女性类风湿关节炎住院病人心理健康和生活质量状况及其认知行为干预研究

发布时间：2018-01-12 17:04

本文关键词：女性类风湿关节炎住院病人心理健康和生活质量状况及其认知行为干预研究　出处：《安徽医科大学》2008年硕士论文　论文类型：学位论文

【摘要】： 目的调查了解女性类风湿关节炎(rheumatoid arthritis, RA)住院病人焦虑和抑郁症状的流行状况以及生活质量状况;探讨身体疲劳、社会支持、应对方式及婚姻调适度等因素与女性RA住院病人焦虑和抑郁症状及生活质量的关系;探讨认知行为干预方法对降低女性RA住院病人焦虑抑郁症状,提高其生活质量的有效性和可行性。方法定性研究现场为安徽省中医院风湿科,以安徽省中医院2006年8月1日至2006年9月30日在风湿科住院的女性RA病人为研究对象,应用个人深入访谈的方法,对20例符合临床诊断标准的女性RA住院病人按照统一的访谈提纲进行访谈。调查员在调查对象签署知情同意书之后,遵循自愿、保密和匿名的原则,由经过培训的专业人员按照统一制定的访谈提纲进行个人深入访谈并录音。访谈内容包括RA疾病的发生、发展状况及病人的社会支持状况、病人的心理健康状况及对心理健康服务需求的内容和形式、对不良情绪的调节能力、临床服务的内容和方式。每次访谈时间大约1小时。资料经访谈员整理后由另一名访谈员核对原始录音和整理后的文本,确定两者之间的一致性。资料的整理和分析步骤:①阅读原始资料并熟悉资料内容,将访谈的文本资料按访谈提纲问题进行编码;②为分析资料设立统一的选择标准,进行“目的性抽样”,根据访谈的线索和反映的主要内容,选取能说明研究问题的内容;③拟定分析条目,归纳出访谈对象对该条目给出的所有答案,形成结果报告。以安徽省中医院、安徽医科大学第一附属医院和安徽省立医院为研究现场,进行女性RA住院病人心理健康和生活质量状况的横断面研究。以2007年1月1日至5月31日在三家医院住院部风湿科住院的女性RA病人为研究对象,采用无记名调查问卷的方式,应用焦虑自评量表(self-rating anxiety scale,SAS)和抑郁自评量表(self-rating depression scale, SDS)、WHO生活质量量表中文简表(quality of life questionnaire for world health organization-bref, WHOQOL-BREF),对研究对象进行焦虑和抑郁症状评定及生活质量评定,并对身体疼痛、身体疲劳、社会支持、应对方式和婚姻调适等因素进行调查。以焦虑、抑郁和生活质量评分作为应变量,应用相关分析、χ2检验、多元非条件Logistic回归分析,探讨以上因素与患者的焦虑和抑郁状况及生活质量的关系。以安徽省中医院住院部风湿科为研究现场,以2007年6月1日至8月31日入院的女性RA病人为干预对象,以9月1日至12月31日入院的女性RA病人,按照年龄相差在2岁,病程相差在1年以内的原则进行1:1配比,共选出60人作为对照对象。对照对象按照常规的药物治疗和护理。干预对象除常规的药物治疗和护理外,应用认知行为干预的方法在两个星期内进行4次干预活动。分别在干预前、后采用无记名问卷的方式对干预对象进行健康状况调查。对照病人分别在入院时和住院治疗2周后进行健康状况问卷调查。用配对t检验比较干预病人和对照病人的焦虑和抑郁症状评分、生活质量评分和应对方式的变化。结果定性访谈结果表明多数女性RA住院病人在发病初期并未引起重视,情绪也比较稳定;随着病情的进展,大部分病人出现情绪波动,出现焦虑和抑郁情绪;病人在住院期间社会支持水平低,缺乏应对不良情绪的能力;医疗服务的内容主要是以疾病治疗为中心,无任何心理健康干预措施。横断面调查结果显示,女性RA住院病人焦虑症状、抑郁症状的检出率分别为37.5%和72.7%。文化程度在初中及以下、居住在农村、家庭人均月收入在800元以下、关节功能在2级及以上、关节有畸形、晨僵时间大于半小时的病人比文化程度在高中及以上、居住在城市、家庭人均月收入在800元以上、关节功能为1级、关节无畸形、晨僵时间小于半小时的病人焦虑和抑郁症状检出率均高(P0.05)。年龄在49岁以上、既往无正规治疗的病人抑郁症状检出率分别高于年龄在49岁以下、既往有正规治疗的病人(P0.01)。焦虑和抑郁症状均与疼痛、应对方式、婚姻调适、身体疲劳及社会支持相关联(P0.01)。