| BACKGROUNDDiabetic retinopathy(DR) is one of the serious concurrent diseases of diabetes mellitus.With the elevation of living and medical standard,the prevalence of DR elevates year by year.The patients of DR have to assume the physiological and psychic pressure for the diabetes mellitus and visual impairment.In modern biology-psychic-society medical model,it is not enough to remaining the visual level and to prevent process aggravation,while it is more important to pay close attention to the life quality and influencing factors of DR patients.As a critical intermediate factor of psychological process of stress,coping is related to the properties and the results of stress events.Although various coping strategies are reflected by different coping questionnaires,it's commonly labeled into two styles named positive coping(PC) and negative coping(NC).Recently,the relationship between coping and health status or/and living quality has been under hot debating in the research of behavioral medicine.Different coping style affects health or/and living quality differently.In some researches of diseases,such as cancers, hepatitis and diabetics,it's discovered that PC facilitates diseases recovering,or has positive effect on living quality,while NC has negative effect,which was supported by major researches.Nevertheless,there also are investigations show that,the effectiveness of different coping styles are related to the stress encountered,there is no universal coping style applicable to all cases.Effective coping style can bring positive affect to health,assist people with problem solution and pressure relief. Whereas,inefficient coping can't lead to effectively catharsis and gradually elimination of nervous and repressive emotions,affect living quality by worsen disease condition.Even though there are literatures debating the quality of life and coping style of DR patients respectively,no systematic investigation focus on the relationship between both or/and their influence factors.As a result,it's essential to investigate in this area.OBJECTIVETo understand the characteristics of the coping strategies of the patients with DR and the status of their life quality,to explore the effects of demographical and sociological factors on the coping strategies and life quality of the patients,to analyze the relationship between the coping strategies of the DR patients and their life quality,to provide theoretical and practicable basis for the psychological intervention of the DR patients.SUBJECT and METHODA total of 268 diagnosed cases of DR,which including non-proliferative diabetic retinopathy(NPDR)(120)and proliferative diabetic retinopathy(PDR)(148),63 diagnosed diabetes mellitus(DM) and 51 health subjects as control group were enrolled in this study.The questionnaire survey was conducted using Trait Coping Strategies Questionnaire(TCSQ) and WHOQOL-BREF.The data was arranged and analyzed using SAS 9.1 and SPSS 16.0 software.The characteristics of the coping strategies of the patients with DR and the status of their life quality was explored using simple analysis while the factors on the coping strategies and life quality of the patients were analyzed using generalize multiple linear regression.RESULT1 Coping strategies of the subjects1.1 The characteristics of the coping strategies of the patients with DR The score of positive coping in the control group,DM,NPDR and PDR was 36.74±5.58,36.73±5.22,36.06±9.19,33.61±9.89 and the result of one-way ANOVA was F=3.74,P=0.0114.The score of NC in the four groups was 26.12±7.21, 26.71±7.16,27.23±8.47,29.19±9.58 and the result of one-way ANOVA was F=2.44, P=0.0642.The results of analysis of covariance exhibited:the corrected score of PC in the four groups was:39.85±1.28,37.05±1.34,38.44±1.17,28.21±2.64,and the F value was 3.95,P value was 0.0009;the corrected score of NC in the four groups was: 24.20±1.24,27.09±0.81,27.92±0.76,28.71±1.18,and the F value was 2.89,P value was 0.0350.1.2 The results of generalize multiple linear regression for coping strategies.The result of generalize multiple linear regression indicated that the determinate coefficient(R2) of the model of positive coping was 0.30944 and the F value was 6.20,(P＜0.0001).The age(F=6.47,P＜0.0001),domestic economic levels(F=11.26, P＜0.0001),occupation(F=4.86,P=0.0025),course of disease(F=7.22,P＜0.0001) and grading of DR(F=3.98,P=0.0083) was choice in the regression equation.The result of generalize multiple linear regression indicated that the determinate coefficient(R2) of the model of negative coping was 0.244101,and the F value was 4.47,(P＜0.0001).The age(F=4.13,P=0.0028),domestic economic levels(F=7.04, P＜0.0001),education levels(F=3.88,P=0.0043) and course of disease(F=3.44, P=0.0089) was choice in the regression equation.2 The quality of life of the subjects2.1 The status of the patients' quality of lifeThe result of one-way ANOVA indicated that the F values of the score of Physical functioning,Psychology mind,Social relation and environment in the control group,DM,NPDR and PDR were 64.05,20.28,4.74,12.59,and the P values were less than 0.05.The results of analysis of covariance exhibited:the corrected score of PC in the four groups was:39.85±1.28,37.05±1.34,38.44±1.17,28.21±2.64,and the F value of the corrected score of the four domains in the four groups was 28.61,15.21,3.62, 14.82,and the P value were less than 0.05。2.2 The results of analysis of simple correlationThe results of analysis of simple correlation indicated that there was positive correlation between the scor of PC and the four domains of QOL,and the correlation coefficients were 0.47,0.70,0.22,0.38;while there was negative correlation between the scor of NC and the four domains of QOL,and the correlation coefficients were -0.36,-0.60,-0.37,-0.36,and the P values were less than 0.05.2.3 The results of generalize multiple linear regression for quality of lifeThe results of generalize multiple linear regression indicated that the scores of Physical functioning were statistically significantly associated with PC(F=46.26, P＜0.0001),education levels(F=3.06,P=0.0169),domestic economic levels(F=6.11, P＜0.0001),the style of medical cost(F=8.71,P=0.0002),course of disease(F=2.94, P=0.0333) and grading of DR(F=5.72,P=0.0008).The determinate coefficient(R~2) of the model of positive coping was 0.61 and the F value was 21.74,(P＜0.0001).The results of generalize multiple linear regression indicated that the scores of Psychology mind were statistically significantly associated with PC(F=128.14,P＜0.0001),NC(F=8.97,P=0.0029),education levels(F=3.48,P=0.0083),domestic economic levels(F=3.01,P=0.0183),the style of medical cost(F=5.83,P=0.0032) and grading of DR(F=5.53,P=0.0010).The determinate coefficient(R~2) of the model of positive coping was 0.666724 and the F value was 28.84,(P＜0.0001).The results of generalize multiple linear regression indicated that the scores of Social relation were statistically significantly associated with NC(F=29.03,P＜.0001), age(F=2.94,P=0.0205),occupation(F=3.76,P=0.0112),course of disease(F=2.77,P= 0.0274).The determinate coefficient(R~2) of the model of positive coping was 0.27 and the F value was 5.42,(P＜0.0001).The results of generalize multiple linear regression indicated that the scores of environment were statistically significantly associated with PC(F=11.26,P=0.0009), the style of medical cost(F=5.19,P=0.0060),education levels(F=3.40,P=0.0096), occupation(F=11.12,P＜0.0001),domestic economic levels(F=2.82,P=0.0252).The determinate coefficient(R~2) of the model of positive coping was 0.45 and the F value was 10.65,(P＜0.0001).CONCLUSION1 Patients of DR in the study trends to using negative coping strategies,and coping strategies was influenced by age,education levels,domestic economic levels, occupation and grading of DR.2 The life quality of DR patients was lower than other subjects in the study.And the life quality was influenced by coping strategies,age,education levels,domestic economic levels,occupation,the style of medical cost,course of disease and grading of DR.3 Coping strategies was one of the influential factors of life quality,and positive coping strategies could elevate the life quality,while negative coping can bring in harmful effects.4 Appropriate directions and intervention should be practiced on the basis of influencing factors of coping strategies and life quality in order to elevate the life quality of DR patients.
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