Abstract: Background　As an important indicator of mental health，resilience has long been a research hotspot of positive psychology，and has become one of the most important indicators for the evaluation of schizophrenia outcomes in recent years.Previous studies have shown significant correlation between self-efficacy，self-esteem，coping style and resilience among patients with schizophrenia，but mechanisms among these factors are not clear.Objective　To explore the relationship between self-efficacy and resilience in patients with schizophrenia and the chain mediating effect of self-esteem and coping style.Methods　A total of 367 inpatients and outpatients with schizophrenia in Chifeng Anding Hospital and the Third Hospital of Daqing，were selected from July to December 2017 by convenient sampling method.General Information Questionnaire，General Self-efficacy Scale，Self-esteem Scale，Simplified Coping Style Questionnaire and Connor Davidson Resilience Scale were used in this survey.We used Mplus 7.0 software to establish the structural equation model and the biased correction percentile Bootstrap program to test the mediating effect.Results　A total of 367 questionnaires were sent out and 350 valid questionnaires were returned，with valid response rate of 95.4%.Self-efficacy 1 score was（11.0±2.6），self-efficacy 2 score was（10.2±2.7），self-esteem 1 score was（12.6±2.3），self-esteem 2 score was（14.4±1.7），positive coping style 1 score was（9.3±4.5），positive coping style 2 score was（9.8±4.3），negative coping style 1 score was（6.9±3.1），negative coping style 2 score was（8.0±2.9），resilience score was（18.9±8.2），optimism score was（14.5±5.5），strength score was（6.2±3.0）.There was no linear correlation between self-esteem 1 score and negative coping 1 score and negative coping 2 score（P>0.05），but there was significant positive correlation between the scores of other dimensions（P<0.01）.Fitting index of the model showed good fit with χ2/df= 0.121 7，comparative fitting index（CFI）= 0.996，Tucker-Lewis index（TLI）= 0.993，root mean square error of approximation（RMSEA）=0.032.The mediating effect analysis showed that self-efficacy influenced the resilience through the path of “self-efficacy →positive coping style→resilience”（β=0.213，P<0.001） and “self-efficacy→self-esteem→positive coping style→resilience”（β=0.094，P<0.001）.The path coefficient of direct effect was 0.535 and sum of the mediating path coefficient was 0.307 which indicated that 36.5% of self-efficacy effect on resilience was mediated by the chain mediating effect of self-esteem and positive coping style.Conclusion　Self-efficacy was the predictor of resilience in patients with schizophrenia.High-level self-efficacy can promote the self-esteem of these patients and lead to positive coping style，so as to improve their resilience.

Key words: Schizophrenia；Self efficacy；Resilience, psychological；Self concept；Coping style

摘要： 背景　心理弹性作为心理健康的重要标志，一直是积极心理学的研究热点，且近年来已成为精神分裂症结局评价的重要指标之一。既往研究显示自我效能、自尊及应对方式与心理弹性呈显著相关关系，但因素间相互作用机制尚未明确。目的　探讨精神分裂症患者自我效能与心理弹性的关系及自尊与应对方式的链式中介效应。方法　采用便利取样方法于2017年7—12月选取赤峰市安定医院及大庆市第三医院住院及门诊收治的精神分裂症患者367例，采用一般资料调查问卷、一般自我效能量表、自尊量表、简易应对方式问卷、心理弹性量表进行调查，采用Mplus 7.0软件建立结构方程模型，采用偏差校正百分位Bootstrap程序检验中介效应。结果　共发放问卷367份，回收有效问卷350份，有效回收率为95.4%。自我效能1得分为（11.0±2.6）分，自我效能2得分为（10.2±2.7）分，自尊1得分为（12.6±2.3）分，自尊2得分为（14.4±1.7）分，积极应对1得分为（9.3±4.5）分，积极应对2得分为（9.8±4.3）分，消极应对1得分为（6.9±3.1）分，消极应对2得分为（8.0±2.9）分，坚韧性得分为（18.9±8.2）分，乐观性得分为（14.5±5.5）分，力量性得分为（6.2±3.0）分。除自尊1得分与消极应对1得分、消极应对2得分无直线相关性关系（P>0.05）外，其余各量表维度得分间均呈正相关（P<0.01）。模型拟合指数为χ2/df=0.121 7，比较适配指数（CFI）=0.996，非规准适配指数（TLI）=0.993，渐进残差均方和平方根（RMSEA）=0.032，表明拟合指数良好。中介效应结果显示，自我效能作用于心理弹性的中介路径包括“自我效能→积极应对→心理弹性”（β=0.213，P<0.001）和“自我效能→自尊→积极应对→心理弹性”（β=0.094，P<0.001）。直接效应的路径系数为0.535，中介效应的路径系数之和为0.307，表明自我效能作用于心理弹性的效应有36.5%是通过自尊与积极应对的链式中介效应所介导。结论　自我效能是精神分裂症患者心理弹性水平的预测因素，高水平的自我效能可以提高患者自尊水平，促使其采取积极应对方式，进而提升精神分裂症患者的心理弹性。

关键词: 精神分裂症；自我效能；韧性, 心理；自我概念；应对方式