糖尿病肾病血液透析患者的社交焦虑网络及潜在剖面分析

Network and Latent Profile Analysis of Social Anxiety in Hemodialysis Patients with Diabetic Nephropathy

摘要: 目的：构建糖尿病肾病血液透析患者社交焦虑的网络及潜在剖面模型，为精准化预防和干预社交焦虑症状提供参考依据。方法：采用便利抽样法，选取湖北省2所三级甲等医院382例糖尿病肾病血液透析患者为研究对象，采用一般资料调查表、社交回避及苦恼量表(SADS)、社会影响量表(SIS)和内在力量量表(ISS)进行问卷调查。采用Mplus和R进行网络和潜在剖面分析，分析潜在分型的相关影响因素。结果：1) 在网络集群中，“在陌生场合会感到放松”(SADS1)和“尽量避免参加社交活动”(SADS2)连接最紧密；SADS1“在陌生场合中会感到放松”(EI = 2.913)与SADS16“当被介绍给别人，会感到紧张和焦虑”(EI = 1.180)的预期影响症状最高。2) 糖尿病肾病血液透析患者的SADS可分为：无社交焦虑组(19.6%)、一般社交焦虑组(54.5%)和严重社交焦虑组(25.9%) 3个潜在分型，其相关影响因素包括文化程度、透析时长、透析治疗方式、病耻感及内在力量(P < 0.05)。3) 不同SADS潜在类别的糖尿病肾病血液透析患者的病耻感与内在力量得分比较，差异均有统计意义(P < 0.05)。结论：糖尿病肾病血液透析患者的社交焦虑症状检出率呈中高水平，症状网络揭示了干预的重要靶点，社交焦虑症状受各种因素影响，应早期关注不同亚组人群的心理健康问题并及时提供合理有效的预防措施。

Abstract: Objective: To construct the network and latent profile model of social anxiety in hemodialysis patients with diabetic nephropathy, so as to provide a reference for precise prevention and intervention of social anxiety symptoms. Methods: Convenience sampling method was used to select 382 hemodialysis patients with diabetic nephropathy from two Grade A tertiary hospitals in Hubei province as the research object. The general information questionnaire, Social Avoidance and Distress Scale (SADS), Social Impact Scale (SIS) and Inner Strength Scale (ISS) were used to investigate. Mplus and R were used for network and latent profile analysis to analyze the related influencing factors of latent typing. Results: 1) In the network cluster, “feeling relaxed in unfamiliar situations” (SADS1) and “trying to avoid social activities” (SADS2) were most closely related to each other. SADS1 “feeling relaxed in unfamiliar situations” (EI = 2.913) and SADS16 “feeling nervous and anxious when introduced to others” (EI = 1.180) had the highest anticipation-influenced symptoms. 2) The SADS of hemodialysis patients with diabetic nephropathy could be divided into three latent types: no social anxiety group (19.6%), general social anxiety group (54.5%) and severe social anxiety group (25.9%). The influencing factors of SADS included education level, dialysis duration, dialysis treatment method, stigma and inner strength (P < 0.05). 3) There were statistically significant differences in the scores of stigma and intrinsic strength of hemodialysis patients with diabetic nephropathy with different SADS latent categories (P < 0.05). Conclusion: The detection rate of social anxiety symptoms in hemodialysis patients with diabetic nephropathy is at a medium to high level. The symptom network reveals an important target for intervention. Social anxiety symptoms are affected by various factors, necessitating early attention to mental health issues across different subgroups and the timely provision of appropriate and effective preventive measures.