魏燕 潘文佳 朱莉

【摘要】 目的：探討自尊在肾病综合征（nephrotic syndrome，NS）患儿自我效能与应对策略之间的中介效应，旨在为提高患儿自我效能与应对能力提供可靠的参考依据。方法：采用横截面调查法，利用状态自尊量表（SSES）、一般自我效能量表（GSES）以及Jackson编制的应对策略问卷分别对118例NS患儿的自尊、自我效能以及应对策略评分进行评价。并分析自尊、自我效能以及应对策略之间的关系，检验自尊在患儿自我效能与应对策略之间的中介效应。结果：患儿自尊（59.98±11.36）分、自我效能（89.36±11.23）分与应对策略（82.36±11.56）分。患儿自尊、自我效能呈正相关（rs=0.687，P<0.01），自我效能与应对策略呈正相关（rs=0.779，P<0.01），自尊与应对策略呈正相关（rs=0.568，P<0.01）。中介效应结果显示，自尊在患儿自我效能与应对策略之间发挥着完全的中介效应，其中中介效应0.224，直接效应为0.589、总效应为0.813，中介效应与总效应比为0.275，直接效应与总效应之比为0.725，即自我效能对应对策略的效应中72.5%为直接效应，27.5%是通过自尊的中介效应作用的。经Bootstrap检验结果显示，自尊在NS患儿希望感自我效能与应对策略间的中介效应95%置信区间为（0.636，0.819）;结论：自尊在NS患儿自我效能以及应对策略之间具有显著的中介效应，可作为自我效能与应对策略之间的预测因素，因此应加强患儿心理干预，提高其自尊水平，改善患儿的自我效能与应对能力。

【关键词】 自尊 肾病综合征 自我效能 应对策略 中介效应

[Abstract] Objective： To investigate the mediating effect of self-esteem on the self-efficacy and coping strategies of children with nephrotic syndrome （NS）， aiming to provide a reliable reference for improving the self-efficacy and coping ability of children. Method： The self-esteem， self-efficacy and coping strategy scores of 118 children with NS were evaluated by cross-sectional survey with the State Self-esteem Scale （SSES）， the General Self-efficacy Scale （GSES） and the coping strategy questionnaire prepared by Jackson. The relationship among self-esteem， self-efficacy and coping strategies was analyzed to test the mediating effect of self-esteem on childrens self-efficacy and coping strategies. Result： The childrens self-esteem was （59.98±11.36） scores， self-efficacy was （89.36±11.23） scores and coping strategy was （82.36±11.56） scores. Childrens self-esteem and self-efficacy were negatively correlated （rs=0.687， P<0.01）， there was a positive correlation between self-efficacy and coping strategies （rs=0.779， P<0.01）， self-esteem was positively correlated with coping strategies （rs=0.568， P<0.01）. Intermediary effect， according to the results of self-esteem in children with self-efficacy and coping strategies played a complete mediation effect between the intermediary effect was 0.224， the direct effect was 0.589， the total effect was 0.813， intermediary effect to the total effect ratio was 0.275， the ratio of the direct effect to the total effect was 0.725， 72.5% self-efficacy effect of coping strategies as the direct effect， 27.5% were through the intermediary effect of self-esteem. The results of Bootstrap test showed that 95%CI of the mediating effect of self-esteem between the desired self-efficacy and coping strategies in NS children was （0.636， 0.819）. Conclusion： Self-esteem has significant mediating effect between self-efficacy and coping strategies in children with NS， which can be used as a predictive factor between self-efficacy and coping strategies. Therefore， psychological intervention should be strengthened to improve self-esteem and self-efficacy and coping ability of children with NS.

[Key words] Self-esteem Nephrotic syndrome Self-efficacy Coping strategies Mediating effect

First-authors address： Jiamusi Maternal and Child Health Hospital， Jiamusi 154002， China

doi：10.3969/j.issn.1674-4985.2021.06.041

肾病综合征（nephrotic syndrome，NS）是多种因素引起的肾小球基底膜渗透性增加，以高脂血症、大量蛋白尿、低蛋白血症、水肿为主要临床表现的泌尿系统疾病[1]。由于小儿身体各器官发育不全，生理功能与免疫功能较差，容易出现多种并发症[2-3]。目前，临床主要采取肾上腺皮质激素治疗，但该病病程长，易反复，用药不良反应多，严重影响正处于发育阶段的小儿心理健康[4-5]。应对策略是个体在面对可察觉威胁时处理焦虑时的努力程度，也是生存质量的重要组成部分。自我效能是由美国心理学家提出，认为自我效能是个体对自己完成某项任务的信念，也是对自身是否能完成任务的自信程度[6]。自尊是一种对自身认知情感的整体评价以及其具备的心理缓冲倾向，对自我效能与应对策略之间的影响尚未明确[7]。为此，本文就自尊在NS患儿自我效能与应对策略之间的中介效应进行深入探究，现报告如下。……