Xiong Na-Na, Wei Jing, Ke Mei-Yun, Hong Xia, Li Tao, Zhu Li-Ming, Sha Yue, Jiang Jing, Fischer Felix
Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Front Psychiatry. 2018 Apr 12;9:122. doi: 10.3389/fpsyt.2018.00122. eCollection 2018.
To investigate the illness perception characteristics of Chinese patients with functional gastrointestinal disorders (FGID), and the mediating role between symptoms, psychopathology, and clinical outcomes.
Six illness groups from four outpatient departments of a general hospital in China were recruited, including the FGID patient group. The modified and validated Chinese version of the illness perception questionnaire-revised was utilized, which contained three sections: symptom identity, illness representation, and causes. The 12-item short-form health survey was utilized to reflect the physical and mental health-related quality of life (HRQoL). The Toronto alexithymia scale was used to measure the severity of alexithymia. Additional behavioral outcome about the frequency of doctor visits in the past 12 months was measured. Pathway analyses with multiple-group comparisons were conducted to test the mediating role of illness perception.
Overall, 600 patients were recruited. The illness perceptions of FGID patients were characterized as with broad non-gastrointestinal symptoms (6.8 ± 4.2), a negative illness representation (more chronic course, worse consequences, lower personal and treatment control, lower illness coherence, and heavier emotional distress), and high numbers of psychological and culture-specific attributions. Fit indices of the three hypothesized path models (for physical and mental HRQoL and doctor-visit frequency, respectively) supported the mediating role of illness perceptions. For example, the severity of alexithymia and non-gastrointestinal symptoms had significant negative effect on mental quality of life through both direct (standardized effect: -0.085 and -0.233) and indirect (standardized effect: -0.045 and -0.231) influence subscales of consequences, emotional representation, and psychological and risk factor attributions. Multi-group confirmatory factor analysis showed similar psychometric properties for FGID patients and the other disease group.
The management of FGID patients should take into consideration dysfunctional illness perceptions, non-gastrointestinal symptoms, and emotion regulation.
探讨中国功能性胃肠病（FGID）患者的疾病认知特征，以及症状、精神病理学与临床结局之间的中介作用。
从中国一家综合医院的四个门诊科室招募了六个疾病组，包括FGID患者组。使用经过修订和验证的中文版疾病认知问卷修订版，该问卷包含三个部分：症状识别、疾病表征和病因。采用12项简短健康调查问卷来反映与身心健康相关的生活质量（HRQoL）。使用多伦多述情障碍量表来测量述情障碍的严重程度。还测量了过去12个月内就诊频率这一额外的行为结局。进行多组比较的路径分析以检验疾病认知的中介作用。
总共招募了600名患者。FGID患者的疾病认知特征为具有广泛的非胃肠道症状（6.8±4.2）、负面的疾病表征（病程更长、后果更差、个人和治疗控制更低、疾病连贯性更低以及情绪困扰更严重）以及大量的心理和文化特异性归因。三个假设路径模型（分别针对身心健康HRQoL和就诊频率）的拟合指数支持了疾病认知的中介作用。例如，述情障碍的严重程度和非胃肠道症状通过直接（标准化效应：-0.085和-0.233）和间接（标准化效应：-0.045和-0.231）影响后果、情绪表征以及心理和风险因素归因的子量表，对心理健康生活质量产生显著负面影响。多组验证性因素分析显示FGID患者和其他疾病组具有相似的心理测量学特性。
FGID患者的管理应考虑功能失调的疾病认知、非胃肠道症状和情绪调节。
