Analysis of the potential dimensions of guilt feelings among family caregivers of elderly patients with multiple chronic conditions and their influencing factors
Article ID:
5377
Keywords:
Polymorbidity in the elderly Family caregivers Guilt Latent profiles Factors influencing
Abstract
患有多种慢性病的老年患者是老年人口中同时患有各种慢性病的个体。这种情况不仅影响了他们的生活质量，也给他们的家庭和社会带来了巨大的经济负担。针对家庭照护者在照护过程中可能经历的心理压力，本研究旨在探讨多种慢性病老年患者家庭照护者内疚感的异质性及其影响因素。采用计划于2024年6月至2025年6月进行的横断面调查设计，选择在武汉某三甲医院接受治疗的多种慢性病老年患者的家庭照护者，采用标准化量表评估其内疚感。将采用潜在概况分析（LPA）来识别具有不同内疚感水平的潜在亚组，并进行多元logistic回归分析以探索影响因素。研究结果有望表明，家庭照顾者的内疚感可分为3种典型的潜在特征，与患者并存疾病数量、自我调节能力、家庭照顾态度、创伤后应激反应显著相关。具体来说，更多的共存疾病、更短的护理时间以及更强的创伤事件影响与更明显的护理人员的内疚感相关;而更强的家庭支持、对自我调节疲劳的抵抗力更强以及自我分化水平越高，导致照顾者的内疚感降低。这些发现强调了加强家庭支持和增强照护者自我调节能力的重要性，揭示了患有多种慢性病的老年患者家庭照护者内疚感的异质性，为未来有针对性的心理干预提供了依据。因此，未来的研究应整合临床和社会心理资源，以提高护理质量，并制定增强家庭福祉的策略。
Published
2025-08-26
Copyright (c) 2025 高华 王, Xiaojie Ma, Ruihan Wu, Lili Zhang, Xiangying Shen, Jiaojiao Wu, Zhen Luo, Xinmei Wang, Doudou Lin
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
1.AlHarkan KS, Aldhawyan AF, Bahamdan AS, et al（2024）. Association between multimorbidity and cognitive decline in the elderly population of the Eastern Province, Saudi Arabia. J Family Community Med.31(2):99-106. doi:10.4103/jfcm.jfcm_268_23 https://pubmed.ncbi.nlm.nih.gov/38800794/
2.Cox IA, de Graaff B, Ahmed H, et al（2023）. The economic burden of idiopathic pulmonary fibrosis in Australia: a cost of illness study. Eur J Health Econ.24(7):11211139.doi:10.1007/s10198022015387.https://pubmed.ncbi.nlm.nih.gov/36289130/
3.Sánchez-Dávila JN, Verástegui EL, Peña-Nieves A, Allende-Pérez SR（2024）. Integration of the geriatric palliative care in oncological care of elderly patient with cancer. Palliat Support Care. 22(4):792-800. doi:10.1017/S1478951524000294 https://pubmed.ncbi.nlm.nih.gov/38621672/
4.Prunty MM, Foli KJ（2019）. Guilt experienced by caregivers to individuals with dementia: A concept analysis. Int J Older People Nurs. 14(2):e12227. doi:10.1111/opn.12227 https://pubmed.ncbi.nlm.nih.gov/30793838/
5.Campos-Sánchez M, Castañeda-Ibáñez NN（2025）. The caring experience: Being a woman, mother and caregiver from patients diagnosed with mucopolysaccharidosis. Enferm Clin (Engl Ed).35(2):502167. doi:10.1016/j.enfcle.2025.502167 https://pubmed.ncbi.nlm.nih.gov/40097106/
6.Bashorum L, McCaughey G, Evans O, Humphries AC, Perry R, MacCulloch A（2022）. Burden associated with Fabry disease and its treatment in 12-15 year olds: results from a European survey. Orphanet J Rare Dis. 17(1):266. Published 2022Jul15.doi:10.1186/s13023022024173https://pubmed.ncbi.nlm.nih.gov/35840992/
7.Mohamed Hussin NA, Mohd Sabri NS（2023）. A qualitative exploration of the dynamics of guilt experience in family cancer caregivers. Support Care Cancer. 31(12):659. Published 2023 Oct 27. doi:10.1007/s00520-023-08060-3 https://pubmed.ncbi.nlm.nih.gov/37889352/
8.Yıldız M, Yazıcı A, Böke O（2010）.Demographic and clinical characteristics in schizophrenia: a multi center cross-sectional case record study]. Turk Psikiyatri Derg. 21(3):213-24. https://pubmed.ncbi.nlm.nih.gov/20818509/
9.Ho AHY, Tan-Ho G, Ngo TA, et al（2021）. A Novel Mindful-Compassion Art-Based Therapy for Reducing Burnout and Promoting Resilience Among Healthcare Workers: Findings From a Waitlist Randomized Control Trial. Front Psychol. 12:744443. Published. doi:10.3389/fpsyg.2021.744443 https://pubmed.ncbi.nlm.nih.gov/34744918/
