| BackgroundMicrotia is the most common congenital craniofacial defects in plastic surgery, most previous studies were focused on clinical surgical treatment, surgical improvements, basic research on cartilage tissue engineering level, or only on psychosocial defects of microtia patients, but some microtia patients adapted well, that might be relevant to "psychological resilience" which recently being hot spots in psychological research. This phenomenon is being paid attention in current days. For psychological effects caused by a range of birth defects, whether microtia patients can actively respond to and how to adjust it in mind will influence if the microtia surgery can proceed smoothly, and also related to patients with microtia physiological for psychological health of long-term stable development. Thus, study for patients with microtia system resilience issues will play an important role in the prevention and improvement of microtia patients with physical and mental health problems.ObjectivesTo understand the mental health status and problems in the Congenital microtia patients; to analyze the relevant risk factors inducing their mental health problems; to systematically review the international interventions on mental health of involuntary migrants, in order to explore intervention strategies targeting the Congenital microtia patients and provide scientific evidence for promoting their mental health.To understand the adaptability status and resilience problems for microtia patients in our hospital; to analysis related risk factors of resilience of microtia patients; using quantitative research to build equation structure modeling for resilience in microtia patients, combined domestic and international non-Voluntary surgical microtia patients with mental health interventions, provide scientific evidence for targeted interventions with risk factors of development for microtia patients.Methods1. Through the 250 cases randomly selected patients with microtia and to adapt to the results of their interviews with four types of scale survey, to preliminarily understand the adaption status of patients with microtia, analyze the measuring characteristics of each scale for test, understand the basic situation of resilience in microtia patients, provide a realistic basis to establish the basic assumption of this study.2. Using resilience questionnaire of the "youth resilience scale" compiled by Huyue Qin and Gan Yiqun, we made a survey on 161 microtia patients, then used of exploratory factor analysis and confirmatory factor analysis to explore the structure of resilience in microtia patients, and preliminarily constructed equation structural modeling of resilience in microtia patients.3. In this study, after accessing to psychological factors and related data of resilience, we analyzed the causal relationship between them to determine the three types of indicators:one can predict the antecedent variables of psychological flexibility, and the second one to represent the five state mental flexibility dimension variables and the third one to indicate the consequences of the results of psychological variables of reduced resilience. Computerize the questionnaire of Measurement of these three variables in order to establish the early warning systems for microtia patients with reduced resilience. Combined with the domestic and abroad intervention strategies for microtia patients with mental health problems, we developed psychological intervention measures for microtia patients to improve their resilience, and promote physical and mental health of their future development.Results1. The results of questionnaire survey of microtia patients adaptation status(1) mental health and adaptation status in patients with microtia Generally speaking, the patients with microtia without surgery had poorer mental health than their counterparts. The questionnaire results showed that the total scores and the factor scores of psychological well-being scale, physical self-esteem Scale, Life Satisfaction Scale, scores were significantly lower than the.surgical group. Mental health problems were more prevalent in the patients with microtia without surgery in comparison with their counterparts. It is common that lower-expectation, lower subjective well-being score, weak tending to get help and poor psychological pressure regulation in the first group. Born under different district, microtia patients have lower resilience in rural areas to adapt in the ones in city.(2) The results and psychological factors of resilience in microtia patients Factors of resilience in microtia patients include four aspects:â‘ social and environmental factors:such as life events and psychosocial stress, social support, social and cultural adaptation, teachers and students supporting, interpersonal assistance, external ear reconstructive surgery incident stress etc.;â‘¡Family factors:such as the support of parents and relatives;â‘¢individual factors:gender, emotional control, positive cognitive, goal focused coping styles and so on. Among them, the psycho-social stress, family support, external ear reconstruction of events and other social factors in patients with microtia are important factors in mental health.2. Resilience Modeling Construction of Microtia patients and Early Warning Mechanism Model StudyAfter regression analysis of various factors of the patient's resilience, combined with structural equation modeling, we come to the preliminary formula. We also analyzed the existing interventions and found the targeted population were mainly refugees and asylum seekers caused by the war, violence and other tortures, while only one study targeted at microtia patients. All the psychological interventions were divided into prevention intervention and treatment intervention. The main interventions include: integrated psychological intervention, group treatment, cognitive behavior therapy, testimony, narrative exposure therapy, supportive counseling service, family support and therapy, etc. Of which, integrated psychological interventions are the most common intervention. Most of the studies evaluating effectiveness are observational studies. The results of most evaluation studies show that the implemented psychological interventions have positive impact on mental health of microtia patients under involuntary surgery.Conclusions As a whole, the microtia patients under involuntary surgery had poorer resilience than their surgical counterparts, and resilience of the microtia patients from different place had specific characteristics. Social factors, natural environmental factors, personal factors and other factors combined to produce a complex impact on the resilience of microtia patients. Therefore, an integrated psychological intervention strategy would be helpful to achieve better effects. Based on the general characteristics of microtia patients, as well as currently available evidence related to psychological interventions on mental health of involuntary sugary, a comprehensive intervention strategy is proposed for the congenital microtia patients. The strategy adopts comprehensive interventions with prevention as its priority. From three levels of the social, school, family, hospital and microtia individual patients, focused on the main factors of resilience in microtia patients, through a variety of interventions to reduce microtia patients with psychosocial stress, improve their social support and increase the resilience of microtia patients, so as to improve the mental health of microtia patients. In addition, parents, teachers and a doctor should pay attention to the psychological problems of microtia patients who refused surgery and carry out some targeted psychological intervention.
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