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Article(id=1325501723741139544, tenantId=1146029695717560320, journalId=1256213402557890569, issueId=1325501647736156411, articleNumber=null, orderNo=null, doi=10.16835/j.cnki.1000-9817.2025079, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1734451200000, receivedDateStr=2024-12-18, revisedDate=1738684800000, revisedDateStr=2025-02-05, acceptedDate=null, acceptedDateStr=null, onlineDate=1793953837570, onlineDateStr=2026-11-06, pubDate=1742832000000, pubDateStr=2025-03-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793953837570, onlineIssueDateStr=2026-11-06, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793953837570, creator=13701087609, updateTime=1793953837570, updator=13701087609, issue=Issue{id=1325501647736156411, tenantId=1146029695717560320, journalId=1256213402557890569, year='2025', volume='46', issue='3', pageStart='305', pageEnd='456', issueExtLink='null', onlineDate='null', pubDate='1742832000000', pubDateStr='2025-03-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793953819450, creator='13701087609', updateTime=1793953819450, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=382, endPage=385, ext={EN=ArticleExt(id=1325501724202512985, articleId=1325501723741139544, tenantId=1146029695717560320, journalId=1256213402557890569, language=EN, title=Analysis of the relationship between stigma and mental resilience in adolescent patients, columnId=1259565855189418448, journalTitle=Chinese Journal of School Health, columnName=Mental Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the relationship between stigma and mental resilience in adolescent epilepsy patients and associated factors, so as to provide reference for future psychological intervention in adolescent patients with epilepsy.

Methods

A total of 295 adolescent patients with epilepsy from Wuhan Mental Health Center were enrolled as participants from February 2021 to October 2024. The stigma was evaluated by Kilifi Stigma Scale for Epilepsy (KSSE), and psychological resilience was evaluated by Connor-Davidson Resilience Scale (CD-RISC). Associated factors of stigma and psychological resilience in adolescent patients with epilepsy were analyzed by multivariate Logistic regression analysis.

Results

In the adolescent patients with epilepsy, KSSE score was (10.90±4.13) points, with 138 cases (46.78%) at low level, 154 cases (52.20%) at moderate level and 3 cases (1.02%) at high level. CD-RISC score was (50.19±5.97) points, there were 170 cases (57.63%) at low level and 125 cases (42.37%) at high level. Multivariate Logistic regression analysis showed that disease course >3 years (OR=2.22), family history of epilepsy (OR=4.18), monthly family income ≤5 000 yuan (OR=2.05), single parent family (OR=2.46) and middle and high stigma level (OR=1.72) had a higher risk on low level of mental resilience (P < 0.05). The course of disease >3 years (OR=2.20), family history of epilepsy (OR=3.54), general seizure (OR=2.12), monthly family income ≤5 000 yuan (OR=2.70), low level of mental resilience (OR=2.03) of adolescent epilepsy patients showed a high risk on moderate-high level of stigma (P < 0.05).

Conclusions

The stigma level is higher, while psychological resilience is lower in adolescent patients with epilepsy. Clinically, targeted intervention should be implemented based on related factors such as stigma in addescent patients with epilepsy.

, authors=Weiwei YANG, Zhongyang RUI, Biao LI*, Jing CHEN, authorsList=Weiwei YANG, Zhongyang RUI, Biao LI, Jing CHEN, authorCompany=null, correspAuthors=Biao LI, authorNote=null, correspAuthorsNote=null, copyrightStatement=Copyright ©2025 Chinese Journal of School Health. All rights reserved., copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1325501724693246554, articleId=1325501723741139544, tenantId=1146029695717560320, journalId=1256213402557890569, language=CN, title=青少年癫痫患者病耻感与心理弹性的关系及相关因素分析, columnId=1259565858817491410, journalTitle=中国学校卫生, columnName=心理卫生, runingTitle=null, highlight=null, articleAbstract=
目的

探讨青少年癫痫患者病耻感和心理弹性的关系及其相关因素，为开展青少年癫痫患者心理干预提供参考。

方法

选取2021年2月—2024年10月武汉市精神卫生中心接收的295例青少年癫痫患者作为研究对象，采用Kilifi癫痫患者羞耻感中文量表(KSSE)评估患者病耻感，采用心理韧性量表(CD-RISC)评估患者心理弹性。采用多因素Logistic回归分析青少年癫痫患者病耻感和心理弹性的相关因素。

