JOURNAL OF SCIENCF OF HNUF SocialScience, 2017 Vol, 62, Iss 11, pp 158-166 This paper is available online al htlp-//sldb.hnue edu.vn DOL 10 I8I7.V2354-I067.20I7-0101 CACH UNG PHO VA MOI QUAN HE GlUA CACH UNG PHO V6l MU'C DO SANG CHAN TAM LI CUA PHU NU BAO LUC GIA DINH Le Thi Tubng Van Vien Nghien citu Pint nif Hoe vien Phu nit Viet Nam Toin tat Ong phd cua phu nfl hi bao lUc gia dinh lit moi yeu l6 quan irong, co mdi quan he nhil dinh vdi ,sang chin tam If ho, bieu hien dcac trieu chflng PTSD, trim cam, lo au, stress Dilu Ira 165 phu nfl bi bao lUc gia dlnh d linh Ha Nam va Ric Ninh cho thiy, Ung phd dinh hudng xiic cam va dinh hUdng ne tranh co mdi IUdng quan ihuan, ngUdc lai, ting phd dinh hudng giai quyel van de co mdi lUdng quan nghich vdi cac tneu chflng sang chin tam If cHa hg Trong dd, flng d]nh hudng xiic cam cd lUOng quan chat che nhat vdt bieu hien sang chan tim If d phu nfl bi bao lUc gia dinh Phiil hien cua nghien cflu cho thiy, cong tac can thiep, hd Ird cin giiip phu nfl tfch cUc tham gia boat dong hUdng din giai quyll cac vin dl lien quan den bao lUc gia dinh, han che each flng phd tap trung vao xuc cam hay ne tranh hoan ciinh ciia minh, cd the din din kha nang phat trien cac tneu chflng sang chin tam If nghiem hcfn Tif khoa: Phu nfl, flng pho, bao lUc gia dinh, sang chin lam If, PTSD Mci diu Sang chin tam If lii mpt van de dUdc nhac tdi nhieu lam If hgc hien dai, dung de noi den ket qua cua viec tilp xiic vdi (nhflng) sU kten cUc ki cang thang, pha v6 ciim giac an toiin cua ca nhan [5, 8, 9], lam cho cit nhiin cam ihiy bi de dga nghiem irong va bit lUc irong viec flng vdi nd Cang nhieu cam giac sd hai, bit luc, cang khd khan viec flng phd vdi sU kien cang thing Ihi cang cd nhieu kha nang ca nhan bj sang chin lam If [9, 10] Nhfl vay flng phd la mgt nhan lo quan Irgng de hieu vesang chan Iam If - cho dii nd rat phflc tap, bdi vi mdt mat flng CO the dUdc hieu nhU lit yeu td dU bao sang chan lam If, mat khac nd lai lii ket qua ciia sang chan tSm If (Mary Ann Dutton vit cdng sU, 2009) [7] Nghien cflu se trinh bay each flng phd va phan tfch mdi quan he gifla cac ciich flng phd vdi mflc sang chin tam If d phu nfl bj bao lUc gia dinh Ngay nhan bai: 15/3/2017 Ngay siia hai 11/7/2017, Ngay nhan dang: 20/10/2017 Lien he: Le Thi Titclng Van, c-mail; ievananhtbi]@gmail,com Cach t/ng phd vd nu'ii quan he giita cdth itng phd vdi mtfc dd sang chdn tdm li Noi dung nghien cihi 2.1 Khach the va phiroing phap nghien cii'u 2.1.1 Khach the nghien cihi Nghien cflu dieu tra bang bang hdi 165 phu nfl bj bao Iflc gia dinh tai xa/ phudng Ihuoc tinh' Phudng Thanh Chau - thiinh Phu Ly, xa Thanh Hfldng- huyen Thanh Liem (Ha Nam); xa Cach Bi va Ngoc Xa, huyen Que Vo (Bic Ninh) 113 ngudi da hoac dang tham gia cac cau lac bd phong chong bao lUc gia dinh (chiem 68,3%), Irong dd, hg dUdc