Email Alert | RSS    帮助

中国防痨杂志 ›› 2020, Vol. 42 ›› Issue (4): 366-371.doi: 10.3969/j.issn.1000-6621.2020.04.012

• 论著 • 上一篇    下一篇

308例耐多药肺结核患者心理健康状况及其影响因素分析

符婷(),黄丽菊,杨进军,卓越,肖华   

  1. 572000 三亚中心医院 海南省第三人民医院感染管理科
  • 收稿日期:2019-11-11 出版日期:2020-04-10 发布日期:2020-04-07
  • 通信作者: 符婷 E-mail:18508936565@163.com

Psychological health status of 308 patients with MDR-PTB and its influencing factors

FU Ting(),HUANG Li-ju,YANG Jin-jun,ZHUO Yue,XIAO Hua   

  1. Hospital Infection Management Department, the Third People’s Hospital of Hainan Province, Sanya Central Hospital, Sanya 572000, China
  • Received:2019-11-11 Online:2020-04-10 Published:2020-04-07
  • Contact: Ting FU E-mail:18508936565@163.com

摘要:

目的 通过问卷调查了解并分析耐多药肺结核(MDR-PTB)患者心理健康状况及其影响因素,为干预和提高患者的心理健康水平提供科学依据。方法 于2012年1月至2018年6月,对三亚中心医院、三亚市人民医院和三亚中医院收治的316例MDR-PTB患者,采用症状自评量表(SCL-90)进行心理健康状况调查,包括躯体化、强迫症状、人际关系敏感、抑郁、焦虑、敌对、恐怖、偏执、精神病性9个因子。发放316份问卷调查表,最终收回合格问卷308份,合格率为97.5%。采用logistic回归分析影响MDR-PTB患者心理健康的因素。结果 MDR-PTB患者的负性心理以焦虑、抑郁、偏执和恐惧多见,分别占43.5%(134/308)、40.6%(125/308)、16.9%(52/308)、9.7%(30/308)。308例MDR-PTB患者,其中225例有负性心理(心理健康状况差组),83例未发生负性心理(心理健康状况好组)。心理健康状况差组SCL-90评估平均得分为(1.83±0.68)分,高于心理健康状况好组[(1.20±0.26)分],差异有统计学意义(t=5.317,P<0.05)。单因素分析显示,心理健康状况差组已婚者占61.8%(139/225),独居者占34.2%(77/225),睡眠质量一般或差者占65.3%(147/225),经济收入<3万元/年者占63.6%(143/225),有结核空洞者占61.3%(138/225),有抗结核药物不良反应者占57.8%(130/225),治疗效果无好转者占64.0%(144/225),心理健康状况好组分别为74.7%(62/83)、19.3%(16/83)、45.8%(38/83)、37.3%(31/83)、34.9%(29/83)、74.7%(62/83)、42.2%(35/83),差异均有统计学意义(χ 2=4.465,P=0.035;χ 2=6.425,P=0.011;χ 2=9.661,P=0.002;χ 2=16.942,P<0.001;χ 2=17.017,P<0.001;χ 2=7.394,P=0.007;χ 2=11.872,P=0.001)。logistic回归分析显示,睡眠质量一般或差(OR=2.813,95%CI:1.718~6.529;P=0.018)、经济收入<3万元/年(OR=2.390,95%CI:1.604~5.748;P<0.001)、有结核空洞(OR=1.975,95%CI:1.416~4.530;P=0.037)、有抗结核药物不良反应(OR=3.517,95%CI:2.135~8.762;P=0.024)及治疗无好转(OR=6.113,95%CI:4.835~16.204;P=0.006)是影响MDR-PTB患者心理健康的危险因素。结论 MDR-PTB患者心理健康状况较差,影响其心理健康的危险因素为睡眠质量一般或差、经济收入<3万元/年、有结核空洞、有抗结核药物不良反应及治疗无好转,应加强对MDR-PTB患者的心理支持和关怀。

关键词: 结核,肺, 结核,抗多种药物性, 健康状况指标, 问卷调查, 结果评价(卫生保健), 因素分析,统计学

Abstract:

Objective The mental health status and its influencing factors of multidrug-resistant pulmonary tuberculosis (MDR-PTB) patients were investigated and analyzed by questionnaire, so as to provide scientific basis for improving the mental health level of patients. Methods From January 2012 to June 2018, 316 MDR-PTB patients admitted to Sanya Central Hospital, Sanya People’s Hospital and Sanya Hospital of Traditional Chinese Medicine were investigated with Symptom Checklist-90 (SCL-90), including 9 factors of somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobia, paranoia and psychosis. Three hundred and sixteen questionnaires were sent out and 308 qualified questionnaires were finally collected, with a qualified rate of 97.5%. Logistic regression analysis were used to analyze the univariate and multivariate variables influencing mental health of MDR-PTB patients. Results Anxiety, depression, paranoia and fear were the most common negative psychology in MDR-PTB patients, accounting for 43.5% (134/308), 40.6% (125/308), 16.9% (52/308) and 9.7% (30/308), respectively. Among 308 MDR-PTB patients, 225 had negative psychology (poor mental health group), 83 had no negative psychology (good mental health group).The total average score of SCL-90 in poor mental health group(1.83±0.68)was higher than that in the good mental health group(1.20±0.26), the difference was statistically significant (t=5.317,P<0.05). Univariate analysis showed that in the group with poor mental health, 61.8% (139/225) were married, 34.2% (77/225) lived alone, 65.3% (147/225) had average or poor sleep quality, 63.6% (143/225) had income less than 30000/year, 61.3% (138/225) had tuberculosis cavities, 57.8% (130/225) had adverse reactions to anti-tuberculosis drugs, 64.0% (144/225) had no improvement in the treatment effect, which compared with (74.7% (62/83), 19.3% (16/83), 45.8% (38/83), 37.3% (31/83), 34.9% (29/83), 74.7% (62/83), 42.2% (35/83)) in the group with good mental health, and the differences were statistically significant (χ 2=4.465,P=0.035;χ 2=6.425,P=0.011;χ 2=9.661,P=0.002;χ 2=16.942,P<0.001;χ 2=17.017,P<0.001;χ 2=7.394,P=0.007;χ 2=11.872,P=0.001). Logistic regression analysis showed that sleep quality was average or poor (OR=2.813, 95%CI: 1.718-6.529,P=0.018), income was less than 30000/year (OR=2.390, 95%CI: 1.604-5.748,P<0.001), tuberculosis cavity (OR=1.975, 95%CI: 1.416-4.530,P=0.037), adverse reactions to antituberculosis drugs (OR=3.517, 95%CI: 2.135-8.762,P=0.024) and no improvement in treatment (OR=6.113, 95%CI: 4.835-16.204,P=0.006) were risk factors affecting mental health of MDR-PTB patients. Conclusion The mental health of MDR-PTB patients is poor, and the risk factors affecting their mental health are average or poor sleep quality, economic income less than 30000/year, tuberculosis cavity, adverse reactions of anti-tuberculosis drugs and no improvement in treatment. Psychological support and care for MDR-PTB patients should be strengthened.

Key words: Tuberculosis,pulmonary, Tuberculosis,multidrug-resistant, Health status indicators, Questionnaires, Outcome assessment (health care), Factor analysis,statistical