Using Structural Equation Model To Explore The Relationship Between Stressful Psychological Reaction And Its Influential Factors Of Inpatients

Objectives: 1. To test the reliability and validity of a series of scales especially the Hospital Stress Rating Scale(HSRS). 2. Using structural equation model to explore and confirm the relationship between hospital stressor, or mediating factors and stressful psychological reaction, these results can help clarify the relationship between these factors and determine their relative impact.Methods: This cross-sectional designed study used a stratified-random-cluster method to recruit 754 inpatients from 8 hospitals in Changsha. Participants were asked to fill out a series of questionnaires assessing hospital stressor, social support, personality, coping style, self-efficacy, and stressful mental response. Statistic description, analysis of variance (ANOVA), correlations, multiple linear regressions, confirmatory factor analysis, and structural equation model analysis (SEM) were conducted using SPSS 13.0 and LISREL8.70.Results: 1. In terms of validity, Cronbach's alpha coefficients of these scales were above 0.60, and most inter-item correlation means were between 0.10-0.50; Alpha coefficient of PSI was 0.952, MIC was 0.371, alpha of sub-scales were 0.79～0.87, and MICs were 0.30～0.48; Alpha coefficient of HSRS was 0843, MIC was 0.102, alpha of sub-scales were 0.47～0.73, and MICs were 0.1～0.2. In terms of validity, all scales showed met the adequacy of fit standards as shown by GFIs, CFIs, IFIs (≥0.90) and RMSEA (＜0.10). 2. Factors included in the SEM were: social support, eroticism (N), extraversion (E), avoidance, resignation, self-efficacy, course of disease and economic status. 3. The final model showed: X~2/df＜3, all of the CFIs, IFIs, GFIs were above 0.90, RMSEA＜0.05.Conclusions: 1. Using SEM analysis, a model of mental status showed good fit index. 3. This model revealed that self-efficacy significantly impacted mental status; hospital stress can influence patients' mental status directly and indirectly; social support, negative coping styles and personality (N, E) can influence mental status directly and indirectly, and these links were mediated by self-efficacy; course of disease and economical status exert influence on mental level; and economical status can also impact social support. 3. Most of these scales met requirements to be used in SEM, because HSRS demonstrated acceptable reliability and validity, it can be used in this study.