Nguyen nhan tram earn Cd nhidu nghien cim vd nguyen nhan tram cam, vi vay, cac each giai thich vd CO chd tao ra trim cam la khac nhau.. - Cae nghien cira tram cam tu gde do sinh hpc tap
Trang 1TRAM C A M 6 PHU NQ VIET NAM
Nghidn cihi nay la mdt phan cua de tai: Phu nit bi bao liK gia dinh dt/tx TruiJng Oai hpc Vanderbilt tai ira
PGS.TS 06 Ngpc Khanh
Tnrdng phdng Phong Tdm ly hoc Idm sdng \ ien Tdm ly hpc
PGS.TS Bahr Weiss
Khoa Peahody, Dai hoc Vanderbilt, I loa Ky
I T O M T A T
Trdm cdm Id mpt trpng nhimg rpi lpan tdm Ihdn phd biin nhdt vd gdy ra nhieu Idn hai vi sire khoe vd ldi ehinh nhdl trong cdc logi henh ve sire khoe tdm thdn Ty If trdm cam a phu nir cao hon gdp hai ldn so vai nam giin O I iet Xam cdc nghiin cira khdc nhau dua ra cdc ly le trdm cdm khdc nhau tiiy thudc vc'ip timg vung dia ly cua khdch thi nghien ciru \ghiin ciru ndy thuc Men v&i 243 phu nir dd kit hdn a 5 tinh thdnh trpng ca nuac Kit qua nghien ciru cho thdy, ly li I rdm cam a phu nir Viil N'li"
Id 5.0% Xhirng nguai sdng d ndng ihon cd nguy ca hi trdm cam cao him nhirng ngudi sdng a thdnh phd Phu nir Irong dp tudi tir 30 din 50 cd mirc dp trdm cam cao han so vdi phu nu dudi 30 tudi vd Iren 50 tudi Nhimg phu nir hi hao hdnh cd nguy ca
hi trdm cdm cao han nhirng phu nir khdng hi bgo hdnh Thai gian ket hdn cdng ddi ihi mifL dp trdm cam cdng cao
Tir khoa: Trdm cdm: Rdi hgn Idm thdn: Trdm cdm a phu nir Viet Nam
\gdy nhdnbdi 20/7/2015; \giiy duyet ddng hdi 25/12/2016
A B S T R A C T
Depression is one Ihe most common mental disorders It causes the greatest health and financial losses among mental health illnesses The rale of depression in women is IMice higher than that of men In Vietnam, different studies give different rates of people with depression, depending on Ihe geographical area.s of the stuliy participants This study conducted with 243 married women who come from 5 provinces and cities in Vietnam The results indicated that 5% of Vietnamese women have depres\ion People living in rural areas tend lo have higher risk of depres.sion than those living in cities Women aged 30 lo 50 had higher seventy of depression than
ll omen under 30 and over 50 years old The abused women are at higher risk of
depression Ihan those who are not abused Among these women, the longer duration
of marriage, the higher the level of depression
Key words: Depression Mental disorders: Depression among Vietnamese women
Trang 2Tram cam (depression) la mot trong nhimg roi loan tam than pho bien nhat
trong cae loai benh \ c sire khoe lam than Tram cam con la benh xuat hien dong
Ihdi vdi cac benh khae cao nhat 'ITico To chiie Y te The gidi tren the gidi co
khoang 200 trieu ngudi chiem gan 5,0°'o dan so cd cae trieu chiing tram cam
dicn hinh Rieng d Viet Nam ty le ngudi bi lr§m cam la 2.8°o (WHO 2000)
Nhicu nghien ciru eho lha> t\ lc phu nii bi tram cam eao htm nam gidl il nhat 2
lan (1)SM-1\'| Co nhieu nguyen nhan dan den Iram cam mdt trong nhirng ngu>en
nhan \e mat xa hpi la do ap lue cudc song Phu nir thudng chju nhicu ap luc
