Risk factors for social withdrawal in amyotrophic lateral sclerosis/motor neurone disease
Risk factors for social withdrawal in amyotrophic lateral sclerosis/motor neurone disease
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DOI：
10.1080/21678421.2018.1508477
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发表时间：
2018-01-01
影响因子：
2.8
通讯作者：
Young, Carolyn A.
中科院分区：
文献类型：
--
作者：
Schluter, Daniela K.;Tennant, Alan;Young, Carolyn A.
背景资料：更大的社交退缩与更高水平的心理困扰和对肌萎缩侧索硬化症诊断的更差适应有关。目的：研究人口统计学和功能缺陷是否可用于评估哪些患者可能存在社交退缩的风险，以及包括抑郁和焦虑在内的症状是否可为识别风险个体提供额外信息。此外，研究是否病人感知的耻辱有一个中介的作用，任何预测社会退缩。研究方法：在正在进行的神经系统疾病结局轨迹（TONiC）研究中，共有559名参与者完成了一份问卷，收集了人口统计学数据和一系列患者报告的测量数据。采用多元回归分析评估功能能力、人口统计学、躯体症状、焦虑和抑郁与社交退缩的关系。通过发展一个污名和社会退缩的二元线性回归模型，评估污名的中介作用。结果：延髓和运动功能障碍、焦虑和抑郁是社交退缩的重要预测因素。污名是社会退缩最强的单一预测因子，并被发现部分介导功能缺陷和情绪对社会退缩的影响。结论：社交退缩与更严重的运动障碍和更差的延髓功能以及增加的焦虑和抑郁有关。污名化是一个强大的预测社会退缩;进一步的工作应调查是否污名化是一个潜在的目标，心理干预，旨在减少社会退缩和提高生活质量。
Background: Greater social withdrawal is related to higher levels of psychological distress and poorer adaptation to a diagnosis of amyotrophic lateral sclerosis. Objectives: To examine whether demographics and functional deficits can be used to assess which patients may be at risk of social withdrawal and whether symptoms including depression and anxiety can provide additional information for identifying individuals at risk. Furthermore, to examine whether patient-perceived stigma has a role in mediating the effects of any of the predictors of social withdrawal. Methods: A total of 559 participants in the ongoing Trajectories of Outcomes in Neurological Conditions (TONiC) study completed a questionnaire pack collecting data on demographics and a range of patient reported measures. Multiple regression analysis was employed to assess associations of functional ability, demographics, physical symptoms, anxiety, and depression with social withdrawal. The mediating role of stigma was assessed through the development of a bivariate linear regression model for stigma and social withdrawal. Results: Disability in the bulbar and motor domains, anxiety and depression were found to be significant predictors of social withdrawal. Stigma was the strongest single predictor of social withdrawal and was found to partially mediate the effects of functional deficits and mood on social withdrawal. Conclusions: Social withdrawal is associated with worse motor disability and poorer bulbar function, as well as increased anxiety and depression. Stigma is a powerful predictor for social withdrawal; further work should investigate whether stigma is a potential target for psychological interventions aimed at reducing social withdrawal and improving quality of life.