McFarland Daniel C, Shen Megan Johnson, Polizzi Heather, Mascarenhas John, Kremyanskaya Marina, Holland Jimmie, Hoffman Ronald
Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY (DCM).
Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine.
Psychosomatics. 2017 Jan-Feb;58(1):46-55. doi: 10.1016/j.psym.2016.10.002. Epub 2016 Oct 5.
Myeloproliferative neoplasms (MPNs), a group of chronic hematologic malignancies, carry significant physical and psychological symptom burdens that significantly affect patients' quality of life.
We sought to identify the relationship between early childhood adversity (ECA) and psychological distress in patients with MPNs, as ECA may compound symptom burden.
Patients with MPNs were assessed for ECA (i.e., the Risky Families Questionnaire-subscales include abuse/neglect/chaotic home environment), distress (i.e., Distress Thermometer and Problem List), anxiety (i.e., Hospital Anxiety and Depression Scale-Anxiety [HADS-A]), depression (i.e., Hospital Anxiety and Depression Scale-Depression [HADS-D]), meeting standardized cutoff thresholds for distress (i.e., Distress Thermometer and Problem List≥ 4 or ≥ 7)/anxiety (HADS-A ≥8)/depression (HADS-D ≥ 8), and demographic factors.
A total of 117 participants completed the study (78% response rate). ECA was associated with depression (p < 0.000), anxiety (p < 0.000), and distress (p < 0.000) and problem list variables emotional (p < 0.000), physical (p = 0.004), family (p = 0.01), and spiritual (p = 0.01) by bivariate analysis and only with distress (HADS) (p = 0.038) on multivariate analysis. ECA was associated with meeting cutoff threshold criteria for distress (p = 0.007), anxiety (p = 0.001), and depression (p = 0.02). ECA subscale variables abuse and chaotic home environment were associated with psychological outcomes. ECA was higher based on disease subtypes with greater symptom burden (other > polycythemia vera > myelofibrosis > essential thrombocythemia) (p = 0.047) and taking an antidepressant (p = 0.011).
ECA is associated with psychological distress and meets screening criteria for anxiety and depression in patients with MPNs. ECA may help to explain individual patient trajectories, and further understanding may enhance patient-centered care among patients with MPNs.
骨髓增殖性肿瘤（MPNs）是一组慢性血液系统恶性肿瘤，具有显著的身体和心理症状负担，严重影响患者的生活质量。
我们试图确定儿童期早期逆境（ECA）与MPNs患者心理困扰之间的关系，因为ECA可能会加重症状负担。
对MPNs患者进行ECA评估（即风险家庭问卷子量表包括虐待/忽视/混乱的家庭环境）、困扰（即困扰温度计和问题清单）、焦虑（即医院焦虑抑郁量表-焦虑[HADS-A]）、抑郁（即医院焦虑抑郁量表-抑郁[HADS-D]），确定是否达到困扰（即困扰温度计和问题清单≥4或≥7）/焦虑（HADS-A≥8）/抑郁（HADS-D≥8）的标准化临界阈值，以及人口统计学因素。
共有117名参与者完成了研究（应答率为78%）。通过双变量分析，ECA与抑郁（p<0.000）、焦虑（p<0.000）和困扰（p<0.000）以及问题清单变量中的情绪（p<0.000）、身体（p = 0.004）、家庭（p = 0.01）和精神（p = 0.01）相关，而在多变量分析中仅与困扰（HADS）（p = 0.038）相关。ECA与达到困扰（p = 0.007）、焦虑（p = 0.001）和抑郁（p = 0.02）的临界阈值标准相关。ECA子量表变量虐待和混乱的家庭环境与心理结果相关。基于症状负担较重的疾病亚型（其他>真性红细胞增多症>骨髓纤维化>原发性血小板增多症）（p = 0.047）和服用抗抑郁药（p = 0.011），ECA更高。
ECA与心理困扰相关，并且符合MPNs患者焦虑和抑郁的筛查标准。ECA可能有助于解释个体患者的病程，进一步的了解可能会加强MPNs患者以患者为中心的护理。
