【作者】 刘素花；

【导师】 刘桂萍；

【作者基本信息】 郑州大学 ， 护理学， 2012， 硕士

【摘要】 目的调查护理学硕士研究生(以下简称护理硕士生)的心理健康状况,分析应对方式、社会支持等对护理学硕士生心理健康的影响,为今后开展护理学硕士生的心理健康教育或咨询提供科学依据。方法采用便利抽样法,抽取国内12所高校的2008、2009、2010级全日制护理硕士生为研究对象。同时将护理硕士生心理健康状况与其中9所高校的医学硕士207人、6所高校的非医学类硕士204人、河南省的本科护生449人的心理健康状况进行比较。调查工具包括症状自评量表(SCL-90),社会支持评定量表(SSRS),应对方式问卷及一般情况问卷。数据资料使用SPSS17.0建立数据库,统计方法包括描述性分析、t检验、秩和检验、方差分析、spearman相关分析、二元逻辑回归及多元线性逐步回归分析等。结果1.护理硕士生心理健康现状1.1共发放问卷288份,回收有效问卷273份,有效回收率94.79%。SCL-90总分90-275,平均(122.85±35.86),中位数112；总均分1.00～3.06,平均(1.37±0.40),中位数1.24；以总分≥160为心理健康检出阳性,检出率为12.45%；任一因子分≥3者检出率为6.23%；以任一因子分≥2为检出阳性,各因子阳性检出率由高至低依次为：强迫18.68%,抑郁14.65%,人际关系敏感12.45%,焦虑12.45%,敌对11.36%,其他9.16%,偏执6.96%,恐怖6.59%,精神病性6.59%,躯体化5.86%。1.2护理硕士生SCL-90各因子得分均低于全国青年常模和本科护生；焦虑因子评分差异无统计学意义,其余因子评分均低于青年常模；偏执因子评分高于医学硕士,SCL-90总分及其他9项因子评分均低于医学硕士；躯体化、强迫症状因子评分低于非医学类硕士,抑郁、焦虑、敌对、精神病性因子评分高于非医学类硕士,其他因子评分差异无统计学意义。1.3以一般情况资料做单因素分析显示：护理硕士生心理健康状况在年龄组、婚姻状况、学费来源、工作经验、父母学历方面的差异有统计学意义,是否独生子女、不同来源地、年级、生源等方面的差异无统计学意义。2.护理硕士生心理健康影响因素分析2.1护理硕士生SCL-90总分、躯体化、人际关系敏感、抑郁与社会支持总分之间；躯体化与客观支持之间；抑郁与主观支持之间；人际关系敏感、抑郁与支持利用度之间呈不同程度的负相关(P<0.05),其余相关性无统计学意义(P>0.05)；护理硕士生心理健康与解决问题呈负相关,与自责、幻想、退避、合理化呈正相关(P<0.05),其余相关性无统计学意义(P>0.05)。2.2对护理硕士生心理健康影响因素的logistic回归分析：年龄组、学费来源、解决问题、自责4项进入SCL-90总分的回归方程；解决问题、自责进入躯体化因子回归方程；解决问题、自责进入强迫因子回归方程；父母学历、解决问题、自责进入人际关系敏感回归方程；解决问题、自责进入抑郁因子回归方程；学费来源、自责进入焦虑因子回归方程；自责、退避进入敌对因子回归方程；自责进入恐怖因子回归方程；自责进入偏执因子回归方程；解决问题、自责、幻想进入精神病性回归方程；解决问题、自责进入其他因子回归方程。3.护理硕士生社会支持现状及影响因素3.1社会支持总分24-56,平均(40.18±6.08)；客观支持3～17,平均(9.44±2.94)；主观支持13-32,平均(22.32±3.66)；支持利用度5～12,平均(8.43±1.62)。与医学硕士和本科护生相比,护理硕士生的社会支持总分及社会支持的3个维度评分较高,与非医学类硕士相比,护理硕士生的客观支持评分较高,差异有统计学意义(P<0.05)；社会支持在不同年龄组、工作经验、年级、来源地、生源、独生子女、婚姻状况,学费来源,父母学历等方而差异均有统计学意义。3.2护理硕士生社会支持多元线性逐步回归显示：进入社会支持总分回归方程的有：来源地、婚姻状况、学费来源、父母学历,可预测社会支持总分12.90%的变异量；进入客观支持回归方程的有：学费来源、父母学历、工作经验,可预测客观支持7.70%变异量；进入主观支持回归方程的有：独生子女、婚姻状况、学费来源,可解释主观支持13.20%的变异量；进入支持利用度回归方程的有：学费来源,可预测支持利用度2.20%的变异量。4.护理硕士生的应对方式现状及影响因素4.1护理硕士生应对方式各维度的评分分别为解决问题(0.87±0.12)；自责(0.42±0.35)；求助(0.72±0.20)；幻想(0.56±0.28)；退避(0.50±0.29)；合理化(0.52±0.26)。解决问题、求助2个维度评分明显高于医学硕士,应对方式问卷的其他4个维度评分明显低于医学硕士；自责、求助2维度评分低于非医学类硕士,幻想维度评分高于非医学类硕士；解决问题、求助、合理化3个维度评分明显高于本科护生；应对方式在有无工作经验、父母学历2方面差异有统计学意义,其他差异无统计学意义。4.2工作经验进入自责和幻想的回归方程,分别预测3.60%和2.20%的变异量；父母学历进入求助的回归方程,可预测其4.20%的变异量。5.社会支持各因子、应对方式各因子对心理健康的路径分析应对方式直接对心理健康有影响作用,社会支持通过自责和解决问题间接对心理健康产生影响。结论1.护理硕士生的心理健康状况总体上比医学硕士、本科护生、全国青年常模、全国大学生常模好,但与非医学类硕士相比还存在一定的心理问题。护理硕士生心理健康中的强迫症状、抑郁、人际关系敏感和焦虑4个因子的症状检出率较其他因子高。有6.23%的护理硕士生存在中度以上的心理问题。2.学费来源、自责是护理硕士生心理健康的危险因素,年龄组、解决问题是其保护因素。3.护理硕士生社会支持系统整体上优于医学硕士、非医学类硕士和本科护生。护理硕士生的应对方式比医学硕士、非医学类硕士和本科护生成熟。4.应对方式直接对心理健康产生影响,社会支持间接对其产生影响。更多还原

【Abstract】 ObjectiveTo investigate the mental health distribution characteristics of Nursing postgraduates and analyze its influencing factors, especially the influence of coping style and social support, in order to provide a scientific basis for the mental health education of Nursing postgraduates.MethodsWith the convenience sampling method,273nursing postgraduates from12universities of China were surveyed. And the mental health status of those Nursing postgraduates was compared to that of207Medical postgraduate students from9universities, that of204non-medical postgraduate students from6universities and that of449undergraduate nursing students of He Nan Province.The survey tools including symptom checklist90(SCL-90), the Social Support Rating Scale(SSRS), Coping Style Questionnaire and the general questionnaire. Data were analyzed by SPSS17.0,statistical methods including descriptive analysis,single-sample t test, two independent samples t-test,rank sum test, ANOVA analysis, Spearman correlation analysis, binary logistic regression,Multiple linear stepwise regression analysis. Results1. Mental health status of Nursing