Longitudinal Study Of Psychosocialadaptation And Its Influencing Factors In Young And Middle-aged Patients After PCI

ObjectiveLongitudinal investigation was conducted on the level of psychosocial adaptation of young and middle-aged patients after PCI from hospitalization to 6 months after discharge,to explore the level of psychosocial adaptation at different time points and its influencing factors,and analyze its change trajectory,so as to provide a basis for subsequent targeted intervention studies.MethodsA longitudinal study design was used to select 170 young and middle-aged patients who had been successfully treated with PCI from the department of Cardiovascular Medicine of three grade A hospitals in Henan Province for questionnaire surveys.During hospitalization(T0),the investigator fully informed the patients of the purpose,method and coordination points of the study face-to-face.After signing the informed consent letter,patients were invited to fill in the general data questionnaire,Type D Personality Scale-14(DS14),Self-Report psychosocial adaptation to Illness Scale(PAIS-SR),Perceived Social Support Scale(PSSS),and Chinese version of Posttraumatic Growth Inventory(C-PTGI).After discharge,patients were followed up by telephone or outpatient,and investigated at 1 month(T1),3 months(T2),and 6months(T3)after discharge,using PAIS-SR,PSSS and C-PTGI.Statistical methods:Descriptive statistics were performed on the patient’s demographic and disease-related data in the form of mean±standard deviation/number of cases(percentage);PAIS-SR,PSSS and C-PTGI scores at four time points were statistically described by mean±standard deviation and repeated measure ANOVA.The scores of PAIS-SR in different types of patients were compared by one-way ANOVA/independent sample t test,and the influencing factors of PAIS-SR at different time points were analyzed by multiple linear regression.Longitudinal data were analyzed using generalized estimation equation to analyze the changing trend of PAIS-SR and its influencing factors in t0-T3 period of young and middle-aged patients after PCI.Results1.Results of follow-up:170 patients were initially included,and 152 patients were followed up after 6 months,of which 15 were lost to follow-up(8.82%),3 were re-stents,and the incidence of secondary stents was 1.76%.2.The trend of psychosocial adaptation:The PAIS-SR scores of patients at T0～T3 time points were:(59.94±14.36),(58.40±12.77),(54.43±11.16),(52.05±10.10).The analysis by generalized estimation equation showed that the level of psychosocial adaptation of young and middle-aged patients after PCI gradually improved over time(WaldX~2=17.509,P=0.001).The factors influencing the change trajectory were gender(WaldX~2=10.693,P=0.001);per capita monthly income(WaldX~2=27.296,P<0.001);diabetes(WaldX~2=36.464,P<0.001);PCI frequency(WaldX~2=22.503,P<0.001);cardiac function class(WaldX~2=42.103,P<0.001);Type D personality(WaldX~2=38.019,P<0.001);perceived social support(WaldX~2=119.148,P<0.001);and post-traumatic growth(WaldX~2=117.288,P<0.001).3.The Influencing factors of psychosocial adaptation at each time point:(1)Influencing factors at T0 were gender,per capita monthly income,type D personality,previous PCI times,cardiac function class,diabetes,PSSS and C-PTGI,explaining 51.1%of the total variance;(2)Influencing factors at T1were per capita monthly income,type D personality,previous PCI times,cardiac function class,diabetes,PSSS and C-PTGI,explaining 54.9%of the total variance;(3)Influencing factors at T2 were per capita monthly income,D-type personality,cardiac function class,diabetes,PSSS and C-PTGI,explaining 55.1%of the total variation;(4)Influencing factors at T3 were working status,D-type personality,cardiac function class,diabetes,PSSS and C-PTGI,explaining 49.4%of the total variance.Conclusions1.The psychosocial adaptation of young and middle-aged patients after PCI is at a lower-middle level.2.Patients have the lowest level of psychosocial adaptation during hospitalization after PCI, which should be paid attention to by medical staff.Six months after the operation,the degree of their psychosocial adaptation has been continuously improved,but there are still many adaptive challenges,suggesting that clinical nursing staff should gradually improve the continuity of care system,timely identification of their psychosocial needs.3.The psychosocial adaptation of young and middle-aged PCI patients is affected by multiple factors,dealing with women,heavy economic burden,different working status,previous history of PCI,type D personality,diabetes,cardiac insufficiency,with lower level of perceived social support and lower posttraumatic growth should be paid more attention,and in view of the controllable factors intervene to promote psychosocial adaptation.