我所见即我所感。多发性硬化症中疾病认知模式的识别及其与适应结局的关联——一项为期 5 年的前瞻性研究。

How I see is how I feel. Identification of illness perception schema and its association with adaptation outcomes in multiple sclerosis - a 5-year prospective study.

机构信息

University of Silesia, Katowice, Poland.

出版信息

PLoS One. 2021 Oct 28;16(10):e0258740. doi: 10.1371/journal.pone.0258740. eCollection 2021.

Abstract

The aim of the study was to assess the role of illness perception in adaptation to chronic disease among patients with relapsing-remitting multiple sclerosis (RRMS). The differences between the obtained configurations of the illness perception components during four measurements and the model of predictions of the values of adaptation indicators, i.e. depression, anxiety and quality of life during subsequent measurements, were analyzed. Illness representation was assessed at baseline via the Illness Representation Questionnaire-Revised. The adaptation indicators-anxiety, depression (measured by HADS) and quality of life (measured by MSIS-29) were measured at baseline and three more times over a five-year period. The k-means cluster analysis (with two-way and repeated measures ANOVA) was conducted in a group of 90 patients (48.89% women and 51.11% men). Subsequently, the mean values of depression, anxiety, physical and psychological quality of life were compared between the clusters using the Kruskall-Wallis test. Finally, a cross-lagged panel modeled for HADS and MSIS-29 subscales in each measurement occasion (T1-T4). Three different illness perception clusters (Anxious, Realistic and Fatalistic Illness Perception named AIP, RIP and FIP) were composed which differentiated the depression, anxiety, quality of life level and age. FIP showed the lowest adaptation outcomes with small differences between AIP and RIP. It was also significantly characterized by the highest age. The positive adaptation indicators were related to the RIP cluster. The model presented rather satisfactory fit (χ2(48) = 81.05; CFI = .968; TLI = .925; SRMR = .050) with slightly inflated RMSEA = .087 (90%CI .053-.120). Based on initial measurements of individual characteristics, it was possible to predict the functioning of patients after several years. For patients with AIP, the covariance of anxiety and depression was significant, for patients with RIP-depression and anxiety, and for patients with FIP-depression. In addition, each of the variables was a predictor of subsequent measurements in particular time intervals, illustrating the dynamics of changes. Results highlight that illness perceptions formed at the beginning of RRMS are important for the process of adaptation to the disease. Moreover, they showed the differences between the adaptation outcomes supporting the idea that a cognitive representation might be important for the level of psychological functioning.

摘要

本研究旨在评估疾病认知在复发性缓解型多发性硬化症(RRMS)患者适应慢性病过程中的作用。分析了在四个测量时间点获得的疾病认知成分配置与后续测量中适应指标(抑郁、焦虑和生活质量)值预测模型之间的差异。使用修订后的疾病认知问卷(Illness Representation Questionnaire-Revised)在基线时评估疾病表现。在五年内进行了四次测量,评估了适应指标(焦虑、抑郁(通过 HADS 测量)和生活质量(通过 MSIS-29 测量))。对 90 名患者(48.89%女性和 51.11%男性)进行了 k-均值聚类分析(双向和重复测量 ANOVA)。随后,使用 Kruskal-Wallis 检验比较了聚类之间抑郁、焦虑、身体和心理生活质量的平均值。最后,对每个测量时间点(T1-T4)的 HADS 和 MSIS-29 子量表进行交叉滞后面板建模。由三个不同的疾病认知集群(命名为 AIP、RIP 和 FIP 的焦虑、现实和宿命论的疾病认知)组成,这些集群可以区分抑郁、焦虑、生活质量水平和年龄。FIP 表现出最低的适应结果,AIP 和 RIP 之间的差异很小。它的年龄也显著较高。积极的适应指标与 RIP 集群相关。该模型表现出相当令人满意的拟合度(χ2(48) = 81.05;CFI =.968;TLI =.925;SRMR =.050),略微膨胀的 RMSEA =.087(90%CI.053-.120)。基于个体特征的初始测量,有可能预测患者在几年后的功能。对于 AIP 患者,焦虑和抑郁的协方差是显著的,对于 RIP 患者,抑郁和焦虑是显著的,对于 FIP 患者,抑郁是显著的。此外,每个变量都是特定时间段后续测量的预测指标,说明了变化的动态。研究结果强调,RRMS 开始时形成的疾病认知对于适应疾病的过程很重要。此外,它们还显示了适应结果之间的差异,支持认知表现可能对心理功能水平很重要的观点。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70bc/8553031/587cc5077d8f/pone.0258740.g001.jpg

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