trong cupc song gia dinh hon nam gidi nhai la d Vict Nam noi van con nhieu
dinh kicn \c gidi Day co the la nuu\cn nhan dan den vice phu nir co t\ lc tram
cam cao ban nam gidi Tram cam ciing la benh ga) ra nhicu ton hai \c kinh te \a
la benh ga\ ra ihucmg tat Urn nhat trong cac loai benh tat eiia eon ngudi I y le
ngudi tu sat do tram cam nga> cang tang cao tren the gidi chiem 46.0% so ngudi tu
sal (Bourgeois, 1998)
O Vict Nam trong nhiing nam gan da\, van de siic khde tam than noi chung
vT tram cam ndi rieng da dupc Chinh phti eae co quan chiic nang va cac nha
nghien ciiu quan tam dac biet Nam 2012, Chinh phii da dua ra dc an 1215 Trp
giiip xa hpi va phue hoi ehirc nang cho ngudi lam than, nguiifi roi nhicu tam iri
dua vao cong ddng giai doan 2011 - 2020 Nhieu cong trinh nghien cim khoa
hpe ve tram cam dupc lien hanh vdi cac qu\ mo khac nhau Cac nghien ciiu ve
dich tc hoc cung da dua ra con so thong kc khae nhau vc tram cam nhu nghien
ciiu cua Ngd Ngpc lan \a Cao T icn Dire (2001) d mot phutmg cho thay ty le
ngudi mac benh tram cam la 3.4"o Trong khi tac gia La Thi Budi phat hien ra
CO 4.l*'.o ngudi mac benh tram cam d mot phudng trong mpt thanh pho ldn
Nghien cuu khac ciia \gu>cn Van SiC'm va cpng su d mot xa \iing nong thon
eho thii) ty lc mac Irani cam la 8.35"o dan so (dan theo Ngu\cn Kim Viet
2006) Cac nghien cuu lap trung vao tim hicu tir goc dp dich ic hpc ehua lim
ra nhirng khae biet \ e muc dp tram cam theo mpt so \cu to khac, dac biet chua
CO nghien cuu nao tap trung nghien ciru \an dc tram cam d phu nir co gia dinh
Nghien cuu nay nham tim hicu tram cam d phu nii d eac viing mien khac nhau
trong ca nudc de co dupc birc tranh chung vc tram cam IT phu nii Viet Nam la
can thiet
Khai niem tram cam
Co nhieu lac gia dua ra cac khai niem cung nhu bieu hicn khac nhau eiia
tram cam Tuy nhien, trong nghien cim na) ehiing toi six dung khai niem tram cam
cua Hiep hpi Tam ly hpc Hoa K\ Iheo do trdm cdm la trang thai buon chan \a
mai himg thii \(Ti cac hoat dong co the anh hudng den cac suy nghT hanh \i cam
xiic va cam giac hanh phuc ciia ca nhan Nhirng ngudi tram cam cam th^y bu6n lo
Trang 3kinh, dau ddn, khdng thd thu gian (Salmans, Sandra, 1997) Up cd the mat hung thit tham gia eac boat ddng mang lai nidm \aii, mit cam giac ngon mieng hoac an qua nhidu gap khd khan trong lap tmng chu > ghi nhd chi tidt dua i^ cac quyet djnh
va cd thd ed y nghi hoac da thu lir sat mat ngu hoac ngu qua nhieu, mdi met, mit nang lupng dau nhue co thd hoac cd cae van de ve lieu hda ("NIMI1 » Depression" 2012)
Nguyen nhan tram earn
Cd nhidu nghien cim vd nguyen nhan tram cam, vi vay, cac each giai thich
vd CO chd tao ra trim cam la khac nhau Ndi bat la cac hudng tiep can tir gde do sinh hpc mdi trucmg sdng nhan thire va hanh vi
- Cae nghien cira tram cam tu gde do sinh hpc tap trung vao nghien ciru
