School of Public Health, Dalian Medical University, 9 Western Section, Lvshun South Street, Lvshunkou District, Dalian, 116044, Liaoning, China.
BMC Infect Dis. 2021 Jun 12;21(1):563. doi: 10.1186/s12879-021-06284-4.
BACKGROUND: Psychological distress, a major comorbidities of tuberculosis (TB) patients, has posed a serious threat to the progress being made in global TB programs by affecting treatment adherence and health outcomes. However, the magnitude and associated factors of psychological distress have not been fully studied in China. The aim of the current study was to assess the prevalence of psychological distress in TB patients and to further determine the effects of socio-demographic characteristics, health-related variables, substance use status, social support, and experienced stigma on psychological distress. METHODS: A cross-sectional survey was conducted among TB patients attending three medical institutions in Dalian, Liaoning Province, Northeast China from November 2020 to March 2021. A structured questionnaire was developed to collect data on patients' socio-demographic characteristics, health-related information, substance use status, psychological distress, family function, doctor-patient relationship, policy support, experienced stigma and so on. The binary logistics regression model was used to determine the associated factors of psychological distress. RESULTS: A total of 473 TB patients were enrolled in this study, and the prevalence of psychological distress was 64.1%. Binary logistic regression analysis revealed that patients with a middle school education level or above (OR: 0.521, 95%CI: 0.279-0.974), no adverse drug reactions (OR: 0.476, 95%CI: 0.268-0.846), and regular physical exercise (OR: 0.528, 95%CI: 0.281-0.993) were more likely to stay away from psychological distress. However, patients who had a high economic burden (OR: 1.697, 95%CI: 1.014-2.840), diabetes (OR: 2.165, 95%CI: 1.025-4.573), self-rated illness severe (OR: 3.169, 95%CI: 1.081-9.285), perceived poor resistance (OR: 2.065, 95%CI: 1.118-3.815), severe family dysfunction (OR: 4.001, 95%CI: 1.158-13.823), perceived need for strengthen psychological counseling (OR: 4.837, 95%CI: 2.833-8.258), and a high experienced stigma (OR: 3.253, 95%CI: 1.966-5.384) tended to have a psychological distress. CONCLUSIONS: The study found that the proportion of psychological distress among TB patients was high in Northeast China, and it was influenced by a variety of factors. Effective interventions to reduce psychological distress in TB patients urgently need to be developed, and greater attention should be given to patients with risk factors.
背景：心理困扰是结核病（TB）患者的主要合并症之一，它通过影响治疗依从性和健康结果，对全球结核病规划所取得的进展构成了严重威胁。然而，中国尚未充分研究心理困扰的严重程度及其相关因素。本研究旨在评估 TB 患者心理困扰的流行程度，并进一步确定社会人口统计学特征、健康相关变量、物质使用状况、社会支持和经历的耻辱感对心理困扰的影响。
方法：本横断面研究于 2020 年 11 月至 2021 年 3 月在辽宁省大连市的三家医疗机构对 TB 患者进行了调查。采用结构化问卷收集患者的社会人口统计学特征、健康相关信息、物质使用状况、心理困扰、家庭功能、医患关系、政策支持、经历的耻辱感等数据。采用二元逻辑回归模型确定心理困扰的相关因素。
结果：本研究共纳入 473 名 TB 患者，心理困扰的患病率为 64.1%。二元逻辑回归分析显示，具有中学及以上学历（OR：0.521，95%CI：0.279-0.974）、无药物不良反应（OR：0.476，95%CI：0.268-0.846）和定期进行体育锻炼（OR：0.528，95%CI：0.281-0.993）的患者更有可能远离心理困扰。然而，经济负担重（OR：1.697，95%CI：1.014-2.840）、患有糖尿病（OR：2.165，95%CI：1.025-4.573）、自我评估疾病严重程度高（OR：3.169，95%CI：1.081-9.285）、自我感知抵抗力差（OR：2.065，95%CI：1.118-3.815）、家庭功能严重障碍（OR：4.001，95%CI：1.158-13.823）、需要加强心理咨询（OR：4.837，95%CI：2.833-8.258）和经历高度耻辱感（OR：3.253，95%CI：1.966-5.384）的患者更易出现心理困扰。
结论：本研究发现，东北地区 TB 患者的心理困扰比例较高，且受多种因素影响。急需制定有效的干预措施来降低 TB 患者的心理困扰，应更加关注有风险因素的患者。
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