结果

青少年癫痫患者KSSE评分为(10.90±4.13)分，138例(46.78%)低水平，154例(52.20%)中水平，3例(1.02%)高水平；CD-RISC评分为(50.19±5.97)分，170例(57.63%)低水平，125例(42.37%)高水平。多因素Logistic回归分析结果显示，病程＞3年(OR=2.22)、有癫痫家族史(OR=4.18)、家庭月收入≤5 000元(OR=2.05)、单亲家庭(OR=2.46)、中高水平病耻感(OR=1.72)的青少年癫痫患者出现低水平心理弹性风险更高；病程＞3年(OR=2.20)、有癫痫家族史(OR=3.54)、全面性发作(OR=2.12)、家庭月收入≤5 000元(OR=2.70)、低水平心理弹性(OR=2.03)的青少年癫痫患者出现中高水平病耻感风险更高(P值均 < 0.05)。

结论

青少年癫痫患者病耻感水平较高、心理弹性较低，临床可基于青少年癫痫病患者病耻感的相关因素开展针对性心理干预。

, authors=杨蔚蔚, 芮忠洋, 李彪*, 陈静, authorsList=杨蔚蔚, 芮忠洋, 李彪, 陈静, authorCompany=null, correspAuthors=李彪, authorNote=

杨蔚蔚(1986-)，女，安徽蚌埠人，大学本科，主治医师，主要研究方向为临床精神病学和心理学

, correspAuthorsNote=
李彪，E-mail：
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杨蔚蔚(1986-)，女，安徽蚌埠人，大学本科，主治医师，主要研究方向为临床精神病学和心理学

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杨蔚蔚(1986-)，女，安徽蚌埠人，大学本科，主治医师，主要研究方向为临床精神病学和心理学

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Univariate analysis of psychological resilience and stigma in adolescent patients with epilepsy

, figureFileSmall=null, figureFileBig=null, tableContent=
因素选项人数心理弹性病耻感
低水平高水平χ2值P值中高水平低水平χ2值P值
性别男16393(57.06)70(42.94)0.050.8384(51.53)79(48.47)0.420.52
女13277(58.33)55(41.67)73(55.30)59(44.70)
年龄/岁>15~18212114(53.77)98(46.23)4.560.03116(54.72)96(45.28)0.770.38
13~158356(67.47)27(32.53)41(49.40)42(50.60)
文化程度初中及以下10859(54.63)49(45.37)0.630.4354(50.00)54(50.00)0.710.4
高中及以上187111(59.36)76(40.64)103(55.08)84(44.92)
病程/年>310674(69.81)32(30.19)10.06< 0.0169(65.09)37(34.91)9.37< 0.01
≤318996(50.79)93(49.21)88(46.56)101(53.44)
独生子女有17898(55.06)80(44.94)1.220.2797(54.49)81(45.51)0.290.59
无11772(61.54)45(38.46)60(51.28)57(48.72)
户籍所在地农村15789(56.69)68(43.31)0.120.7395(60.51)62(39.49)7.16< 0.01
城镇13881(58.70)57(41.30)62(44.93)76(55.07)
癫痫家族史有1815(83.33)3(16.67)5.190.0214(77.78)4(22.22)4.640.03
无277155(55.96)122(44.04)143(51.62)134(48.38)
发作类型全面发作6945(65.22)24(34.78)2.130.1547(68.12)22(31.88)8.03< 0.01
局灶性/混合性发作226125(55.31)101(44.69)110(48.67)116(51.33)
家庭月收入/元>5 00019199(51.83)92(48.17)7.450.0187(45.55)104(54.45)12.80< 0.01
≤5 00010471(68.27)33(31.73)70(67.31)34(32.69)
家庭结构正常家庭242131(54.13)111(45.87)6.740.01125(51.65)117(48.35)1.330.25
单亲家庭5339(73.58)14(26.42)32(60.38)21(39.62)
病耻感中高水平157102(64.97)55(35.03)7.410.01
低水平13868(49.28)70(50.72)
心理弹性低水平170102(60.00)68(40.00)7.41< 0.01
高水平12555(44.00)70(56.00)
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青少年癫痫患者心理弹性和病耻感的单因素分析

