中南大学学报 ( 医学版 ) 认知性情绪调节问卷在高血压病患者中的应用, 朱熊兆

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1 532 中南大学学报 ( 医学版 ) JCentSouthUniv(MedSci) 2011,36(6) CognitiveEmotionRegulationQuestionnaireinhypertensivepatients DUANShu 1,LIUYiqun 1,XIAOJing 2,ZHAOShuiping 1,ZHUXiongzhao 3 (1.DepartmentofCardiology,SecondXiangyaHospital,CentralSouthUniversity,Changsha410011; 2.DepartmentofPsychology,CapitalNormalUniversityEducationColege,Beijing100048; 3.CenterofMedicalPsychology,SecondXiangyaHospital,CentralSouthUniversity,Changsha410011,China) Abstract: Objective Toexaminethereliability,validity,andpracticabilityofCognitive EmotionRegulationQuestionnaire(CERQ)inhypertensivepatientsinChina.Methods Altogether 434hypertensivepatientsand462healthysubjectswererecruited.Althesubjectswereasesed withthecerq Chineseversion(CERQ C),DysfunctionalAtitudeScale(DAS),MoodandAnxi etysymptomquestionnaire ShortForm(MASQ SF),andCenterforEpidemiologicStudiesDepres sionscale(ces D).Wecalculatedthemeaninter item corelationsforthetotalcerqandfor eachofthesubscales.cronbach salphacoeficientwasusedtoanalyzetheinter corelationandreli ability,andconfirmatoryfactoranalysiswasusedtoexaminethe9 factormodel.results 1)Hy pertensiongroup reported significantly higherscore than thatofhealthy oneson rumination (12.19±2.51vs.11.51±2.60,P<0.001),catastrophizing(8.82±2.19vs.8.11±2.70,P< 0.001),andblamingothers(10.76±2.11vs.9.88±2.48,P<0.001),andhadsignificantlylow erscorethanthatofhealthyonesonpositivereappraisal(13.80±3.55vs.14.71±4.11,p< 0.001).2)Reliability:InthehypertensiongrouptheCronbach salphaforthetotalcerq was 0.80,andthatforthe9subscalesrangedfrom0.71(self blame)to0.90(rumination).inthe healthygroupthecronbach salphaforthetotalcerq was0.79,andthatforthe9subscales rangedfrom0.71(positivereappraisal)to0.90(rumination).themeaninter itemcorelationco eficientforthe9subscaleswas (thehypertensiongroup)/ (thehealthy group).inthehypertensiongroup,thetest retestreliabilityofthetotalscalewas0.82,thetest re testreliabilityofthe9subscalesrangedfrom0.73to0.92.theconfirmatoryfactoranalysisshowed thatthe9first orderfactordatafitedboth2sampleswel.conclusion CERQmeetsthepsycho metricstandardanditisreliableandvalidforcognitiveemotionregulationstrategies,whichmaybe regardedasanappropriateasesmenttool. Keywords: hypertension; cognitiveemotionregulation; reliability; validity; structuralequationmodeling 认知性情绪调节问卷在高血压病患者中的应用 段书 1, 刘轶群 1, 肖晶 2, 赵水平 1 3, 朱熊兆 (1. 中南大学湘雅二医院心内科, 长沙 ;2. 首都师范大学教育学院心理系, 北京 ; 3. 中南大学湘雅二医院医学心理研究中心, 长沙 ) [ 摘要 ] 目的 : 研究认知性情绪调节问卷 (CognitiveEmotionRegulationQuestionnaire,CERQ) 在中国高血压病患者中应用的信 效度及适用性 方法 : 在 434 例高血压病患者和 462 名正常人群完成 CERQ 中文版 认 Dateofreception Biography DUANShu,Ph.D,asociateprofesor,mainlyengagedintheresearchofmentalhealthandcardiacdiseases. Correspondingauthor DUANShu,E mail:duanshu@medmail.com.cn

