Mo J B, Huang L, Qin J J, Liang B
Department of Nephrology, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, China.
Zhonghua Gan Zang Bing Za Zhi. 2023 Jan 15;39(1):13-19. doi: 10.3760/cma.j.cn441217-20220722-00730.
To investigate the psychological effect of physical function dependence on maintenance hemodialysis (MHD) patients and their primary family caregivers. The study was a cross-sectional survey. The MHD patients in the hemodialysis centre, the Third Affiliated Hospital of Guangzhou Medical University from March 2022 to June 2022 were enrolled. The patients' demographics and laboratory data were collected. Katz and Lawton-Brody questionnaires were used to assess patients' physical function, and Five Item Mental Health Inventory (MHI-5) was used to evaluate the psychological conditions of the patients and their primary family caregivers. Multiple linear regression analysis was used to analyze the influencing factors of MHI-5 scores of the patients and their primary family caregivers. A total of 116 patients were included, with 61 males and 55 females. There were 47 patients (40.5%) with physical function dependence. In the physical function dependence group, serum albumin (=-2.512, =0.013), MHI-5 scores of patients and their primary family caregivers (=-8.461, < 0.001; =-8.533, < 0.001) and male ratio (=8.467, =0.002) were significantly lower, and the age (=9.754, < 0.001) and the proportions of hypertension (=20.421, < 0.001), diabetes (=10.470, =0.002), cardiovascular and cerebrovascular diseases (=9.898, =0.003) were significantly higher than those in the normal physical function group. The incidence of mental disorders in MHD patients was 39.7%(46/116), and the incidence of mental disorders in the physical function dependence group was significantly higher than that in the normal physical function group [72.3%(34/47) . 17.4%(12/69), =35.275, < 0.001]. The incidence of mental disorders in the primary family caregivers was 32.8%(38/116), and the incidence of mental disorders in the primary family caregivers of physical function dependence group was significantly higher than that in the normal physical function group [66.0%(31/47) . 10.1%(7/69), =39.536, < 0.001]. The incidence of mental disorders in the primary family caregivers of MHD patients who were not spouses was significantly higher than that of spouses [46.0%(29/63) . 17.0%(9/53), =11.028, =0.001], and in physical function dependence group, the incidence of mental disorders in non-spouses was significantly higher than that in spouses [80.6%(25/31) . 37.5%(6/16), =8.749, =0.003]. Multiple linear analysis showed that bathing (=-5.182, =0.015), doing laundry (=-7.053, < 0.001), taking medication (=-8.680, =0.003), and female patients (=-2.982, =0.030) were the influencing factors of MHI-5 scores decline in MHD patients. Bathing (=-4.404, =0.032), preparing meals (=-3.954, =0.041), managing money (=-5.067, =0.021), and female patients (=-2.466, =0.042) were the influencing factors of MHI-5 scores decline in primary family caregivers. The incidence of physical function dependence in MHD patients is high, and its manifestations and influencing factors are diverse. The incidence of mental disorders in MHD patients and their primary family caregivers is also high, especially in patients with physical function dependence and non- spouse family caregivers. Clinicians should pay attention to and assess the physical function dependence of MHD patients as early as possible, and intervene in time. At the same time, they should also pay attention to the mental health of MHD patients and their primary family caregivers.
探讨维持性血液透析(MHD)患者身体功能依赖对其及主要家庭照顾者心理的影响。本研究为横断面调查。选取2022年3月至2022年6月在广州医科大学附属第三医院血液透析中心的MHD患者。收集患者的人口统计学资料和实验室数据。采用Katz和Lawton - Brody问卷评估患者身体功能,采用五条目心理健康量表(MHI - 5)评估患者及其主要家庭照顾者的心理状况。采用多元线性回归分析患者及其主要家庭照顾者MHI - 5得分的影响因素。共纳入116例患者,其中男性61例,女性55例。有47例患者(40.5%)存在身体功能依赖。在身体功能依赖组,血清白蛋白(=-2.512,=0.013)、患者及其主要家庭照顾者的MHI - 5得分(=-8.461,<0.001;=-8.533,<0.001)及男性比例(=8.467,=0.002)显著降低,年龄(=9.754,<0.001)以及高血压(=20.421,<0.001)、糖尿病(=10.470,=0.002)、心脑血管疾病(=9.898,=0.003)的比例显著高于身体功能正常组。MHD患者精神障碍发生率为39.7%(46/116),身体功能依赖组精神障碍发生率显著高于身体功能正常组[72.3%(34/47). 17.4%(12/69),=35.275,<0.001]。主要家庭照顾者精神障碍发生率为32.8%(38/116),身体功能依赖组主要家庭照顾者精神障碍发生率显著高于身体功能正常组[66.0%(31/47). 10.1%(7/69),=39.536,<0.001]。非配偶的MHD患者主要家庭照顾者精神障碍发生率显著高于配偶[46.0%(29/63). 17.0%(9/53),=11.028,=0.001],在身体功能依赖组,非配偶的精神障碍发生率显著高于配偶[80.6%(25/31). 37.5%(6/16),=8.749,=0.003]。多元线性分析显示,洗澡(=-5.182,=0.015)、洗衣服(=-7.053,<0.001)、服药(=-8.680,=0.003)以及女性患者(=-2.982, =0.030)是MHD患者MHI - 5得分下降的影响因素。洗澡(=-4.404,=0.032)、做饭(=-3.954,=0.041)、理财(=-5.067,=0.021)以及女性患者(=-2.466,=0.042)是主要家庭照顾者MHI - 5得分下降的影响因素。MHD患者身体功能依赖发生率高,其表现及影响因素多样。MHD患者及其主要家庭照顾者精神障碍发生率也高,尤其是身体功能依赖患者及非配偶家庭照顾者。临床医生应尽早关注并评估MHD患者的身体功能依赖情况,并及时进行干预。同时,也应关注MHD患者及其主要家庭照顾者的心理健康。