希望和积极应对在甲状腺癌症患者宽恕与主观幸福感间的多重中介作用

  目的  探讨甲状腺癌症患者希望、积极应对、宽恕和主观幸福感之间的关系并检验希望和积极应对在宽恕和主观幸福感间的多重中介效应，为制定提升甲状腺癌症患者主观幸福感水平的干预方案提供科学依据。  方法  选取2019年5月—2021年3月安徽医科大学附属宿州医院普外三科治疗的甲状腺癌症患者177例，采用Heartland宽恕量表(HFS)、总体幸福感量表(GWB)、Herth希望量表(HHI)和简易应对方式问卷(SCSS)进行调查，运用结构方程模型和Bootstrap程序进行中介效应检验。  结果  (1) 甲状腺癌患者宽恕、希望、积极应对和主观幸福感的得分分别为(103.97±20.45)分、(34.76±3.78)分、(15.38±5.78)分、(57.50±10.10)分。(2)宽恕与希望、积极应对、主观幸福感呈正相关关系(r=0.229、0.513、0.480，均P＜0.01)；希望与积极应对、主观幸福感呈正相关关系(r=0.278、0.390，均P＜0.01)，积极应对与主观幸福感呈正相关关系(r=0.508，P＜0.01)。(3)多重中介检验结果显示宽恕对主观幸福感的直接效应显著；希望、积极应对在宽恕和主观幸福感之间起到并行多重中介效应(95% CI:0.132~0.409)，总效应为0.62，直接效应为0.35，总中介效应为0.27，中介效应占总效应的43.5%。  结论  宽恕可直接影响主观幸福感，也可通过希望和积极应对间接影响主观幸福感，本研究结果可为甲状腺癌症患者心理健康干预方案的制定提供理论依据。 

Relationship between forgiveness and general well-being in patients with thyroid cancer: multiple mediating effects of hope and positive coping

  Objective   To explore the relationship among hope, positive coping, forgiveness and subjective well-being of thyroid cancer patients, and to test the multiple mediating effect of hope and positive coping between forgiveness and general well-being, so as to provide scientific basis for formulating intervention programs to improve the level of general well-being of thyroid cancer patients.  Methods   A total of 177 patients with thyroid cancer in the Third Department of Gneral Surgery of Suzhou Hospital Affiliated to Anhui Medical University from May 2019 to March 2021 were selected. They were surveyed by simple coping style scale (SCSS), general well-being scale (GWB), Herth hope index (HHI), and Heartland forgiveness scale (HFS). The structural equation model was established, and the mediation effect test was performed by Bootstrapping method.  Results   (1) The scores of forgiveness, hope, positive coping and general well-being of patients with thyroid cancer were (103.97±20.45), (34.76±3.78), (15.38±5.78) and (57.50±10.10) points respectively. (2) Forgiveness was positively correlated with hope, positive coping and general well-being (r=0.229, 0.513, 0.480, all P < 0.01); hope was positively correlated with positive coping and general well-being (r=0.278, 0.390, all P < 0.01); positive coping was positively correlated with general well-being (r=0.508, P < 0.01). (3) Multiple mediation effect model analysis showed that the level of forgiveness had a significant direct effect on the general well-being of patients with thyroid cancer. Hope and positive coping style had concurrent multiple mediating effect between forgiveness and general well-being (95% CI: 0.132-0.409). The total effect was 0.62; the direct effect was 0.35, and the total mediation effect was 0.27. The mediating effect accounts for 43.5% of the total effect.  Conclusion   Forgiveness can directly affect the general well-being. It can also influence the general well-being through hope and positive coping style indirectly. Results of this study can provide a theoretical basis for the formulation of mental health intervention programs for patients with thyroid cancer.