经多元非条件Logistic回归分析发现,进入焦虑症状方程的变量为屈服应对方式、身体疲劳。居住在农村、文化程度在初中及以下、晨僵时间在半小时以上、屈服性应对方式、婚姻调适度差和社会支持差可增加病人抑郁症状的危险性。女性RA住院病人生活质量各领域评分均低下。单因素分析表明,影响病人生活质量的因素有病人的文化程度、婚姻状况、关节有无畸形、既往有无正规治疗,目前关节功能分级、目前居住地。病人的身体疼痛、身体疲劳、应对方式、社会支持及婚姻调适度和生活质量相关联(r=-0.307/-0.516/0.378/0.262/-0.588/0.433/0.528, P0.01)。经多元非条件Logistic回归分析,进入生活质量方程的变量有病人的文化程度、关节功能分级、屈服性应对方式、关节畸形和社会支持。干预研究结果表明,采用配对T检验的方法比较时,干预对象与其配对的对照的焦虑症状评分、抑郁症状评分、生活质量各领域评分以及面对应对方式、回避应对方式和屈服应对方式评分,结果显示差异无统计学意义(P0.05)。干预对象基线时焦虑症状和抑郁症状评分与评估时评分差值的均数分别为6.47±7.81和8.00±10.79,其对照基线时的焦虑症状和抑郁症状评分与评估时评分差值的均数分别为1.35±8.46和1.93±11.84,经配对T检验,结果显示差异有统计学意义。生活质量评定结果表明,干预对象基线时生理和社会关系领域评分与评估时评分差值的均数分别为-2.98±3.26和-0.87±2.42,低于其对照相应的评分差值的均数(0.44±3.08和0.65±2.67);干预对象心理领域基线评分与评估评分差值的均数为-0.86±3.65,低于其对照基线与评估评分差值的均数(0.46±3.09);干预对象环境领域基线时评分与评估时评分差值的均数为-3.58±9.71,低于其对照相应评分差值的均数(1.15±8.76)。有关应对方式评分的配对T检验表明,干预对象基线时面对和回避方式评分与评估时评分差值的均数分别为-3.35±3.21和-2.85±3.26,低于其对照相应的评分差值的均数(-0.33±3.23和-0.20±3.37);干预对象屈服方式基线评分与评估评分差值的均数为1.83±2.68,高于其对照的相应评分差值的均数(-0.32±2.75)。结论女性RA住院病人心理健康问题严重,生活质量低。病人对疾病采取的应对方式和自我感觉的身体疲劳程度与病人的焦虑症状相关联;病人的抑郁症状受到目前居住地、文化程度、晨僵时间、屈服应对方式、婚姻调适度和社会支持的影响;病人的文化程度、医疗费用支付方式、关节功能分级、屈服性应对方式、婚姻调适度和社会支持影响到自身的生活质量。认知行为干预能有效地降低患者的焦虑和抑郁症状,促进病人的生活质量。这提示在临床工作中不仅仅要关注患者临床症状的缓解,还要关注她们的情绪状态,应重视提高患者生活质量为目的。
[Abstract]:Objective to investigate the women with rheumatoid arthritis (rheumatoid arthritis, RA) inpatients with anxiety and depressive symptoms of epidemic situation and the quality of life; to investigate the physical fatigue, social support, the relationship between anxiety and depressive symptoms and quality of life in patients with coping styles and marital adjustment factors such as moderate and female RA Hospital; to explore the cognitive behavioral intervention to reduce female RA Hospital Anxiety and depression symptoms of patients, improve the effectiveness and feasibility of the quality of life.