2 CognitiveEmotionRegulationQuestionnaireinhypertensivepatients DUANShu,etal. 533 知失调性态度问卷 心境与焦虑症状问卷 ( 简式 ) 流调中心用抑郁量表 4 种问卷的评定 采用条目间平均相关系数 Cronbachα 系数及重测信度来检验 CERQ 的信度 采用 CERQ 的 9 个分量表分别与下列量表进行相关分析以评估 CERQ 的聚合与区分效度 : 认知失调性态度问卷 心境与焦虑症状问卷 流调中心用抑郁量表 采用 t 检验比较高血压病组与正常对照组的认知性情绪调节策略 采用单因素多变量方差分析比较认知性情绪调节策略的性别差异 结果 :1) 量表得分情况 : 高血压病组与正常对照组均在积极重新评价分量表得分最高, 灾难化分量表得分最少 而 2 组的认知性情绪调节策略的使用上差异有统计学意义 高血压病组在沉思 (12.19±2.51vs.11.51±2.60,P<0.001) 灾难化 (8.82±2.19vs.8.11±2.70,P<0.001) 责难他人 (10.76±2.11vs.9.88±2.48,P<0.001)3 个分量表得分明显高于正常对照组 而在积极重新评价分量表得分明显低于正常对照组 (13.80±3.55vs.14.71±4.11,P<0.001) 2) 信度 : 高血压病组中,9 个分量表的条目间平均相关系数在 0.21~0.42 之间 ; 正常对照组样本中,9 个分量表的条目间平均相关系数在 0.19~0.32 之间 高血压病组 CERQ 总的 Cronbachα 系数为 0.80,9 个分量表的 Cronbachα 系数在 0.71~0.90 之间 ; 高血压病组 CERQ 总的重测信度为 0.82,9 个分量表的重测信度在 0.73~0.92 之间 3) 结构效度 : 验证性因素分析结果显示 2 个样本中 CERQ 的 9 因子模型的拟合指数良好 结论 :CERQ 在高血压病患者中显示了良好的信 效度, 是用来评价中国高血压病患者的认知性情绪调节策略的有效且可靠的测量工具 [ 关键词 ] 高血压病 ; 认知性情绪调节 ; 信度 ; 效度 ; 结构方程模型 DOI: /j.isn Primaryhypertension(PH)isatypeofpsycho somaticdisease.psychologicalandsocialfactorsplay animportantroleintheoccurence,development, andprognosisofph [1].Garnifskietal. [2] proposed thatindividual semotion regulation strategies(or styles)weremeasuredfrom thesolecognitiveper spective. They developed the Cognitive Emotion RegulationQuestionnaire(CERQ)whichwascon structedonthetheoreticbasisofemotionregulation andsituationcoping.cerqisaself reportquestion nairedesignedtomeasurethecognitiveemotionreg ulationstrategiesorcopingstylesafterexperiencing negativeevents,andismainlyusedtoasesthe adaptabilityandstabilityofthosestrategies,namely, theactualcopingstrategyanindividualadoptsina specificsituationandtheprobablethoughtsorcogni tivestylesoftheindividualwhenencounteringstres events [3]. ThepresentstudyusedCERQ toasespa tientswithhypertension.a Chineseversionofthe questionnairewasdevelopedanditsvalidity,relia bility,andfeasibilityinstudiesofchinesehyperten sionpatientswasasesed,aimingtoprovideanef fectiveinstrumentforasesingthecognitiveemotion regulation strategiesofchinese hypertension pa tients. 1 SUBJECTSANDMETHODS 1.1 Subjects Participantsinhypertensiongroup Altogether434patientswererandomlyselected fromatotalnumberof1400patientsrecordedin5 top rankhospitalsandthehypertensioncentrein Changsha, Hunan Province, ofwhich223 were maleand211werefemale.theiragesrangedfrom 31to78yearsold,withameanageof53.66± Thepatientswhometthediagnosticcriteriaof GuidelinesforPreventionandTreatmentofHyper tension in China [4], more specificaly, systolic presure 140mmHg,and/ordiastolicpresure 90mmHg,andwhovoluntarilyinvolvedwereeligi bletoparticipateinthestudy. Patientswhohadapparentmentalretardation, severecognitivedysfunction,personalorfamilyhis toryofmentaldisorders,secondaryoracutehyper tension,coronaryheartdisease,diabetesmelitus, cardiac,cerebral, hepatic, and renaldeficiency, historyofsubstanceabuse,oruncooperativepatients wereexcluded Controlgroup The462carers(226malesand236females)of thepatientsinthehypertensiongroupconstitutedthe controlgroup.theirageswere34-75(54.40± 5.84)yearsold. Theparticipantswhose systolic presure was lesthan140mmhganddiastolicpresurelesthan 90mmHg,andwhovoluntarilyinvolvedcouldbein culed. Patientswhohadapparentmentalretardation, severecognitivedysfunction,mentaldisorders,his toryofsubstanceabuse,orchronicsomaticdiseases wereexcluded.

