تدوين مدل معادلات ساختاري شدت علائم مثبت بيماران مبتلا به اسكيزوفرني بر اساس روابط موضوعي، واقعيت‌ سنجي و كاركرد خانواده

A Structural Model of Positive Symptoms of Schizophrenia Disorder Based on Object Relations, Reality Testing, and Family Functioning

زمينه ‌و‌ هدف: اسكيزوفرني اختلالي است كه باوجود آنكه درصد كمي از افراد جامعه را مبتلا مي‌كند، خسارات هنگفتي به‌بار مي‌آورد. هدف پژوهش حاضر، تدوين مدل ساختاري شدت علائم مثبت بيماران مبتلا به اسكيزوفرني براساس روابط موضوعي، واقعيت‌سنجي و كاركرد خانواده بود. روش‌بررسي: مطالعهٔ حاضر به‌روش همبستگي و از نوع مدل‌سازي معادلات ساختاري انجام شد. جامعهٔ آماري شامل 250 نفر از بيماران مراجعه‌كننده به بيمارستان 505 شهر تهران در سال 1398 بود كه با استفاده از نمونه‌گيري دردسترس انتخاب شدند. شركت‌كنندگان به مقياس كاركرد خانواده (اپستاين و همكاران، 1983)، پرسشنامۀ روابط موضوعي و واقعيت‌سنجي بل (بل و همكاران، 1986) و مقياس علائم مثبت و منفي اسكيزوفرني (كي و همكاران، 1987) پاسخ دادند. داده‌ها با استفاده از مدل‌يابي معادلات ساختاري با نرم‌افزارهاي آماري SPSS نسخهٔ 22 و AMOS نسخۀ 22 تحليل شدند. سطح معناداري آزمون‌ها در اين پژوهش، 0٫05 در نظر گرفته شد. يافته‌ها: نتايج نشان داد كه ضريب مسير مستقيم بين روابط موضوعي بر شدت علائم‌ مثبت (0٫001>p، 0٫23=β( مثبت ‌و معنادار است و ضرايب مسير بين كاركرد خانواده بر شدت علائم‌ مثبت (0٫001>p، 0٫44=β( و بين روابط موضوعي بر واقعيت‌سنجي (0٫001>p، 0٫22=β( مثبت و معنادار است. همچنين ضرايب مسير بين كاركرد خانواده بر واقعيت‌سنجي (0٫001>p، 0٫24-=β( و بين واقعيت‌سنجي بر شدت علائم‌ مثبت (0٫001>p، 0٫29-=β( منفي ‌و معنادار است. درنهايت، ضريب مسير غيرمستقيم بين روابط موضوعي بر شدت علائم مثبت (0٫001>p، 0٫45=β( مثبت ‌و معنادار است. شاخص‌هاي نكويي برازش محاسبه‌شدهٔ روابط بين شدت علائم مثبت، روابط موضوعي، واقعيت‌سنجي و كاركرد خانواده نشان داد كه واقعيت‌سنجي، رابطهٔ بين روابط موضوعي و كاركرد خانواده را با علائم‌ مثبت اسكيزوفرني ميانجيگري مي‌كند (0٫89=AGFI، 0٫066=RMSEA). نتيجه‌گيري: براساس يافته‌هاي اين پژوهش مي‌توان گفت كه روابط موضوعي و كاركرد خانواده با نقش ميانجي واقعيت‌سنجي مي‌توانند مدل مطلوبي براي پيش‌بيني شدت علائم مثبت باشند كه مي‌توان در سطوح درماني از اين مدل استفاده كرد.

Background & Objectives: Schizophrenia is a disorder that, despite affecting a small percentage of the population, causes enormous damage. Numerous researchers believe that schizophrenia is rooted in the interaction of genetic, biopsychosocial, and family factors and the pathology of their parents. Ego functions are among the components that essentially affect explaining the psychoanalysis model of schizophrenia. Thematic and fact–checking relationships are among the functions of the ego, i.e., considered important in psychopathology. In addition to the theoretical approaches of psychodynamics, what is currently emphasized as an important research finding, is the role of relationships and family environment as characteristics affecting the incidence of schizophrenia. There exist multiple research gaps in identifying the relationship between the severity of the positive symptoms of schizophrenia based on object relations and family functioning; therefore, the present study aimed to investigate the mediating role of reality testing in the relationship between object relations and family functioning, and the positive symptoms of schizophrenia. Methods: The present correlational study employed structural equation modeling. The statistical population of this study consisted of all patients with schizophrenia and their families referring to 505 Hospital in Tehran City, Iran, in 2019. According to the inclusion criteria of the study (all patients with schizophrenia who were diagnosed by psychiatrists with the positive and negative symptoms of schizophrenia; were visited in the outpatient ward, in the period of relative recovery; feeling the need for low therapeutic intervention; patients with an age range of 20 to 50 years; patients' willingness to participate in the study), 250 patients were selected by convenience sampling method. The required data were collected using the Bell Object Relations and Reality Testing Inventory (Bell et al., 1986), the Family Functioning Scale (Epstein et al., 1983), and the Schizophrenia Positive and Negative Symptoms Scale (Kay et al., 1987). The obtained data were analyzed using structural equation modeling in SPSS and AMOS. The significance level of the tests in this study was set at 0.05. Results: The present research findings suggested that the total path coefficient (total direct & indirect path coefficient) between object relations and the severity of positive symptoms (β=0.68, p<0.001) was positive and significant. Besides, the total path coefficient between family functioning and the severity of positive symptoms (β=0.44, p<0.001) was positive and significant; the direct path coefficient between object relations and the severity of positive symptoms (p<0.001, β=0.23) was positive and significant. Moreover, the path coefficients between family functioning and the severity of positive symptoms (p<0.001, β=0.44), as well as between object relations and reality testing (p<0.001, β=0.22) were positive and significant. Additionally, path coefficients between family function and reality testing (p<0.001, β=–0.24) and realism on the severity of positive symptoms (p<0.001, β=–0.29) were negative and significant. Finally, the indirect path coefficient between object relations and the severity of positive symptoms (p<0.001, β=0.45) was positive and significant. The calculated goodness–of–fit indices of the relationships between positive symptom severity, object relations, reality testing, and family functioning suggested that reality testing mediated the relationship between object relations and family functioning, and the positive symptoms of schizophrenia (AGFI=0.89, RMSEA=0.066). Conclusion: Based on the current study findings, reality testing played a mediating role in the relationship between object relations and family functioning, and the severity of the positive symptoms of schizophrenia.