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因素选项人数心理弹性病耻感
低水平高水平χ2值P值中高水平低水平χ2值P值
性别男16393(57.06)70(42.94)0.050.8384(51.53)79(48.47)0.420.52
女13277(58.33)55(41.67)73(55.30)59(44.70)
年龄/岁>15~18212114(53.77)98(46.23)4.560.03116(54.72)96(45.28)0.770.38
13~158356(67.47)27(32.53)41(49.40)42(50.60)
文化程度初中及以下10859(54.63)49(45.37)0.630.4354(50.00)54(50.00)0.710.4
高中及以上187111(59.36)76(40.64)103(55.08)84(44.92)
病程/年>310674(69.81)32(30.19)10.06< 0.0169(65.09)37(34.91)9.37< 0.01
≤318996(50.79)93(49.21)88(46.56)101(53.44)
独生子女有17898(55.06)80(44.94)1.220.2797(54.49)81(45.51)0.290.59
无11772(61.54)45(38.46)60(51.28)57(48.72)
户籍所在地农村15789(56.69)68(43.31)0.120.7395(60.51)62(39.49)7.16< 0.01
城镇13881(58.70)57(41.30)62(44.93)76(55.07)
癫痫家族史有1815(83.33)3(16.67)5.190.0214(77.78)4(22.22)4.640.03
无277155(55.96)122(44.04)143(51.62)134(48.38)
发作类型全面发作6945(65.22)24(34.78)2.130.1547(68.12)22(31.88)8.03< 0.01
局灶性/混合性发作226125(55.31)101(44.69)110(48.67)116(51.33)
家庭月收入/元>5 00019199(51.83)92(48.17)7.450.0187(45.55)104(54.45)12.80< 0.01
≤5 00010471(68.27)33(31.73)70(67.31)34(32.69)
家庭结构正常家庭242131(54.13)111(45.87)6.740.01125(51.65)117(48.35)1.330.25
单亲家庭5339(73.58)14(26.42)32(60.38)21(39.62)
病耻感中高水平157102(64.97)55(35.03)7.410.01
低水平13868(49.28)70(50.72)
心理弹性低水平170102(60.00)68(40.00)7.41< 0.01
高水平12555(44.00)70(56.00)
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Multivariate Logistic regression analysis of related factors of psychological resilience in adolescent patients with epilepsy(n=295)

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自变量β值标准误Wald χ2值OR值(95%CI)P值
年龄13~15岁0.030.280.011.03(0.60~1.78)0.90
病程＞3年0.800.279.062.22(1.32~3.74)< 0.01
有癫痫家族史1.430.674.554.18(1.12~15.56)0.03
家庭月收入≤5 000元0.720.277.052.05(1.21~3.46)0.01
单亲家庭0.900.356.572.46(1.24~4.88)0.01
中高水平病耻感0.540.207.311.72(1.16~2.55)< 0.01
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青少年癫痫患者心理弹性相关因素的多因素Logistic回归分析(n=295)

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自变量β值标准误Wald χ2值OR值(95%CI)P值
年龄13~15岁0.030.280.011.03(0.60~1.78)0.90
病程＞3年0.800.279.062.22(1.32~3.74)< 0.01
有癫痫家族史1.430.674.554.18(1.12~15.56)0.03
家庭月收入≤5 000元0.720.277.052.05(1.21~3.46)0.01
单亲家庭0.900.356.572.46(1.24~4.88)0.01
中高水平病耻感0.540.207.311.72(1.16~2.55)< 0.01
), ArticleFig(id=1325501735820735107, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325501723741139544, language=EN, label=Tab.3, caption=

Multivariate Logistic regression analysis of related factors of stigma in adolescent patients with epilepsy(n=295)

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自变量β值标准误Wald χ2值OR值(95%CI)P值
病程＞3年0.790.278.472.20(1.29~3.74)< 0.01
有癫痫家族史1.270.624.183.54(1.05~11.92)0.04
全面性发作0.750.315.882.12(1.15~3.88)0.02
家庭月收入≤5 000元0.990.2713.492.70(1.59~4.59)< 0.01
低水平心理弹性0.710.267.622.03(1.23~3.36)< 0.01
), ArticleFig(id=1325501735896232580, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325501723741139544, language=CN, label=表3, caption=

