健康与遗传心理学研究室知识库

摘要：背景：失独家庭是指独生子女不幸死亡，母亲已到生育极限年龄（49岁以上），无法再生子女的家庭。目前全国失独家庭超过百万，且每年新增7.6万的失独家庭。失独父母不仅陷入经济、养老等困境，还面临严重的心理问题，包括创伤后应激障碍（Posttraumatic Stress Disorder, PTSD）、抑郁、哀伤等。数目庞大的失独父母做为我国特有的弱势群体，需要给予关注。目的：本研究旨在探讨失独父母PTSD与抑郁症状的潜在类别分布特征，了解人口学变量和社会支持对潜在类别的影响。方法：2016年11月至2017年7月，采用分层整群抽样的方法选取我国五省十市的385名失独者，其平均年龄61.46(SD=7.98)，184（48%）名女性，研究运用创伤后应激障碍检查表第5版（PCL-5）、简版流调中心抑郁量表（CES-D-10）和领悟社会支持量表（PSSS）进行问卷调查。结果：采用潜在类别分析方法（Latent class analysis, LCA）探索了1-5各潜在类别模型，随分类数目增加log likelihood检验、AIC、BIC、aBIC不断减小，3个类别时Entropy值最理想，LMR显著，综合考虑潜在类别模型适配指数最终选择3个潜在类别，将其分别命名为PTSD/抑郁共病组（26.5%）、心理韧性组（36.4%）和PTSD组（37.1%）。进一步的分析发现，失独父母的性别、年龄、失独年限在3个潜在类别的分布差异有统计学意义（χ2=12.01~14.72, p<0.01）；婚姻状况、失独原因和孩子的年龄差异没有统计学意义（χ2=2.98~6.41, p>0.05）；领悟社会支持三个维度，即家庭支持、朋友支持和他人支持得分在三个潜在类别的差异有统计学意义（F=15.24~32.15, p<0.001）。Logistic回归结果显示，女性、≤60岁的失独父母在PTSD/抑郁共病组（OR分别为0.59、0.94）和PTSD组（OR分别为0.53、0.94）中所占的比例大；领悟到的低家庭支持在PTSD/抑郁共病组（OR=0.90）所占的比例大，而朋友支持和他人支持对三个潜在类别的预测作用没有统计学意义（p>0.05）。结论：失独父母的PTSD与抑郁症状存在三种不同的潜在类别，性别、年龄和家庭支持对三个潜在类别有显著影响。应及时关注和有效干预女性、年龄≤60岁的失独者，并鼓励家庭成员之间的相互支持，以改善失独父母的PTSD和抑郁症状。

Abstract： Introduction: There has been emerged a remarkable number of families who lost their only child known as Shidu family, as a result of the one-child policy in China. The Shidu family means that the couple have had only child who has died, the mother has passed her reproductive age (over the age of 49 years) so that the couple have no ability to regenerate another child. These parents are referred to as Shidu parents in China.. At present, there are more than one million Shidu families, and about 76,000 Shidu families occur each year according to the population census statistics. Shidu parents are not only trapped in the economic and old-age predicament, but also face serious psychological problems, including post-traumatic stress disorder(PTSD), depression and grief symptoms. Shidu parents are a unique vulnerable group in Chinese society. Therefor, mental health problems in Shidu parents deserves attention. Aim: In the present study, we aimed to determine whether there are distinct subgroup or classes of PTSD and depression symptoms in Shidu parents, and examine whether social-demographic, loss-related variables and perceived social support associated with classes membership.

Methods:385 Shidu parents was conducted by using stratified cluster sampling method from November 2016 to July 2017 in ten cities in five provinces. The mean age of participants was 61.46(SD=7.98) years, with females being 48.0 % of the sample. Subjects were asked to complete the PTSD Checklist for DSM-5(PCL-5), Center for Epidemiological Studies Depression Scale (CES-D-10) and the Perceived Social Support Scale(PSSS). We conducted latent class analyses to identify different symptom classes. Predictors of these classes were identified using one-way ANOVA, Chi Square tests and multinomial regression analysis.

Results: we explored 1-5 latent class model, the values of the Log-likelihood, AIC, BIC and aBIC decreased with the increase of number of classes. The three class solution had a higher entropy, the value of LMR was significant. Based on fit-indices and interpretability of the outcomes, a three-class solution was selected as the optimal solution, namely a combined PTSD/depression class (26.5%), a Resilient class (36.4%) and a predominantly PTSD class(37.1%). Classes differed in terms of gender, age and time since loss(χ2=12.01~14.72, p<0.01); No significant differences between the classes were found in terms of marital status, loss-related variables and child’s age(χ2=2.98~6.41, p>0.05); Furthermore, classes differed in terms of perceived social support subscales score, namely family support, friend support, and significant others support(F=15.24~32.15, p<0.001). When gender, age, time since loss, and perceived social support subscales score were included in multinomial regression analyses predicting class membership, it was found that gender and aged less than 60 years were both associated with membership of the PTSD/depression class(OR resp. 0.59 and 0.94) and the PTSD class(OR resp. 0.53 and 0.94). Furthermore, family support was the only variable associated with membership of the PTSD/depression class(OR=0.90).

Conclusion: The present study found three distinct classes of Shidu parents based on the presence of PTSD and depression symptoms, and proportions of gender, age and family support scores differed in each latent class. Attention and effective intervention should be given to those Shidu parents who was female, aged less than 60 years, and also encourage family members to give support each other, in order to improve the PTSD and depressive symptoms of the Shidu parents.