A Study On The Relationships Among Illness Perceptions,Coping Styles And Vision-related Quality Of Life In Patients With Diabetic Retinopathy

Objective:To investigate the characteristics of illness perceptions,coping styles and vision-related quality of life(VR-Qo L)in patients with diabetic retinopathy(DR),and to investigate the relationships among them.Methods:Patients with DR were recruited from the Department of Ophthalmology of a general grade A tertiary hospital in Changsha by convenient sampling from October 2020 to September 2021.General sociodemographic and clinical information were collected.Illness perceptions,coping styles and VR-Qo L were assessed by the Brief Illness Perception Questionnaire(BIPQ),the Medical Coping Modes Questionnaire(MCMQ)and the 25-item National Eye Institute Visual Function Questionnaire(NEI-VFQ-25),respectively.T tests,Analysis of variance(ANOVA)and correlation analyses were conducted to identify the factors associated with illness perceptions,coping styles and VR-Qo L;correlation analyses,regression analyses and mediation analysis were conducted to explore the relationships among them.Results:(1)Three hundred and three patients with DR were included in the data analysis,including 158 males(52.1%).The mean age of the samples were 55.21 years.Seventy percent of patients had junior middle school or higher education.The median of duration of diabetes mellitus(DM)was10 years.(2)The BIPQ total score of DR patients was(47.09±8.00).Patients with medical insurance reported lower BIPQ total score as compared with self-paying patients(t=3.42,P<0.001).Patients who received DR education reported lower BIPQ total score as compared with those with no DR education history(t=2.08,P<0.04).Patients with a better presenting vision reported lower BIPQ total score(r=0.23,P<0.001).(3)The scores of the confrontation,avoidance and surrender subscales of MCMQ reported by patients with DR were(18.53±3.54),(15.93±2.49),(10.10±3.18),respectively.Patients with DR reported significantly higher scores in the avoidance(t=2.52,P<0.05)and surrender(t=3.30,P<0.01)subscales of MCMQ than the norms of Chinese patients with chronic diseases.Patients who received DR education reported higher scores in the confrontation(t=3.01,P<0.01)and avoidance(t=2.71,P<0.01)subscales than those with no history of DR education.Patients with longer duration of DM reported higher scores in the MCMQ confrontation subscale(r=0.12,P<0.05).Patients with better presenting vision reported higher scores in the MCMQ avoidance subscale(r=-0.13,P<.05)and lower scores in the MCMQ surrender subscale(r=0.17,P<0.01).(4)The total score of NEI-VFQ-25 reported by patients with DR were(55.33±17.96).Age(r=-0.17,P<0.01),duration of DM(r=-0.21,P<0.001),presenting vision(r=-0.32,P<0.001)were negatively correlated with VRQo L.(5)MCMQ confrontation subscale score was positively correlated with the scores of identity(r=0.12,P<0.05),concern(r=0.14,P<0.05),emotional response(r=0.17,P<0.01),and negatively correlated with treatment control(r=-0.15,P<0.01)and understanding(r=0.31,P<0.001)items of BIPQ.MCMQ surrender subscale score was positively correlated with the consequences(r=0.18,P<0.01),timeline(r=0.36,P<0.001),treatment control(r=0.18,P<0.01),identity(r=0.16,P<0.01),emotional response(r=0.24,P<0.001)item scores and total score(r=0.33,P<0.001)of BIPQ,and negatively correlated with the concern(r=-0.14,P<0.05)item score of BIPQ.BIPQ total score was negatively correlated with the total score and all subscale scores except for driving of NEI-VFQ-25.MCMQ confrontation subscale score was negatively correlated with the total score and scores of the mental health,role difficulties,dependency subscales of NEI-VFQ-25.MCMQ surrender subscale score was negatively correlated with the total score and all subscale scores except for driving of NEI-VFQ-25.Regression analyses showed that BIPQ total score,MCMQ surrender subscale score,presenting vision,age and MCMQ confrontation subscale score were independent predictors of NEI-VFQ-25 total score,which explained 32.9% of variance of NEI-VFQ-25 total score.(6)MCMQ surrender subscale score partially mediated the relationship between BIPQ total score and NEI-VFQ-25 total score,with the mediation effect accounting for 17.4% of the total effect.Conclusions:(1)Patients with DR perceive their illness as a severe threat.Medical insurance,DR education history and presenting vision are important factors influencing the illness perceptions of patients with DR.(2)Patients with DR adopt more avoidance and surrender coping than the norms of patients with a chronic condition.DR education history,duration of DM,presenting vision are important factors influencing the coping styles of patients with DR.(3)Illness perceptions,coping styles and VR-Qo L are closely related with each other in patients with DR.Surrender coping partially mediated the relationship between illness perceptions and VR-QoL.