Warchala Anna, Wojtyna Ewa, Krysta Krzysztof
Department of Psychiatry and Psychotherapy, Medical University of Silesia, Ziolowa 45/47, 40-635 Katowice, Poland,
Psychiatr Danub. 2015 Sep;27 Suppl 1:S415-22.
Acute leukaemia and bone marrow transplantation (BMT) as a method of its treatment are great psychological stressors, which are responsible for anxiety and depression in the group of patients. The aim of the study was to assess the patients' mental state and its psychophysical predictors before and after BMT.
The study was of a longitudinal and self-descriptive character. The questionnaires: LOT-R, AIS, Mini-Mac, CECS, RSCL and HADS were filled by 60 patients with acute leukaemia before and after BMT.
There were no essential statistical differences between the severity of anxiety and depression before and after BMT but the pattern and the power of various mental state predictors changed in the course of the hospitalization. Anxiety before transplantation was greater when the psychological stress and the strategy of "anxious preoccupation" were stronger and the strategy of "fighting spirit" and the level of generalized optimism were weaker. The factors explained 51% variations of anxiety before transplantation. After BMT 77% variations of anxiety were explained, which were associated with a high level of distress at the end of the hospitalization, higher level of anxiety before transplantation, weaker strategy of "fighting spirit" before transplantation and stronger strategy of "anxious preoccupation" after BMT. Before transplantation 36% variations of depression were explained and estimated as weaker "fighting spirit" and worse "global life quality". The essential predictors of depressive symptoms after transplantation, explained by 81% variations of depression, were weaker "fighting spirit" before transplantation, stronger "anxious preoccupation" after transplantation, worse "global life quality" after transplantation and higher level of anxious and depressive symptoms on admission to hospital.
The psychological and pharmacological interventions, which reduce anxiety, depression and "anxious preoccupation" as well as enhance "fighting spirit", should be introduced before BMT to improve the patients' mental state.
急性白血病以及作为其治疗方法的骨髓移植（BMT）是巨大的心理压力源，会导致患者群体出现焦虑和抑郁。本研究的目的是评估骨髓移植前后患者的心理状态及其心理生理预测因素。
本研究具有纵向和自我描述的性质。60例急性白血病患者在骨髓移植前后填写了以下问卷：生活取向测验修订版（LOT-R）、焦虑自评量表（AIS）、简易应对方式问卷（Mini-Mac）、癌症患者生活功能指标量表（CECS）、症状自评量表（RSCL）和医院焦虑抑郁量表（HADS）。
骨髓移植前后焦虑和抑郁的严重程度没有本质上的统计学差异，但在住院过程中各种心理状态预测因素的模式和影响力发生了变化。当心理压力和“焦虑关注”策略更强，而“斗志”策略和总体乐观水平较弱时，移植前的焦虑程度更高。这些因素解释了移植前焦虑变异的51%。骨髓移植后，焦虑变异的77%得到了解释，这与住院末期的高痛苦水平、移植前较高的焦虑水平、移植前较弱的“斗志”策略以及骨髓移植后较强的“焦虑关注”策略有关。移植前，抑郁变异的36%得到了解释，估计为较弱的“斗志”和较差的“总体生活质量”。移植后抑郁症状的主要预测因素解释了抑郁变异的81%，包括移植前较弱的“斗志”、移植后较强的“焦虑关注”、移植后较差的“总体生活质量”以及入院时较高的焦虑和抑郁症状水平。
应在骨髓移植前引入心理和药物干预措施，以减轻焦虑、抑郁和“焦虑关注”，同时增强“斗志”，从而改善患者的心理状态。
