Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Psycho-Oncology, Peking University Cancer Hospital and Institute, Beijing, China.
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department 3 of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, Beijing, China.
Psychooncology. 2021 Aug;30(8):1339-1346. doi: 10.1002/pon.5688. Epub 2021 May 7.
To assess changes in body image distress (BID) over time, identify factors associated with BID, and explore the mediating role of body image on the longitudinal association between stoma status (permanent stoma, temporary stoma, or nonstoma) and psychological distress in postoperative colorectal cancer (CRC) patients in China.
Participants (N = 255) 1-2 weeks postsurgery completed self-report questionnaires assessing BID (Body Image Scale) and psychosocial distress (Distress Thermometer, Hospital Anxiety and Depression Scale); 212 (83%) completed 6-month follow-up surveys. Generalized estimating equations were used to identify factors associated with BID for longitudinal data analysis.
A total of 46.7% of participants reported BID at follow-up. Prevalence of BID and BID scores did not significantly change over time in the total sample. Body image scores decreased in patients whose temporary stoma was removed during follow-up (p < 0.05). Prevalence of BID decreased in nonstoma patients at follow-up (p < 0.05). There were significant decreases in the prevalence and scores of distress, anxiety, and depression between baseline and follow-up (p < 0.001). Stoma presence, later clinical stages, greater distress, anxiety, and depression were risk factors for poorer body image. Body image had partial mediating effects on the longitudinal association between stoma status and distress.
Our findings indicate that BID remains stable even as psychological distress decreases. BID should be addressed early postoperation to avoid persistent impairment in CRC patients.
评估身体意象困扰（BID）随时间的变化，确定与 BID 相关的因素，并探讨身体意象在永久性造口、临时性造口和非造口术后结直肠癌（CRC）患者的造口状态和心理困扰的纵向关联中的中介作用。
参与者（N=255）在手术后 1-2 周内完成了自我报告问卷，评估身体意象（身体意象量表）和心理困扰（困扰温度计、医院焦虑和抑郁量表）；212 名（83%）完成了 6 个月的随访调查。广义估计方程用于识别与纵向数据分析相关的 BID 因素。
共有 46.7%的参与者在随访时报告了 BID。在总样本中，BID 的患病率和 BID 评分在随访期间没有显著变化。在随访期间临时造口被切除的患者中，身体意象评分下降（p<0.05）。非造口患者在随访时 BID 的患病率下降（p<0.05）。在基线和随访之间，困扰、焦虑和抑郁的患病率和评分都有显著下降（p<0.001）。造口存在、较晚的临床分期、较大的困扰、焦虑和抑郁是身体意象较差的危险因素。身体意象对造口状态和困扰的纵向关联有部分中介作用。
我们的发现表明，即使心理困扰减轻，BID 仍然稳定。BID 应该在手术后早期得到解决，以避免 CRC 患者持续受损。
