑郁、经验性回避和认知融合均呈显著负相关（r=-0.437～-0.295，p<0.01）；寻求意义感分别与经验性回避、认知融合呈显著正相关（r=0.208、0.219，p<0.01），与焦虑、抑郁、生命意义感均相关不显著（p>0.05）。 第六， 以焦虑、抑郁为因变量，心理灵活性为自变量进行层级回归，在控制了婚姻、发现时间、手术时间和睡眠的影响后，只有生命意义感进入回归方程，睡眠和生命意义感β值分别为0.310（p<0.001）和-0.230（p<0.05），共可解释焦虑43.9%的变异量。因变量是抑郁时，在控制变量后，经验性回避和生命意义感进入回归方程，睡眠、经验性回避和生命意义感的β值分别为0.196（p<0.01），0.353（p<0.05）和-0.291（p<0.01），共可解释抑郁34.4%的变异量。 第七， 生命意义感的中介效应检验。以经验性回避为自变量，生命意义感为中介变量，抑郁为因变量时，生命意义感在经验性回避与抑郁间起到26.07%的中介效应；以经验性回避为自变量，生命意义感为中介变量，焦虑为因变量时，生命意义感在经验性回避与焦虑间起到23.29%的中介效应。 本论文结论为： 第一，甲状腺癌术后人口学变量中，不同婚姻状况患者在焦虑、经验性回避上差异显著。 第二，甲状腺癌术后患者的焦虑、抑郁、经验性回避和认知融合，均是睡眠不好组的得分显著高于睡眠良好组。 第三，甲状腺癌患者发现距今和手术距今在认知融合得分上存在显著差异，1年以上组高于1年及以下组。 第四，甲状腺癌术后患者的焦虑抑郁得分均显著高于正常人群。 第五，甲状腺癌术后患者的经验性回避、认知融合程度越高，其焦虑、抑郁情况越重；生命意义感越强，其焦虑、抑郁、经验性回避和认知融合程度越轻；寻求意义感越强，认知融合程度越高。生命意义感在“认知融合—焦虑”和“经验性回避—抑郁”的关系中发挥了部分中介的作用。

 Thyroid Carcinoma is the most common malignancy in endocrine system. In recent years, the incidence of thyroid carcinoma has been increasing rapidly in many countries. This study focused on the thyroid carcinoma patients who had received thyroidectomy and aimed to explore their anxiety and depression with psychological flexibility. Objective: To evaluate the relationship among the contents of psychological flexibility, anxiety and depression, and explore an effective psychological intervention method for postsurgical thyroid carcinoma patients. Methods: A cluster sampling of 184 patients who were treated between Aug.4,2013 and Nov.25,2013 in one of the nuclear medicine clinic were selected and assessed with the Acceptance and Action Questionnaire-Second Edition (AAQ-Ⅱ), Cognitive Fusion Questionnaire(CFQ), Self-Rating Anxiety Scale(SAS), Self-rating depression scale(SDS)and the Meaning in Life Questionnaire (MLQ).T-test, Analysis of Variance, Pearson Correlation Analysis and stepwise multiple regression analysis were conducted in 157 quesionaires which were effective by using SPSS 19.0. Results: 1.There were no significant differences of AAQ-Ⅱ, CFQ, SAS, SDS, MLQ-P，MLQ-S on gender and Education. There were significant differences of SAS and AAQ-Ⅱon Marital status （F=8.059、4.563，p<0.001、p<0.05）, which was the score of divorce patients higher than the score of unmarried and married patients. 2. There were significant differences of SAS, SDS, AAQ-Ⅱ and CFO on Sleep（t=-6.565～1.318，p<0.05）, which was the score of bad-sleep patients higher than the score of good-sleep patients. 3. There were significant differences of CFQ on the time of Find（z=-1.984，p<0.05）,and there were significant differences of SAS and CFQ on the time of operation（p<0.05）, which were the scores of the 1 year and above higher than the 1 year. 4. The scores of SAS and SDS were（32.38±6.992） and （34.73±7.871）respectively, which were significant higher than the domestic constant. 5. There was significant positive correlation between AAQ-Ⅱ, CFQ and SAS, SDS respectively（r=0.288～0.471，p<0.01）. There was significant negative correlation between MLQ-P and SAS, SDS, AAQ-Ⅱ,CFQ respectively（r=-0.437～-0.295，p<0.01）.There was significant positive correlation between MLQ-S and AAQ-Ⅱ, CFQ respectively（r=0.208、0.219，p<0.01）. 6. With controlling the effect of marriage, the time of find the disease, the time of after operation and sleep, the sleep （β=0.310,p<0.001） and MLQ-P（β=-0.230, p<0.05）can explain 43.9% of SAS. With control these variables, the AAQ-Ⅱ（β=0.196,p<0.01） and MLQ-P（β=-0.353, p<0.05）can explain 34.4%% of SDS. 7. AAQ-Ⅱ as the independent variable, MLQ-P as the intervening variable and depression as the dependent variable, MLQ-P make 26.07% intermediate effect between AAQ-Ⅱ and depression. AAQ-Ⅱ as the independent variable, MLQ-P as the intervening variable and anxiety as the dependent variable, MLQ-P make 23.29% intermediate effect between AAQ-Ⅱ and depression. Conclusion: 1. There were significant differences of marital status on SAS and AAQ-Ⅱ. 2. There were significant differences of SAS, SDS, AAQ-Ⅱand CFO on Sleep, which was the score of bad-sleep patients higher than the score of good-sleep patients. 3. There were significant differences of CFQ on the time of find the disease and the time of operation, which were the scores of the 1 year and above higher than the 1 year. 4. The degree of SAS and SDS of the patients after thyroid Carcinoma art were higher than the norm, but all were mild degree. 5. The higher the degree of the AAQ-Ⅱand CFO in the patients of after thyroid Carcinoma were, the more serious of the SAS and SDS were. The higher the degree of the MLQ-P were, the lower the degree of the SAS,SDS, AAQ-Ⅱand CFQ were. The stronger the degree of the MLQ-S was, the more serious of the CFQ was. MLQ-P make partial intermediate effect between AAQ-Ⅱand depression and AAQ-Ⅱand anxiety.