thuc trang tram cam cua eac thanh \ien trong gia dinh cac cSp song sinh nghien cuu mdi quan he gitta tram cam cua cha mc rupl vdi nhttng dira con da cho lam con nudi trong cac gia dinh khac nghien eiru eo che sinh hda, nghien cim > eu td van hda xa hdi dc tim ra mdi quan he gitta gen di truyen va tram cam Cac ket qua nghien cuu tram cam cua thanh vien trong gia dinh cho thay, gen di truyen cd kha nang la tac nhan gay ra tram cam Nhttng ngudi cd mdi quan h? gan vdi ngudi dupc chan doan tram cam (vi du, nhttng ngudi nhu anh em, con,
bd me ed 50% citng gen) cd kha nang bi tram cam nhicu hon gap 2 den 3 lan so vdi nhirng nguoi ma hp hang gan cua hp khdng bi tram cam (Oruc va edng s\r, 1998) Nghicii cira gan day nhat ciia I'rankel va edng su (2010) cung eho thiy trieu chung tram cam cao d cha me ed tuong quan vdi trieu chirng trim cam eao
d con Cac nha nghien cuu cac cap song sinh khing djnh ring, trim cam la do gen di iru>cn Ket qua njhien eOni cho thiy, cac eSp song sinh cimg trimg cd ty
le ca hai bj trim cam nhicu hon cac cap song sinh khac tning vdi ty le la 46% so vdi 20% (McGurtln ya edng su, 1996) Tuy nhidn, vi nghien cijm gia dinh va cic cap song sinh ed didm ydu la thucmg hp cimg cd mdi trudng sdng gidng nhau
nen khd khang djnh tram cam do mdi trudng huy do gen Chinh vi vay, nhttng
nghien cuu ve con nudi giitp giai quydt didm yeu nay Nhttng nghidn cira con nudi da so sanh nhQng ngudi dupe nhan nudi khi cdn nhd vdi cac anh em rupt vS anh em nudi Kcl qua cho thiy, mac dii sdng xa cha me rupt va dupc nudi trong mdt mdi trudng hoan loan khac (ydu Id trim cam phat sinh do mdi trudng dupc loai bd) nhung van cd mdi tuong quan thuan gitta mue dp trim cam d nhttng
ngudi dupe eho lam con nudi va bd me rupt cua hp (Wendcr va cpng s\f, 1986)
Phan Idn cae nghien eira ehi ra ring, nhttng dua Ire con nudi bi trim cam cd Chan doan tuong tu nhu anh cm rudt nhidu hon anh cm nudi 20% so vdi 5 - 10% (Harrington va cdng su 1993) Cac nghien cuu sinh hda tap Uung vao nghien ciiu cac ehat dan Uuycn than kinh tac ddng ddn trim cam Ngudi ta thiy ring, cac
Trang 4cue Mot nhom thudc gay nghien lam tang chai dan truyen than kinh serotonin \a
noradrenaline Nghien cim ciia Schildkraul (1965) dua tren co sd l\ ihuyci eho
rang, sinh boa dong vai tro quan trpng Irong tram cam da dua ra gia ihuycl rang
qua nhicu chat noradrenaline gay ra hung cam trong khi qua it chat do ga\ ra
Uam cam Nghien cim sau do ciing eho thay serotonin cung dong vai tro luong tu
- Cac nghien ciiu ve \ cu to van hoa xa hoi nhu la nguyen nhan ciia tram cam
gom nghien ciiu ciia Brown va Harris (1978), nghien eiiu ciia Nolen -1 loeksema
(1990) Cae kei qua thu dupe lir nghien ciiu ciia cac tac nay \ c cae nhom phu nii
CO hoan eanh kinh le xa hpi khac nhau cho thay cac nhdm phu nii do ed miic dp
tram cam khac nhau Cac nghien ciiu \e gidi tinh cho thay phu nii co t\ !e tram
cam cao hon gap 2 lan nam gidi bdi vai tro cua phu nu trong gia dinh \'a xa hpi
khac biel vdi nam gidi phu nii ehiu nhieu ap tuc hon nam gidi khi phai ganh vac
nhicu traeh nhiem hon nam gidi trong gia dinh nhung lai co chat lupng eupc
