| 【Objective】To investigate the status of social alienation and stigma,coping style of breast cancer survivors,understand the characteristics of social alienation of breast cancer survivors,explore the relationship and actionpath among the three variables,test the mediating role of coping style between stigma and social alienation.In order to provide theoretical and practical basis for medical staff to carry out social alienation intervention for breast cancer survivors and promote their social integration.【Methods】The method of cross-sectional investigation was applied.From May 2019to September 2019,the convenience sampling method was used to select the breast cancer survivors from outpatient or ward of breast surgery in two Grade-A hospitals in Shandong Province as the research objects.The self-made general situation questionnaire,social avoidance scale,social anxiety scale,loneliness scale and social impact scale,medical coping style questionnaire were used to conduct the questionnaire survey.SPSS21.0 and AMOS23.0 were used for statistical analysis of the collected data,include descriptive statistical analysis,independent sample T-test,one-way ANOVA analysis,least significant difference(LSD),Pearson correlation analysis,multiple linear stepwise regression analysis and constructing structural equation model.【Results】1.The scores of social avoidance,social anxiety and loneliness were(5.43±3.37),(9.62±5.08)and(38.98±9.31),all of which were higher than the healthy population(P<0.01).The total and each dimension scores of stigma for breast cancer survivors were higher than those of the general cancer population(P<0.01),the scores of each dimension were economic discrimination(2.67±0.54),internal shame(2.49±0.51),social isolation(2.36±0.46),and social exclusion(2.18±0.46).The scores of avoidance and yield in coping styles for breast cancer survivors were higher than those of the general population(P<0.01),and there was no statistically significant difference between the score of facing and the general population,the scores of the three dimensions were avoidance(2.40±0.37),face(2.39±0.43),yield(2.06±0.53).2.The results of T-test and univariate analysis showed that there were significant differences in the scores of social alienation among breast cancer survivors with different age,education level,marital status,employment status,family residence,family per capita monthly income,operation mode,postoperative time and whether or not had received radiotherapy or chemotherapy(P<0.05).3.Person correlation analysis showed that the scores of social avoidance,social anxiety and loneliness in social alienation were positively correlated with the total scores of stigma and the scores of all dimensions(P<0.05,P<0.01);the scores of social avoidance and loneliness were negatively correlated with facing coping(P<0.05,P<0.01),and the scores of social avoidance,social anxiety and loneliness were significantly positively correlated with avoidance coping and yield coping(P<0.01).The total score of stigma and the scores of all dimensions showed a significant positive correlation with avoidance coping and yield coping(P<0.01).4.Multiple linear stepwise regression analysis showed that social isolation,internal shame and yield coping,avoidance coping were significant predictors of social avoidance(P<0.01),accounting for 37.8%of the variance,and significant predictors of social anxiety(P<0.05),accounting for 28.1%of the variance;social isolation and yield coping,avoidance coping,face coping were significant predictors of loneliness(P<0.01),accounting for34.9%of the variation.5.The structural equation model was used to explore the mediating effect of coping style,the fitting indexes of the structural equation model were:χ~2=17.663,CMIN/DF=1.214,GFI=0.983,AGFI=0.965,NFI=0.979,TLI=1.009,CFI=1.000,RFI=0.966,RMSEA=0.000.Stigma indirectly predicted the level of social alienation by using avoidance coping and yield coping as the mediating variables,and its standardized path coefficient was 0.085 for avoidance response and 0.192 for yield response.The total effect value of stigma on social alienation was 0.085+0.192+0.433=0.710.The mediating effect of coping style accounted for 39.01%of the total effect,of which avoidance coping accounted for 11.97%,and yield coping accounted for 27.04%.【Conclusion】1.The social avoidance,social anxiety and loneliness of the breast cancer survivors were significantly higher than the healthy population,and there was social alienation;the stigma of the breast cancer survivors was in the middle level,higher than the general cancer population;breast cancer survivors mostly used avoidance and yield coping styles,and less used face coping styles.2.There were differences in social alienation among breast cancer survivors with different age,education level,marital status,employment status,family residence,family per capita monthly income,operation mode,postoperative time and whether or not had received radiotherapy or chemotherapy.3.Social alienation of breast cancer survivors is related to stigma and coping style.Social alienation was positively correlated with stigma;social alienation was negatively correlated with facing coping,and was positively correlated with avoidance coping and yield coping;stigma was positively correlated with avoidance coping and yield coping.social isolation,internal shame and yield coping,avoidance coping were significant predictors of social avoidance and social anxiety,social isolation and yield coping,avoidance coping,face coping were significant predictors of loneliness.4.Coping style plays a part of mediating role between stigma and social alienation.The stigma of breast cancer survivors can not only directly predict their level of social alienation,but also indirectly predict their level of social alienation by avoidance coping and yield coping. |
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