目的:调查患者冷漠之间的关系,认知障碍,抑郁症,焦虑,肌萎缩侧索硬化症(ALS)的照顾者负担。
方法:采用横断面研究设计。
方法:本研究在武汉市某三甲医院进行,湖北,中国。
方法:共纳入109例ALS患者及其照顾者。
方法:使用爱丁堡认知和行为筛查对ALS患者进行筛查,贝克抑郁量表-II,广义焦虑症-7和冷漠量表评估他们的认知,抑郁症,焦虑和冷漠,分别。主要护理人员完成了Zarit负担访谈。冷漠之间的联系,认知障碍,抑郁症,使用逻辑回归分析焦虑和照顾者负担。采用中介模型研究患者冷漠对抑郁/焦虑与照顾者负担关系的中介作用。
结果:高照顾者负担组患者的抑郁水平明显升高,与低照顾者负担组相比,焦虑和冷漠(p<0.05)。护理者负担与病程之间呈正相关(rs=0.198,p<0.05),抑郁(rs=0.189,p<0.05),焦虑(rs=0.257,p<0.05)和冷漠(rs=0.388,p<0.05)。护理者负担与修订的ALS功能评定量表之间存在负相关(rs=-0.275,p<0.05)。冷漠是较高照顾者负担的独立危险因素(OR1.121,95%CI1.041至1.206,p<0.05)。冷漠完全介导了抑郁与照顾者负担之间的关系(β=0.35,95%CI0.16至0.54,p<0.05),而部分介导了焦虑与照顾者负担之间的关系(β=0.34,95%CI0.16至0.52,p<0.05)。
结论:冷漠,抑郁和焦虑对ALS患者的照顾者负担产生不利影响。冷漠在抑郁与照顾者负担、焦虑与照顾者负担的关系中起中介作用。这些发现强调了在ALS的背景下识别冷漠和开发干预措施的重要性。
OBJECTIVE: To investigate the relationship among patients\'
apathy, cognitive impairment, depression, anxiety, and caregiver burden in amyotrophic lateral sclerosis (ALS).
METHODS: A cross-sectional study design was used.
METHODS: The study was conducted at a tertiary hospital in Wuhan, Hubei, China.
METHODS: A total of 109 patients with ALS and their caregivers were included.
METHODS: Patients with ALS were screened using the Edinburgh Cognitive and Behavioural Screen, Beck Depression Inventory-II, Generalised Anxiety Disorder-7 and
Apathy Scale to assess their cognition, depression, anxiety and
apathy, respectively. The primary caregivers completed the Zarit Burden Interview. The association between apathy, cognitive impairment, depression, anxiety and caregiver burden was analysed using logistic regression. Mediation models were employed to investigate the mediating effect of patients\' apathy on the relationship between depression/anxiety and caregiver burden.
RESULTS: Patients in the high caregiver burden group exhibited significantly higher levels of depression, anxiety and apathy compared with those in the low caregiver burden group (p<0.05). There was a positive association observed between caregiver burden and disease course (rs=0.198, p<0.05), depression (rs=0.189, p<0.05), anxiety (rs=0.257, p<0.05) and apathy (rs=0.388, p<0.05). There was a negative association between caregiver burden and the Revised ALS Functional Rating Scale (rs=-0.275, p<0.05).
Apathy was an independent risk factor for higher caregiver burden (OR 1.121, 95% CI 1.041 to 1.206, p<0.05).
Apathy fully mediated the relationship between depression and caregiver burden (β=0.35, 95% CI 0.16 to 0.54, p<0.05) while partially mediating the relationship between anxiety and caregiver burden (β=0.34, 95% CI 0.16 to 0.52, p<0.05).
CONCLUSIONS: Apathy, depression and anxiety exerted a detrimental impact on caregiver burden in individuals with ALS. Apathy played a mediating role in the relationship between depression and caregiver burden and between anxiety and caregiver burden. These findings underscore the importance of identifying apathy and developing interventions for its management within the context of ALS.