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2019年冠状病毒病恐慌期间中国血液透析患者的心理特征

Psychological Profiles of Chinese Patients With Hemodialysis During the Panic of Coronavirus Disease 2019.

作者信息

Yang Zhen-Hua, Pan Xiao-Ting, Chen Yu, Wang Lu, Chen Qiu-Xin, Zhu Yan, Zhu Yu-Jia, Chen Yong-Xi, Chen Xiao-Nong

机构信息

Department of Nephrology, Ruijin Hospital Affiliated to Shanghai Jiaotong University, School of Medicine, Shanghai, China.

出版信息

Front Psychiatry. 2021 Mar 3;12:616016. doi: 10.3389/fpsyt.2021.616016. eCollection 2021.

Abstract

Hemodialysis patients not only suffer from somatic disorders but are also at high risks of psychiatric problems. Early this year, the outbreak of coronavirus disease 2019 (COVID-19) has caused great panic and anxiety worldwide. The impact of this acute public health event on the psychological status of hemodialysis patients and its relationship with their quality of life have not been fully investigated. This study comprised two parts. The initial study enrolled maintenance hemodialysis patients treated in Ruijin Hospital for more than 3 months from March to May 2020 during the ongoing COVID-19 pandemic. Patients completed three questionnaires including the Impact of Events Scale-Revised (IES-R), General Health Questionnaire-28 (GHQ-28), and Kidney Disease Quality of Life (KDQOL) Short Form (SF). Follow-up study was performed from December 2020 to January 2021, when the pandemic of COVID-19 has been effectively contained in China. Only patients enrolled in the initial study were approached to participate in the follow-up study. There were 273 maintenance dialysis patients enrolled in the initial study and 247 finished the follow-up study. For the initial study, the estimated prevalence of nonspecific psychiatric morbidity was 45.8% (125/273) by GHQ-28. By IES-R, 53/273 (19.4%) patients presented with total scores above 24 that reflected clinical concerns. We found a significant difference regarding KDQOL scores between patients with different stress response (IES-R) groups ( = 0.026). Our follow-up study showed that KDQOL and SF-36 scores were significantly improved in comparison with those in the initial study ( = 0.006 and = 0.031, respectively). Though total scores of GHQ-28 and IES-R did not change significantly, some subscales improved with statistical significance. Furthermore, gender, education background, and duration of hemodialysis were three factors that may affect patients' mental health, quality of life, or health status while dialysis duration was the only variable that correlated with those parameters. However, these correlations were combined effects of the COVID-19 pandemic and the dialysis itself. We found a correlation between changes in the mental health status of dialysis patients and changes in their quality of life. These responses were also mediated by patients' psychosocial parameters. Our results urge the necessity of psychotherapeutic interventions for some patients during this event.

摘要

血液透析患者不仅患有躯体疾病,还面临着较高的精神问题风险。今年年初,2019冠状病毒病(COVID-19)的爆发在全球范围内引起了极大的恐慌和焦虑。这一急性公共卫生事件对血液透析患者心理状态的影响及其与生活质量的关系尚未得到充分研究。本研究包括两个部分。初始研究纳入了在COVID-19大流行期间于2020年3月至5月在瑞金医院接受维持性血液透析治疗超过3个月的患者。患者完成了三份问卷,包括事件影响量表修订版(IES-R)、一般健康问卷-28(GHQ-28)和肾脏病生活质量(KDQOL)简表(SF)。随访研究于2020年12月至2021年1月进行,当时COVID-19在中国已得到有效控制。仅邀请初始研究中纳入的患者参与随访研究。初始研究纳入了273例维持性透析患者,247例完成了随访研究。对于初始研究,通过GHQ-28评估的非特异性精神疾病患病率估计为45.8%(125/273)。通过IES-R评估,53/273(19.4%)的患者总分高于24,这反映出存在临床问题。我们发现不同应激反应(IES-R)组的患者在KDQOL评分上存在显著差异(P = 0.026)。我们的随访研究表明,与初始研究相比,KDQOL和SF-36评分有显著改善(分别为P = 0.006和P = 0.031)。尽管GHQ-28和IES-R的总分没有显著变化,但一些子量表有统计学意义的改善。此外,性别、教育背景和血液透析时长是可能影响患者心理健康、生活质量或健康状况的三个因素,而透析时长是与这些参数相关的唯一变量。然而,这些相关性是COVID-19大流行和透析本身的综合影响。我们发现透析患者心理健康状态的变化与生活质量的变化之间存在相关性。这些反应也由患者的心理社会参数介导。我们的结果表明在这一事件期间对部分患者进行心理治疗干预的必要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8d45/7965959/ad54ba268532/fpsyt-12-616016-g0001.jpg

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