Methods the qualitative study was conducted in Department of rheumatism of Anhui Provincial Hospital of traditional Chinese medicine, the TCM Hospital of Anhui province from August 1, 2006 to September 30, 2006 in the Department of rheumatism in the female RA patients as the research object, method of application of individual in-depth interview, according to the diagnostic criteria of 20 cases of female RA patients were interviewed according to the unified interview. Later, investigators in the survey signed informed consent and follow the voluntary, confidential and anonymous principle, in-depth interview and recorded by trained professionals in accordance with the unified interview. The interview included the occurrence of RA disease, the development and the status of social support of patients, mental health status of patients and the need for mental health service contents and forms and the ability to regulate the bad mood, contents and methods of clinical services. Each interview time is about 1 hours. The whole staff interview After treated by another interviewer check text of the original records and finishing, to determine the consistency between the two. The data collection and analysis steps: reading the original data and familiar with the information content, the interview text information according to the interview outline of the selection criteria for encoding; analysis of data for the establishment of a unified. "Purposive sampling", according to the main content of the interview and selection can reflect the clues, explains the research questions; the selected item analysis, summed up the interview all the answers to the entry form gives the result report.
Anhui Provincial Hospital of traditional Chinese medicine, the First Affiliated Hospital of Medical University Of Anhui and Anhui Provincial Hospital as the research site, cross-sectional study of patients' psychological health and quality of life of female inpatients of RA. From January 1, 2007 to May 31st in the three hospital inpatient hospital department of rheumatism female RA patients as the research object, using anonymous questionnaires using self rating anxiety table (self-rating anxiety scale, SAS) and self rating Depression Scale (self-rating depression scale, SDS WHO), quality of life scale Chinese (quality of life questionnaire for World Health Organization-Bref, WHOQOL-BREF), anxiety and depression symptom assessment and evaluation of the quality of life of the object of study, and the physical pain, physical fatigue survey, social support, coping style and marital adjustment and other factors. The anxiety, depression and quality of life score should be as Variables, correlation analysis, chi 2 test and multivariate non conditional Logistic regression analysis were used to investigate the relationship between the above factors and the patient's anxiety and depression and the quality of life.
Anhui Province Hospital of TCM Department of rheumatism as the research site, from June 1, 2007 to August 31st were female RA patients as intervention objects, from September 1st to December 31st were female RA patients, according to age at the age of 2, the duration of phase ratio of 1:1 within 1 years in principle, to elect a total of 60 people as the control object. The control object according to the conventional drug treatment and nursing intervention objects. In addition to the routine drug treatment and nursing, methods of application of cognitive behavioral intervention of 4 interventions in two weeks respectively. Before intervention, after using anonymous questionnaire on health intervention objects are investigated. The control patients were in hospital and hospital treatment of health survey questionnaire after 2 weeks. The symptoms of anxiety and depression in paired t test was used to compare intervention patients and control patients score, the score of life quality and coping style change .
The results of qualitative interviews showed that most women did not pay attention to RA patients in the early stage of the disease, the mood is relatively stable; with the development of the disease, most patients have mood swings, anxiety and depression; patients in the hospital during the low level of social support, the lack of ability of coping; medical service is the main content of the disease the treatment center, without any mental health interventions.
