Self-perception Of Patients Receiving Glucocorticoid Maintenance Therapy And Its Influencing Factors On Mental Health

[Objective]To describe the self-perception of glucocorticoid maintenance therapy in patients with systemic lupus erythematosus(SLE),to explore the real experience and needs of these patients in physiology and life during medication,and to analyze the influencing factors of mental health in patients with SLE treated with glucocorticoid maintenance therapy,so as to provide psychological nursing for the formulation of scientific and effective glucocorticoid maintenance therapy in SLE patients.[Methods]Qualitative research design:Under the guidance of phenomenological method,16 SLE patients hospitalized in rheumatology and Immunology Department of Nanjing Gulou Hospital from March 2018 to December 2018 were selected as the subjects.The sample size was determined according to the principle of information saturation.Based on literature review and clinical work,the interview outline was drawn up.After the interview scheme was confirmed,2-3 samples were selected for pre-interview,and the final interview outline was revised and determined according to the interview results.Semi-structured interviews were used to collect data and Colaizzi 7-step analysis was used to analyze the data.Cross-sectional survey:Survey indicators were general sociodemographic data,depression,anxiety and social support of patients with systemic lupus erythematosus treated with glucocorticoid maintenance therapy in Gulou Hospital Affiliated to Medical College of Nanjing University.Using convenience sampling method,SLE patients hospitalized in Rheumatology and Immunology Department of Nanjing Gulou Hospital from January 2019 to June 2019 were selected as the study subjects.In this study,multivariate analysis involves 12 variables.According to M.Kendall et al.,in multivariate analysis,the sample size should be 5-10 times the number of independent variables.Considering the incomplete data or the number of missing questionnaires,the sample size was increased by 10%,and 130 valid questionnaires were finally received.The self-compiled general sociodemographic data questionnaire,Self-Rating Depression Scale(SDS),Self-Rating Anxiety Scale(SAS)and Social Support Rating Scale(SSRS)were used.[Results]1.The results of the interview have four themes:theme 1 is lack of knowledge about glucocorticoids;Theme 2 is the decrease of subjective well-being of patients;Theme 3 is the increase of patients’burden of self-perception;and theme 4 is patients’self-identification and acceptance.Theme 2 includes four sub-themes:self-realization constraints,marital and reproductive crisis,image disorders,lifestyle changes;and Theme 3 includes three sub-themes:increased negative emotions,increased economic burden,and insufficient social support.2.Univariate analysis showed that the depression status of SLE patients treated with glucocorticoid maintenance therapy had significant difference in the family per capita monthly income,work/study status(P<0.05).There were no significant differences in gender,duration of illness,duration of medication,educational level,occupational status,health insurance,work/study status and type of care.3.Univariate analysis showed that the anxiety status of SLE patients treated with glucocorticoid maintenance therapy had significant difference in the family per capita monthly income,work/study status(P<0.05).There were no significant differences in gender,duration of illness,duration of medication,educational level,occupational status,medical insurance and type of care.4.Pearson correlation coefficient analysis showed that the total scores of depression and anxiety were negatively correlated with the total scores of social support,objective social support,subjective social support and the utilization of support.The correlation coefficient was r=-0.308～0.116/r=-0.242～-0.101,P<0.05.5.Multivariate regression analysis showed that education level(P=0.003,OR=2.153),family income per capita(P=0.017,OR=0.591),working/learning status(P=0.003,OR=2.697)and social support utilization(P=0.002,OR=0.670)were the influencing factors of depression in SLE patients treated with glucocorticoid maintenance therapy.6.Multivariate regression analysis showed that work/study status(P=0.036,OR=1.781)and social support utilization(P=0.003,OR=0.712)were the influencing factors of anxiety in SLE patients with glucocorticoid maintenance therapy.[Conclusions]1.In the process of glucocorticoid maintenance therapy,patients have insufficient knowledge of glucocorticoid,and there are many kinds of burdens and demands.Among them,financial burdens,marriage and childbearing burdens,image disorders and negative emotions are the most troublesome problems.2.Household per capita monthly income is the influencing factor of depression in SLE patients treated with glucocorticoid maintenance therapy.The higher the family per capita monthly income,the lower the risk of depression.3.Work/study status is the influencing factor of depression or anxiety in SLE patients treated with glucocorticoid maintenance therapy.The worse the work/study status,the higher the risk of depression or anxiety.4.Education level is the influencing factor of depression in SLE patients treated with glucocorticoid maintenance therapy.The higher the cultural level of SLE patients,the higher the risk of depression.5.The degree of social support of patients is negatively correlated with their depression or anxiety,that is,the higher the degree of social support,the lower the risk of depression or anxiety.