宫颈癌筛查阳性女性病耻感与性功能的关系：心理困扰的中介效应

Relationship between Stigma and Sexual Function in Women with Abnormal Cervical Cancer Screening: The Mediating Effect of Psychological Distress

摘要: 目的：调查门诊宫颈癌筛查阳性女性的病耻感、心理困扰(焦虑、抑郁)及性功能现状，并探讨抑郁与焦虑在病耻感与性功能之间的中介效应。方法：采用横断面研究设计，纳入2024年5月至2025年5月某院门诊就诊的187名宫颈癌筛查异常女性。采用慢性疾病病耻感量表(SSCI)、广泛性焦虑量表(GAD-7)、患者健康问卷抑郁量表(PHQ-9)及女性性功能指数量表(FSFI)进行横断面评估。采用Spearman秩相关分析变量间相关性，并运用SPSS PROCESS宏程序(Model 4)检验中介效应。结果：1) 筛查阳性女性的焦虑、抑郁及女性性功能障碍(FSD)检出率分别为63.6%、61.5%及91.4%，其中52.9%的患者存在病耻感。2) 病耻感与焦虑(r = 0.43)、抑郁(r = 0.19)呈显著正相关(P < 0.05)，与性功能总分呈显著负相关(r = −0.29, P < 0.01)。3) 中介效应分析表明，抑郁在病耻感与性功能间起部分中介作用(间接效应值−0.033, 95% CI (−0.090, −0.0002))，占总效应的11.34%；而焦虑的中介效应不显著。此外，病耻感可通过抑郁间接加剧焦虑(中介占比16.02%)。结论：宫颈癌筛查阳性女性普遍面临高水平的心理困扰与性功能受损。病耻感不仅直接损害性功能，还通过加重抑郁情绪发挥间接抑制作用。临床干预应在筛查异常期及早开展去污名化教育，并重点加强针对抑郁情绪的疏导，以保护患者性健康。

Abstract: Objective: To investigate the status of stigma, psychological distress (anxiety and depression), and sexual function in outpatient women with abnormal cervical cancer screening results, and to explore the mediating effects of depression and anxiety between stigma and sexual function. Methods: A cross-sectional study design was adopted, enrolling 187 outpatient women with abnormal cervical cancer screening results at a hospital from May 2024 to May 2025. Cross-sectional assessments were conducted using the Stigma Scale for Chronic Illness (SSCI), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Female Sexual Function Index (FSFI). Spearman’s rank correlation was used to analyze the correlations among variables, and the SPSS PROCESS macro (Model 4) was utilized to test the mediating effects. Results: 1) The prevalence of anxiety, depression, and female sexual dysfunction (FSD) was 63.6%, 61.5%, and 91.4%, respectively; 52.9% of participants reported stigma. 2) Stigma was positively correlated with anxiety (r = 0.43) and depression (r = 0.19) (P < 0.05), and negatively correlated with FSFI scores (r = −0.29, P < 0.01). 3) Mediation analysis revealed that depression partially mediated the relationship between stigma and sexual function (indirect effect = −0.033, 95% CI (−0.090, −0.0002)), accounting for 11.34% of the total effect. The mediating effect of anxiety was not significant. Additionally, stigma indirectly exacerbated anxiety through depression (mediation ratio: 16.02%). Conclusion: Women with abnormal cervical screening results face substantial psychological distress and impaired sexual function. Stigma impairs sexual health both directly and indirectly by exacerbating depressive symptoms. Clinical interventions should emphasize early destigmatization during the screening observation period and prioritize depression-focused psychological support to improve patients’ sexual well-being.