Xu Minlan, Markström Urban, Lyu Juncheng, Xu Lingzhong
School of Public Health, Shandong University, Wenhuaxi Road 44, Jinan 250012, China.
Department of Social Work, Umeå University, 90187 Umeå, Sweden.
Int J Environ Res Public Health. 2017 Oct 4;14(10):1171. doi: 10.3390/ijerph14101171.
Depressed patients had risks of non-adherence to medication, which brought a big challenge for the control of tuberculosis (TB). The stigma associated with TB may be the reason for distress. This study aimed to assess the psychological distress among TB patients living in rural areas in China and to further explore the relation of experienced stigma to distress. This study was a cross-sectional study with multi-stage randomized sampling for recruiting TB patients. Data was collected by the use of interviewer-led questionnaires. A total of 342 eligible and accessible TB patients being treated at home were included in the survey. Psychological distress was measured using the Kessler Psychological Distress Scale (K10). Experienced stigma was measured using a developed nine-item stigma questionnaire. Univariate analysis and multiple logistic regression were used to analyze the variables related to distress, respectively. Odds ratios (ORs) and 95% confidence intervals (CIs) were used to present the strength of the associations. Finally, the prediction of logistic model was assessed in form of the Receiver Operating Characteristic (ROC) curve and the area under the ROC curve (AUC). According to the referred cut-off point from K10, this study revealed that 65.2% (223/342) of the participants were categorized as having psychological distress. Both the stigma questionnaire and the K10 were proven to be reliable and valid in measurement. Further analysis found that experienced stigma and illness severity were significant variables to psychological distress in the model of logistic regression. The model was assessed well in predicting distress by use of experienced stigma and illness severity in form of ROC and AUC. Rural TB patients had a high prevalence of psychological distress. Experience of stigma played a significant role in psychological distress. To move the barrier of stigma from the surroundings could be a good strategy in reducing distress for the patients and TB controlling for public health management.
抑郁症患者存在不遵医嘱服药的风险，这给结核病（TB）的控制带来了巨大挑战。与结核病相关的耻辱感可能是导致痛苦的原因。本研究旨在评估中国农村地区结核病患者的心理痛苦状况，并进一步探讨所经历的耻辱感与痛苦之间的关系。本研究是一项采用多阶段随机抽样招募结核病患者的横断面研究。数据通过访谈员主导的问卷收集。共有342名在家接受治疗的符合条件且可接触到的结核病患者被纳入调查。使用凯斯勒心理痛苦量表（K10）测量心理痛苦。使用自编的九项耻辱感问卷测量所经历的耻辱感。分别采用单因素分析和多元逻辑回归分析与痛苦相关的变量。比值比（OR）和95%置信区间（CI）用于表示关联强度。最后，以受试者工作特征（ROC）曲线和ROC曲线下面积（AUC）的形式评估逻辑模型的预测能力。根据K10的参考临界点，本研究显示65.2%（223/342）的参与者被归类为有心理痛苦。耻辱感问卷和K10在测量中均被证明可靠有效。进一步分析发现，在逻辑回归模型中，所经历的耻辱感和疾病严重程度是心理痛苦的显著变量。该模型以ROC和AUC的形式，通过所经历的耻辱感和疾病严重程度对痛苦进行预测的效果良好。农村结核病患者心理痛苦的患病率较高。耻辱感经历在心理痛苦中起重要作用。消除周围环境中的耻辱感障碍可能是减轻患者痛苦和公共卫生管理中结核病控制的一个良好策略。