10.Pfutzenreuter KC, da Silva Falcão DV, Losada-Baltar A, Márquez-González M(2024).Transcultural Adaptation of the "Caregiver Guilt Questionnaire" (CGQ).ClinGerontol:110.PublishedonlineOc3.doi:10.1080/07317115.2024.2408639 https://pubmed.ncbi.nlm.nih.gov/39360340/
11.Mayorga-Muñoz C, Gallardo-Peralta L, Galvez-Nieto JL（2019）. Psychometric properties of APGAR-family scale in a multiethnic sample of Chilean older people. Rev Med Chil. 147(10):1283-1290. doi:10.4067/s0034-98872019001001283 https://pubmed.ncbi.nlm.nih.gov/32186636/
12.Hunt N, Evans D（2004）. Predicting traumatic stress using emotional intelligence. Behav Res Ther. 42(7):791-8. doi:10.1016/j.brat.2003.07.009 https://pubmed.ncbi.nlm.nih.gov/15149899/
13.Solberg Nes L, Ehlers SL, Patten CA, Gastineau DA（2013）. Self-regulatory fatigue in hematologic malignancies: impact on quality of life, coping, and adherence to medical recommendations. Int J Behav Med. 20(1):13-21. doi:10.1007/s12529-011-9194-1 https://pubmed.ncbi.nlm.nih.gov/21928059/
14.Sheikh F, Khodabakhshi Koolaee A, Rahmati Zadeh M（2013）. The Comparison of Self-differentiation and Self-concept in Divorced and Non-divorced Women Who Experience Domestic Violence. Int J High Risk Behav Addict.2(2):6671.doi:10.5812/ijhrba.10029https://pubmed.ncbi.nlm.nih.gov/24971277/
15.Thomas S, Schäfer J, Kanske P, Trautmann S（2024）. Patterns of social-affective responses to trauma exposure and their relation to psychopathology. PLoSOne.2024;19(3):e0289664.PublishedNone.doi:10.1371/journal.pone.0289664 https://pubmed.ncbi.nlm.nih.gov/38442107/
16.Stone SM, Giraldo-Santiago N, Miller A, et al（2025）. Development of a Mindfulness and Self-compassion (MASC) Stress Reduction Program for Caregivers of Persons With Dementia With Behavioral Symptoms. Gerontologist. 65(4). doi:10.1093/geront/gnaf058 https://pubmed.ncbi.nlm.nih.gov/39928550/
17.White Makinde K, Pitzer KA, Benson JJ, et al(2025). Does Family Functioning Matter?Understanding the Relationship Between Family Interactions and Depressive Symptoms for Caregivers of Cancer Patients. Am J HospPalliatCare.42(7):696704.doi:10.1177/10499091241263016https://pubmed.ncbi.nlm.nih.gov/38881044/
18.Liang J, Lee SJ, Storer BE, et al(2019). Rates and Risk Factors for Post-Traumatic Stress Disorder Symptomatology among Adult Hematopoietic Cell Transplant Recipients and Their Informal Caregivers. Biol Blood Marrow Transplant.25(1):145150.doi:10.1016/j.bbmt.2018.08.002https://pubmed.ncbi.nlm.nih.gov/30098393/
19.Shen A,Wu P, Qiang W, et al(2023). Predicting lymphedema self-management behaviours in breast cancer patients: A structural equation model with the Integrated Theory of Health Behaviour Change. J Adv Nurs.79(12):47784790.doi:10.1111/jan.15759https://pubmed.ncbi.nlm.nih.gov/37358074/
20.Evans BC, Coon DW, Belyea MJ, Ume E(2017). Collective Care: Multiple Caregivers and Multiple Care Recipients in Mexican American Families. J TranscultNurs.28(4):398407.doi:10.1177/1043659616657878https://pubmed.ncbi.nlm.nih.gov/27389911/
21.Tong H, Qiu F, Fan L(2022). Characterising common challenges faced by parental caregivers of children with type 1 diabetes mellitus in mainland China: a qualitative study. BMJ Open. 12(1):e048763. Published 2022 Jan 11. doi:10.1136/bmjopen-2021-048763 https://pubmed.ncbi.nlm.nih.gov/35017233/
22.Wehrli LA, Ariefdjohan M, Ketzer J, et al(2024). "Take It One Dilation at a Time": Caregiver Perspectives of Postoperative Anal Dilations in Pediatric Patients with Colorectal Conditions. Behav Sci (Basel). 14(5). Published 2024 Apr 30. doi:10.3390/bs14050379 https://pubmed.ncbi.nlm.nih.gov/38785870/
