| Objectives In view of the sudden onset of acute myocardial infarction(AMI)in young and middle-aged patients,who had great responsibility for life,social activities and other prominent psychosocial problems,the subject took young and middle-aged patients with AMI as the research object to understand the distribution of type D personality,investigate psychosocial adaptation level,and explore the relationship between type D personality and adaptation in young and middle-aged patients with AMI.On the basis of these factors,an intervention model for promoting psychosocial adaptation of young and middle-aged AMI patients with type D personality was constructed,which could provide basis and reference for future psychosocial intervention of young and middle-aged AMI patients.Methods The study was divided into three parts.The first part: Meta-integration and Meta-analysis were used to describe the research progress of psychosocial adaptation of young and middle-aged AMI patients at home and abroad.Based on theoretical analysis,a theoretical framework for the study of intervention model of psychosocial adaptation of young and middle-aged AMI patients was preliminarily constructed.The sencond part: Quantitative study on psychosocial adaptation and type D personality of young and middle-aged patients with AMI.General information questionnaire,Psychosocial adaptation scale for disease,Type D personality scale,Simple coping style questionnaire,Social support rating scale,Chronic disease self-efficacy scale and Simple version of disease perception questionnaire were used to investigate the psychosocial adaptation,type D personality and other related factors of young and middle-aged patients with AMI.The effects of D-personality and other related variables on psychosocial adaptation were explored through hierarchical regression analysis.The mediating effects of social support,coping style and self-efficacy on disease perception and psychosocial adaptation of young and middle-aged patients with AMI were analyzed by parallel multiple mediating effect analysis.The third part: The qualitative research on the psychosocial adaptation of young and middle-aged AMI patients.Based on descriptive phenomenological method,the interviewees were selected by purposeful sampling method,and the data were collected by face-to-face semi-structured interviews.Using Colaizzi’s seven-step analysis method as the main strategy of data analysis,to understand the real experience of psychosocial adaptation of young and middle-aged AMI patients and the process of physical and mental adjustment.Part 4: The construction of the rudimentary intervention model of psychosocial adaptation of young and middle-aged AMI patients with type D personality.Based on literature research,theoretical interpretation,quantitative and qualitative research,the intervention model of promoting psychosocial adaptation of young and middle-aged AMI patients with type D personality was preliminarily constructed.Results The first part: Based on the literature analysis and theoretical research,the theoretical framework was preliminarily formed.The second part: Among 176 young and middle-aged patients with AMI,66(33.0%) were found to have type D personality,the score of psychosocial adaptation of young and middle-aged patients with AMI was 39.76±17.86,the residence of young and middle-aged patients with AMI(β=--2.431,P<0.01),diabetes mellitus(β=-6.581,P<0.01),NYHA classification(β=2.840,P<0.01),D personality(β=-7.960,P<0.001).P < 0.001),disease perception(β=0.507,P<0.001),social support(β=-0.604,P<0.001)were independent influencing factors of psychosocial adaptation.Among them,the indirect effect path of disease perception of young and middle-aged AMI patients on psychosocial adaptation through social support(β= 0.1427,95% CI[0.0595,0.2494])Bootstrap 95% confidence interval does not include 0,which has statistical significance,suggesting that patients’ social support was an intermediary variable between disease perception and psychosocial adaptation.The 95%confidence interval of Bootstrap does not include 0 through indirect path of psychosocial adaptation to negative coping style(β= 0.0614,95% CI [0.0126,0.1231]),which has statistical significance,suggesting that patients’ negative coping style was the mediator variable of disease perception and psychosocial adaptation.The third part: Through interviews,4 themes of the connotation of psychosocial adaptation,adaptive challenges,the main promoting factors of psychosocial adaptation and the process of physical and mental adjustment of young and middle-aged AMI patients were analyzed.Psychosocial adaptation of young and middle-aged patients with AMI presents the characteristics of role conflict,mood adjustment,self-criticism and social weakening.The adaptive challenges they face were six sub-themes,which include the tangle between their healthy behavior and colorful life,the contradiction between family care and self-care,the conflict between support and unspeakable demand,the confusion between seeking solutions and complicated diseases,the confusion between happy and active tendencies and fixed attention,the imbalance between role empowerment and physical fatigue.The process of psychosocial adaptation of patients could be summarized into three stages:confused reflection,adaptation reconstruction and acceptance integration.The main factors promoting psychosocial adaptation include personal resources,social resources,cognitive processing and cognitive coping.Part 4: Preliminary formation of the intervention model of psychosocial adaptation of young and middle-aged AMI patients with type D personality:(1)Focusing on young and middle-aged AMI patients were the main body of psychosocial adaptation needs,and adopting targeted measures according to different personality characteristics of patients.(2)Young and middle-aged AMI patients with type D personality were the key implementation objects of psychosocial adaptation intervention.(3)Intervention objectives could converge patients promotion with self-recognition,role integration and social reconstruction.(4)Intervention could be based on the three stages of confused reflection,adaptive reconstruction and acceptance integration,and adopt technical,supportive and sharing communication respectively.(5)Intervention strategies could focus on adapting to patients’ challenges,promote effective cognitive processing and coping,and enhance patients’ perception and utilization of social resources.Conclusion(1)The psychosocial adaptation level of young and middle-aged AMI patients was medium,and their D-type personality,disease perception and social support were independent influencing factors of their psychosocial adaptation.Psychosocial adaptation of young and middle-aged patients with AMI was characterized by role conflict,mood regulation,self-criticism and social weakening.The process of psychological adjustment could be summarized into three stages: confused reflection,adaptive reconstruction and acceptance integration.(2)The preliminary psychosocial adaptation intervention model of young and middle-aged patients with AMI,such as psychosocial adaptation characteristics,adaptation process,adaptation challenges and main facilitating factors,including intervention objectives,principles and strategies to promote psychosocial adaptation of young and middle-aged patients with AMI,was scientific and practical. |
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