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Study on Mental Health, Quality of Life and Cognitive Behavioral Intervention among Women with Rheumatoid Arthritis in Clinical Setting

Author: WuHongHua
Tutor: ZhangHongBo；LiuJian
School: Anhui Medical University,
Course: Child and adolescent health and maternal and child health science
Keywords: Rheumatoid arthritis Anxiety symptoms Depressive symptoms Quality of life Cognitive-behavioral intervention
CLC: R395
Type: Master's thesis
Year: 2008
Downloads: 201
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Abstract

The factors female RA inpatients purpose of investigation about women with rheumatoid arthritis (rheumatoid arthritis, RA) popular inpatients symptoms of anxiety and depression status, and quality of life status; explore fatigue, social support, coping style, and marital tune moderate anxiety and the effectiveness and feasibility of depressive symptoms and quality of life; explore the cognitive behavioral interventions to reduce female RA inpatients anxiety and depression, and improve their quality of life. Qualitative research site for Anhui Province Traditional Chinese Medicine Hospital Rheumatology, Anhui Province Traditional Chinese Medicine Hospital on August 1, 2006 to 2006, 30 female RA patients hospitalized in rheumatology as the research object, the application of the methods of the individual in-depth interviews, interviews with 20 female patients met the clinical diagnostic criteria for RA inpatients in accordance with the unified interview outline. Signed informed consent by the investigators in the survey, according to the principles of voluntary, confidential and anonymous principle of recording and personal in-depth interviews by trained professionals to develop a unified interview outline. The interviews include the occurrence of RA disease status of the development of the condition and the patient's social support, the patient's mental health status and on the content and form of the mental health service needs, the ability to regulate negative emotions, clinical services, content and manner. Each interview time is about 1 hour. Information through interviews after finishing the original recording and checked by another interviewer after finishing the text, to determine the consistency between the two. Data collection and analysis steps: ① read the raw data and are familiar with the data content, the interview text information encoded interview outline; ② to analyze the data to establish a single selection criteria, purposive sampling, based on interviews with clues and reflect the main content, select describes the content of the research questions; ③ proposed analytical entry summarized interviewed all the answers given in the entry, and a report on the results. , Anhui Province Traditional Chinese Medicine Hospital, the First Affiliated Hospital of Anhui Medical University, Anhui Provincial Hospital as a research site, the cross-sectional study of female RA inpatient mental health and quality of life status. Rheumatology hospital in-patient departments of three hospitals from January 1 to May 31 in 2007 female RA patients for the study, the use of anonymous questionnaire was way, the application of the Self-Rating Anxiety Scale (self-rating anxiety scale, SAS) WHO Quality of Life Scale and the Self-Rating Depression Scale (self-rating depression scale SDS) Chinese summary table (quality of life questionnaire for world health organization-bref, WHOQOL-BREF), the study of anxiety and depressive symptoms assessed and quality of life assessment, and body aches, fatigue, social support, coping methods and marital adjustment factors to investigate. Anxiety, depression, and quality of life scores as the dependent variable, correlation analysis, χ2 test, and multivariate non-conditional logistic regression analysis, to explore the above factors and in patients with anxiety and depression status and quality of life relationship. Anhui Chinese medicine hospital inpatient department rheumatology research site, the intervention object to female RA patients admitted to hospital on June 1 to August 31 2007, the female RA patients admitted to September 1 to December 31, 1:1 ratio in accordance with the principle of the age difference between the 2-year-old course of a difference of less than 1 year, and 60 were selected as a control object. Control objects in accordance with conventional medical treatment and care. Intervention objects in addition to conventional drug treatment and care, the application cognitive behavioral intervention method four times within two weeks of intervention activities. Health survey, respectively, before the intervention, after the anonymous questionnaire on intervention object. Control patients on admission and after two weeks of hospitalization, health status survey. Intervention patients and control patients compared with a paired t-test anxiety and depression symptom scores, quality of life score and respond to changes in the way. Results of qualitative interviews showed that the majority of female RA inpatients in the early stages, did not pay attention to the emotions relatively stable; With the progression of the disease, most of the patients had mood swings, anxiety and depression; patients