3 534 中南大学学报 ( 医学版 ),2011,36(6) 1.2 Methods Measurementprocedures Alparticipantsfiledoutthefolowing4scales undertheinstructions:cognitiveemotionregulation questionnaire (CERQ), Dysfunctional Atitude Scale(DAS),MoodandAnxietySymptomQuestion naire(shortform)(masq SF),andCenterfor EpidemiologicStudiesDepresionScale(CES D). Theparticipantswereinvitedtoatendthelectureon cardiovascularhealth,andcompletethescalesunder theinstructionofskiledqualifiedpsychologicaland cardiologyspecialists Instruments Personalinformationform:Aself designedform consistedoftheitemssuchasage,sex,profesion, education, income, diseasecourse, pastmedical history,andsoon. CognitiveEmotion Regulation Questionnaire:A self reportquestionnairedesignedbygarnifskietal. [2] in2001,andisusedtoasesthecognitiveemotion regulationstrategiesorcopingstylesofanindividualaf terexperiencingnegativeevents [5].Thehigherscoreis gained,themoreposibletheexamineeemploysthe strategy.thequestionnairewasintroduced by Zhu Xiongzhaoetal. [6],andhasbeenproventobeofgood reliabilityandvalidity.thisstudyadoptedthechinese versiontranslatedbyzhuetal. [6]. DysfunctionalAtitudeScale [7] :Aninstrument designedbyweismanandbeck(1978)tomeasure thedepresion relatedatitudes.itcanidentifythe potentialandspontaneousthoughts,andisbelieved tobeabletoidentifystablespecificdysfunctionalat titudes [6].Thescaleconsistedof40items,and7 pointscalerangingfrom totalydisagreetoagree stronglywithan8 factorstructure(vulnerability,at tractionandrejection,perfectionism,enforceability, needforapproval,dependence,autonomousatitude andcognitivephilosophy).ahigherscoresuggestsse verercognitivedysfunction.thecoeficientofinternal consistencyofthisscaleis0.87basedondomestic studyresults [7].Thecoeficientinthepresentstudy was0.87/0.82,whichwasuptotherequirement. Mood and Anxiety Symptom Questionnaire (ShortForm) [8 9] :Aself report,62 item question nairedesignedbyprofesorclarkandwatson [8] of theuniversityofiowain1991toasesspecificand non specificanxietyanddepresivesymptoms.the coeficientofinternalconsistencyofthisquestion nairewas0.78/0.76,whichwasuptotherequire ment. CenterforEpidemiologic Studies Depresion Scale(CES D):A self rating20 item scalede signedbyradlof [10] in1977forthepurposeofas sesingthepresentdepresivesymptoms,whichre quiresthesubjectstostatethefrequencyofrelevant symptomsorfeelings,occurswithinaweek.the sumofaltheitems scoresisthefinalscoreofthe measure.thehigherscoretheparticipantgets,the severerthedepresionis.accordingtoexistingfor eignresearch [5],thecoeficientofinternalconsisten cyofces D is0.90.inthisresearch,coeficient was0.89/0.83,whichwasuptotherequirement. 