truyin thong niing cao nhan thflc va dUdc tap huin ve ki nang phan flng v6i bao lUc gia dinh Do tudi trung binh ciia mau lii 48: nghe nghiep chu yeu la Iam nong nghiep (72,7%) Dungcu * Sang chdn tdm li: Nghien cflu lim hieu bdn bieu hien cua sang chin tam If, gdm rdi loan stress sau sang sang chan (PTSD), tram ciim, lo au vii stress Trong do, sU dung bang kiem PTSD danh cho DSM'5* [Diagnostic and Statistical Manual of Menial Disorders - version (So lay Thdng ke va Chan doan cac Roi loan Tam than phien ban ihfl cua Hiep Hoi cac nha Tam than hgc My (American Psychiatric Association), Thang 5/2013] (The PTSD Checklist for DSM-5/PCL-5) de danh gia 20 trieu chflng cu the cua PTSD [8]; ddng thdi diJng thang DASS-42 (Depression, Axiety and Stress Scale 42 items) vdi ban dich dang dUdc dung de chan ddiin tai Khoa Tam than Benh vien Bach Mai) de danh gia cac trieu chflng tram cam, lo au, stress * Cdch ling phfl: Nghien cflu tham khao Bang kiem flng vdi cac tinh hudng cang thing (Coping Inventory for Stressful Situations /CTSS) (Endler & Parker, 1990; Avero, P., Corace, K, M., Endler, N S , & Calvo, M G., 2003) (dt Le Van Hao, 2014) [I] phien ban 21 item Trong dd, 10/21 item cua CISS da dUdc sfl dung vii bd sung them cau mdi cho phu hdp vdi khach the nghien cflu Tong so 18 item theo cac each flng phd khac dUdc xap sep xen ke vdi DUa tren sU phan bd diem dat dUdc danh gia ve each flng phd, chung tdi chia thang mdi each flng phd lam nhom nhU sau: Bdng I Cdc nhdm diem thang cdch dng phd ciia phu nif bi bao luc gia dinh Cach uHg Ung dinh hudng xuc cam Ung djnh hudng giai quyel van de Ung phd dinh hUdng ne tranh 2.2 Mu'c thap I,6I Ket qua nghien cull 2.2.1, Mot so van de li luan ve each u'ng cua phu nit bi bao lufc gia dmh T^ng phd (coping) dUdc hieu la cac nd lUc vl mat nhan ihflc va hiinh vi thay ddi thudng xuyen degiai quyet cac ddi hdi cap bach tfl ben ngoiii hoac ben irong hoac la ca hai (Corsini, 1999, tr.223) [dt.l] Cach flng phd la sU chu ddng lfla chgn nhflng phUdng an, nhflng each thflc flng phd cu the cho mgt tinh huong cu the ma ca nhan cam thay la phu hdp vdi hoan canh cua hg Xem xet mgt sd If thuyet ve flng phd cua cac tac gia Lazarus & Foikman (1986); Carver C.S.vaScheierM.F (1989); Vitaliano P.P (1990): Cox vil Ferguson (l991):Ensel WM.LinN (1991) , chiing tdi thay cd each flng phd da dUdc nhieu nha tam If hoc ndi den dUdi cac hinh thflc khac nhau, phu hdp vdi ddi tUdng ciia nghien cflu niiy, dd la: flng phd dinh hudng giai quyel 159 LeThi Tudng Van van d l ; flng phd dinh hfldng cam xuc; va flng dinh hUdng ne tranh (dt Phan Thi Mai Hudng, 2007; Le Van Hao, 2014, DUdng Thj Kim Oanh, 2013) [1, 3, 4] - Ung phd dinh hfldng giai quyel van de- Cach flng mang tinh chit tfch cUc, thfch nghi lot vi the hien sU nd lUc tap trung vao nhflng vin de cin giat quyel, ddng thdi Ihflc