hospitalized during the low level of social support lack of ability to deal with negative emotions; medical services mainly based on disease treatment, without any mental health interventions. The cross-sectional survey results show that the female RA inpatients anxiety symptoms, depression symptoms, the detection rate of 37.5% and 72.7%, respectively. Patients the level of education in junior high school and below, live in rural household per capita monthly income of less than $ 800, the joint function 2 and above, joint deformity, duration of morning stiffness greater than half an hour more than the level of education in high school and living , per capita household income in the city in more than 800 yuan, the joint function of a no deformity, joints, morning stiffness time of less than a half hour of patient anxiety and depressive symptoms detection rate (P lt; 0.05). Patients aged more than 49 years old, who had no formal treatment of depressive symptoms detection rates were higher than the age of 49 years of age previous regular treatment patients (P lt; 0.01). Symptoms of anxiety and depression were associated with pain, coping style, marital adjustment, fatigue and social support associated (P lt; 0.01). Multivariate non-conditional logistic regression analysis revealed that enter the the anxiety symptoms equation the variable yield coping style, physical fatigue. Living in rural areas, the level of education in junior high school and below, the duration of morning stiffness for more than half an hour, the yield coping style marriage tune moderately poor and poor social support can increase the risk of patients with depressive symptoms. Female RA inpatients in all areas of quality of life scores were low. Univariate analysis showed that factors affect patients' quality of life, patient education level, marital status, joint with or without deformity, with or without previous formal treatment, joint function classification, the current residence. The patient's physical pain, fatigue, coping style, social support and marital adjust the a proportionate and quality of life associated (r = -0.307/-0.516/0.378/0.262/-0.588/0.433/0.528 P lt; 0.01). Multivariate non-conditional logistic regression analysis, the patient's level of education, joint functional classification of variables into the quality of life equation yield coping style, joint deformity and social support. Controlled intervention study results show that, using paired T-test comparison intervention object paired anxiety symptom scores, depressive symptom scores, quality of life score confrontation coping, avoidance coping style, and yield coping style score, results the difference was not statistically significant (P gt; 0.05). Symptoms of anxiety and depression symptom score assessment intervention object baseline mean score difference was 6.47 ± 7.81 and 8.00 ± 10.79, respectively, baseline control the symptoms of anxiety and depression symptom score and assessment mean score difference. 1.35 ± 8.46 and 1.93 ± 11.84, paired T-test results show that the difference was statistically significant. Quality of life assessment results show that the intervention target baseline score and assessment of physiological and social relations field ratings mean difference -2.98 ± 3.26 and -0.87 ± 2.42, below its control mean score difference ( mean of -0.86 ± 3.65, lower than the control baseline assessment score difference between the mean (0.46 ± 3.09); intervention object of the intervention in the field of object psychological baseline score and evaluation score difference of 0.44 ± 3.08 and 0.65 ± 2.67); the environmental field score and baseline assessment mean score difference of -3.58 ± 9.71, lower than that of the control corresponding score difference mean (1.15 ± 8.76). Coping style score paired T-test showed that the mean score difference in the face and interfere with the object baseline evasive manner ratings and assessment were -3.35 ± 3.21 and -2.85 ± 3.26, lower than its control score difference mean (-0.33 ± 3.23 and -0.20 ± 3.37); the intervention object yield the way baseline score and evaluation score difference the corresponding score difference with a mean of 1.83 ± 2.68, higher than the control mean (-0.32 ± 2.75). Conclusion the female RA inpatient mental health problem is serious, low quality of life. Patients taken to deal with the disease and feel fatigue degree of patient anxiety symptoms associated; depressive symptoms of patients affected by the current place of residence, education level, duration of morning stiffness, yield coping style, marriage tone of moderation and social support ; the patient's level of education, medical expenses, payment methods, joint functional classification yield coping style, marital moderate tone and social support affect the quality of life of its own. Cognitive behavioral interventions can effectively reduce the patient's anxiety and depressive symptoms, and quality of life for patients. This suggests that the clinical work not only pay attention to the remission of clinical symptoms, but also concerned about their emotional state, attention should be paid to improving the quality of life of patients for the purpose.

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