本文關(guān)鍵詞：女性類風(fēng)濕關(guān)節(jié)炎住院病人心理健康和生活質(zhì)量狀況及其認(rèn)知行為干預(yù)研究　出處：《安徽醫(yī)科大學(xué)》2008年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 類風(fēng)濕關(guān)節(jié)炎 焦慮癥狀 抑郁癥狀 生活質(zhì)量 認(rèn)知行為干預(yù)

【摘要】： 目的調(diào)查了解女性類風(fēng)濕關(guān)節(jié)炎(rheumatoid arthritis, RA)住院病人焦慮和抑郁癥狀的流行狀況以及生活質(zhì)量狀況;探討身體疲勞、社會(huì)支持、應(yīng)對(duì)方式及婚姻調(diào)適度等因素與女性RA住院病人焦慮和抑郁癥狀及生活質(zhì)量的關(guān)系;探討認(rèn)知行為干預(yù)方法對(duì)降低女性RA住院病人焦慮抑郁癥狀,提高其生活質(zhì)量的有效性和可行性。 方法定性研究現(xiàn)場(chǎng)為安徽省中醫(yī)院風(fēng)濕科,以安徽省中醫(yī)院2006年8月1日至2006年9月30日在風(fēng)濕科住院的女性RA病人為研究對(duì)象,應(yīng)用個(gè)人深入訪談的方法,對(duì)20例符合臨床診斷標(biāo)準(zhǔn)的女性RA住院病人按照統(tǒng)一的訪談提綱進(jìn)行訪談。調(diào)查員在調(diào)查對(duì)象簽署知情同意書之后,遵循自愿、保密和匿名的原則,由經(jīng)過培訓(xùn)的專業(yè)人員按照統(tǒng)一制定的訪談提綱進(jìn)行個(gè)人深入訪談并錄音。訪談內(nèi)容包括RA疾病的發(fā)生、發(fā)展?fàn)顩r及病人的社會(huì)支持狀況、病人的心理健康狀況及對(duì)心理健康服務(wù)需求的內(nèi)容和形式、對(duì)不良情緒的調(diào)節(jié)能力、臨床服務(wù)的內(nèi)容和方式。每次訪談時(shí)間大約1小時(shí)。資料經(jīng)訪談員整理后由另一名訪談員核對(duì)原始錄音和整理后的文本,確定兩者之間的一致性。資料的整理和分析步驟:①閱讀原始資料并熟悉資料內(nèi)容,將訪談的文本資料按訪談提綱問題進(jìn)行編碼;②為分析資料設(shè)立統(tǒng)一的選擇標(biāo)準(zhǔn),進(jìn)行“目的性抽樣”,根據(jù)訪談的線索和反映的主要內(nèi)容,選取能說明研究問題的內(nèi)容;③擬定分析條目,歸納出訪談對(duì)象對(duì)該條目給出的所有答案,形成結(jié)果報(bào)告。 以安徽省中醫(yī)院、安徽醫(yī)科大學(xué)第一附屬醫(yī)院和安徽省立醫(yī)院為研究現(xiàn)場(chǎng),進(jìn)行女性RA住院病人心理健康和生活質(zhì)量狀況的橫斷面研究。以2007年1月1日至5月31日在三家醫(yī)院住院部風(fēng)濕科住院的女性RA病人為研究對(duì)象,采用無記名調(diào)查問卷的方式,應(yīng)用焦慮自評(píng)量表(self-rating anxiety scale,SAS)和抑郁自評(píng)量表(self-rating depression scale, SDS)、WHO生活質(zhì)量量表中文簡(jiǎn)表(quality of life questionnaire for world health organization-bref, WHOQOL-BREF),對(duì)研究對(duì)象進(jìn)行焦慮和抑郁癥狀評(píng)定及生活質(zhì)量評(píng)定,并對(duì)身體疼痛、身體疲勞、社會(huì)支持、應(yīng)對(duì)方式和婚姻調(diào)適等因素進(jìn)行調(diào)查。以焦慮、抑郁和生活質(zhì)量評(píng)分作為應(yīng)變量,應(yīng)用相關(guān)分析、χ2檢驗(yàn)、多元非條件Logistic回歸分析,探討以上因素與患者的焦慮和抑郁狀況及生活質(zhì)量的關(guān)系。 以安徽省中醫(yī)院住院部風(fēng)濕科為研究現(xiàn)場(chǎng),以2007年6月1日至8月31日入院的女性RA病人為干預(yù)對(duì)象,以9月1日至12月31日入院的女性RA病人,按照年齡相差在2歲,病程相差在1年以內(nèi)的原則進(jìn)行1:1配比,共選出60人作為對(duì)照對(duì)象。對(duì)照對(duì)象按照常規(guī)的藥物治療和護(hù)理。干預(yù)對(duì)象除常規(guī)的藥物治療和護(hù)理外,應(yīng)用認(rèn)知行為干預(yù)的方法在兩個(gè)星期內(nèi)進(jìn)行4次干預(yù)活動(dòng)。分別在干預(yù)前、后采用無記名問卷的方式對(duì)干預(yù)對(duì)象進(jìn)行健康狀況調(diào)查。對(duì)照病人分別在入院時(shí)和住院治療2周后進(jìn)行健康狀況問卷調(diào)查。用配對(duì)t檢驗(yàn)比較干預(yù)病人和對(duì)照病人的焦慮和抑郁癥狀評(píng)分、生活質(zhì)量評(píng)分和應(yīng)對(duì)方式的變化。 結(jié)果定性訪談結(jié)果表明多數(shù)女性RA住院病人在發(fā)病初期并未引起重視,情緒也比較穩(wěn)定;隨著病情的進(jìn)展,大部分病人出現(xiàn)情緒波動(dòng),出現(xiàn)焦慮和抑郁情緒;病人在住院期間社會(huì)支持水平低,缺乏應(yīng)對(duì)不良情緒的能力;醫(yī)療服務(wù)的內(nèi)容主要是以疾病治療為中心,無任何心理健康干預(yù)措施。 橫斷面調(diào)查結(jié)果顯示,女性RA住院病人焦慮癥狀、抑郁癥狀的檢出率分別為37.5%和72.7%。