song thap ban nam gidi Mat khac phu nii thudng lam nhiing cong vice eo \ i the
thap, thudng bi qua tai \ e cong viec co quan \'a cdng \ icc nha chju nhicu ap lire
ve mat van hoa hon so vdi nam gidi \i \ a \ dc bi cang thang Nghien cihi ciia
I-ranke! va edng su (2010) chi ra ring, mau thuan Irong hon nhan co tmmg quan
CO y nghTa vdi trieu chiing tram cam ciia cha me \ a eon va mdi tuong quan na\'
la khac nhau ihco gidi tinh ciia cha me va eon Dae biet mdi quan he giira eac
trieu chiing tram cam ciia cha me \ a cac thanh to nhat dinh ciia bdi canh gia dinh
manh hon doi vdi con gai so vdi con Uai trong khi mdi tuong quan giiia cac
thanh to boi canh gia dinh va cac trieu chirng iram cam cua eon manh hon doi
vdi me trong so sanh vdi cha
- Nguyen nhan Uain cam con dupc ly giai dua vao diuyet hdnh vi (Lcwinsohn
(1979) Seligman (1975)) Cae luc gia cho rJng, tram cam la kcl qua cua qua
trinh hpc tap qua quan sat, ngudi tram cam il nhan dupc cac ciing co lich cue
tir xa hdi hp hi lusct vpng do lap nhiem Nhiing ngudi tram cam hpc dupc
rang, mdi Irudng sinh !> \a xa hpi nam ngoai kha nang kiem soat eiia ca nhan
vi \a> hp khdng co gang de thoat ra khoi nhiing dicu kicn kho khan
\'hd!i ihirc lieu cue la mpt trong nhiing nguyen nhan ciia tram cam dupc
Beck (1997) khang dinh Theo ong tram cam bat ngudn lir nhan ihLre sai lech
trudc nhiing sir kien anh hudng den con ngudi Con ngudi cd nhung loi trong
nhan thiic nhu khai quat hoa qua miic triru lupng hoa co chpn Ipc, khiing
hoang hda van de, nhiing su\ nghT am anh lam anh hudng den niem tin vc ban
than, vc the gidi xung quanh va vc tuong lai ciia hp
Phyong phap nghien ciru
Nghien ciru nay dupc thuc hien tren 243 phu nu da ket hdn d Ha Ndi,
Quang Ninh, Dong Nai Quang Ngai \a Thanh Hoa Tuoi Irung binh eua khaeh
Trang 5thd dupc chpn mdt each nglu nhien ti;ong danh sach phu nu cua phudng T?i
Ha Not khach thd la nhirng phii ntt sdng trong ndi Ihanh (cu dan do thj) T|i bdn tinh Quang Ninh Ddng Nai Quang Ngai va Ihanh Hda khach the la nhttng phu nu sinh sdng tai cac vung ndng thdn
Trong nghien cim nay chitng tdi dung thang do Tram cam PHQ-9 Thang
do PHQ-9 dupc du an "Thuc ddy chdm sdc sire khde ldm ihdn dtra vdo cdng ddng: thi diim md hinh chdm sdc kit hop tirng btr&c" do Quy Cuu chien binh
My tai Viet Nam thyc hicn djch va sua ddi thich nghi nen c(3 dp hieu lue \a dp tin cay cao khi dung cho ngudi Viet Nam Bang PHQ-9 gdm 9 cau hdi ve 4 mat nhan thuc, cam xuc, hanh vi sinh ly
Nhihig uieu chung phai keo dai il nhat trong 2 tuan Mdi cau tra ldi dupc gan cho gia trj tu 0 - 3, theo muc dp tang dan: (0) khdng ngay nap, (I) vai ngay ( 1 - 7 nga)) (2) hon mdt nua sd ngay ttong hai tuan ( 8 - 1 1 ngay) (3) gan nhu mpi ngay (12- 14 ngay) Trong nghien cim nay, he sd Alpha eua Cronbach ciia thang do la 0,89 cho thay dp tin cay tdt
De danh gia muc dp \a theo ddi can linh diem va phan loai Caeh tinh diem nhu sau: cdng diem cua tat ea cac cau Itt 1 ddn 9 tdng diem cao nhat se la
27 Viec phan loai theo ldng didm dupc tinh nhu sau:
^ Dicm 0 - 4 : Khdng tram cam;