1.3 Statisticalanalysis Althedatawereinputandanalyzedwiththe statisticalsoftwarespss12.0 andamos5.0. The scales constructvaliditywasanalyzedusingamos 5.0.Comparisonofthe2groupsingender,nation ality,economicstatus,educationallevel,andpro fesionwasanalyzedwithchi squaretest.wecalcu latedthecronbach salphacoeficients,thetest re testcorelation,andmeaninter itemcorelationsfor thetotalcerq C andforeachofthesubscales. Pearson scorelationwasusedtoanalyzetheinter corelationsandtest retestreliability.a Pvalueof lesthan0.05wasconsideredsignificantlydiferent. 2 RESULTS 2.1 Personalinformationofthesamples Thehypertensiongroupconsistedof434 pa tients,including223malesand211females.the controlgroupcomposedof462subjects,ofwhich 226weremaleand236werefemale.Comparisonof personalinformation showed thatpatientsselected andthoseexcludedwasnotsignificantlydiferentin thesenseofdemography.therewerenosignificant diferenceinagesofthesamplesbetweenthehyper tensiongroupandcontrolgroup(53.66±6.49vs ±5.84;P>0.05).Diferencesbetweenthe 2groupswerenotstatisticalysignificant(P>0.05, Tab.1). 2.2 Characteristicsofcognitiveemotionregula tion strategiesand comparison between the2 groups Theresultshowedthatbothgroupsgotthehigh estscoresinpositivereappraisalsubscale,andthe lowestscoresincatastrophizingsubscale,andthat diferencebetweenthe2groupsincognitiveemotion

4 CognitiveEmotionRegulationQuestionnaireinhypertensivepatients DUANShu,etal. 535 regulationstrategieswasstatisticalysignificant.re sultspresentedintable2showedthatthehyperten siongroupgotsignificantlyhigherscoresthanthe controlgroupinthesubscalerumination(12.19± 2.51vs.11.51±2.60,P<0.001),catastrophizing (8.82±2.19vs.8.11±2.70,P<0.001),and blamingothers(10.76±2.11vs.9.88±2.48,p< 0.001),andgotlowerscoresinpositivereappraisal subscale(13.80±3.55vs.14.71±4.11,p< 0.001). Tab.1 Personalinformationofthesamples Indexes Hypertensiongroup(n=434) Samplesize/No. Samplerate/% Controlgroup(n=462) Samplesize/No. Samplerate/% χ 2 ortvalue P Gender Male Female Nationality Han Minority Income <2000 /month /month >5000 /month Profesion Farmer Oficial Worker Others Educationalbackground Inferiortojuniorhighschool Juniorhighschool Seniorhighschool Colegeandabove Ages(x±s)/years 53.66± ± ReliabilityofCERQ Cronbach sαcoeficient Cronbach sαcoeficientofcerqofthehyper tensiongroupwas0.80,andthatofthe9subscales was cronbach sαcoeficientofcerq ofthecontrolgroupwas0.79,andthatofthe9sub scaleswas Meaninter term correlation Mean inter term corelation (MIc) ofthe CERQwaslistedinTable1-3.TheMIcsofthe9 subscalesofthehypertensiongroupwere ,andthoseofthecontrolgroupwere Retestreliability RetestreliabilityofCERQ inthehypertension groupwas0.82,andthatofthe9subscaleswas RetestreliabilityofCERQinthecon trolgroupwas0.79,andthatofthe9subscaleswas AnalysisofCERQ Constructvalidity Resultsofconfirmatoryfactoranalysisshowed that:fitindexesofthe9 factormodelinthe2sam plesweregood.theχ 2 /dfvaluewas2.28(hyper tensiongroup)and2.34(controlgroup),respec tively,andbothwascloseto2andsmalerthan5. Comparativefitindex(CFI),incrementalfitindex (IFI),Tucker Lewisindex(TLI)>0.90,root meansquareerorofapproximation(rmsea) 0.08inbothgroups.