hien mdt sd boat dgng nham muc dfch giiii quyet van de hoiic thay ddi van de lien quan den bao lUc gia dinh va linh Irang khd chiu (do bj sang chin tam If) cua ban than Bdi vay, each flng phd niiy cd the giup phu nfl giam nhe cac irieu chflng sang chan tam If hdn nhflng each flng phd khac - Ung phd dmh hUdng cam xuc Muc dfch cua phu nfl flng phd theo each niiy la de giam cang thing, va thich nghi tam thdi vdi tinh hudng da xay ma ho coi la khong the thay doi dUdc Hp chip nhan bao lUc gia dinh nhu mgi phin cua sd phan ihong qua cam xuc cua ca nhan hoac mong muon lim kiem vii nhiin dUdc sU Ihau hieu, dong vien, an lit va sU ho trd tfl ngfldi khac Tuy nhien, ve mat dai han, nhflng cang thing cd the cang tich luy, don nen tang them vii dan den cac he qua nhu phat trien ihanh cac trieu chflng Io au va tram cam, Ngudi flng phd theo phong each djnh hudng cam xuc IhUdng cd phan flng nhu tflc gian, Uu phien hay cd bj am anh (Le Van Hiio, 2014, tr.34) [1], nen cd the dU bao sang chan liim If nhieu hdn - Ung phd ne tranh cd the mang tinh thi'ch nghi ve mat ngin ban ddi vdi cac vin de khong the kiem soat dUdc hay vUdI kha nang, ngudrl lUc tam li cua cii nhan Ne tranh theo kieu lang Iranh, chay Iron la nham cd quen di nhflng gi dang liim ho cang thang, sd hai bang sU cd gang liim ngd hoac bang cac hoat ddng xoa diu tinh than khac nhu tim den chat kfch thfch (rUdu, chit gay nghien ) (Le Van Hao, 2014, tr.34) [1] Nhflng viec niiy h i u hit khdng xay bdi canh van hda Viet Nam, mil phu nfl ihudng "chay tron" vao cac boat dong khac nhfl: di xem bdi, di le chua cau may man, binh an flng phd ne tranh da dUdc phat hien lii yeu td dU bao sang chin tam If nghiem irgng hdn (Dutton, 2009) [7;tr2l5-2l6] Nhu vay, cac each flng phd khac se lien quan den sang chan tam If cua phu nfl bj bao lUc gia dinh d cac mflc khac 2.2.2 T h y c t r a n g each ihig phd cua p h u nu* bi b a o lUc gia d m h 1.42 Bieu Cdc cdch ifng phd vdi iinh trang hi tdn thUdng ldm li ctia phu nQ bi bao life gia dinh (ddn vi tinh: DTB) Khi d hoiin canh bi bao Iflc gia dinh va bat dau cd nhflng bieu hien cua sang chan tam li, ngUdi phu nfl se cd nhflng cam giac rit khd chiu, khdng thoai mai ve nhilu mat, nen thdng C-acn lfng pno va moi quan ne giUa cdch ifng phd vdi miic dd sang c hdn Idm li Ihudng hg se phai lam gi dd de ddi phd/giai quyet tinh trang bat on niiy Kel qua khao sal cho thay, each flng djnh hfldng giai quyet van de dUdc lUa chgn nhieu nhit (DTB =1.42); each flng phd dmh hfldng xuc cam dUdc lUa chgn it nhit, the hien d diem trung binh thip nhil (DTB =0,70) Tren IhUc te, da so phu nfl dUdc phdng van da hoac dang tham gia vao cac chUdng trinh phdng chong bao lUc gia dinh vii ho trd nan nhiin (chiem 68,3%) nen ho da dUdc trang bj nhflng kien ihflc, kT nang khoa hoc nhit dinh de ddi phd vdi linh trang bao life gia