Jones Salene M, Amtmann Dagmar
Group Health Research Institute.
Department of Rehabilitation Medicine.
Rehabil Psychol. 2014 Aug;59(3):354-9. doi: 10.1037/a0037074. Epub 2014 Jul 14.
PURPOSE/OBJECTIVE: People with multiple sclerosis (MS) experience higher levels of depression and anxiety than the general population. This is the first study to examine the relationship of worry about affording health care and symptoms in MS.
RESEARCH METHOD/DESIGN: People with MS (n = 405) were recruited for a needs assessment study. Participants completed a structured telephone interview measuring depression, anxiety, fatigue, sleep disturbance, pain interference, social function, and perceived cognitive functioning, and rated their worry about the following: premiums increasing, income decreasing, affording health care services, insurance dropping coverage, and affording prescriptions. Multiple regression analyses controlled for age, gender, disability status, education, income, and health insurance coverage.
The highest rated worry was inability to afford health care services. Higher health care worry was reported by women, younger participants, participants with lower incomes, and those with only private (vs. public) insurance. Total level of health care worry was significantly related to depression, anxiety, fatigue, sleep disturbance, pain interference, social function, and perceived cognitive functioning.
CONCLUSIONS/IMPLICATIONS: Health care worry was significantly related to psychological, physical, and cognitive symptoms. Future research should compare health care worry in MS with other populations (i.e., healthy adults) and should examine changes in health care worry over time.
目的/目标：与普通人群相比，多发性硬化症（MS）患者经历更高水平的抑郁和焦虑。这是第一项研究MS患者对医疗保健费用的担忧与症状之间关系的研究。
研究方法/设计：招募了405名MS患者进行需求评估研究。参与者完成了一项结构化电话访谈，测量抑郁、焦虑、疲劳、睡眠障碍、疼痛干扰、社会功能和感知认知功能，并对他们对以下方面的担忧进行评分：保费增加、收入减少、负担医疗保健服务、保险覆盖范围下降以及负担处方费用。多元回归分析对年龄、性别、残疾状况、教育程度、收入和医疗保险覆盖范围进行了控制。
评分最高的担忧是无力负担医疗保健服务。女性、年轻参与者、低收入参与者以及仅拥有私人（而非公共）保险的参与者报告的医疗保健担忧程度更高。医疗保健担忧的总体水平与抑郁、焦虑、疲劳、睡眠障碍、疼痛干扰、社会功能和感知认知功能显著相关。
结论/启示：医疗保健担忧与心理、身体和认知症状显著相关。未来的研究应比较MS患者与其他人群（即健康成年人）的医疗保健担忧情况，并应研究医疗保健担忧随时间的变化。
