Patterns of psychosocial risk and long-term outcomes in rheumatoid arthritis.
Patterns of psychosocial risk and long-term outcomes in rheumatoid arthritis.
复制标题
DOI：
10.1080/13548500801927113
复制
发表时间：
2008-10-01
期刊：
影响因子：
--
通讯作者：
Katz, Patricia P
中科院分区：
文献类型：
--
作者：
Morris, Anne;Yelin, Edward H;Katz, Patricia P
本研究在考虑了人口统计学因素和随时间推移自我报告的症状严重程度后，探讨了心理社会风险模式与类风湿关节炎（RA）长期结局的独特相关程度。数据收集超过8年的时间，从561人与RA谁是正在进行的UCSF RA小组研究在1995年的参与者。小组成员每年接受采访，采用全面的结构化电话采访。评估的心理社会因素包括掌握，对社会支持的充分性，RA的影响和自我评估的能力，以科普RA和满意度与健康和功能的看法。对心理社会因素的聚类分析确定了三种不同的心理社会风险模式/水平（高、中、低风险）。使用增长曲线分析，估计了心理社会风险状态对抑郁症状、基本功能限制、全球疼痛评分和8年内平均每年医生就诊次数变化的独特影响。控制人口统计学因素的分析（性别、婚姻/伴侣状况、教育程度、年龄和种族）、小组中的疾病持续时间和年份以及随时间变化的自我报告的症状严重程度（晨僵、肿胀关节计数、合并症、关节外RA症状和变化）关节外观），以及随时间推移服用的自我报告药物（改善疾病的抗风湿药物[DMARDS]和泼尼松）。总体而言，抑郁症状总方差的32.4%由完全估计模型解释，其中12.9%与心理社会风险状态唯一相关。一半的总方差（50.0%）的基本功能限制的解释，12.1%的方差唯一预测的心理社会风险状态。心理社会风险状态对总体疼痛评分（总计= 38.6%，增量= 3.2%）和平均年总医生就诊次数（总计= 10.9%，增量= 1.5%）的总解释方差相对较小。因此，随着时间的推移，心理社会风险因素与抑郁症状和功能的联系更加紧密。全球疼痛和利用似乎与疾病因素更密切相关。
This study examined the extent to which patterns of psychosocial risk were uniquely associated with long-term outcomes of rheumatoid arthritis (RA), after demographic factors and self-reported symptom severity over time were accounted for. Data were collected over an 8-year period from 561 individuals with RA who were participants in the ongoing UCSF RA Panel Study in 1995. Panel members were interviewed annually, using a comprehensive structured telephone interview. Psychosocial factors assessed included mastery, perceptions about adequacy of social support, the impact of RA and self-assessed ability to cope with RA and satisfaction with health and function. Cluster analysis of psychosocial factors identified three distinctive patterns/levels of psychosocial risk (high, medium and low risk). The unique effects of psychosocial risk status on changes in depressive symptoms, basic functional limitations, global pain ratings and average annual doctor visits over an 8-year period were estimated, using growth curve analyses. Analyses controlled for demographic factors (gender, marital/partner status, education, age and ethnicity), disease duration and year in the panel and time-varying self-reported symptom severity (morning stiffness, swollen joint counts, co-morbid medical conditions, extra-articular RA symptoms and changes in joint appearance), as well as self-reported medications taken over time (disease-modifying antirheumatic drugs [DMARDS], and prednisone). Overall, 32.4% of total variance in depressive symptoms was accounted for by the fully-estimated model, with 12.9% uniquely associated with psychosocial risk status. Half of the total variance (50.0%) in basic functional limitations was explained, with 12.1% of variance uniquely predicted by psychosocial risk status. Psychosocial risk status accounted for comparatively little total explained variance in global pain ratings (total = 38.6%, incremental = 3.2%), and average annual total doctor visits (total = 10.9%, incremental = 1.5%). Thus, psychosocial risk factors are more closely linked to depressive symptoms and function over time. Global pain and utilization appear to be more closely related to disease factors.