dlnh, cung nhU tU hd trd cho ban than Ket qua la phan dong phu nfl da cd each flng phd kha tfch cUc Bieu hien cu the cac each flng phd cua phu nfl bi bao lUc gia dinh nhU sau: * Ung dinh hifdng gidi quyet vdn de: Bang Ung dinh hudng gidi quyet vdn de cua ph u nUbibao lUc gia dinh Cac bieu hien DTB DI,C Cac mu'c (%) Khong Mot Khd Rdt CO chiu nhieu nhieu Co gang lap trung vao cong viec lioac cham lo gia dinh de quen di nhflng suy nghT lien quan den 1,09 1,96 16,2 13,2 28,4 42,1 bao IUC gia dlnh Co gang tham gia vao cac hoat dong xii hoi, cong d6ng de quen di bao lljc gia d'mh va n5i bufln l,.'i8 1,13 23,4 22,3 27,4 26,9 ciia biin thiin Noi chuyen, chia se vdi ngu6i than, ban be vg 1,82 0,99 10,2 28,9 29,4 31,5 nhflng cam giac, suy ngliT va tinh Irang ciia minh DSn tram y te xii/ phudng de thiim Icham/ di6u 0,32 0,77 74,1 15,2 3,6 7,1 Iri benh va tfl van ve sdc Ichoe tinh than Den cac cti s3 CO chuyen mon tchac (nhu bac s7 tfl nhan, benh vien, nha lam lanh, phong tfl vin ) 1,00 65,0 12,7 14,2 8.1 detham kham, dieu tri benh va tfl vin ve siic khtie 0,61 tinh thiin Co gang litm mot s6 viiic gi di: thay dcii tinh 1,12 22,3 26,4 23,4 27,9 I,.'i7 hinh bao lire gia dinh 11,7 24,4 10 Tfl an Qi de khong cam thSy cuoc s6ng l6i te 1,81 1,04 29,9 34,0 11 Lam viec gi dt; ft phai nghi ve nhflng viec lien quan den bao liic gia dinh (xem tivi, du hch, 1,.51 1,06 21,3 25,9 30,5 22,3 dgc bao, ngii, den nha ban .) 12 Co ging lac quan va nhin nhan moi viec lich 28,4 22,3 18,8 30,5 1,66 1,13 cflc hdn ting dinh hucing gidi quyet vdn de 1,42 0,61 Trong each flng dinh hudng giai quyet van d l , phu nfl thudng cd gang tap trung vao cdng viec hoac cham Io gia dinh de quen di nhflng suy nghT lien quan den bao Iflc gia dinh (DTB= 1,96); not chuyen, chia se vdi ngUdi thiin, ban be ve nhflng cam giiic, suy nghT vii tinh trang cua minh (DTB=1,82), t u a n ui de khong cam Ihiy cugc sdng ldi te (DTB=1.81), hoac cd ging tham gia vao cac hoat dgng xahdi, cdng ddng de quen dt bao Iflc gia dinh vanoi budn cua ban than (DTB=I,58)viec tham gia vao cau lac bd phong chdng bao lUc gia dinh cung dUdc coi la mpi nhflng boat ddng cgng ddng dd Dang chu y la nhflng viec can thiet nhu: "den tram y te xa/ phudng de tham kham/ dieu 161 LeThi Tudng Van Iri benh va IU van ve sflc khde tinh lhan"; hoac "den ciic cd sd cd chuyen mon khac (nhU bac sT lu nhan, benh vien, nha tam liinh, phdng IU van ) de tham kham/ dieu tri benh vii tU van ve sflc khde linh than" thi mflc dd thflc hien thip nhit (DTB lin lUdt la 0,32 vii 0,61) Trad ddi vdi phu nfl bi bao lUc gia dinh cho thay, mgt so chi len iram y le xa/ phudng de kham, dilu iri nhflng trUdng hdp bi bao lUc gay thUdng tfch nghiem trgng nhU: bi chong tat tdi mflc bi riich mat, moc mat ngoai phai di khiiu; cd nhflng vet rach diii gay chay nhieu mau phai di khau, ran xUdng/ gay