青少年癫痫患者病耻感相关因素的多因素Logistic回归分析(n=295)

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自变量β值标准误Wald χ2值OR值(95%CI)P值
病程＞3年0.790.278.472.20(1.29~3.74)< 0.01
有癫痫家族史1.270.624.183.54(1.05~11.92)0.04
全面性发作0.750.315.882.12(1.15~3.88)0.02
家庭月收入≤5 000元0.990.2713.492.70(1.59~4.59)< 0.01
低水平心理弹性0.710.267.622.03(1.23~3.36)< 0.01
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青少年癫痫患者病耻感与心理弹性的关系及相关因素分析
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杨蔚蔚 , 芮忠洋 , 李彪 * , 陈静
中国学校卫生 | 心理卫生 2025,46(3): 382-385
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中国学校卫生 |心理卫生 2025 , 46 (3) : 382 -385
青少年癫痫患者病耻感与心理弹性的关系及相关因素分析
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杨蔚蔚, 芮忠洋, 李彪* , 陈静
作者信息
  • 武汉市精神卫生中心精神科，湖北 430012
通讯作者:
李彪，E-mail：
作者简介:

杨蔚蔚(1986-)，女，安徽蚌埠人，大学本科，主治医师，主要研究方向为临床精神病学和心理学

Analysis of the relationship between stigma and mental resilience in adolescent patients
Weiwei YANG, Zhongyang RUI, Biao LI* , Jing CHEN
Affiliations
  • Department of Psychiatry, Wuhan Mental Health Center, Wuhan (430012), Hubei Province, China
出版时间: 2025-03-25 doi: 10.16835/j.cnki.1000-9817.2025079
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摘要
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目的

探讨青少年癫痫患者病耻感和心理弹性的关系及其相关因素，为开展青少年癫痫患者心理干预提供参考。

方法

选取2021年2月—2024年10月武汉市精神卫生中心接收的295例青少年癫痫患者作为研究对象，采用Kilifi癫痫患者羞耻感中文量表(KSSE)评估患者病耻感，采用心理韧性量表(CD-RISC)评估患者心理弹性。采用多因素Logistic回归分析青少年癫痫患者病耻感和心理弹性的相关因素。

结果

青少年癫痫患者KSSE评分为(10.90±4.13)分，138例(46.78%)低水平，154例(52.20%)中水平，3例(1.02%)高水平；CD-RISC评分为(50.19±5.97)分，170例(57.63%)低水平，125例(42.37%)高水平。多因素Logistic回归分析结果显示，病程＞3年(OR=2.22)、有癫痫家族史(OR=4.18)、家庭月收入≤5 000元(OR=2.05)、单亲家庭(OR=2.46)、中高水平病耻感(OR=1.72)的青少年癫痫患者出现低水平心理弹性风险更高；病程＞3年(OR=2.20)、有癫痫家族史(OR=3.54)、全面性发作(OR=2.12)、家庭月收入≤5 000元(OR=2.70)、低水平心理弹性(OR=2.03)的青少年癫痫患者出现中高水平病耻感风险更高(P值均 < 0.05)。

结论

青少年癫痫患者病耻感水平较高、心理弹性较低，临床可基于青少年癫痫病患者病耻感的相关因素开展针对性心理干预。

癫痫  /  羞耻  /  精神卫生  /  弹性  /  回归分析  /  青少年
Objective

To explore the relationship between stigma and mental resilience in adolescent epilepsy patients and associated factors, so as to provide reference for future psychological intervention in adolescent patients with epilepsy.

Methods

A total of 295 adolescent patients with epilepsy from Wuhan Mental Health Center were enrolled as participants from February 2021 to October 2024. The stigma was evaluated by Kilifi Stigma Scale for Epilepsy (KSSE), and psychological resilience was evaluated by Connor-Davidson Resilience Scale (CD-RISC). Associated factors of stigma and psychological resilience in adolescent patients with epilepsy were analyzed by multivariate Logistic regression analysis.

