Zhou Yang, Liu Yanping, Guo Yabin, Liu Xiaotong, Zhou Yang
Xiang Ya Nursing school, Central South University, Changsha, China.
Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, China.
Sci Rep. 2025 Mar 25;15(1):10253. doi: 10.1038/s41598-025-95212-6.
Existing studies have focused on post-traumatic stress disorder (PTSD) after surgery in patients with knee osteoarthritis (KOA), whereas PTSD in non-operated elderly KOA patients has not been adequately studied. The aim was to assess the current status of PTSD and its influencing factors among non-surgical elderly KOA patients. From October to November 2021, a cross-sectional study was conducted among 320 consecutive patients aged ≥ 65 years with radiologically confirmed KOA and no history of knee surgery or psychiatric disorders, recruited from three community hospitals in Changsha, Hunan Province. A total of 314 participants completed validated assessments for PTSD (PTSD Checklist-Civilian Version), pain (Numerical Rating Scale), anxiety (Generalized Anxiety Disorder Scale), depression (Patient Health Questionnaire-9), and social support (Social Support Rating Scale). Data were analyzed using non-parametric tests and Spearman correlation. Structural equation modeling (SEM) was performed with Amos 24.0, employing maximum likelihood estimation and 1000 bootstrap samples to test mediation effects. Among 314 analyzed participants (mean age 72.91 ± 6.384 years; 60.80% female and 39.20% males), PTSD prevalence was 18.20%. Significantly higher PTSD risk was associated with low education levels (Z=-2.398, P = 0.016), low salaries (H = -2.398, P = 0.005), unemployed patients (H = 10.030, P = 0.007), no exercise (H = 9.328, P = 0.025), smoking (Z = -2.504, P = 0.012) and no leisure activities (Z=-2.074, P = 0.038). Structural equation modeling revealed a direct effect of depression on PTSD with the path coefficient of 0.701 (95% CI 0.518-0.879, P = 0.001) and an indirect effect of pain on PTSD through social support with the path coefficient of -0.014 (95% CI -0.049 to -0.001, P = 0.035 < 0.05). Non-surgical elderly patients with knee osteoarthritis exhibit clinically significant post-traumatic stress disorder rates (18.20%), primarily driven by depression and mediated through pain-social support pathways. These findings underscore the need for integrated biopsychosocial interventions targeting pain management, mental health screening, and social support enhancement in this population.
现有研究主要聚焦于膝关节骨关节炎（KOA）患者术后的创伤后应激障碍（PTSD），而对于未接受手术的老年KOA患者的PTSD尚未进行充分研究。本研究旨在评估非手术治疗的老年KOA患者中PTSD的现状及其影响因素。2021年10月至11月，在湖南省长沙市的三家社区医院，对320例年龄≥65岁、经影像学确诊为KOA且无膝关节手术史或精神疾病史的连续患者进行了一项横断面研究。共有314名参与者完成了PTSD（PTSD检查表-民用版）、疼痛（数字评分量表）、焦虑（广泛性焦虑障碍量表）、抑郁（患者健康问卷-9）和社会支持（社会支持评定量表）的有效评估。采用非参数检验和Spearman相关性分析数据。使用Amos 24.0进行结构方程建模（SEM），采用最大似然估计和1000次自抽样来检验中介效应。在314名分析参与者中（平均年龄72.91±6.384岁；女性占60.80%，男性占39.20%），PTSD患病率为18.20%。PTSD风险显著升高与低教育水平（Z=-2.398，P=0.016）、低工资（H=-2.398，P=0.005）、失业患者（H=10.030，P=0.007）、不运动（H=9.328，P=0.025）、吸烟（Z=-2.504，P=0.012）和无休闲活动（Z=-2.074，P=0.038）有关。结构方程建模显示抑郁对PTSD有直接效应，路径系数为0.701（95%CI 0.518-0.879，P=0.001），疼痛通过社会支持对PTSD有间接效应，路径系数为-0.014（95%CI -0.049至-0.001，P=0.035<0.05）。非手术治疗的老年膝关节骨关节炎患者表现出临床上显著的创伤后应激障碍发生率（18.20%），主要由抑郁驱动，并通过疼痛-社会支持途径介导。这些发现强调了对该人群进行针对疼痛管理、心理健康筛查和增强社会支持的综合生物心理社会干预的必要性。
