遗传性大肠癌患者心理健康状况及应对方式对生活质量影响的研究

Study on the effect of mental health status and coping styles on the quality of life of patients with hereditary colorectal cancer

目的探究遗传性大肠癌患者心理健康状况及应对方式对患者生活质量的影响。方法采用立意抽样法,调查复旦大学附属肿瘤医院2019年2月-2021年4月确诊为遗传性大肠癌的患者。采用单一样本问卷进行调查,包括:(1)一般资料调查问卷;(2)心理健康状况调查问卷:采用国内常用的医院焦虑抑郁量表;(3)应对方式问卷:采用国内常用的简单应对方式问卷,(4)生活质量问卷:采用欧洲癌症研究和治疗组织生活质量核心问卷(EORTCQLQ-C30)。回收上述调查问卷进行统计分析,采用均数±标准差描述定量数据,分别应用t检验、方差分析和多元线性回归分析进行单因素和多因素分析。结果发放问卷126份,回收126份。结果显示:(1)一般因素对遗传性大肠癌患者生活质量的影响:患者的性别、年龄、文化程度、职业状态和有无放化疗等一般因素对遗传性大肠癌患者生活质量影响比较差异均无统计学意义(P>0.05);(2)心理健康状况对遗传性大肠癌患者生活质量的影响:与无焦虑/抑郁的患者相比,出现焦虑或抑郁症状的患者的EORTCQLQ-C30总体评分低(P<0.05);(3)应对方式对遗传性大肠癌患者生活质量的影响:采取积极应对方式的患者的EORTCQLQ-C30总体评分较高,而采取消极应对方式的患者EORTCQLQ-C30总体评分较低2者之间差异有统计学意义(P<0.05);(4)影响遗传性大肠癌患者生活质量的多因素分析:将患者的一般资料、应对方式以及心理健康状况(焦虑抑郁)多项因素纳入对患者EORTCQLQ-C30总体评分的综合多因素分析,结果表明,在多项混杂因素中,患者的应对方式及焦虑、抑郁的心境状态是影响患者EORTCQLQ-C30总体评分的独立风险因素。患者采取消极应对方式和焦虑/抑郁状态与其EORTCQLQ-C30总体评分之间存在负相关(P<0.05)。结论患者的性别、年龄、文化程度、职业状态和有无放化疗等一般因素对遗传性大肠癌患者的生活质量无明显影响;患者采取积极应对方式可提高生活质量,反之患者若采取消极应对方式则会降低其生活质量;患者的心理无论出现焦虑还是抑郁状态时,生活质量均有所降低。

Objective To explore the effect of mental health status and coping styles on the quality of life(QOL)of patients with hereditary colorectal cancer(CRC).Methods The patients with hereditary CRC diagnosed in the Cancer Hospital Affiliated to Fudan University from February,2019 to April,2021 were investigated by purposive sampling method.A single sample questionnaire was used for the survey,including:(1)General Information Questionnaire;(2)Mental health questionnaire:The Hospital Anxiety and Depression Scale(HADS)used in China;(3)Coping style questionnaire:The Ways of Coping Questionnaire(WCQ)used in China;(4)QOL questionnaire:The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire(EORTCQLQ-C30).The survey results were collected for statistical analysis.The mean±standard deviation was used to describe the quantitative data.t-test,analysis of variance and multiple linear regression analysis were used for univariate and multivariate analysis,respectively.Results 126 questionnaires were distributed and 126 ones were recovered.The results show that:(1)Effects of general factors on the QOL of patients with hereditary CRC:There was no significant difference in the effects of general factors,such as gender,age,educational level,occupational status and the presence or absence of radiotherapy and chemotherapy on the QOL of the patients(P>0.05).(2)Effect of mental health status on the QOL of patients with hereditary CRC:Compared with the patients without anxiety/depression,the overall score of EORTCQLQ-C30 of the patients with anxiety or depression was lower(P<0.05).(3)Effect of coping style on the QOL of patients with hereditary CRC:The patients with positive coping style had a higher overall score of EORTCQLQ-C30,while the patients with negative coping style had a lower overall score of EORTCQLQ-C30.There was significant difference between the two groups(P<0.05).(4)Analysis of multiple factors affecting the QOL of patients with hereditary CRC:The general information,coping style and mental health status(anxiety and depression)were included in the comprehensive multivariate analysis of the overall score of EORTCQLQ-C30 of the patients.The results showed that among the multiple confounding factors,the coping style,anxiety and depression were the independent risk factors affecting the overall score of EORTCQLQ-C30 of the patients.There was a negative correlation between patients’negative coping style,anxiety/depression and their overall score of EORTCQLQ-C30(P<0.05).Conclusion The general factors,such as gender,age,education level,occupational status,presence or absence of radiotherapy and chemotherapy have no significant effect on the QOL of patients with hereditary CRC.Positive coping styles can improve the QOL of the patients,while negative coping styles can reduce their QOL.Regardless of whether the patient’s mental state is anxious or depressed,their QOL is reduced.