Results

In the adolescent patients with epilepsy, KSSE score was (10.90±4.13) points, with 138 cases (46.78%) at low level, 154 cases (52.20%) at moderate level and 3 cases (1.02%) at high level. CD-RISC score was (50.19±5.97) points, there were 170 cases (57.63%) at low level and 125 cases (42.37%) at high level. Multivariate Logistic regression analysis showed that disease course >3 years (OR=2.22), family history of epilepsy (OR=4.18), monthly family income ≤5 000 yuan (OR=2.05), single parent family (OR=2.46) and middle and high stigma level (OR=1.72) had a higher risk on low level of mental resilience (P < 0.05). The course of disease >3 years (OR=2.20), family history of epilepsy (OR=3.54), general seizure (OR=2.12), monthly family income ≤5 000 yuan (OR=2.70), low level of mental resilience (OR=2.03) of adolescent epilepsy patients showed a high risk on moderate-high level of stigma (P < 0.05).

Conclusions

The stigma level is higher, while psychological resilience is lower in adolescent patients with epilepsy. Clinically, targeted intervention should be implemented based on related factors such as stigma in addescent patients with epilepsy.

Epilepsy  /  Shame  /  Mental health  /  Elasticity  /  Regression analysis  /  Adolescent
杨蔚蔚, 芮忠洋, 李彪, 陈静. 青少年癫痫患者病耻感与心理弹性的关系及相关因素分析. 中国学校卫生, 2025 , 46 (3) : 382 -385 . DOI: 10.16835/j.cnki.1000-9817.2025079
Weiwei YANG, Zhongyang RUI, Biao LI, Jing CHEN. Analysis of the relationship between stigma and mental resilience in adolescent patients[J]. Chinese Journal of School Health, 2025 , 46 (3) : 382 -385 . DOI: 10.16835/j.cnki.1000-9817.2025079
正文
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癫痫是一种以反复发作为特征的慢性神经疾病，由大脑中异常的电活动导致[1]。据统计，我国约有近1 000万癫痫患者，且每年新增约(40~60)万患者[1]。癫痫临床主要表现为视听觉异常、抽搐、肌阵挛、意识障碍等，不仅可导致大脑损伤，还可能对患者的心理和社会功能产生不良影响[2]。青少年期是癫痫发病的高峰年龄段，且其整体发病率和患病率呈上升趋势[2]。青少年癫痫患者由于正处于身心发展的敏感时期，更容易给身心健康带来不良影响[3-4]。病耻感是癫痫患者常见的不良心理，相关研究发现，89%的癫痫患者和76%的患者家属有羞耻感，其不仅会导致患者产生负面情绪，还可能对预后康复和生活质量造成不利影响[5-6]。最近一项研究发现，高水平的心理弹性可提高癫痫患者的抗压能力，其在癫痫患者病耻感和生活质量之间存在中介效应[7]。本研究旨在通过分析青少年癫痫患者病耻感和心理弹性的关系及其相关因素，为指导该类患儿的心理干预提供参考。
1　对象与方法
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1.1　对象