5 536 中南大学学报 ( 医学版 ),2011,36(6) Tab.2 Comparisonofcognitiveemotionregulationstrategiesbetweenthehypertensiongroupandcontrolgroup(x±s) Subscales Hypertensiongroup(n=434) Controlgroup(n=462) tvalue P Self blame 12.53± ± Acceptance 12.72± ± Rumination 12.19± ± Positiverefocusing 12.37± ± Refocusingonplanning 12.75± ± Positivereappraisal 13.80± ± Putingintoperspective 12.01± ± Catastrophizing 8.82± ± Blameothers 10.76± ± CorrelationanalysisofCERQ anddas Inthehypertensiongroup,scoresoftheself blame(r=0.14,p<0.01),catastrophizing(r= 0.55,P<0.001),andblaming otherssubscale (r=0.47,p <0.001) werepositivelycorelated withthetotalscoreofdas;scoresofthepositivere focusing(r=-0.21,p<0.01)andputinginto perspective(r= -0.27,P<0.001) scalewere negativelycorelatedwiththetotalscoreofdas; andscoresoftherestsubscaleswerenotsignificantly corelatedwiththetotalscoreofdas(p>0.05). Inthecontrolgroup,scoresoftheself blame (r=0.37,p<0.001),rumination(r=0.61,p< 0.001),catastrophizing(r=0.67,P<0.001), andblaming otherssubscale(r=0.49,p<0.001) werepositivelycorelated with the totalscore of DAS;scoresoftherefocusingonplanning(r= -0.27,P<0.001),andputingintoperspective (r=-0.33,p<0.001)werenegativelycorelated withthetotalscoreofdas;andscoresoftherest subscaleswerenotsignificantlycorelatedwiththe totalscoreofdas(p>0.05) Correlation analysis of CERQ and MASQ SF Scoresofnegativecognitiveregulationstrategies suchasself blame,rumination,andcatastrophizing werepositivelycorelatedwiththescoreofmasq; whereasscoresofpositivestrategiessuchaspositive refocusingandputingintoperspectivewerenega tivelycorelatedwiththescoreofmasq. 3 DISSCUSION Ithasbeenprovenbyconsiderableamountsof studies [5,11] thatemotionregulationstrategiesplaya crucialrolewhenanindividualencountersnegative incidentsandstresandiscloselyrelatedtomental health,andthattheconsequenceofdiferentstrate giesisdiferent.tostudythemechanismofemotion regulationstrategiesinmentalhealth,theprimary isueistoensurethevalidityandreliabilityofthe asesmentinstrument. Application ofcerq in severalcountrieshasprovenitsvalidityandreliabili ty.itcanbeusedtoasestheemotionregulation strategiesandcanbeusedtoasesnegativeemotion ofanindividualabove12yearsold.thechinese versionofthequestionnairewasintroducedbypro fesorzhuxiongzhaoetal. [6],andhasbeenproved tobeofgoodvalidityandreliabilitywithcolege studentsamples.however,noinstrumentformeas uringthecognitiveemotionstrategiesofpatientswith hypertensionisavailableinchinanow,soitisnec esarytostudytheapplicabilityofquestionnairein thisgroup,andtoprovidetheoreticbasisforthe emotionalinterventionofhypertension. Thehypertensiongroupgotsignificantlyhigher scoresthanthecontrolgroupinthesubscalerumina tion,catastrophizing,andblamingothers,andlower scoresinpositivereappraisalsubscale.rumination, catastrophizing, and blaming othersare negative cognitiveemotionregulationstrategies.sowecan seethatpatientswithhypertensiontendtoresortto negative, unreasonable regulation methods. They mayrecalandthinkovertheseeventsrepeatedly, which could magnify the influence and conse quences.ithasbeenprovenbymanyrelevantstud ies [12 13] thatnegativeemotionregulationstrategies suchasrumination, catastrophizing, and blaming othersarecloselyrelatedtotheemotionoftheexam inees.thesenegativestrategieswilnotcausede presionthemselves.onlywhenpromotedbysimu lative events wildepresion occurs. Depresive

