Stigma And Its Influencing Factors Of First-ever Ischemic Stroke Patients:A Longitudinal Study

Research Purpose:The purpose of this study was to investigate the level of stigma and its influencing factors in patients with first-ever ischemic stroke at different time points from the acute hospitalization to six months after hospital discharge,and to analyze its trajectory,to explore the main factors of influencing stigma at various stages,so as to provide reference for the later implementation of effective and targeted psychological nursing intervention.Research Methods:This study used a prospective longitudinal study design.Starting from December 2018,148patients with stroke who met the criteria for admission were selected from Neurology Department,Rehabilitation Medicine Department and Emergency Department of a third-level general hospital in Huzhou city by a convenient sampling method.The self-made general data questionnaire,Stigma Scale for Chronic Illness?SSCI?,Barthel Index?BI?,social support rating scale?SSRS?and Self-rating Depression Scale?SDS?were performed at four time points,during patients'acute hospitalization?baseline?,one month post discharge,three months after discharge and six months after discharge?follow-up?.After discharge,the patients will be investigated in monthly out-patient review or by telephone.The collected data was entered by two-person check and statistical analysis was performed using SPSS 21.0 software.The frequency,percentage,and mean±standard deviation were used for statistical description.T test,analysis of variance and Pearson correlation analysis were performed to analyze the relationship between the patient's SSCI and general information,BI,SSRS and SDS.Multiple regression analysis was used to analyze the influencing factors of stigma at various stages.Repeated measurement variance was applied to predict the trend of stigma and its influencing factors.The difference was statistically significant at P<0.05.Research Results:1.Follow-up survey completed:160 patients were included in this study.After 6 months of follow-up,9 patients were lost and the rate of lost follow-up was 5.63%,3 patients died and the mortality rate was 1.88%.2.The level of stigma at different time points:?1?The average score of stigma at T₁ point was?46.31±8.90?,which was at the subaverage level.The internal stigma dimension score was?26.43±5.52?,and the external stigma dimension score was?19.89±4.00?.?2?The average score of stigma at T₂ point was?52.05±8.19?,which was at a medium level.The internal stigma dimension score was?27.82±4.76?,and the external stigma dimension score was?24.23±5.03?.?3?The average score of stigma at T₃ point was?63.25±14.69?,which was at the upper-middle level.The internal stigma score was?36.57±9.39?,and the external stigma score was?26.68±6.63?.?4?The average score of stigma at T₄ point was?60.66±14.86?,which was at the upper-middle level.The internal stigma score was?37.41±9.01?,and the external stigma score was?23.24±7.21?.3.The change trend of stigma:The SSCI scores of the study subjects increased first and then decreased slightly as a whole at the four time points,the difference was statistically significant?P<0.001?.The score of the internal stigma dimension showed a rising trend,and the score of the external stigma dimension also showed a rising trend and then a slight decline.4.Analysis of influencing factors of stigma at each time point:?1?The main influencing factors of stigma at T₁ point were income,time of treatment after onset,ability of daily living,subjective support,availability of support and depression.?2?The main influencing factors of stigma at T₂ were income,time of treatment after onset,ability of daily living,subjective support,availability of support and depression.?3?The main influencing factors of stigma at T₃ were time of treatment after onset,whether it is combined with other chronic diseases,ability of daily living,subjective support,availability of support and depression.?4?The main influencing factors of stigma at T₄ were income,time of treatment after onset,whether it is combined with other chronic diseases,ability of daily living,subjective support,objective support and depression.Research Conclusion:1.The level of stigma in patients with first-onset ischemic stroke is not optimistic during hospitalization to 6 months after discharge and is generally at a moderately high level.2.The overall level of stigma in patients with first-onset ischemic stroke during hospitalization to 6 months after discharge showed a trend of rising first and then slightly decreasing with time.3.The degree of stigma of patients with first-onset ischemic stroke was affected by a variety of factors,and more attention should be paid to strengthening intervention on patients who have heavy economic burden,the long interval between consultations after the onset,other chronic diseases,low ability of daily living,low level of social support and post-stroke depression,so as to reduce the level of their stigma.4.The main influencing factors of stigma in patients with first-onset ischemic stroke changed at different time points,suggesting that medical staff should pay attention to identifying the influencing factors at different stages and timely implement targeted nursing intervention and psychological support for patients.