| Objectives To know the content and pattern of medical service and to explore their demand for mental health service;To determine the Anxiety and Depression symptom and Quality of life of women who suffered from Rheumatoid Arthritis in hospital and to develop effective mental healthy promoting methods for the women.Methods The qualitative study was conducted in Hospital of Anhui Chinese medicine. The women who suffer from Rheumatoid Arthritis and stayed in the hospital during August 2006 to October were invited to be as subjects. After informed consent, the in-depth interview was used to interview twenty participants who met the clinical diagnosis standards. The participants were interviewed followed the outline of interview and the interviewing. The contents of the interview involved the development and treatment of Rheumatoid Arthritis, social support, mental health, the needs of social and psychological support services, as well as the skills of dealing with negative emotion and the demand for mental health services. Each interview round lasted about one hour. To be sure of the consistency between the original records and finishing texts, the record of the interviews was transformed into word file by one investigator and was checked by another investigator. The criterion was established for data selection, and then"sampling purposes"was used to choose the targeting content based on interview clues.The cross-section study was conducted in the hospital of Anhui Chinese medicine, the first affiliated hospital of Anhui medical university and Anhui provincial hospital. The subjects were women who suffered from Rheumatoid Arthritis and stayed in the three hospitals during January 2007 to June. Anonymous questionnaires were finished by 240 participants. Anxiety rating, depression rating, quality of life were done by using SAS, SDS and WHOQOL-BREF respectively and social support, marriage adjustment, coping behavior were also investigated. The patients completed the questionnaires independently. The Chi square test was used to determine the relationship between socio-demographic characteristics and women's anxiety, depression and quality of life with Rheumatoid Arthritis. The relationship between social support, marital adjustment, fatigue and patient's anxiety, depression and quality of life were found out by correlate anynasis. The multiple non-conditional Logistic regression analysis was conducted to know the factors of anxiety, depression and quality of life among participants.The congnitive behavior intervention was conducted in Anhui Chinese medicine hospital. The women who suffered from Rheumatoid Arthritis and stayed in the hospital during June 2007 to December were invited to be as intervention subjects and those who stsyed in the hospital from June 1st 2007 to August 31st 2007, were selected to be control matching by age no more than 2 years and disease lasting time course no more than 1 year. The participants in intervention were received two-week cognitive behavioral intervention based on routine clinical therapy and nursing. The participants in control were only received routine clinical therapy and nursing. To assess the effects of the intervention, the questionnaire of health status was conducted at baseline and two weeks later. Paired-Samples T test was used to test the changes score of anxiety and quality of life between the two groups'subjects.Results Most of the patients in their early stages of Rheumatoid Arthritis didn't pay enough attention to disease, and their emotion is relatively stable. With the progress of the disease developing, most patients had emotional fluctuations, anxiety and depression symptoms and had low level of social support. The patients were leak of shill of dealing with emotional problem. It was found that the medical service concentrated on disease treatment and mental health intervention was neglected.The rate of anxiety was 37.5% and that of depression was 72.7% among women suffered from RA in hospital. The rate of anxiety and depression was significantly difference between variety of education level, living in location, the month's earning, the body condition, the joints function, the joints abnormality, and the morning stiffness. The rate of depression was significantly higher among women with RA who are at least 49 years old and had no formal therapy. Both the anxiety and depression were correlated with pain, coping behavior, marriage adjustment, fatigue and social support. By Logistic regression analysis, submission of coping style and fatigue were associated with anxiety; living in rural, under the education of middle school, suffering from the morning lasting over half an hour, submission of coping style, lack of skill of marriage adjustment and social support could increase the risk of depression. The score of quality of life among Rheumatoid Arthritis women was low. The factors were sociated with quality of life, included the patient's education level, marital status, joint deformities, formal treatment previous, current physical functional status, place of residence. The variable of patient's education level, body function classification, Passive approach, joint deformities and social support enter the equation of quality of life by means of Logistic regression analysis.There were no statistically differences between participants in intervention and in control among anxiety score, depression score, quality of life score and coping score at baseline. The mean scores of deviation of anxiety and depression between baseline and assessment of participants in intervention were 6.47±7.81 and 8.00±10.79 respectively, and those in control were 1.35±8.46 and 1.93±11.84 accordingly. The results showed that these differences were significant by using paired-samples T test. Regarding to quality of life, the mean scores of deviation among the physical and social field between baseline and assessment of the participants in intervention were -2.98±3.26 and 0.87±2.42 respectively, which were lower significant than those in control (0.44±3.08 and 0.65±2.67). In other word, the mean scores of deviation of the psychological and environment field between baseline and assessment of the participants in intervention were -0.86±3.65 and -3.58±9.71 respectively, which were lower significantly also than those in control (0.46±3.09 and 1.15±8.76). With the respect of coping skill, the mean scores of deviation of confrontation and obviatation between baseline and assessment of the participants in intervention were -3.35±3.21 and -2.85±3.26 respectively, which were lower significantly than those in control (-0.33±3.23 and -0.20±3.37); The mean score of deviation of submission between baseline and assessment of the participants in intervention was 1.83±2.68, and higher significantly than that in control (-0.32±2.75).Conclusions The development of Rheumatoid Arthritis disease makes negative impact on patients'physical, psychological and all social aspects. Health care workers should not only concern with the elimination and improvement of patients'somatic symptoms but also should pay attention to patients with psychological problems during their medical care activities and psychological intervention should be up with the clinical treatment so as to improve the quality of life of Rheumatoid Arthritis hospital women. Cognitive behavioral intervention could promote the mental health and improve the quality of life of women who suffered from Rheumatoid Arthritis.
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