病耻感和自我形象在结直肠癌肠造口患者自我效能与社交回避及苦恼间的链式中介效应 [中文引用][英文引用]

目的 探讨病耻感和自我形象在结直肠癌肠造口患者自我效能与社交回避及苦恼间的中介效应。方法 采用便利抽样法，选取 2024 年 11 月— 2025 年 11 月武汉市、西安市及宝鸡市 5 所三级甲等综合医院收治的 745 例结直肠癌肠造口患者作为研究对象。采用一般资料调查问卷、一般自我效能量表（general self⁃efficacy scale，GSES）、社交回避及苦恼量表（socialavoidance and distress scale，SADS）、社会影响量表（social impact scale，SIS）和自我形象量表（body image scale，BIS）进行调查，使用 AMOS 26.0 软件构建病耻感和自我形象在自我效能和社交回避及苦恼间的中介效应结构方程模型，并采用 Bootstrap 法检验中介效应。结果 703 例患者完成研究。结直肠癌肠造口患者的自我效能、病耻感、自我形象、社交回避及苦恼总分分别为（21.76±7.83）分、（52.92±10.28）分、（5.78±5.05）分、（11.11±7.92）分。相关性分析结果显示，自我效能与社交回避及苦恼呈负相关（r=-0.515，P<0.01），与病耻感（r=-0.261，P<0.01）、自我形象呈负相关（r=-0.392，P<0.01）；病耻感与自我形象（r=0.647，P<0.01）、社交回避及苦恼（r=0.695,P<0.01）呈正相关，自我形象与社交回避及苦恼呈正相关（r=0.731，P<0.01）。中介效应分析结果表明，病耻感和自我形象在结直肠癌肠造口患者自我效能与社交回避及苦恼间存在链式中介效应，中介效应值为 -0.104，占总效应值的 19.33%。结论 结直肠癌肠造口患者的自我效能既可直接影响其社交回避及苦恼，还可通过病耻感和自我形象的链式中介作用间接影响社交回避及苦恼。提示，医护人员可通过提升患者自我效能，减轻病耻感和改善自我形象，从而促进患者社会功能的逐步恢复。

Objective To examine the mediating effects of stigma and self-image on the relationship between self-efficacy and social avoidance and distress in colorectal cancer patients with an ostomy. Methods A convenience sampling method was adopted to recruit 745 colorectal cancer patients who had undergone ostomy from five Tier-IIIA hospitals in Wuhan, Xi’an, and Baoji between November 2024 and November 2025. Data were collected using a general information questionnaire, the general self-efficacy scale （GSES）, social avoidance and distress scale（SADS）, social impact scale（SIS）, and body image scale（BIS）. AMOS 26.0 software was used to establish a structural equation model for evaluation of the serial mediating effects of stigma and self-image on the relationship between self-efficacy and social avoidance and distress. Bootstrap method was applied to test the significance of the mediating effects. Results All 703 colon cancer patients with an ostomy completed the study. The total mean scores for self-efficacy, stigma, self-image and social avoidance and distress were 21.76±7.83, 52.92±10.28, 5.78±5.05, and 11.11±7.92, respectively. Correlation analysis showed that self-efficacy was negatively correlated with social avoidance and distress（r=-0.515）, stigma（r=-0.261）, and self-image （r=-0.392）（all P<0.01）, The stigma was positively correlated with self-image（r=0.647）, social avoidance and distress（r=0.695）（both P<0.01）, and self-image was positively correlated with social avoidance and distress（r=0.731, P<0.01）. Mediating effect analysis revealed that stigma and self-image played a serial mediating role in the relationship between self-efficacy and social avoidance and distress, with a total indirect effect of -0.104 and accounting for 19.33% of the total effect. Conclusion Self-efficacy in colorectal cancer patients with ostomy excels a direct effect on social avoidance and distress. Meanwhile it also has an indirect effect through the serial mediation of stigma and self-image. These findings suggest that clinical interventions could enhance the self-efficacy of patients to alleviate stigma and improve self-image, thereby facilitating the gradual recovery of social functioning.