+ Diem 5 - 9 : Trieu chirng ldi thidu cd nguy ep;
t Dicm 10 - 14: TVam cam nhe;
+ Dicm 15 - 19: Tram cam vtta;
+ Dicm 20 - 27: Tram cam nang
Ket qua nghien eihi
u Ty If phu nir hi Iram cdm
Kcl qua nghien cuu chi ra d bang 1 cho thiy, cd hom mpt nua sd khaeh th^ nghien cuu khdng cd diu hieu trim cam, 30,9% sd phu nO cd nguy co trim cam Mire dp phu ntt bj trim cam nhi; la 11,1%, trim cam vua la 3,3% va muc
dp nang la 1,6% trong tdng sd phu ntt dupc nghien ciru Nhu vay ty Id phu nu trong nhdm khach the nghien cuu bj trim cam tu nhe ddn nSng chidm khoang 16% va neu chi tinh t\ le phu ntt bj trim cam vua va nang la gin 5% So sanh ket qua nghien ciru ciia chimg tdi vdi kdt qua nghien cuu d My vdi phat hipn cd
tu 5 den 9°'o sd phu ntt \1> bj trim cam vua va nang, trong khi nam gidi My bj tram cam ehi chiem tu 2 den 3% eho thiy kdt qua nghien cira nay la phu hpp vdi tinh hinh chung tren thd gidi, luy nhien nim d ngu<>ng thip
Trang 6thuc tuong tu nen rat khd so sanh ket qua Tuy nhien khi so sanh ket qua nghien cuu nay vdi cae ket qua nghien ciru cua cac nha khoa hpc di trudc d Viet Nam tren mau chung ca nam va ntt thi thay ty le phu ntt trong nghien ciru cua chiing
tdi bi tram cam cao han ty le ngudi bi tram cam d khu vuc thanh thj (2.8%
trong nghien cira dich te hpc benh tam than cua Tran Van Cudng (2002) d cac viing dd thi khac nhau; 3,4% va 4,1% trong nghien cuu ctia Ngd Ngpc Tan
Cao Tien Due (2001) va La Thj Budi a vung thanh thj) nhung thdp han so vdi
ket qua nghien ciru nhdm khach the d ndng thdn cua Nguydn Van Siem la 8.35% tren tdng khach the nghien cira Cac con sd khac nhau nay cd the la do mau cua ehung tdi la phu ntt, vi vay se eao ban khi so vdi cac mau chung d vung thanh thj hay cac vimg kinh te xa hdi khac nhau luy nhien, mau nay cd dai dien ca ndng thdn lan thanh thj nen ty- le thap hon so vdi nghien curu d cac vung ndng thdn rieng biet Cac nghien cira cho thay, ty le sd ngudi dan bi tram cam d nhirng vung ndng thdn va kinh te kem sS eao hem neu so vdi khu vye do thj va kinh te phat trien
Bang I: Ty li phu nir bi trdm cdm theo cdc mirc dp
T y 1^ % phu nu
tram cam
Khong CO bieu hi^n 53.1
Co nguy
Cff
30,9
Mirc dp nhe
I I J
Mirc dp vira 3,3
Mure dp nSng 1,6
b Mure dp tram cdm a phu nir cd dp tuoi khdc nhau
Theo bao cao mdi nhat ciia Trung lam Kiem soat va Phong ngira Dich b?nh Hoa Ky (CDC), benh tram cam tang theo ty le thuan vdi ludi, ly le ngudi mSe benh tram cam trong dp tuoi 12 - 17 la 5,7% nhung den dp ludi 40 - 59 ty
le nay la 9,8% d ca hai gidi Rieng nhom ngudi d eae eo sd dieu tri than kinh tbi ly I? mac b?nh eao hem, mac dii dupc dieu tri so vdi nhiing ngudi binh thudng
Ket qua nghien ciiu ciia chiing toi cung phu hpp vdi kei qua bao cao ciia CDC khi cac con so trong bang 2 cho Ihay co mdi luong quan thuan giCia dp tudi va diem trung binh ciia miic dp tram cam cua khach the nghien ciru Ngudi eang nhieu tuoi eang co diem irung binh miic dp tram cam cao hon ngudi it ludi (R2 = 0.16 vdi p = 0,00) Cu the, nhdm ngudi dudi 30 tudi cd miic dp iriim cam thap nhat (DTB = 4,66), trong khi dd, nhdm lir 40 den 50 luoi cd miic dp trSm cam cao nhat (DTB = 7,95) Nhom khaeh the tuoi tir 30 den 40 eo didm