文化程度在初中及以下、居住在農(nóng)村、家庭人均月收入在800元以下、關(guān)節(jié)功能在2級(jí)及以上、關(guān)節(jié)有畸形、晨僵時(shí)間大于半小時(shí)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、關(guān)節(jié)功能為1級(jí)、關(guān)節(jié)無畸形、晨僵時(shí)間小于半小時(shí)的病人焦慮和抑郁癥狀檢出率均高(P0.05)。年齡在49歲以上、既往無正規(guī)治療的病人抑郁癥狀檢出率分別高于年齡在49歲以下、既往有正規(guī)治療的病人(P0.01)。焦慮和抑郁癥狀均與疼痛、應(yīng)對(duì)方式、婚姻調(diào)適、身體疲勞及社會(huì)支持相關(guān)聯(lián)(P0.01)。經(jīng)多元非條件Logistic回歸分析發(fā)現(xiàn),進(jìn)入焦慮癥狀方程的變量為屈服應(yīng)對(duì)方式、身體疲勞。居住在農(nóng)村、文化程度在初中及以下、晨僵時(shí)間在半小時(shí)以上、屈服性應(yīng)對(duì)方式、婚姻調(diào)適度差和社會(huì)支持差可增加病人抑郁癥狀的危險(xiǎn)性。女性RA住院病人生活質(zhì)量各領(lǐng)域評(píng)分均低下。單因素分析表明,影響病人生活質(zhì)量的因素有病人的文化程度、婚姻狀況、關(guān)節(jié)有無畸形、既往有無正規(guī)治療,目前關(guān)節(jié)功能分級(jí)、目前居住地。病人的身體疼痛、身體疲勞、應(yīng)對(duì)方式、社會(huì)支持及婚姻調(diào)適度和生活質(zhì)量相關(guān)聯(lián)(r=-0.307/-0.516/0.378/0.262/-0.588/0.433/0.528, P0.01)。經(jīng)多元非條件Logistic回歸分析,進(jìn)入生活質(zhì)量方程的變量有病人的文化程度、關(guān)節(jié)功能分級(jí)、屈服性應(yīng)對(duì)方式、關(guān)節(jié)畸形和社會(huì)支持。 干預(yù)研究結(jié)果表明,采用配對(duì)T檢驗(yàn)的方法比較時(shí),干預(yù)對(duì)象與其配對(duì)的對(duì)照的焦慮癥狀評(píng)分、抑郁癥狀評(píng)分、生活質(zhì)量各領(lǐng)域評(píng)分以及面對(duì)應(yīng)對(duì)方式、回避應(yīng)對(duì)方式和屈服應(yīng)對(duì)方式評(píng)分,結(jié)果顯示差異無統(tǒng)計(jì)學(xué)意義(P0.05)。干預(yù)對(duì)象基線時(shí)焦慮癥狀和抑郁癥狀評(píng)分與評(píng)估時(shí)評(píng)分差值的均數(shù)分別為6.47±7.81和8.00±10.79,其對(duì)照基線時(shí)的焦慮癥狀和抑郁癥狀評(píng)分與評(píng)估時(shí)評(píng)分差值的均數(shù)分別為1.35±8.46和1.93±11.84,經(jīng)配對(duì)T檢驗(yàn),結(jié)果顯示差異有統(tǒng)計(jì)學(xué)意義。生活質(zhì)量評(píng)定結(jié)果表明,干預(yù)對(duì)象基線時(shí)生理和社會(huì)關(guān)系領(lǐng)域評(píng)分與評(píng)估時(shí)評(píng)分差值的均數(shù)分別為-2.98±3.26和-0.87±2.42,低于其對(duì)照相應(yīng)的評(píng)分差值的均數(shù)(0.44±3.08和0.65±2.67);干預(yù)對(duì)象心理領(lǐng)域基線評(píng)分與評(píng)估評(píng)分差值的均數(shù)為-0.86±3.65,低于其對(duì)照基線與評(píng)估評(píng)分差值的均數(shù)(0.46±3.09);干預(yù)對(duì)象環(huán)境領(lǐng)域基線時(shí)評(píng)分與評(píng)估時(shí)評(píng)分差值的均數(shù)為-3.58±9.71,低于其對(duì)照相應(yīng)評(píng)分差值的均數(shù)(1.15±8.76)。有關(guān)應(yīng)對(duì)方式評(píng)分的配對(duì)T檢驗(yàn)表明,干預(yù)對(duì)象基線時(shí)面對(duì)和回避方式評(píng)分與評(píng)估時(shí)評(píng)分差值的均數(shù)分別為-3.35±3.21和-2.85±3.26,低于其對(duì)照相應(yīng)的評(píng)分差值的均數(shù)(-0.33±3.23和-0.20±3.37);干預(yù)對(duì)象屈服方式基線評(píng)分與評(píng)估評(píng)分差值的均數(shù)為1.83±2.68,高于其對(duì)照的相應(yīng)評(píng)分差值的均數(shù)(-0.32±2.75)。 結(jié)論女性RA住院病人心理健康問題嚴(yán)重,生活質(zhì)量低。病人對(duì)疾病采取的應(yīng)對(duì)方式和自我感覺的身體疲勞程度與病人的焦慮癥狀相關(guān)聯(lián);病人的抑郁癥狀受到目前居住地、文化程度、晨僵時(shí)間、屈服應(yīng)對(duì)方式、婚姻調(diào)適度和社會(huì)支持的影響;病人的文化程度、醫(yī)療費(fèi)用支付方式、關(guān)節(jié)功能分級(jí)、屈服性應(yīng)對(duì)方式、婚姻調(diào)適度和社會(huì)支持影響到自身的生活質(zhì)量。認(rèn)知行為干預(yù)能有效地降低患者的焦慮和抑郁癥狀,促進(jìn)病人的生活質(zhì)量。這提示在臨床工作中不僅僅要關(guān)注患者臨床癥狀的緩解,還要關(guān)注她們的情緒狀態(tài),應(yīng)重視提高患者生活質(zhì)量為目的。
[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.

