| Systemic lupus erythematosus(SLE)is a chronic autoimmune disease with multiple system impairment manifestations,characterized by delayed healing,disease remission and relapse appearing alternately.Benefit from the continuous development of diagnostic techniques,the prognosis and therapy of patients with SLE has improved but they still cannot be cured,most patients are still suffering from discomfort companied with chronic diseases and treatment.Mental health problems are particularly prominent.The incidence of anxiety and depression in patients with SLE is much higher than the normal population.The negative emotional problems of patients have received extensive attention,but there are relatively few studies and discussions about positive psychology of patients.Resilience is the ability of individuals to respond to negative life events such as setbacks,stress and trauma.People with better resilience have the flexible ability to adapt to changes in the external environment.Resilience is an important protective factor for mental health.Traditional psychological care is usually aimed at reducing the negative emotions of patients,and it lacks the stimulation and guidance of the potential and positive psychology of the patients.With the development of positive psychology,the solution focused approach(SFA)model has been gradually improved and widely used in the psychological care of patients,family members and other people.Good results are achieved.The focus of this study is on how the SFA model is applied to patients with SLE,and how effective is the application.Therefore,this study selected patients with SLE as the research object,investigating and analyzing the influencing factors of anxiety,depression and resilience in patients,exploring the effect of psychological intervention by SFA model in patients with SLE,and to improve the mental health of patients to provide scientific basis and practical guidance.Objective:The purpose of this study was to investigate the anxiety,depression and psychological resilience of patients with SLE and to analyze the main factors influencing the current situation,especially the interventional factors.Combined with the psychological characteristics of patients with SLE,psychological intervention based on SFA model was implemented in patients,to try to improve the mental health of patients with SLE and to provide a theoretical basis and practical reference.Method:This study is divided into two parts:The first part is a cross-sectional survey.By taking the convenience sampling methods,420 SLE patients were selected as the research object who visited the Department of Rheumatology and Immunology of a tertiary hospital in Xi'an from December 2016 to May 2017.Questionnaire investigation was used.The instruments include the general information and disease-related information questionnaire,Self-rating Anxiety Scale(SAS),Beck Depression Inventory(BDI)and Connor-Davidson Resilience Scale(CD-RISC).The data were collected to analysis of anxiety,depression and resilience of the status and influencing factors.Mean,standard deviation,frequency were used to statistically describe the status of anxiety,depression,and resilience of the patients.Variance analysis and multiple linear regression analysis were used to explore the influencing factors of anxiety,depression,and resilience.The second part is a randomized controlled trial.The 104 patients with anxiety and depression in the cross-sectional study were selected as the objects.They were randomly divided into control group and experimental group.The control group was given routine psychological care,and the experimental group was based on conventional psychological care to implement SFA model psychological intervention.The first intervention time was the second day after hospitalization;the second and the third intervention were two weeks after discharge and four weeks after discharge.The anxiety,depression and resilience of the two groups were evaluated before and after intervention to compare the effects of intervention.Before the first intervention and after the last intervention,patients were surveyed by using questionnaires composed of SAS,BDI,and CD-RISC.The effect of the intervention was compared.Results:1.Anxiety,depression and resilience in patients with SLE.A total of 420 questionnaires were distributed in this study,and 404 valid questionnaires were returned.The SAS score of patients was 47.21 ± 10.59,the BDI score was 7.92 ± 6.21,and the incidence of anxiety and depression were 39.4% and 40.3% respectively.The overall resilience score for SLE patients was 53.79±20.81,which was lower than the national norm(t=-11.274,p<0.001).CD-RISC scores for each dimension were 26.53 ± 11.29 for toughness,18.56 ± 7.07 for strength,and 8.70 ± 3.74 for optimistic.The ranking of the three dimensions from low to high is toughness,optimism and strength.2.The influencing factors of anxiety,depression and mental resilience in patients with SLE.Multivariate linear regression analysis showed that occupation and average monthly household income,hormone dosage,Visual Analogue Score(VAS)and SLE Disease Activity Index(SLEDAI)were the influencing factors of anxiety in patients with SLE,which can explain the variance of the total SAS score of 22.4%;Occupation,marital status,average monthly household income,exercise frequency,hormone dosage,VAS,relapse and SLEDAI are the influencing factors of depression in patients,which can explain the variance of the total BDI score of 27.3%.There was a significant negative correlation between each dimension of resilience and anxiety and depression scores(r=-0.352~-0.576,p<0.001).Resilience of patients was also influenced by educational level,average monthly household income and exercise frequency.The above variables can explain the variation of 40.6% of total CD-RISC.3.Intervention effect of SFA model on anxiety,depression and resilience in patients with SLE.During the intervention,3 patients withdrew from the study due to aggravation of the disease,and 3 patients were lost to follow-up.The final study included 98 subjects,including 51 in the control group and 47 in the experimental group.There was no significant difference in anxiety,depression and psycho-elastic scores between the two groups before the intervention(p > 0.05).Anxiety and depression scores of the experimental group were lower than those of the control group after intervention,and the scores of resilience were higher than those of the control group,and the difference was statistically significant(p < 0.05).There was no significant difference in anxiety,depression and resilience before and after intervention in the control group.The scores of anxiety and depression in the experimental group decreased after intervention,and the difference was statistically significant(p<0.05).The score of resilience increases,but the difference was not statistically significant(p=0.059).Conclusion:1.The SLE patients have a higher incidence of anxiety and depression,and are subject to many factors such as social and disease.Health care providers should pay close attention to their negative emotions.2.SLE patients' psychological resilience is at a low level,which is negatively correlated with anxiety and depression.Health care workers should alleviate the negative emotions of patients and stimulate their positive psychology.3.Psychological intervention based on the solution focused approach model can effectively relieve the anxiety and depression in patients with SLE,improve the patients' psychological resilience and improve their mental health. |
PDF Full Text Request