Irung binh ckc bieu hi^n tram cam cao hon mpt chiil so vdi nhdm khach the
tren 50 tudi Cu the, cd d^n 14,3% so khaeh the tir 40 den 50 ludi cd bidu hien
TAP CHi TAM LV H(X, Sd 1 (214) 1 -2017
Trang 7nhe Nhdm khach thd^lua tudi tu 30 den 40 cd ty le ngudi mic tram cam vua \i
nang dung thu hai (13.1% tren tijng khach thd lua tudi nay) Trong nhdm khich thd dudi 30 tudi chi cd 1.8% sd ngucri cd trim cam vua va nJng Cac khac bipt
vd muc dp trim cam trpng cac nhdm khach thd d liia ludi khac nhau cd >' nghta
\a Uidng ke khi so sanh Anova vdi kdt qua F = 4,91 va p = 0.00 Ket qua thu dupc trong nghien cuu nax hoan loan phu hpp vdi kdt qua nghien ciiu tren the
gidi \i anh hudng cua lira tudi ddn trim cam Cac nghien ciru eho thay ludi
khdi phat cua benh ttim cam trai dai tu giai doan 10 den 65 tudi tuy nhien lira
tudi thudng gap trim cam nhidu nhit la 25 - 44 tudi Nghien cim cho lha\ cd
khoang 24.0° o sd ngudi d lua tudi 48 bj trim cam trong khi nhttng ngudi tu 65 ludi trd Icn l\ lc trim cam chi khoang 10 - 15% Nhu vay Ida tudi tu 30 ddn
50 ed nguy co bj trim cam cao nhit bdi vi lua tudi nay la lua tudi dang sung sue dang tap trung vao lao ddng dd tich luy Lua ludi na\ cung cd eon dang tip tudi di hpc cd nhidu khd khan vd lam h' ctia tudi day thi do \ a> cha mc ed nhicu
ap lyc trong \ icc nudi da\' con
Bdng 2: Mdi ttrang quan giira tuoi va mirc dp lo du trdm cdm
M i i c dn t r a m
cam
Dicm trung
binh
Khong CO bieu
hi^n
Tram cam nh?
Tram cam vira
va n$ng
Dirol 30
t u o i
4.66
8<).:%
9.0%
I.X°
T i r 30 den
40 l u o i 6.76
73.7%
13.2%
13,1%
T i r 40 den
50 l u o i 7,95
66,7%
19,0%
14.3%
T r e n 50
t u o i 6.67
73.3%
2 0 , 0 %
6.7%
F 4.91 SiR 0,00
c So sanh mice dp Iram cdm giira phu nd' & nong Ihon va do thj Theo cac ket qua nghien cuu cua cac tac gia khac nhau it Vi?t Nam khi
nghien cuu d eac khu vuc khac nhau thi thiy cd sy khac bidt vd ly Id ngudi bj tram cam d cac khu vuc ndng thdn va dd thj Nhdm khach thd p khu vyc ndng thdn cd ly lc tram cam cao hon gip hai lin so vdi nhdm khach thd d dd thj (8.35°b so viVi 3.4% va 4.1% theo nghidn cuu cita Nguydn Van Siem Ngd Ngpc Tan va I.a I'hj Budi) Kcl qua nghien cuu eua chimg tdi cung phii hirp vdi eac kcl qua trdn gitta phu ntt d ndng thdn va thanh phd eung ed su khac bipt cd >'
56
Trang 8thap hon nhung ngudri d ndng thdn Thyc te cho thay ty le tram cam thudng tuong ddi cao d ngudi ngheo dan tdc thidu sd va nhung ngudi cd ngudn trp cap thip Nam 1978 Brpwn va Harris nghien cim 458 phu ntt d Nam London,
da phat hien rang, lang Idp xa hdi la mpt yeu Id anh hudng den mue dp tram