postgraduates1.1288questionnaires were distributed273were valid questionnaires, and the effective rate was94.79%.The total score of SCL-90of nursing postgraduates was93-275with an average of(122.85±35.86), median of112while the average total score of it was(1.00～3.06)with an average of(1.37±0.40)and a median of1.24. A total of more than160for mental health were positive, the positive rate being12.45%; any factor score≥3detection rate was6.23%; any factor≥2was positive, the positive rate of each factor from high to low were as following:Obsessive-compulsive18.68%, Depression14.65%, Interpersonal sensitivity12.45%, Anxiety12.45%, Hostility11.36%, Other9.16%, Paranoia6.96%, Terror6.59%, Psychotic6.59%, Somatization5.86%.1.2The SCL-90score of nursing postgraduate students show that each factor of those Nursing postgraduate students was lower than that of the national youth norm and that of undergraduate nursing students; Anxiety factor score was of no significant difference;the remaining factor scores were lower than those of the Youth norm; Paranoid factor score was higher than that of Medical postgraduates; the SCL-90total score and the other nine factor scores were lower than those of Medical postgraduates; Somatization symptoms factor score was lower than that of non-medical postgraduates,Depression, Anxiety, Hostility, Psychosis factor scors were higher than those of the master of the non-medical postgraduates, and other factors scores were not statistically significant.1.3Different age groups, work experience, marital status, sources of tuition, educational level of parents of Nursing postgraduate students, statistically significant to the mental health status of Nursing postgraduates; Among Master of nursing, the only child, origin and grade,were not statistically significant.2. Influencing factor analysis of mental health of nursing postgraduates2.1Between social support and the SCL-90total score, Somatization, Interpersonal sensitivity, Depression were negative correlation (P<0.05); between the objective support and Somatization, Subjective support and Depression, the Utilization support and Interpersonal ensitivity, Depression were also negative correlation (P<0.05); the remaining correlations were not statistically significant (P>0.05); Nursing postgraduate students’ mental health was negatively correlated with Problem-solving, positively correlated with Self-blame, Fantasy, Retreat, Rationalization (P<0.05), the remaining correlations were not statistically significant (P>0.05).2.2Nursing postgraduates’ mental health factors, logistic regression analysis: age group, tuition sources, Problem-solving, Self-blame those four factors enter the regression equation of SCL-90total score;Problem-solving, Self-blame enter the Somatization factor regression equation; Problem-solving, Self-blame enter the forcing factors regression equation; educational level of parents, Problem-solving, Self-blame enter the Interpersonal sensitivity regression equation; Problem-solving, Self-blame enter the Depression factor regression equation; Tuition source, Self-blame enter the Anxiety factor regression equation; Self-blame, Retreat enter the Hostile factors regression equation; Self-blame enter the Terror factor regression equation; Self-blame enter the Paranoia factor regression equation; Problem-solving, Self-blame, Fantasy enter the psychotic regression equation; Problem-solving,Self-blame enter the Other factor regression equation.3. Influencing factor analysis of social support status of Nursing postgraduates.3.1Social support score from24to56, average (40.18±6.08); Objective support3～17, average (9.44±2.94); Subjective support13～32, average (22.32±3.66); Utilization support5～12, average(8.43±1.62). Compared with those of Medical postgraduate and undergraduate nursing students, three dimensions of Nursing postgraduates’social support score score were higher;compare with those of non-medical postgraduate,Nursing postgraduate students’ Objective support score was higher, and the difference was statistically significant (P<0.05); The differences in age groups,work experience, grade, origin, source, only children, marital status, tuition source, parental education level were statistically significant.3.2Nursing postgraduate students social support multiple linear stepwise regression revealed:origin, marital status, educational level of parents, tuition source enter the total score of social support regression equations, can predict12.90%of the variance; tuition source, parents’ educational level, work experience enter the Objective support regression equations,can predict7.70%of the variance; only children, marital status, tuition source enter the Subjective support regression equation, can predict13.20%of the variance; tuition source enter the Utilization support regression equations,can predict2.20%of the variance.4. Coping styles of nursing postgradudtes Status and influencing factors4.1Nursing postgradudtes’coping styles each dimension scores were Problem solving (0.87±0.12); Self-blame (0.42±0.35); Help (0.72±0.20); Fantasy (0.56±0.28); Retreat (0.50±0.29); Rationalization (0.52±0.26). Problem solving, Help significantly higher than those of medical postgraduate;other four dimension scores of Nursing postgraduates were significantly lower than those of Medical postgraduates, Self-blame and Help scores were lower than those of non-medical postgraduates; Fantasy dimension score was higher than those of non-medical postgraduate; Problem-solving, Help, Rationalization scores were significantly higher than those of undergraduate nursing students; coping styles in work experience, educational level of parents were of significant differences, other differences were not statistically significant.4.2Working experience entered Self-blame’s and Fantasy’s regression equation, respectivelypredict3.60%and2.20%of the variance; parent’s education level entered the Help regression equation, can predict4.20%of the variance.5. Social support factors, coping style factor analysis of the path of mental healthCoping style has direct effect on mental health; social support through self-blame and problem-solving has indirect influence on mental health.Conclusions1.Overall mental health status of the Nursing postgraduate students better than those of Medical postgraduate, undergraduate nursing students, the National Youth norm and the National college students norm, but compared with the non-medical postgraduate there are some certain psychological problems.Compared to other factors, the Nursing postgraduate students’mental health the Obsessive-symptoms, Depressive symptoms, Interpersonal sensitivity and the Anxiety detection rate were higher. There are still6.23%of the Nursing postgraduates survival in moderate psychological problems. 2. Tuition sources, Self-blame are the risk factors; Age,Problem-solving is the protective factor.3. Overall social support system of Nursing postgraduate students are better than those of the Medical postgraduates, non-medical postgraduates and undergraduate nursing students. Coping styles of Nursing postgraduate students more mature than those of Medical postgraduates, non-medical postgraduates and undergraduate nursing students.4. Coping style has direct effect on mental health; social support has indirect influence on mental health.更多还原