XUdng; ngat xiu, Nhflng phu nfl tu den cac cd sd cd chuyen mon khac (nhfl bac sT tfl nhiin, benh vien, nha tam lanh, phdng lU v a n , ) de tham kham/ dieu trj benh va IU vin ve sflc khde tinh than" la nhflng irUdng hdp bj bao lUc ciia chdng gay IhUdng ti'ch nghiem trgng hdn (nhu bi dii vao bung dudi gay dau bung dUdi, rong kinh nhieu ) * X^ngphd dinh hudng ne trdnh: Bdng l^ng dinh hudng ne trdnh cua phu nii bi bao li^c gia dinh DTB DLC Cac miic (%) Cac bieu hien Khdng Mdt Khd Rdt chut cd nhieu nhieu Bo di khoi nha mot Ihiji gian cho khuiiy khoa 1,17 0,86 26,7 33,3 36,4 3,6 15 Khong iam gi, de lau roi mpi vin delflkhoi/tfl 0,58 0,47 6L8 24,8 7,3 6,1 mat di 16 Di le chiia nhieu hdn 0,69 0,57 58,2 24,2 7,9 9,7 17 Di xem bdi ve tUdng lai, s6 phan ciia minh 0,37 0,34 69,1 27,9 0,0 3,0 0,99 tjngphd ne trdnh (1,61 Cach flng phd bien thfl hai cua phu nfl bj bao lUc gia dinh mang tfnh dinh hudng ne tranh, vdi DTB= 0,99 Tuy cd nhieu phu nfl da dUdc tham gia vao cac chUdng trinh hd Ird phdng chdng bao lUc gia dinh, nhung each flng phd djnh hudng lang tranh hay chay trdn vin dUdc lUa chgn kha nhieu, giiip cho nan nhan han che phai tiep xuc, doi dien vdi cac sfl kien bao lUc gia dinh gay cang thing cho hg Su ne tranh cdng la bieu hien ve mat hanh vi cua nhflng khd khan tam If dau tranh chong lai bao lUc gia dinh (Ly Thj Minh Hing, 2013) [2] Hanh vi phd bien nhat each flng phd labd di khdi nha mgt thdi gian cho khuay khda, chiem 73,3% (DTB-1,17), hoac di Ie, di chua cau an nhieu hdn (DTB=0,69) Phu nfl bj bao lUc gia dinh chia se ring, cugc song cua hg nhU dja nguc, cd the mgt mat hg vfla phai chiu dUng dau kho tfl cac cugc bao lUc tfl ngfldi chdng, mat khac, ho bj hanh bdi nhflng bieu hien sang chan tam If Cho nen, du vao thdi diem bao lUc dang dien hay khong dien Ihi hg vln cam thay cupc sdng cua ho la toi te De chay Iron, lang Iranh cam giac niiy, nhieu chi dii dl le nha thd, di chua nhieu hdn de cau mong, hy vgng sU binh an se den va dau dc dfldc than hdn Cd chi cho biet, tuin riim nao cung len chua, hoac cac cu di Ie d xa, nhU Nghe An, Lao Cai cung cd theo So phu nfl tim den viec xem bdi ve tfldng lai, sd phan cua minh il nhit (DTB= 0,37), nhung cung chiem gin 1/3 sd ngudi dUdc phdng van (30,9%) Mdt sd phti nfl khac khdng lam gi, de lau cho mgi van de tfl khdi/tu mat di (DTB= 0,58 vdi 38.2% phu nfl cd hiinh vi flng phd d cac tan suit khac nhau) Trong bdi canh van hda Viet Nam, khong dng phd ne tranh bang each sfl dung rUdu hay lam dung cac chit gay nghien khac Nhin chung, viec sfl dung each flng phd ne Iranh thudng phan anh nhflng trUdng hdp phu nfl cam thay vUdt qua sflc/vUdi qua kha nang ngudn iflc tam li ma hg ihiy khdng cdn tin tfldng vao each nao khac cd the giup ho vUdt qua tinh trang cang thing, nen nd la yeu to lam cho sang chan tam If CO the tang len Cdch ling phd vd mdi quan