cam Nhttng phu ntt d tang Idp lao dpng cd hpan canh khd khan nhu ddng con thidu ban be than thich khdng ed vide lam them cd kha nang bj tram cam cao hem nhdm phu nu d tang Idp trung binh \a hoan canh thuan Ipi hon Nhttng ngudi timg thieu \ e mat kinh te thudng trai qua nhicu sy kien lieu eye trong cudc sdng ban nhimg ngudi kinh te kha gia vi \'ay hp de bj tram cam hon (Brown G.W va Harris T.O 1978) Nhu va\ eongviec ctia phu ntt d ndng thdn thudng khdng tdt nhu phu ntt d thanh thj (rong mau ehpn da sd phu ntt ndng thdn lam ndng nghi?p d nha lam edng nhan, trong khi phu ntt d thanh thj deu lam can bd, nhan vien cdng ty cdng \icc dn djnh) Ihu nhap cua phu ntt d Ha Npi cap ban, dicu kicn kinh tc kha hon so vdi phu ntt d ndng thdn chinh \ i \ a>
l> lc phu ntt d ndng thdn bj tram cam cao hon phu ntt n Ha Ndi !a dicu dc hicu Bdng 3: Ty li vd mirc dp trdm cdm & phu nir ndng thdn vd thdnh thi
Khong tram cam
Tram cam nhi;
i r a m cam vira va nang
Dicm trung binh mirc dg tram cam
Nong Ihon
33.3%
18.5%
4.9%
6.29
Thanh Ihi
30.9%
12.3%
0,0%
4.18
Tong
64.2%
30.9%
4.9%
Chi binh phinmg
10.95
T-test = 3.49
M i i e do c6 y nghTa
0.00
0,00
rf So sanh mirc do trdm cdm giira nhirng phu nir chiu hao hdnh khdc nhau bai chong ciia hg
So sanh muc dp bj bao hanh d cae hinh Ihuc khac nhau \ di muc dp tram cam d phu ntt kdt qua cho thay cd sy khae biet cd \' nghTa \ c mat thdng kc Cu the d nhdm phu nu khdng cd bieu hicn tram cam thi diem trung binh \c' tin suat \a hanh vi ciia cae dang bao hanh ma hp phai hung chju la rit thip (DIB
bj bao hanh v e the chat = 0.29; linh than ^2.47; linh due = 0.67 va kidm soat = 0,51), trong khi dd dicm trung binh ve tan suat va hanh \ i cua cac dang bao hanh thd chai tinh than, linh due va kiem soat d nhdm phu ntt cd nguy ca trim cam lin lupt la 2.44, 4.84; 0.88 va 1,16, nhdm phu ntt ed trim cam nhe la 2,69; 6,92;
TAP CHI TAM LV HOC, Sd 1 (214), 1 - 2017
Trang 9phu ntt ed muc dd tfim cam nJng cd diem trung binh muc dp bi b^o hanh rat
cao cu thd DTB bao hanh Nd thd chat la 14.5: bao hanh ve tinh than \i 15,75;
bao hanh vd tinh due la 1.75 va bao hanh dang kiem soat la 3,75 Ket qua nghien cuu trudng hpp didn hinh mdt lin ntta khang djnh bao hanh gia dinh la nguydn nhan gay ra trim cam d phu ntt Trudc khi ket hdn, ngudi phu nO khdng cp dau hieu ciia trim cam tuv nhien sau khi kdt hdn, bj ngudi chdng ludn mang chui, ndi chi la ngudi kem edl, ching bidt lam vice gi Chj ludn bi cang thang vi luc nap cung so minh lam sai va bj ming chui Ket qua la ch; bl tram cam nJng keo dai 10 nam Sau khi 1\ hdn khdng cdn bj nhiec mdc mang chui, ngum phy ntt nay da khdi ttim cam (Ca, phu ntt tri thuc 35 tudi Ha Npi)
Nhidu nghien cuu vd anh hudng ciia bap hanh ddn van de stic khde tam diin da khing dinh bao hanh gia dinh la nguyen nhan gay ra tram cam (Andrews
va Brown 1988; Astin va cpng sy,1993; Krug va cdng sy, 2002; Tang, 1997) Bao hanh gia dinh lam eho phu ntt m^c cam, ty ti giam sut ve mat sue khde, tinh thin, cam thiy bit lyc tdi te nen rit de din ddn tinh trang tram cam Ndi vd linh trang hdn nhan Herr va cpng sy cho ring, ca dan dng va phu ntt cd lich su trim cam ddu bao eao ring, hp it hai ldng vdi cupc hdn nhan cua
hp ban nhttng ngudi khdng cd tidn su trim cam (Herr, Hammen va Brennan, 2007) va cac trieu ehung trim cam eua vp va chdng cd tuong quan thuan vdi muc dp xung dpi hdn nhan (Cummings va cpng sy, 2005)