6 CognitiveEmotionRegulationQuestionnaireinhypertensivepatients DUANShu,etal. 537 emotionhasanimportantinfluenceontheoccur rence,development,andprognosisofhypertension, sotoknowandcorectthenegativeemotionregula tionstrategiesisofgreatimportanceforphysicaland mentalhealthofpatientswithhypertension. Reliabilityreferstothestabilityandaccuracyof themeasuringinstrument.theoreticaly,itisthe extenttowhichthementalcharacteristicisactualy measured.themeasurementsofreliabilityvarywith sourceoferors.thepresentstudyusedcronbachα coeficientandmicfordiferenterorvariances.the Cronbachαcoeficientismainlyusedtodetermine thecorelation between theitems, theinter item consistency(i.e.,whetherdiferentpartsofthein strumentareconsistent),andtheextenttowhich accordantcontentorcharacteristicisobtained.as suggestedbygeorgeetal. [14] thatcronbachαcoef ficient>0.7isacceptable,<0.5suggestsbadreli ability.itisgeneralyacknowledgedthatcronbach αcoeficientbeing indicatesthatthereli abilityisgood,and >0.9meansthereliabilityis verygood.however,cronbachαcoeficientmayaf fectedbythenumberofitems,themoreitemsthere is,thehigherthecronbachα coeficientwilbe. MIc,isnotafectedbythenumberofitems,which difersitfromcronbachαcoeficient.micbeingbe tween0.1and0.5isacceptable [15].Inthepresent study,thecronbachα coeficientsofthegeneral scaleand9subscalesofthehypertensiongroupand thecontrolgroupwas and ,respectively,indicatingthatthereliabilityis quitegood.theresultwasinaccordancewiththat inholand(α= ;α= ), America(α= ),andFrance(α= ) [11].TheMIcofthegeneralscaleand 9subscaleswere and ,re spectivelyinthehypertensiongroupandthecontrol group, which were within the range recommen ded [8],andwereuptotherequirement.Althese factsindicatethatcerq isofgoodreliabilityin studyofpatientswithhypertension. Inthisresearch, confirmatoryfactoranalysis wasperformedtoasestheconstructvalidityofthe CERQ.Andthefitindexesofthe9 factormodelsin bothsampleswereacceptable,indicatingthatcerq hasastable9 factorstructurewithboththepopula tionwithandwithouthypertension.thestudywith colegestudentsusingconfirmatoryfactoranalysis cariedoutbyprofesorzhuxiongzhaoetal. [6] also foundthatthe9 factorstructureofcerqhasgood fitindex,whichfurtherprovedthestabilityofthe9 factorstructureofcerq intheapplicationtothe Chinesewithvariousagesandhealthstatus. ConvergentanddiscriminantvalidityofCERQ wasexamined using dysfunctionalatitude scale. Bothsamplesshowedsimilarspecificnegativecogni tivedimensions,whichwaspositivelycorelated.in thehypertensiongroup,thescoreofthecerqsub scaleself blame,catastrophizing,andblamingoth erswerepositivelycorelatedwiththetotalscoreof DAS;inthecontrolgroup,scoresoftheCERQsub scaleself blame,rumination,catastrophizing,and blaming otherswerepositivelycorelatedwiththeto talscoreofdas.inthehypertensiongroup,scores ofthecerqsubscalepositiverefocusingandputing intoperspectivewerenegativelycorelatedwiththat ofthedas; in thecontrolgroup, scoresofthe CERQsubscalerefocusingonplanningandputing intoperspectivewerenegativelycorelatedwiththat ofthedas.theresultsshowedgoodconvergentand discriminantvalidity. Inconclusion,wefoundthattheChinesever sionofcerq hasgoodreliabilityandvaliditywith peoplediagnosedwithhypertension.thestudycon firmed9 factormodelasumedbytheoriginaldesig nerandprovedthatcerq couldbeusedtoases thecognitiveemotionregulationstrategiesofchinese patientswithhypertension. REFERENCES: [1] 段书, 肖晶, 赵水平, 等. 心理社会因素在高血压中的作用及其研究进展 [J]. 中华高血压杂志,2008,16(12): DUANShu,XIAOJing,ZHAOShuiping,etal.Researchon theroleofpsychosocialfactorsinhypertension[j].chinese JournalofHypertension,2008,16(12): [2] GarnefskiN,KraaijV,deGraafM,etal.Psychologicalinter ventintargetsforpeoplewithvisualimpairments:theimpor tanceofcognitivecopingandgoaladjustment[j].disabilre habil,2010,32(2): [3] GarnefskiN,KraaijV.Cognitivecopingandpsychologicalad justmentindiferenttypesofstresfullifeevents[j].individu aldiferencesresearch,2009,7: [4] 中国高血压防治指南修订委员会. 中国高血压防治指南 (2005 年修订版 )[S]. 北京 : 人民卫生出版社,2006. Revision Commitee ofchinese Hypertension Guidelines. GuidelinesofChineseHypertension(2005version)[S].Bei jing,people smedicalpublishinghouse,2006.

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