选取2021年2月—2024年10月武汉市精神卫生中心接收的295例青少年癫痫患者作为研究对象；其中男生163例，女生132例；年龄13~18岁，平均年龄(16.03±1.11)岁。纳入标准：符合2015版原发性癫痫诊断标准[8]；活动性癫痫，且病程＞3个月；年龄13~18岁；临床资料完整。排除标准：合并脑炎、脑肿瘤等颅脑疾病；既往脑外伤、脑外科手术史；严重心、肝、肺部疾病；听力障碍或语言障碍者；意识障碍或精神疾病者。本研究经过武汉市精神卫生中心伦理委员会审批(批准号：YYLL202102C101)，青少年患者及家属知情并签署同意书。
1.2　调查方法
1.2.1　一般情况
通过调查问卷收集青少年癫痫患者性别、年龄、文化程度、病程、独生子女、户籍所在地、癫痫家族史、发作类型、家庭月收入、家庭结构等资料。
1.2.2　病耻感评价
采用Kilifi癫痫患者羞耻感中文量表(Kilifi Stigma Scale for Epilepsy, KSSE)[9]评估，共计15个条目，采用3级评分，分为一点也不(0分)、有时(1分)、总是(2分)；总分范围为0~30分，分数越高病耻感越强，其中0~10，11~20，21~30分分别为低、中、高水平病耻感。该量表Cronbach α系数为0.93。
1.2.3　心理弹性评价
采用心理韧性量表(Connor-Davidson Resilience Scale, CD-RISC)[10]评估，该量表包括乐观(4条目)、自强(8条目)和坚韧(13条目)3个维度，总计25个条目，采用5级评分，分为从来不(0分)、很少(1分)、有时(2分)、经常(3分)、一直如此(4分)；总分范围为0~100分，总分越高受试者心理弹性越高，其中≤51分为低水平心理弹性，>51分为高水平心理弹性。该量表Cronbach α系数为0.90。
1.3　质量控制
由统一培训的专业人员进行审核、登记调查问卷，对漏填、错填和含糊不清的数据当场返回重填，质控员核查问卷的准确性、完整性，确认无误后回收问卷。使用内部特征进行资料审核, 对问卷所收集数据的误差进行评估和修正。
1.4　统计学分析
采用SPSS 24.0软件分析数据，计数资料以n(%)表示，组间比较采用χ2检验；采用Shapiro-Wilk检验数据的正态性，符合正态性的计量资料用(x ± s)表示；采用多因素Logistic回归分析青少年癫痫患者病耻感和心理弹性的相关因素，采用Pearson等级相关检验青少年癫痫患者病耻感和心理弹性的相关性。检验水准α=0.05。
2　结果
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2.1　青少年癫痫患者病耻感和心理弹性现状
295例青少年癫痫患者KSSE评分为(10.90±4.13)分，其中138例(46.78%)为低水平，154例(52.20%)为中水平，3例(1.02%)为高水平；CD-RISC评分为(50.19±5.97)分，170例(57.63%)为低水平，125例(42.37%)为高水平。
2.2　青少年癫痫患者心理弹性与病耻感的单因素分析
结果显示，年龄13~15岁、病程>3年、有癫痫家族史、家庭月收入≤5 000元、单亲家庭、中高水平病耻感的青少年癫痫患者低水平心理弹性占比高于年龄>15~18岁、病程≤3年、无癫痫家族史、家庭月收入>5 000元(P值均 < 0.05)。见表1。
单因素分析显示，病程>3年、农村户籍、有癫痫家族史、全面性发作、家庭月收入≤5 000元、低水平心理弹性的青少年癫痫患者中高水平病耻感占比高于病程≤3年、城镇户籍、无癫痫家族史、局灶性/混合性发作、家庭月收入>5 000元(P值均 < 0.05)。见表1。
2.3　青少年癫痫患者心理弹性相关因素的多因素Logistic回归分析
以心理弹性为因变量(高水平=0，低水平=1)，单因素分析有统计学意义的变量为自变量(年龄：>15~18岁=0，13~15岁=1；病程：≤3年=0，>3年=1；癫痫家族史：无=0，有=1；家庭月收入：＞5 000元=0，≤5 000元=1；家庭结构：正常家庭=0，单亲家庭=1)纳入Logistic回归方程，结果显示，病程＞3年、有癫痫家族史、家庭月收入≤5 000元、单亲家庭、中高水平病耻感的青少年癫痫患者出现低水平心理弹性风险更高(P值均 < 0.05)。见表2。
2.4　青少年癫痫患者病耻感相关因素的多因素Logistic回归分析
以病耻感为因变量(低水平=0，中高水平=1)，以单因素分析中有统计学意义的变量为自变量(病程：＞3年=1，≤3年=0；户籍所在地：农村=1，城镇=0；癫痫家族史：有=1，无=0；发作类型：全面性发作=1，局灶性/混合性发作=0；家庭月收入：≤5 000元=1，＞5 000元=0；心理弹性：低水平=1，高水平=0)纳入Logistic回归方程，结果显示，病程＞3年、有癫痫家族史、全面性发作、家庭月收入≤5 000元、低水平心理弹性的青少年癫痫患者出现中高水平病耻感风险更高(P值均 < 0.05)。见表3。
2.5　青少年癫痫患者病耻感和心理弹性的相关性