Nhu vay, cd thd kdt luan ring, tinh trang hanh phtic trong hdn nhan lit mpt
ydu td quan trpng anh hudng ddn sue khde tinh than cua ngudi phu ntt, cy the
la tinh tr?ng tram cam cua hp
Bdng 5: Diim trung binh mirc dp bi bgo hdnh & phu nir
cd mirc dd trdm cdm khdc nhau
Mire dQ bi
bao hanh
'ni chSt
Tinh thSn
Tinh due
Kicm soat
Mirc do tram earn Khong
Iram
cam
0.29
2.47
0.6^
0,51
Co nguy
CO tram cam
2.44 4.84 0.88 1.16
T r a m cam nhe
2,69 6,92 2,23 1.11
T r a m ciim vihi
3,25 7,62 2,12 0,75
T r a m cam nSng
14,50 15,75 1,75 3,75
F
9,13 15,82 4,60
8,09
Miircdp
CO y nghla
0,00 0,00 0,00 0,00
Trang 10So sanh khac biet gitta thdi gian kdt hdn vdi muc dp tram cam ket qua phan tich Anova cho thiy cd sy khac biet ve muc dp tram cam gitta nhttng phu ntt cd thdi gian kdt hdn khac nhau (F = 6.34 vdi p = 0.00) Nhttng phu ntt cd thdi gian ket hdn ngin nhit dudi 1 nam ed mue dp tram cam thap nhat (DIB = 4.57), sau dd den nhirng phu nu kdt hdn lu 11 den 20 nam (DTB = 5.35) muc dp tram cam cap nhat la nhdm phu ntt ket hdn tu 5 den 10 nam \ a nhdm ket hdn tren 20 nam Tu ket qua nay cd the khang djnh rang, cupc sdng hdn nhan la mdt tac nhan gay tram cam eho phu ntt Ihdi gian ket hdn cang dai ddng nghia vdi vice cd nhieu sy kien xay ra trong eupc sdng gia dinh (cpn ra ddi cang thing vi viec nudi day con lo lang cho vice hpc hanh cua con rdi dyng vp ga chdng cho con) cang cd nhicu tinh hudng nay sinh mau thuan vi cha me phai giai quyel nhicu vice trong gia dinh, eang cd nhieu kha nang gay cang thang cho ngudi phu ntt Nhdm phu ntt mdi ket hdn, chua cd con, cudc sdng hdn nhan mdi bat dau ehua
cd mau thuan nay sinh vi vay mue dp tram cam it nhat la dc hieu Nhdm phu ntt
da kcl hdn dupc 5 den 10 nam la nhdm cd con trong dp tudi an hpc va cha me can danh nhieu thdi gian cho con, trong khi kinh le gia dinh chua dupc dn djnh, phu ntt d lira tudi nay cd nhicu mdi ban tam Chinh \i \ay ma muc dp tram cam
d nhdm phu ntt nay eao nhat Nhdm phu ntt kcl hdn Itt 11 den 20 nam la nhdm
da dn djnh \ c kinh tc va vc con nen it ap lye cudc sdng hem Nhdm phu ntt cd Ircn 20 nam hdn nhan cung la nhdm phu ntt ldn ludi \ a thudng roi vao thdi ky tien man kinh day la thdi k\ khd khan cua phu ntt do \a\ nguy ep bj tram cam cung tang cao
Bdng 6: So sanh mirc dp trdm cdm & cdc nhdm phu nir
cd thai gian kit hdn khdc nhau
T h i n gian
kei hon
Mirc dp tram
c a m ( D n ) )
1 nam
4.57
2 - 5 nam 6.00
5 - 1 0 nam 10.08
I t - 2 0 nam 5.35
T r e n 20 nam 7.51
F 6.34
.Mu-c do CO
y nghla 0.00
Ket luan
Phu ntt Viel Nam cd ty lc tram cam d ngudng trung binh so vdi phu nu Iren thd gidi NhOng ngudi sdng d ndng thdn cd nguy co bj tram cam cao hem nhttng ngudi sdng d Ihanh phd Phu ntt trong dp tudi itt 30 den 50 cd muc dp trim cam cao hon so \di phu ntt dudi 30 tudi va tren 50 ludi Nhttng phu ntt bj bao hanh cd nguN ca bi tram cam cao hon nhttng phu ntt khdng bj bao hanh ITidi gian kcl hdn cang dai thi muc dp tram cam cang cao