Health Psychology Section, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK; St George's University Hospitals NHS Foundation Trust, London, UK.
Health Psychology Section, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.
J Psychosom Res. 2020 May;132:109969. doi: 10.1016/j.jpsychores.2020.109969. Epub 2020 Feb 15.
To determine the relative contribution of demographic variables, objective testing and psychological factors in explaining the variance in dizziness severity and handicap.
One-hundred and eighty-five consecutive patients on the waiting list to attend a diagnostic appointment in a tertiary neuro-otology clinic with a primary complaint of vertigo or dizziness completed a cross-sectional survey. Primary outcomes were the Dizziness Handicap Inventory and the vertigo subscale of the Vertigo Symptom Scale-Short Form. Psychological questionnaires assessed anxiety and depressive symptoms, illness perceptions, cognitive and behavioural responses to symptoms, beliefs about emotions and psychological vulnerability. Patients also underwent standardised audio-vestibular investigations and tests to reach a diagnosis at appointment.
Objective disease characteristics were not associated with handicap and only the presence of vestibular dysfunction on one test (caloric) was associated with symptom severity. Almost all the psychological factors were correlated with dizziness outcomes. The total hierarchical regression model explained 63% of the variance in dizziness handicap, and 53% was explained by the psychological variables. The regression model for symptom severity explained 36% of the variance, and 30% was explained by the psychological factors. In adjusted models, factors associated with dizziness handicap included age, female gender, distress, symptom focusing, embarrassment, avoidance, and beliefs about negative consequences. Fear avoidance was the only independent correlate in the fully adjusted model of symptom severity.
Self-reported dizziness severity and handicap are not correlated with clinical tests of vestibular deficits but are associated with psychological factors including anxiety, depression, illness perceptions, cognitive and behavioural responses.
确定人口统计学变量、客观测试和心理因素在解释头晕严重程度和障碍程度的差异方面的相对贡献。
185 名连续患者在等待参加三级神经耳科诊所的诊断预约名单上，主要抱怨眩晕或头晕，完成了横断面调查。主要结果是头晕障碍量表和眩晕症状量表-短表的眩晕子量表。心理问卷评估焦虑和抑郁症状、疾病认知、对症状的认知和行为反应、对情绪的信念和心理脆弱性。患者还在预约时进行了标准化的听觉前庭检查和测试以做出诊断。
客观疾病特征与障碍无关，只有一项测试（冷热）出现前庭功能障碍与症状严重程度相关。几乎所有的心理因素都与头晕结果相关。总层次回归模型解释了头晕障碍的 63%的方差，而心理变量解释了 53%。症状严重程度的回归模型解释了 36%的方差，而心理因素解释了 30%。在调整后的模型中，与头晕障碍相关的因素包括年龄、女性性别、痛苦、症状聚焦、尴尬、回避和对负面后果的信念。恐惧回避是症状严重程度的全调整模型中唯一的独立相关因素。
自我报告的头晕严重程度和障碍与前庭缺陷的临床测试不相关，但与包括焦虑、抑郁、疾病认知、认知和行为反应在内的心理因素相关。