23.BURP, Shrivastava K, Rathod DH, Saha R, Kumari S(2024). Experiences of Caregivers in De-addiction Centers in Western Maharashtra, India: A Qualitative Study. Cureus. 16(8):e68155. Published 2024 Aug. doi:10.7759/cureus.68155 https://pubmed.ncbi.nlm.nih.gov/39347300/
24.Liu Y, Wheaton AG, Edwards VJ, Xu F, Greenlund KJ, Croft JB(2020). Short self-reported sleep duration among caregivers and non-caregivers in 2016. SleepHealth.6(5):651656.doi:10.1016/j.sleh.2020.01.015https://pubmed.ncbi.nlm.nih.gov/32331864/
25.Tong H, Qiu F, Fan L(2022). Characterising common challenges faced by parental caregivers of children with type 1 diabetes mellitus in mainland China: a qualitative study. BMJ Open.12(1):e048763. Published 2022 Jan 11. doi:10.1136/bmjopen-2021-048763 https://pubmed.ncbi.nlm.nih.gov/35017233/
26.Jose JM, Gawali G(2025). Exploration of Psychosocial Issues of Parents in Pediatric OncologyJ Pediatr Hematol Oncol.Published online Jul 28, doi:10.1097/MPH.0000000000003085https://pubmed.ncbi.nlm.nih.gov/4071944/
27.Covers MLV, de Jongh A, Huntjens RJC, de Roos C, van den Hout M, Bicanic IAE(2021). Early intervention with eye movement desensitization and reprocessing (EMDR) therapy to reduce the severity of post-traumatic stress symptoms in recent rape victims: a randomized controlled trial. Eur J Psychotraumatol.2021;12(1):1943188.PublishedNone.doi:10.1080/20008198.2021.1943188 https://pubmed.ncbi.nlm.nih.gov/34531963/
28.Wilson IM, Tan KC, Tan JYS, Jones L, Dawood K, Mack W(2025). "I (am) scared I will hurt him, then I will regret it forever": Singaporean caregiver perspectives and elder abuse risk. J Elder Abuse Negl.37(2):150-180. doi:10.1080/08946566.2025.2469054https://pubmed.ncbi.nlm.nih.gov/39989171/
29.Ivers JH, Harris A, McKeown P, Barry J(2021). Mothers experiences of the Parenting Under Pressure Program (PuP) in a Residential Therapeutic Community: A qualitative study. J Psychoactive Drugs. 53(3):230-237. doi:10.1080/02791072.2020.1856455https://pubmed.ncbi.nlm.nih.gov/33320076/
30.Lu S, Wu Y, Mao Z, Liang X. Association of Formal and Informal Social Support With Health-Related Quality of Life Among Chinese Rural Elders. Int J Environ Res Public Health. 2020;17(4). Published 2020 Feb 19. doi:10.3390/ijerph17041351 https://pubmed.ncbi.nlm.nih.gov/32093116/
2.Cox IA, de Graaff B, Ahmed H, et al（2023）. The economic burden of idiopathic pulmonary fibrosis in Australia: a cost of illness study. Eur J Health Econ.24(7):11211139.doi:10.1007/s10198022015387.https://pubmed.ncbi.nlm.nih.gov/36289130/
3.Sánchez-Dávila JN, Verástegui EL, Peña-Nieves A, Allende-Pérez SR（2024）. Integration of the geriatric palliative care in oncological care of elderly patient with cancer. Palliat Support Care. 22(4):792-800. doi:10.1017/S1478951524000294 https://pubmed.ncbi.nlm.nih.gov/38621672/
4.Prunty MM, Foli KJ（2019）. Guilt experienced by caregivers to individuals with dementia: A concept analysis. Int J Older People Nurs. 14(2):e12227. doi:10.1111/opn.12227 https://pubmed.ncbi.nlm.nih.gov/30793838/
5.Campos-Sánchez M, Castañeda-Ibáñez NN（2025）. The caring experience: Being a woman, mother and caregiver from patients diagnosed with mucopolysaccharidosis. Enferm Clin (Engl Ed).35(2):502167. doi:10.1016/j.enfcle.2025.502167 https://pubmed.ncbi.nlm.nih.gov/40097106/
