中国健康心理学杂志

目的：探讨青少年抑郁症患者主要照顾者连带病耻感与照顾负担的关系：感知社会支持、希望水平的中介效应。方法：选取某院2022年5月-2024年8月112例青少年抑郁症患者主要照顾者进行问卷调查，通过Zarit照顾者负担量表（ZBI）、连带病耻感量表（ASS）、感知社会支持量表（MSPSS）、中文版Herth希望指数量表（HHI）评估；采用Pearson相关性分析青少年抑郁症患者主要照顾者照顾负担与连带病耻感、感知社会支持、希望水平的相关性，并通过多重线性回归与结构方程检验感知社会支持、希望水平的中介效应。结果：青少年抑郁症患者主要照顾者ZBI量表评分为41.39±9.93分，其中无负担者9例（8.04%），轻度者36例（32.14%），中度者54例（48.21%），重度者13例（11.61%）；不同性别、年龄、受教育程度、家庭人均月收入主要照顾者ZBI量表评分比较差异无统计学意义（P>0.05）；随着患者抑郁程度增加、病程延长，主要照顾者ZBI量表评分升高，随着协同照护人数增加，主要照顾者ZBI量表评分降低（F=28.430,29.560,14.687;P<0.001）；中重度照顾负担水平主要照顾者ASS量表认知、情绪、行为维度及量表总分高于无或轻度照顾负担者（t=3.051,4.990,5.651,5.545;P<0.001）；中重度照顾负担水平主要照顾者MSPSS量表家庭、朋友、其他支持及量表总分低于无或轻度照顾负担者，HHI量表对采取积极行动的态度、与他人保持密切关系、现实与未来的态度量表总分低于无或轻度照顾负担者（t=5.110,4.864,5.068,3.987,7.669,6.164,6.930,6.350;P<0.001）；青少年抑郁症患者主要照顾者照顾负担与连带病耻感呈现正相关，与感知社会支持、希望水平呈现负相关（r=0.508,-0.477,-0.539;P<0.05）；青少年抑郁症患者主要照顾者连带病耻感与感知社会支持、希望水平呈现负相关（r=-0.442,-0.438;P<0.05）；青少年抑郁症患者主要照顾者感知社会支持与希望水平呈现正相关（r=0.485,P<0.05）；回归方程加入感知社会支持/希望水平变量后，连带病耻感对照顾负担的回归系数均显著，在青少年抑郁症患者主要照顾者连带病耻感影响照顾负担间，感知社会支持、希望水平分别发挥部分中介作用，中介效应分别占总效应的21.49%（总效应量：0.549：中介效应量：0.118）、26.23%（总效应量：0.549：中介效应量：0.144）。结论：青少年抑郁症患者主要照顾者感知社会支持、希望水平在连带病耻感与照顾负担间起部分中介作用，临床可通过提升照顾者社会支持与希望水平，进而减轻照顾负担。

Objective:To explore the relationship between stigma of illness and caregiving burden among primary caregivers of adolescents with depression,and the mediating effects of perceived social support and hope levels.Methods:A questionnaire survey was conducted among 112 primary caregivers of adolescents with depression from our hospital between May 2022 and August 2024.The Zarit Burden Interview(ZBI),the Affiliate Stigma Scale(ASS),the Multidimensional Scale of Perceived Social Support(MSPSS),and the Chinese version of the Herth Hope Index(HHI)were used for assessment.Pearson correlation analysis was employed to examine the correlation between caregiving burden and affiliate stigma,perceived social support,and hope levels among primary caregivers.Multiple linear regression and structural equation modeling were used to test the mediating effects of perceived social support and hope levels.Results:The ZBI scores for primary caregivers of adolescents with depression were(41.39±9.93),with 9 cases(8.04%)reporting no burden,36 cases(32.14%)reporting mild burden,54 cases(48.21%)reporting moderate burden,and 13 cases(11.61%)reporting severe burden.There were no significant differences in ZBI scores based on gender,age,education level,or family per capita monthly income.As the severity of depression and duration of illness increased,the ZBI scores of primary caregivers rose;conversely,as the number of collaborative caregivers increased,ZBI scores decreased(F=28.430,29.560,14.687;P<0.001).Caregivers with moderate to severe burden had higher scores on the ASS cognitive,emotional,and behavioral dimensions and total scores compared to those with no or mild burden(t=3.051,4.990,5.651,5.545;P<0.001).Caregivers with moderate to severe burden had lower scores on the MSPSS family,friends,other support,and total scores compared to those with no or mild burden,and HHI scores for attitudes toward taking positive action,maintaining close relationships,and attitudes toward reality and the future were also lower(t=5.110,4.864,5.068,3.987,7.669,6.164,6.930,6.350;P<0.001).Caregiving burden among primary caregivers of adolescents with depression was positively correlated with affiliate stigma and negatively correlated with perceived social support and hope levels(r=0.508,-0.477,-0.539;P<0.05).Affiliate stigma was negatively correlated with perceived social support and hope levels(r=-0.442,-0.438;P<0.05).Perceived social support was positively correlated with hope levels(r=0.485,P<0.05).After adding the variables of perceived social support/hope levels to the regression equation,the regression coefficients for affiliate stigma on caregiving burden were significant.Perceived social support and hope levels played partial mediating roles in the relationship between affiliate stigma and caregiving burden,accounting for 21.49%(total effect:0.549;mediating effect:0.118)and 26.23%(total effect:0.549;mediating effect:0.144)of the total effect,respectively.Conclusion:Perceived social support and hope levels among primary caregivers of adolescents with depression partially mediate the relationship between affiliate stigma and caregiving burden.Clinical interventions can enhance caregivers' social support and hope levels,thereby alleviating caregiving burden.