Cross sectional survey results show that female RA patients with anxiety symptoms, depressive symptoms were detected in 37.5% and 72.7%. education in junior high school and below, to live in the countryside, the family per capita monthly income below 800 yuan, the joint function in grade 2 and above, joint deformity, morning stiffness time more than half an hour compared with culture in high school degree or above, living in the city, the family per capita monthly income of more than 800 yuan, the joint function was 1, no joint deformity, morning stiffness time is less than patients with symptoms of anxiety and depression in half an hour the detection rate was high (P0.05). At the age of 49 years old or above, the detection rate of patients with depressive symptoms had no formal treatment were higher than those under the age of 49, had a formal treatment of patients (P0.01). Anxiety and depression symptoms were associated with pain, coping style, marital adjustment, associated physical fatigue and social support (P0.01). Multivariate non conditional Logistic Regression analysis found that entered the equation were predictors of anxiety coping style, physical fatigue. Live in the countryside, education in junior high school and below, the time of morning in half an hour or more, the yield of coping styles and marital adjustment to moderately poor and poor social support can increase the risk of patients with depressive symptoms. RA score of each female inpatients the field of quality of life patients were low. Univariate analysis showed that the factors affecting the quality of life of patients with education, patient's marital status, there is no joint deformity, who had no formal treatment, the joint function grading, current residence. The patient's body pain, physical fatigue, coping style, social support and marital adjustment and the quality of life associated (r=-0.307/-0.516/0.378/0.262/-0.588/0.433/0.528, P0.01). By regression analysis multivariate non conditional Logistic into the quality of life variables have the culturallevel patients Degree, joint function classification, yield coping style, joint deformity and social support.
The intervention results show that compared with the paired T test, paired intervention control object anxiety symptom score, depression score, all areas of quality of life score and facing coping style, coping style and avoidance coping style score, the results showed no statistically significant difference (P0.05). The mean score of intervention and evaluation the object of baseline anxiety symptoms and depressive symptoms score were 6.47 + 7.81 and 8 + 10.79, the score difference control score and assessment of anxiety symptoms and depressive symptoms at baseline when were respectively 1.35 + 8.46 and 1.93 + 11.84, the result of paired T test showed that there were statistically significant differences. The evaluation results show that the quality of life, the mean score and the intervention evaluation object baseline physiological and social relations when the score was -2.98 + 3.26 and -0.87 + 2.42, lower than the corresponding control The difference between the mean score (0.44 + 3.08 and 0.65 + 2.67); psychological intervention object field baseline scores and assessment score difference are the number of -0.86 + 3.65, lower than the baseline control and evaluation score were (0.46 + 3.09); intervention baseline object environmental field score and evaluation score difference are the number of -3.58 + 9.71, lower than the corresponding to the mean score (1.15 + 8.76). Paired T test scores on coping style showed that the mean score and the evaluation object interfere with the baseline and avoidance mode score were -3.35 + 3.21 and -2.85 + 3.26, lower than that of control the corresponding mean score difference (-0.33 + 3.23 and -0.20 + 3.37); intervention objects yield ways of baseline score and assess score difference are the number 1.83 + 2.68, higher than that of the control of the corresponding score difference mean (-0.32 + 2.75).
Conclusion female RA patients with serious mental health problems, low quality of life. The associated degree of fatigue and patient of disease to take the coping style and self perceived symptoms of anxiety; depression in patients affected by the current residence, education level, time of morning stiffness, yielding coping style, marital adjustment and moderate the effect of social support; the culture degree of the patient, payment of medical expenses, joint function grading, yielding coping styles, marriage adaptation and social support affect their quality of life. Cognitive behavioral intervention can effectively reduce the symptoms of anxiety and depression of patients, improve patient's quality of life. This suggests that in clinical work, we should not only focus on the clinical symptoms of the patients the ease, but also pay attention to their emotional state, should pay attention to improve the quality of life of patients for the purpose.

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2008
【分类号】：R593.22;R395

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