6.Bashorum L, McCaughey G, Evans O, Humphries AC, Perry R, MacCulloch A（2022）. Burden associated with Fabry disease and its treatment in 12-15 year olds: results from a European survey. Orphanet J Rare Dis. 17(1):266. Published 2022Jul15.doi:10.1186/s13023022024173https://pubmed.ncbi.nlm.nih.gov/35840992/
7.Mohamed Hussin NA, Mohd Sabri NS（2023）. A qualitative exploration of the dynamics of guilt experience in family cancer caregivers. Support Care Cancer. 31(12):659. Published 2023 Oct 27. doi:10.1007/s00520-023-08060-3 https://pubmed.ncbi.nlm.nih.gov/37889352/
8.Yıldız M, Yazıcı A, Böke O（2010）.Demographic and clinical characteristics in schizophrenia: a multi center cross-sectional case record study]. Turk Psikiyatri Derg. 21(3):213-24. https://pubmed.ncbi.nlm.nih.gov/20818509/
9.Ho AHY, Tan-Ho G, Ngo TA, et al（2021）. A Novel Mindful-Compassion Art-Based Therapy for Reducing Burnout and Promoting Resilience Among Healthcare Workers: Findings From a Waitlist Randomized Control Trial. Front Psychol. 12:744443. Published. doi:10.3389/fpsyg.2021.744443 https://pubmed.ncbi.nlm.nih.gov/34744918/
10.Pfutzenreuter KC, da Silva Falcão DV, Losada-Baltar A, Márquez-González M(2024).Transcultural Adaptation of the "Caregiver Guilt Questionnaire" (CGQ).ClinGerontol:110.PublishedonlineOc3.doi:10.1080/07317115.2024.2408639 https://pubmed.ncbi.nlm.nih.gov/39360340/
11.Mayorga-Muñoz C, Gallardo-Peralta L, Galvez-Nieto JL（2019）. Psychometric properties of APGAR-family scale in a multiethnic sample of Chilean older people. Rev Med Chil. 147(10):1283-1290. doi:10.4067/s0034-98872019001001283 https://pubmed.ncbi.nlm.nih.gov/32186636/
12.Hunt N, Evans D（2004）. Predicting traumatic stress using emotional intelligence. Behav Res Ther. 42(7):791-8. doi:10.1016/j.brat.2003.07.009 https://pubmed.ncbi.nlm.nih.gov/15149899/
13.Solberg Nes L, Ehlers SL, Patten CA, Gastineau DA（2013）. Self-regulatory fatigue in hematologic malignancies: impact on quality of life, coping, and adherence to medical recommendations. Int J Behav Med. 20(1):13-21. doi:10.1007/s12529-011-9194-1 https://pubmed.ncbi.nlm.nih.gov/21928059/
14.Sheikh F, Khodabakhshi Koolaee A, Rahmati Zadeh M（2013）. The Comparison of Self-differentiation and Self-concept in Divorced and Non-divorced Women Who Experience Domestic Violence. Int J High Risk Behav Addict.2(2):6671.doi:10.5812/ijhrba.10029https://pubmed.ncbi.nlm.nih.gov/24971277/
15.Thomas S, Schäfer J, Kanske P, Trautmann S（2024）. Patterns of social-affective responses to trauma exposure and their relation to psychopathology. PLoSOne.2024;19(3):e0289664.PublishedNone.doi:10.1371/journal.pone.0289664 https://pubmed.ncbi.nlm.nih.gov/38442107/
16.Stone SM, Giraldo-Santiago N, Miller A, et al（2025）. Development of a Mindfulness and Self-compassion (MASC) Stress Reduction Program for Caregivers of Persons With Dementia With Behavioral Symptoms. Gerontologist. 65(4). doi:10.1093/geront/gnaf058 https://pubmed.ncbi.nlm.nih.gov/39928550/
17.White Makinde K, Pitzer KA, Benson JJ, et al(2025). Does Family Functioning Matter?Understanding the Relationship Between Family Interactions and Depressive Symptoms for Caregivers of Cancer Patients. Am J HospPalliatCare.42(7):696704.doi:10.1177/10499091241263016https://pubmed.ncbi.nlm.nih.gov/38881044/
18.Liang J, Lee SJ, Storer BE, et al(2019). Rates and Risk Factors for Post-Traumatic Stress Disorder Symptomatology among Adult Hematopoietic Cell Transplant Recipients and Their Informal Caregivers. Biol Blood Marrow Transplant.25(1):145150.doi:10.1016/j.bbmt.2018.08.002https://pubmed.ncbi.nlm.nih.gov/30098393/