【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2008
【分類號(hào)】：R593.22;R395

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2 郭粉蓮;葉志中;徐珊;董慧娟;蔡旭;;功能訓(xùn)練改善類風(fēng)濕性關(guān)節(jié)炎患者生活質(zhì)量的研究[J];護(hù)理學(xué)報(bào);2006年04期

3 宋玲,吳秀媛;心肌梗死患者焦慮因素的調(diào)查分析與護(hù)理對(duì)策[J];齊魯護(hù)理雜志;2000年04期

4 祝蓓里;POMS量表及簡(jiǎn)式中國(guó)常模簡(jiǎn)介[J];天津體育學(xué)院學(xué)報(bào);1995年01期

5 郝元濤,方積乾;世界衛(wèi)生組織生存質(zhì)量測(cè)定量表中文版介紹及其使用說明[J];現(xiàn)代康復(fù);2000年08期

6 王建平,陳仲庚,林文娟,崔俊南;中國(guó)癌癥病人生活質(zhì)量的測(cè)定──EORTC QLQ—C30在中國(guó)的試用[J];心理學(xué)報(bào);2000年04期

7 王建平,林文娟,孫宏偉;癌癥病人心理干預(yù)的效果及其影響因素[J];心理學(xué)報(bào);2002年02期

8 黃建林,曾詠梅,肖小琴,古潔若;類風(fēng)濕關(guān)節(jié)炎患者焦慮和抑郁調(diào)查分析[J];醫(yī)學(xué)理論與實(shí)踐;2005年11期

9 張洪波 ,陶芳標(biāo),曾廣玉,曹秀菁,許韶君,錢冰 ,高茗;安徽省中學(xué)生故意傷害行為及社會(huì)心理特征研究[J];中國(guó)公共衛(wèi)生;2002年05期

10 李小妹,王文茹,車文芳;一例類風(fēng)濕性關(guān)節(jié)炎患者的心理護(hù)理[J];中華護(hù)理雜志;1998年01期

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