اثربخشي يك مدل مداخله دلبستگي محور بر شاخص هاي سلامت و دلبستگي كودكان مبتلا به بيماري مزمن

Effectiveness of an attachment-based intervention on health and attachment indices in children with chronic disease

پژوهش حاضر با هدف بررسي اثربخشي يك مدل مداخله دلبستگي محور ويژه موقعيت هاي پزشكي با عنوان مثلث مادر- كودك- بيماري (MCDT) بر شاخص هاي سلامت و دلبستگي كودكان مبتلا به بيماري مزمن انجام گرفت. به اين منظور 22 زوج مادر- كودك واجد شرايط، پس از اعلام موافقت وارد طرح شدند. كليه كودكان با تشخيص يك بيماري مزمن در مركز طبي اطفال تهران تحت درمان پزشكي بودند. پرسشنامه دلبستگي به والدين و همسالان (IPPA) و مقياس هاي افسردگي بك- ويژه مراقبت-هاي اوليه (BDI-PC) و ادراك بيماري (IPI) توسط كودكان و پرسشنامه سلامت كودك- فرم والدين (CHQ-PF-28) و شاخص استرس والديني (PSI) توسط مادران تكميل شد. گروه آزمايش 10 جلسه مداخله دلبستگي محور و گروه گواه نيز همزمان 10 جلسه گفتگوي ساده به عنوان مداخله ساختگي دريافت كردند. يافته هاي پژوهش نشان داد كه كودكان گروه آزمايش پس از دريافت مداخله دلبستگي محور مذكور، بهبود معنادار در نمرات دلبستگي و زيرمقياس هاي سلامت شامل افسردگي، سلامت جسماني، سلامت رواني- اجتماعي و نمره كل سلامت عمومي در مقايسه با گروه گواه داشتند. نتايج پژوهش حاضر نشان مي دهد كه كاربرد مداخلات روان درمان گرانه، به ويژه مداخلات دلبستگي محور، در كنار درمان هاي پزشكي مي تواند به افزايش ميزان بهبودي و سلامت كودكان مبتلا به شرايط خاص پزشكي كمك كند.

The present study aimed to examine the effectiveness of a new attachment-based intervention model named Mother-Child-Disease Triangle (MCDT) on health and attachment indices in children with chronic disease. Twenty-two mother-child dyads were included in the study as volunteers. All the children were receiving medical treatment in Tehran Pediatric Medical Center hospital following a chronic disease diagnosis. In pre-test stage a battery of questionnaires were administered. This consisted of the Inventory of Parent Attachment (IPPA), Beck’s Depression Inventory- Primary Care (BDI-PC), and Illness Perception Inventory (IPI) which were completed by children, and a 28 item Child Health Questionnaire (CHQ-28) and Parenting Stress Index (PSI) which were completed by mothers. On the basis of pre-test scores, mother-child dyads were paired and then randomly assigned to an experimental or a control group. The experimental group received 10 sessions of MCDT intervention, meanwhile the control group received 10 simple conversational sessions, as a dummy intervention. Both groups were evaluated again by the tools after completing their respective treatment regimens. The analysis of data showed significant differences between the two groups after treatment and revealed significant improvement in attachment and health indices included depression, physiological and psycho-social health and total score of general health in the experimental group in pre-post-treatment stages compared to the control group. These finding suggest that using psychological intervention, especially attachment-based intervention, plus medical treatment, would improve the health and attachment indices in chronic disease inpatient children. Keywords: attachment, mother-child dyad, health, chronic illness