| Percutaneous transluminal coronary intervention(PCI)has been used as the main method for the revascularization of coronary atherosclerotic heart disease.The procedure was characterized by its minimum damage to patients,higher safety and lower mortality,but it still presented risks in the treatment and could cause pain and inconvenien to patients.In addition,many studies have shown that patients experienced significant changes in their mental health status after PCI,with anxiety and depression being the most common problems.Previous studies revealed that mental health problems caused by PCI could seriously affect the compliance and prognosis of patients.Although PCI has been widely used,the problems of postoperative anxiety and depression cannot be ignored.Due to its high incidence and harmfulness,corresponding measures and interventions should be taken on the influencing factors of postoperative anxiety and depression.By understand their relationships with anxiety and depression in patients after PCI,postoperative health outcomes and the quality of life of patients can be improved.Objectives:This study aimed to understand the prevalence rate of anxiety and depression in patients after PCI and their influencing factors through a cross-sectional survey.A path analysis was conducted,on the influencing factors of anxiety and depression in PCI postoperative patients base on the theory of unpleasantsmptoms,to examine the independent and interactive effects between somatic pain relief,self-efficacy and social support on the symptom of insomnia.Meanwhile,the analysis also examined the independent and interactive effects between three independent variables and the effect of insomnia on the anxiety and depression of PCI postoperative patients,and constructed a structural equation model.Then,with the longitudinal follow-ups,the cross-lag model was used to explore the diachronic relationship between insomnia symptoms and performance outcomes of anxiety and depression,and the study explored the developmental trends and trajectories of anxiety and depression in patients after PCI based on individual differences.Meanwhile,changes in the development trajectories of key variables over time were examined to see whether they have significant influences on anxiety and depression of patients at the last time point of the follow up,and provided scientific evidence for the formulation of preventative and intervention strategies for patients with anxiety and depression after PCI.Methods:A self-reported questionnaire survey,which applied continuous sample sampling method,was conducted among patients undergoing coronary stenting in a tertiary hospital in Changchun City from March 2021 to September 2021.The time for the first baseline cross-sectional survey was 3 days after the operation.On the basis of the crosssection,follow ups were conducted at one month and three months after the operation.The survey was conducted three times.Epidata 3.1 software was used to documented the data,and SPSS 24.0 software,Process 3.4 plug-in,R Studio 4.1.2 software and Mplus 8.3 software were used for data processing and analysis.Descriptive statistics were used to describe demographic characteristics of research subjects and the incidence rate of anxiety and depression;chi-square test was used for group comparisons of categorical variables;t-test and analysis of variance were used for group comparisons of continuous variables;binary variables Logistic regression model was used to analyze influencing factors;and hierarchical multiple linear regression analysis was used to test the the relationship between antecedent variables and anxiety and depression,and simple slope analysis was used to further explore the influence of interaction between antecedent variables on the dependent variables.A latent variable growth curve-linear unconditional model was created to explore the average trends of anxiety and depression in patients after PCI;and a latent category growth model was constructed to explore the hetergeneous development trends of anxiety,depression,physical pain relief,self-efficacy,social support and insomnia over time.Binary logistic regression models were used to analyze the effects of four core variables on the final outcomes of anxiety and depression.Results:(1)The prevalence of anxiety and depression in patients after PCI was 25.1% and29.1%,respectively.Among them,the influencing factors of postoperative anxiety include economic assistance,financial burden of seeing a doctor,the degree of worry about taking medicines as prescribed by the doctor,the degree of influence of physical pain on life,and the worry about the seizure of disease or death;the influencing factors of depression include monthly income of the family,the frequency of vegetable consumption,the history of PCI,sleep duration,the degree of worry about taking medicine as prescribed by the doctor,and the impact of physical pain on life(P<0.05).(2)The degree of physical pain relief and self-efficacy significantly affect the insomnia of patients after PCI,and the interaction of the two also affects the insomnia.(3)Self-efficacy alone can affect anxiety in patients after PCI,and three interactions of self-efficacy,the degree of physical pain relief and social support can affect anxiety.(4)The degree of physical pain relief,self-efficacy and social support can independently influence depression in patients after PCI.(5)Insomnia can affect anxiety and depression in patients after PCI,and there is a diachronic interaction relationship.(6)The symptoms of anxiety and depression in patients after PCI revealed declining trends over time,and the development trends of anxiety and depression were belonged to different potential categories,namely "anxiety relief group","persistent anxiety risk group","depression remission group" and "persistent depression risk group".(7)According to the latent category growth model,the change in the trend of physical pain relief over time can be divided into "better group","general group" and "relief group",which accounted for 24.8%,14.7% and 60.5% of the study population,respectively.Self-efficacy can be divided into "high risk group","normal group","medium-high risk group" and "excessive group",which accounted for 8.0%,34.1%,37.2% and 20.7% of the study sample,respectively.Social support can be divided into "higher group","normal group" and "general group",which accounted for 33.1%,56.8%and 10.1% of the total,respectively.Insomnia can be divided into "normal group" and "risk group",which accounted for 81.7% and 18.3% of the total,respectively.(8)Compare to the group with better developmental trend of physical pain relief,people in the general group and the relief group were more likely to develop anxiety and depression.High self-efficacy was a protective factor against the development of anxiety and depression compare to the high-risk group with a declining trend of selfefficacy.Compare to the higher group with increasing developmental trend of social support,patients in normal group and general group were more likely to development anxiety and depression after PCI.Compare to the normal group of insomnia,patients in the risk group showed higher risk of develop anxiety and depression.Conclusions:(1)The more risk factors patients exposed after PCI,the more likely they will develop anxiety and depression.(2)The level of physical pain relief,self-efficacy and social support could,both independently and interactively,affect the symptoms of insomnia,anxiety and depression to certain degree.(3)Insomnia can affect anxiety and depression in patients after PCI,and there is a diachronic interaction relationship.(4)The developmental tends of anxiety and depression declined over time in patients after PCI,and both types of mental disorders demonstrated different developmental trajectories.(5)The developmental tends of physical pain relief,self-efficacy social support and insomnia could significantly affect the development of anxiety and depression. |
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