中重度痤疮患者心理健康状况及影响因素

Psychological health status and influencing factors of patients with moderate-to-severe acne

背景痤疮治疗周期长且有损面容,许多患者容易出现心理健康问题,严重者甚至出现自杀意念。但痤疮患者心理健康问题的影响因素尚不清楚。目的调查中重度痤疮患者心理健康状况并分析其影响因素,为改善患者心理健康状况提供参考。方法选取2021年6月—2023年6月在绵阳市第三人民医院皮肤科门诊进行治疗的120例Ⅱ级~Ⅳ级中重度痤疮患者为研究对象。采用痤疮特异性生活质量量表(Acne-QoL)、抑郁自评量表(SDS)、焦虑自评量表(SAS)、罗森伯格自尊量表(RSES)以及社交恐怖症量表(SPIN)进行评定。根据SDS、SAS、RSES、SPIN评定结果,将患者分为伴心理健康问题组(n=21)和不伴心理健康问题组(n=99)。采用二元Logistic回归分析考查痤疮患者出现心理健康问题的影响因素。结果检出存在抑郁、焦虑、自卑或社交障碍症状者共21例(17.50%)。两组患者的性别、职业、痤疮分级、饮食习惯、年龄、病程、Acne-QoL中的自我感知因子评分、情感功能因子评分、社会功能因子评分以及痤疮症状因子评分比较,差异均有统计学意义(χ2=7.013、23.123、9.028、11.327,t=9.913、13.022、4.081、5.383、5.361、10.203,P均<0.05)。二元Logistic回归分析结果显示,女性(OR=2.243,95%CI:1.136~4.429)、痤疮分级为Ⅲ级(OR=3.615,95%CI:1.269~10.295)或Ⅳ级(OR=1.872,95%CI:1.073~3.266)、病程≥1.6年(OR=2.499,95%CI:1.068~5.851)、饮食习惯辛辣或油腻(OR=3.811,95%CI:1.169~12.427)、Acne-QoL自我感知因子评分≤18分(OR=1.802,95%CI:1.227~2.646)、Acne-QoL情感功能因子评分≤18分(OR=2.252,95%CI:1.016~4.992)、Acne-QoL社会功能因子评分≤14分(OR=3.515,95%CI:1.534~8.053)、Acne-QoL痤疮症状因子评分≤18分(OR=3.586,95%CI:1.098~11.715)是痤疮患者出现心理健康问题的危险因素。年龄≥30岁(OR=0.429,95%CI:0.283~0.648)、职业为干部或企业职工(OR=0.483,95%CI:0.249~0.939)以及其他职业(OR=0.276,95%CI:0.090~0.850)是痤疮患者出现心理健康问题的保护因素。结论部分痤疮患者存在心理健康问题。女性、痤疮分级越高、病程越长、喜食油腻辛辣食物、Acne-QoL各因子评分越低的患者,出现心理健康问题的风险越高。

Background Acne treatment cycle lasts long and will cause facial appearance damage.Many patients are prone to psychological problems and severe patients may even experience suicidal ideation.However,the influencing factors of psychological health problems in acne patients are still unclear.Objective To investigate the mental health status of patients with moderate-to-severe acne and to analyze the influencing factors of their psychological health problems,so as to provide references for improving their mental health.Methods A total of 120 patients with moderate-to-severe acne of grades II-IV were selected as the research subjects,who were treated in the dermatology outpatient department of the Third Hospital of Mianyang from June 2021 to June 2023.All subjects were evaluated by using the Acne-Specific Quality of Life Questionnaire(Acne-QoL),Self-rating Depression Scale(SDS),Self-rating Anxiety Scale(SAS),Rosenberg Self-Esteem Scale(RSES)and Social Phobia Inventory(SPIN).According to the evaluation results of SDS,SAS,RSES,SPIN,subjects were divided into a group with mental health problems(n=21)and a group without mental health problems(n=99).Binary Logistic regression anaylsis was adopted to explore the influencing factors of psychological health problems in acne patients.Results A total of 21 patients(17.50%)were detected to have symptoms of depression,anxiety,inferiority or social dysfunction.Statistically significant difference was observed in comparison between two groups in gender,profession,acne classification,dietary habit,age,illness course as well as the factor scores of self perception,emotional function,social function and acne symptom in Acne-QoL(χ2=7.013,23.123,9.028,11.327,t=9.913,13.022,4.081,5.383,5.361,10.203,P<0.05).The results of binary Logistic regression analysis showed that the followings were risk factors for the occurrence of psychological health problems in acne patients:female(OR=2.243,95%CI:1.136~4.429),acne of grade III(OR=3.615,95%CI:1.269~10.295)or IV(OR=1.872,95%CI:1.073~3.266),course of disease≥1.6 years(OR=2.499,95%CI:1.068~5.851),a spicy or greasy diet(OR=3.811,95%CI:1.169~12.427),Acne-QoL self perception score≤18(OR=1.802,95%CI:1.227~2.646),Acne-QoL emotional function score≤18(OR=2.252,95%CI:1.016~4.992),Acne-QoL social function score≤14(OR=3.515,95%CI:1.534~8.053)and Acne-QoL acne symptom score≤18(OR=3.586,95%CI:1.098~11.715).Protective factors for psychological health problems in acne patients included age over 30 years old(OR=0.429,95%CI:0.283~0.648),occupation as professional cadre or enterprise employee(OR=0.483,95%CI:0.249~0.939)and other occupations(OR=0.276,95%CI:0.090~0.850).Conclusion A part of patients with moderate-to-severe acne may experience psychological health problems.Patients with female gender,higher acne grades,longer disease duration,preference for greasy or spicy foods and lower scores in all Acne-QoL factors have a higher risk of experiencing psychological health problems.