he giita each itng phd vdi mUc dd sang chdn tdm li * Ung phd dinh hudngxuc cdm: Cach flng phd djnh hudng xuc cam ft cd phu nfl lUa chgn hdn ca, diem trung binh chi la 0,70 ThUc te cho thiy, hanh vi gay bao lUc cua ngUdi chdng rat khd thay doi, lam cho vdng trdn chu ki bao Iflc lap di lap lai nhieu lan vii tbudng theo xu hUdng tang nang hdn Bdi viiy, nhieu phti nfl danh chap nhan bao lUc nhu lii mot dieu khdng may cua so phan va ho phat dung each flng phd de mong dUdc giam cang thang, dau budn, va sd hiii, lo ling tam thdi Hanh vi phd bien nhat each flng phd la: chap nhan mdt ihUc te lii nhflng vu vtec bao lUc dd da xay (DTB=1,38); dau hang vi tin la khong the thay ddi dUdc tfnh net cua chdng (DTB=1,2I); va than than trach phan, cho rang sd minh khd (DTB=I,I7) Thai dd chip nhan, dau hang hay viec than than trach phan nhu vay khien cho phu nfl lU xoa diu ban than de cam thiy d6 chiu hdn, de chip nhan (linh trang bao lUc) hdn, vi biet rang sd phiin minh la nhU vay, khong co lUa chgn nao khac Tuy nhien, nd cung phan anh mot sU cam chju, khien phu nfl phiii kim nen cam xuc nhteu hdn, khdng cd ldi cho sU phat trien cac tneu chflng sang chin Iam If Bang Ung phd dinh hudng xiic cdm cua phu nu: bi bao lUc gia dinh DTB DLC Cac bieu liien C a c m ^ c d o (%) Khong Mdt Khd cd chut nhieu Than than trach phan, so minh khd M7 0,86 26,7 36,4 33,3 Dau himg vi tin la khdng the thay doi dfldc tfnh 1,21 18,2 1,02 41,8 17,6 anh iy 13 Chip nhSn mdt thflc le la nhflng vu viec bao L38 1,05 26,7 25,5 30,9 Iflc dd da xay 14 The hien cam giac tieu cflc- cau gat, giiin dii, budn ba, trim tu, lo ling 18.Nhan/ mong nhan dU(3c sfl an ui, dpng vien va Ihiu hieu tfl mdt sd ngfldi khac Vng phd dinh hudng xiic cdm Rdt nhieu 3,6 21,8 17,0 0,47 0,45 74,8 4,9 19,0 1,2 0,70 0,68 51.3 29,2 16,8 2,5 0,70 0,59 Ngoai ra, nhieu ngfldi nhan hoac mong nh n diioc SII an i, dong vien va Ihau hieu tti mo so ngudi khac (DTB=0.70); hay the hien nhflng ciim giiic tieu cUc cua ho nhU: cau gat gian dfl, budn ba, tram tU, lo l a n g (DTB=0,47) Tdm lai, dac diem chung cua each flng phd dinh hudng vao cam xuc la cd the giup phu nfl bj bao luc gia dinh tam ihdi giam nhe sU cang thang, khd chiu, dau budn de thi'ch nghi, nhung nd the hien sU chap nhan, cam chiu cua phu nfl, nen ve litu diu, nd cd the lam lang them cac cam xuc lieu cUc va dSn din cac he qua nhU lo au, tram cam, PTSD - liim cho sang chan tam If cd the ird nen nghiem trgng hdn 2.2.3 Moi q u a n h e giira each ihig phd vdi mu'c sang c h a n t a m li cua p h u nU bi bao lire gia d m h * Tudng quan giUa cdc cdch ding vdi sang chdn tdm li ciia phu nH bi bao lUc gia dinh Ket qua phan tfch cho thay, mac du each flng phd dinh hfldng giai quyet van de cd IUdng quan it chat che nhil nhflng la each flng phd nhit cd IUdng quan nghjeh vdi sang chin tam If (r = - 0,162* va P