Research On Influencing Factors Of Mental Health In Patients With Cirrhosis Based On Structural Equation Model

Objective:To investigate the current situation of the mental health level of patients with cirrhosis and analyze the factors influencing the mental health of patients with cirrhosis.To construct a structural equation model of the physical field,social field and therapeutic field on the psychological field in patients with liver cirrhosis,and to explore whether the physical field affects the psychological field through the social field and therapeutic field,in order to provide a theoretical basis for improving the mental health of patients with liver cirrhosis.Methods:The study was a cross-sectional study,and patients receiving cirrhosis treatment in two general tertiary hospitals in Shanxi Province from December 2021 to September 2022were selected using a convenience sampling method as the study population.A questionnaire survey was conducted using the cirrhosis PRO scale developed by the research group,and a total of 249 valid questionnaires were received.Cronbach’sαcoefficient was calculated to evaluate the internal consistency of the scale;Confirmatory factor analysis was used to verify the structure of the scale;The data were tested for common method deviation by Harman single factor method;The basic data and scale scores of the subjects were described by the mean±standard deviation or percentage;The effect of general demographic information on patient anxiety and depression,self-confidence and fear of disease outcome using univariate analysis;Pearson correlation analysis was used to explore the correlation between physical,social,therapeutic and psychological dimensions of patients with cirrhosis;Latent variable regression analysis was used to identify influences that have a stabilizing effect on the psychological field of patients with cirrhosis.A structural equation model was constructed to analyze and verify the role path and effect of the physical field,social field and therapeutic field on the psychological field of patients,and the bias-corrected percentile Bootstrap technique was used to test the mediating effect of the model.SPSS22.0 and AMOS24.0 statistical software were used for data analysis.Results:（1）The total score of liver cirrhosis PRO scale of 249 patients was 200.87±28.37.The total score of physical field was 68.63±11.29;The total score of psychological field was62.24±11.53;The total score of social field was 37.96±6.46;The total score of therapeutic field was 32.04±4.47.There were three dimensions under the psychological field,with scores of 4.17±0.73 for the entry on anxiety and depression;4.35±0.94 for the entry on self-confidence;and 3.64±1.26 for the entry on fear of disease outcome.（2）The results of univariate analysis showed that the type of medical insurance was an influential factor in the scores of anxiety-depression and fear of disease outcome in patients with cirrhosis,and the presence of comorbidities was an influential factor in the scores of anxiety-depression,self-confidence,and fear of disease outcome in patients with cirrhosis;Pearson correlation analysis showed that all five dimensions under the physical field were positively correlated with anxiety-depression,self-confidence,and fear of disease outcome;under the social field two dimensions,social support was positively correlated with anxiety-depression and self-confidence,and social adjustment was positively correlated with anxiety-depression,self-confidence,and fear of disease outcome;all three dimensions under the therapeutic field were positively correlated with anxiety-depression,self-confidence,and fear of disease outcome;latent variable regression analysis of influencing factors in the psychological field showed that the presence or absence of comorbidity and the presence or absence of medical insurance were no longer statistically significant for the psychological field,and the physical field,social field,and therapeutic field had statistically significant effects on the psychological field（P<0.05）.（3）The physical field（c=0.777,P<0.001）could directly affect the psychological field.The structural equation model was constructed with the physical field as the exogenous latent variable,the psychological field as the endogenous latent variable,and the social field and therapeutic field as the mediating variable.The results showed that the model fitted well,χ²/df=2.805,RMSEA=0.085,SRMR=0.061,GFI=0.904,CFI=0.916.IFI=0.917,TLI=0.890.The physical field had a significant mediating effect on the psychological field through the social field（a₁b₁=0.351,95%CI:（0.100,1.155））and the therapeutic field（a₂b₂=0.234,95%CI:（0.056,0.511））.There was no significant difference in mediating effect between the two fields（a₁b₁-a₂b₂=0.116,95%CI:（-0.271,0.838））.Conclusions:（1）Anxiety and depression,lack of confidence in the future,and fear of disease outcome are common mental health problems in patients with liver cirrhosis.More attention should be paid to patients with complications and those without medical insurance.（2）Social field and therapeutic field are two parallel mediating variables of physical field affecting psychological field in patients with liver cirrhosis.With the aggravation of the disease,patients’ability to adapt to society decreases,and their satisfaction and compliance with therapeutic decreases,which will reduce the mental health of patients.