19.Shen A,Wu P, Qiang W, et al(2023). Predicting lymphedema self-management behaviours in breast cancer patients: A structural equation model with the Integrated Theory of Health Behaviour Change. J Adv Nurs.79(12):47784790.doi:10.1111/jan.15759https://pubmed.ncbi.nlm.nih.gov/37358074/
20.Evans BC, Coon DW, Belyea MJ, Ume E(2017). Collective Care: Multiple Caregivers and Multiple Care Recipients in Mexican American Families. J TranscultNurs.28(4):398407.doi:10.1177/1043659616657878https://pubmed.ncbi.nlm.nih.gov/27389911/
21.Tong H, Qiu F, Fan L(2022). Characterising common challenges faced by parental caregivers of children with type 1 diabetes mellitus in mainland China: a qualitative study. BMJ Open. 12(1):e048763. Published 2022 Jan 11. doi:10.1136/bmjopen-2021-048763 https://pubmed.ncbi.nlm.nih.gov/35017233/
22.Wehrli LA, Ariefdjohan M, Ketzer J, et al(2024). "Take It One Dilation at a Time": Caregiver Perspectives of Postoperative Anal Dilations in Pediatric Patients with Colorectal Conditions. Behav Sci (Basel). 14(5). Published 2024 Apr 30. doi:10.3390/bs14050379 https://pubmed.ncbi.nlm.nih.gov/38785870/
23.BURP, Shrivastava K, Rathod DH, Saha R, Kumari S(2024). Experiences of Caregivers in De-addiction Centers in Western Maharashtra, India: A Qualitative Study. Cureus. 16(8):e68155. Published 2024 Aug. doi:10.7759/cureus.68155 https://pubmed.ncbi.nlm.nih.gov/39347300/
24.Liu Y, Wheaton AG, Edwards VJ, Xu F, Greenlund KJ, Croft JB(2020). Short self-reported sleep duration among caregivers and non-caregivers in 2016. SleepHealth.6(5):651656.doi:10.1016/j.sleh.2020.01.015https://pubmed.ncbi.nlm.nih.gov/32331864/
25.Tong H, Qiu F, Fan L(2022). Characterising common challenges faced by parental caregivers of children with type 1 diabetes mellitus in mainland China: a qualitative study. BMJ Open.12(1):e048763. Published 2022 Jan 11. doi:10.1136/bmjopen-2021-048763 https://pubmed.ncbi.nlm.nih.gov/35017233/
26.Jose JM, Gawali G(2025). Exploration of Psychosocial Issues of Parents in Pediatric OncologyJ Pediatr Hematol Oncol.Published online Jul 28, doi:10.1097/MPH.0000000000003085https://pubmed.ncbi.nlm.nih.gov/4071944/
27.Covers MLV, de Jongh A, Huntjens RJC, de Roos C, van den Hout M, Bicanic IAE(2021). Early intervention with eye movement desensitization and reprocessing (EMDR) therapy to reduce the severity of post-traumatic stress symptoms in recent rape victims: a randomized controlled trial. Eur J Psychotraumatol.2021;12(1):1943188.PublishedNone.doi:10.1080/20008198.2021.1943188 https://pubmed.ncbi.nlm.nih.gov/34531963/
28.Wilson IM, Tan KC, Tan JYS, Jones L, Dawood K, Mack W(2025). "I (am) scared I will hurt him, then I will regret it forever": Singaporean caregiver perspectives and elder abuse risk. J Elder Abuse Negl.37(2):150-180. doi:10.1080/08946566.2025.2469054https://pubmed.ncbi.nlm.nih.gov/39989171/
29.Ivers JH, Harris A, McKeown P, Barry J(2021). Mothers experiences of the Parenting Under Pressure Program (PuP) in a Residential Therapeutic Community: A qualitative study. J Psychoactive Drugs. 53(3):230-237. doi:10.1080/02791072.2020.1856455https://pubmed.ncbi.nlm.nih.gov/33320076/
30.Lu S, Wu Y, Mao Z, Liang X. Association of Formal and Informal Social Support With Health-Related Quality of Life Among Chinese Rural Elders. Int J Environ Res Public Health. 2020;17(4). Published 2020 Feb 19. doi:10.3390/ijerph17041351 https://pubmed.ncbi.nlm.nih.gov/32093116/