Pearson等级相关性分析显示，青少年癫痫患者KSSE评分和CD-RISC评分呈负相关(r=-0.42，P < 0.05)。
3　讨论
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受传统观念、认知、家庭、社会歧视等因素的影响，青少年癫痫患者病耻感较高，可导致患者回避与社会交往并产生负面情绪，严重影响健康恢复[11]。心理弹性是保证癫痫患者在面对疾病时保持正确认知，采取合适生活方式的重要要素[12]。心理弹性指个体对压力、创伤等的抵抗能力，高水平心理弹性可提高患者的应激能力，使患者积极配合临床干预，改善预后[13]。本研究中，青少年癫痫患者CD-RISC评分为(50.19±5.97)分，其中57.63%为低水平，与钱国红等[13]研究结果一致。青少年由于正处于身体、心理发育成熟的关键阶段，对外界刺激高度敏感，在罹患重大疾病时更容易发生心理弹性水平降低[14-15]。二元Logistic回归分析结果显示，病程＞3年、有癫痫家族史、家庭月收入≤5 000元、单亲家庭、中高水平病耻感均为青少年癫痫患者低水平心理弹性的风险因素。患者病程越长及有癫痫家族史，其治愈信心越低，对疾病进展的恐惧心理越严重[16]。家庭月收入在一定程度上可反映家庭对风险应对的能力，已经在抑郁症患者中发现，高收入家庭在面对高昂的治疗费用时，能够减轻应激源带来的消极影响，进而心理弹性相对较高[17]。单亲家庭由于缺乏父母其中一方的情感支持，更容易因疾病感到自卑。
本研究295例青少年癫痫患者中，46.78%为低水平病耻感，52.20%为中水平病耻感，1.02%高水平病耻感，这一比例高于Fite等[18]研究中的中高水平病耻感(44.65%)。究其原因，可能与患者年龄、地域、国家不同有关。二元Logistic回归分析显示，病程＞3年、有癫痫家族史、全面性发作、家庭月收入≤5 000元的青少年癫痫患者更易出现病耻感。其中病程是影响青少年癫痫患者病耻感的常见因素，主要是因为病程越长，其对患者脑部健康与发育造成的危害也越严重，进而对患者日常生活影响也越大，患者更容易产生病耻感[19]。存在癫痫家族史的患者由于长期受到社会偏见和歧视，更容易产生病耻感。有数据显示，87%的人反对自己的子女与癫痫患者结婚，57%反对自己的子女与癫痫患者一起上课或玩耍[20]。全面性发作是癫痫发作中最严重的一种，这类患者由于病情更严重、共情能力受损等，患者情绪更多变，性格更内向[21]。在成人癫痫患者中发现，经济能力越好，患者的病耻感也相应越低[22]。其主要原因为癫痫需要长期接受药物治疗，对于经济能力差的家庭，患者需要承受的心理压力更大，更容易产生内疚感，导致病耻感水平较高；经济条件较好的家庭往往能接受有效的治疗，对疾病知识了解更多、更全面，病耻感相对较低。
Pearson等级相关性分析结果显示，青少年癫痫患者KSSE评分和CD-RISC评分呈负相关；二元Logistic回归分析显示，低水平心理弹性为青少年癫痫患者中高水平病耻感的风险因素，提示青少年癫痫患者病耻感与心理弹性呈负相关，临床可基于心理弹性评估患者病耻感。病耻感会对青少年癫痫患者心理状况造成影响，使患者无法正确面对疾病，并过分在意他人的看法，进而导致患者治疗的积极性下降，严重者可能会使患者出现逃避社交等现象[23]。而心理弹性较高的人群在面对疾病、困难时能迅速调动内外资源，积极主动寻求帮助，并适应环境，该类人群心理压力较小，病耻感水平也相对较低。
研究的局限性在于本研究样本量较少，年龄、家庭月收入等因素，对青少年癫痫患者病耻感和心理弹性的影响仍需进一步研究验证。
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  • 湖北省卫生健康委员会科研项目(WJ2023M141)
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参考文献 引证文献
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2025年第46卷第3期
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doi: 10.16835/j.cnki.1000-9817.2025079
  • 接收时间：2024-12-18
  • 首发时间：2026-11-06
  • 出版时间：2025-03-25
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  • 收稿日期：2024-12-18
  • 修回日期：2025-02-05
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    武汉市精神卫生中心精神科，湖北 430012

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光柄菇属 Pluteus 5 2.39
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