| 其他摘要 | With the accelerating global aging population and changes in modern lifestyles, the number of patients with brain injuries due to aging, vascular diseases, tumors, trauma, ischemia, and hypoxia is increasing year by year. Moreover, 80% of these patients have varying degrees of functional impairment, causing inconvenience to both patients and their families. Brain injury is a significant stress event that profoundly affects the marital relationships and quality of life (QoL) of patients and their spouses. Dyadic coping (DC) is the reaction and decision-making process in which both spouses (the dyads) respond to mitigate the adverse effects of stress events. Patients and their spouses each cope with stress in their own way, but their responses interact with each other. Given the critical role of DC in disease management, promoting rehabilitation exercise motivation, preventing the recurrence of brain injuries, and home-based rehabilitation in recent years, research on DC in brain injured patients has gained attention. However, there are still limitations in the analysis of paired dyadic data, and the analysis is often limited to the individual level.
This study aimed to investigate the DC levels of brain injured patients with functional impairments and their spouses during rehabilitation treatment. Based on data analysis models such as the Common Fate Model (CFM), Actor-Partner Interdependence Model (APIM), or mixed models, we explored their correlation between DC and marital satisfaction as well as QoL among couples. This study provides a theoretical basis for DC interventions for brain injured patients and their spouses during the rehabilitation period.
The research was conducted from October 2022 to June 2023 at the China Rehabilitation Research Center. Seven wards that treat brain injured rehabilitation patients were selected. A total of 101 brain injured patients with functional impairments and their spouses were surveyed. Participants completed questionnaires that included general information, Dyadic Coping Scales, the Kansas Marital Satisfaction Scale, and the World Health Organization Quality of Life-BREF.
The results of the questionnaire survey showed:
(1) the average DC score of the couples (with a total score of 148) fell within the normal range. Patients had a higher average score than their spouses, with scores of 101.96±22.74 and 94.39±22.98, respectively.
(2) Using JASP 0.17.3 software, suitable CFM, APIM, and mixed models were chosen based on variable characteristics to analyze the relationships between DC (communication, supportive, delegated, negative, cooperation, evaluation) and marital satisfaction & QoL(physiological, psychological, social relations, environment).
Using CFM and mixed models to analyze the relationship between dyadic coping and marital satisfaction, the results show: Except for the dimensions of spouses' stress communication and negative coping, which are not significantly correlated with marital satisfaction, all other dimensions of dyadic coping are significantly positively correlated with marital satisfaction for both spouses. In other words, the higher the level of dyadic coping, the higher the marital satisfaction.
Using APIM and mixed models to analyze the relationship between dyadic coping and QoL, the results show: Except for the patient's dimension of negative coping, which is not significantly related to their QoL, all other dimensions are significantly positively correlated with the overall QoL for both spouses. In other words, positive dyadic coping strategies (communication, supportive, delegated, cooperation) and higher coping assessments predict the QoL for both spouses positively. In the analysis of all dimensions of QoL, positive coping strategies are significantly positively correlated with the couples' psychological and the spouses' physical dimensions, but not significantly correlated with the patients' physical dimension. In terms of their impact on social relations and environmental dimensions, there is diversity between patients and spouses, with spouses showing a stronger effect. Negative dimension is only significantly related to the spouse's physical and psychological dimensions.
Therefore, during the rehabilitation, treatment, and care nursing, it is advisable to consider brain injured patients and their spouses as a whole, incorporate them into clinical management, leverage the dyadic resources, enhance their DC ability and avoid negative coping styles, to promote positive psychological adaptation. This can facilitate better rehabilitation outcomes & QoL and prepare them for reintegration into their families and society. |
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