Influencing Factors And Structural Equation Model Of Mental Health In Patients Undergoing Total Hysterectomy

ObjectiveThis study investigated and analyzed the mental health status of patients undergoing total hysterectomy and its influencing factors based on the psychological stress system model,and explored the pathways of each influencing factor on the mental health of patients undergoing total hysterectomy by constructing a structural equation model,in order to provide an empirical basis for clinical healthcare professionals to provide more accurate and effective psychological care interventions to patients undergoing total hysterectomy.MethodsFrom April 2022 to February 2023,214 patients admitted to a women and children’s grade-A tertiary specialized hospital in Guangzhou and receiving total hysterectomy were selected by convenience sampling.The general data questionnaire,Self-Rating Anxiety Scale,Self-Rating Depression Scale,Comprehensive Assessment of Acceptance and Commitment Therapy Processes,Multimentional Health Locus of Control Scale,Perceived Social Support Scale and Medical Coping Modes Questionnaire were used to investigate the mental health and influencing factors of patients undergoing total hysterectomy.SPSS 22.0 software was used for statistical analysis of the data.Frequency and composition ratios were used to describe the general information of patients undergoing total hysterectomy,(mean±standard deviation)was used to describe the scores of each study variable,independent samples t-test and one-way ANOVA test were used for one-way analysis,Pearson correlation analysis was used to explore the relationship between anxiety and depression and each study variable,and multiple stepwise regression was used for multifactor analysis.The structural equation models were constructed and tested by Amos 23.0software,the model fit was evaluated by NC,GFI,AGFI,NFI,IFI,CFI and RMSEA,and the Bootstrap method was used to verify the path effect.All tests were statistically significant with p<0.05(two-tailed).Results(1)The patients undergoing total hysterectomy were ranging from28 to 79 years old,with an average age of(51.12±8.41)years old,and the majority were middle-aged(68.7%).Most of the patients lived in urban areas(81.8%),44.9%had middle school education or below,39.3%were employed,45.3%had per capita monthly household income of5,000～10,000 yuan,and the medical expenses were mainly covered by urban medical insurance(69.6%).91.1%of the patients were married,and the number of children raised was mostly 1 or 2,accounting for 36.0%and37.4%respectively.(2)158 cases(73.8%)were benign disease,37 cases(17.3%)were malignant disease,and 19 cases(8.9%)were benign combined malignant disease.The main surgical methods were total hysterectomy(200 cases,93.5%)and laparoscopy(174 cases,81.3%),among which 62.6%were not menopausal before surgery,and 50.0%had postoperative complications of varying degrees.(3)The average anxiety score of patients undergoing total hysterectomy was(43.43±7.53),among which 173 patients(80.8%)had normal anxiety,38 patients(17.8%)had mild anxiety,and 3 patients(1.4%)had moderate anxiety.The average score of depression was(44.03±10.65),among which 136 cases(63.6%)were normal,63 cases(29.4%)were mildly depressed,and 15 cases(7.0%)were moderately depressed.(4)Univariate analysis showed that there were significant differences only in depression scores among total hysterectomy patients with different number of children(F=3.574,p<0.05),and the other variables all had no significant effect on anxiety and depression scores.(5)Pearson correlation analysis showed that anxiety was positively correlated with chance and acceptance-resignation(r=0.349,0.464,p<0.001),but negatively correlated with psychological flexibility,perceived social support and confrontation(r=-0.580,-0.439,-0.305,p<0.001).Depression was positively correlated with chance and acceptance-resignation(r=0.359,0.505,p<0.001),but negatively correlated with psychological flexibility,perceived social support and confrontation(r=-0.614,-0.523,-0.319,p<0.001).(6)The results of multivariate analysis showed that valued action,openness to experience,acceptance-resignation and perceived family support were the main influencing factors of anxiety,R~2=0.375,adjusted R~2=0.363,F=31.381,p<0.001;valued action,openness to experience,perceived family support and acceptance-resignation were the main influencing factors of depression,R~2=0.442,adjusted R~2=0.432,F=41.435,p<0.001.(7)The structural equation models for anxiety and depression in patients undergoing total hysterectomy fit well,and path analysis revealed that perceived family support had direct(-0.146,-0.192,p<0.05)and indirect(-0.258,-0.270,p<0.01)effects on anxiety and depression,acceptance-resignation had direct(0.171,0.184,p<0.05)and indirect effects(0.180,0.186,p<0.01)on anxiety and depression,openness to experience had direct effects on anxiety and depression(-0.242,-0.235,p<0.01),and valued action had direct effects on anxiety and depression(-0.311,-0.330,p<0.01).Conclusions(1)In this study,anxiety and depression scores of patients undergoing total hysterectomy were higher than the general population,with a positive rate of 19.2%for anxiety and 36.4%for depression.The mental health of patients undergoing total hysterectomy is not optimistic.(2)The number of children,psychological flexibility,chance locus of control,perceived social support,confrontation and acceptance-resignation have an impact on the mental health of patients undergoing total hysterectomy.(3)The structural equation model of mental health of patients undergoing total hysterectomy showed that perceived family support has direct effect on mental health and indirect effect on mental health through acceptance-resignation and valued action;acceptance-resignation has direct effect on mental health and indirect effect on mental health through openness to experience and valued action;openness to experience and valued action have direct effect on mental health.