Psychological Symptoms and Social Functioning Following Repair of Obstetric Fistula in a Low-Income Setting.
Psychological Symptoms and Social Functioning Following Repair of Obstetric Fistula in a Low-Income Setting.
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低收入环境中产科瘘修复术后的心理症状和社会功能。
DOI：
10.1007/s10995-016-1950-z
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发表时间：
2016
影响因子：
2.3
通讯作者：
Mosha,MaryV
中科院分区：
文献类型：
--
作者：
Wilson,SarahM;Sikkema,KathleenJ;Watt,MelissaH;Masenga,GileardG;Mosha,MaryV
目的产科瘘是一种母体伤害，导致无法控制的尿液或粪便泄漏，在低收入国家，大多数患此病的妇女生活在贫困中。产科瘘与耻辱和心理发病率高相关，但手术治疗对心理结果的影响尚不确定。这项探索性研究的目的是检查外科瘘管修复、出院和重返家庭后心理症状的变化。方法从坦桑尼亚一家服务于农村集水区的医院招募因产科瘘手术入院的妇女。在手术前评估心理症状和社会功能。出院后大约3个月，一名数据收集者走访了患者的家，重复了心理社会措施，并评估了自我报告的大小便失禁。采用配对t检验，控制多重比较，测量基线到随访的差异。用t检验和Pearson相关分析评估心理结局和漏尿之间的关系。结果28名参与者平均患有瘘管11年。基线心理痛苦较高，并在随访时显著降低。在随访中自我报告持续大小便失禁的参与者认可的创伤后应激障碍和抑郁症状明显高于那些报告被治愈的参与者，渗漏的严重程度与心理痛苦有关。结论瘘管患者在出院后3个月经历了心理健康的改善，但当女性经历残余渗漏时，这些改善就会减弱。考虑到术后压力性尿失禁的发生率，让瘘管患者为不完全治愈的可能性做好准备并帮助他们制定适当的应对策略是很重要的。
ObjectivesObstetric fistula is a maternal injury that causes uncontrollable leaking of urine or stool, and most women who develop it live in poverty in low-income countries. Obstetric fistula is associated with high rates of stigma and psychological morbidity, but there is uncertainty about the impact of surgical treatment on psychological outcomes. The objective of this exploratory study was to examine changes in psychological symptoms following surgical fistula repair, discharge and reintegration home.MethodsWomen admitted for surgical repair of obstetric fistula were recruited from a Tanzanian hospital serving a rural catchment area. Psychological symptoms and social functioning were assessed prior to surgery. Approximately 3 months after discharge, a data collector visited the patients’ homes to repeat psychosocial measures and assess self-reported incontinence. Baseline to follow-up differences were measured with pairedttests controlling for multiple comparisons. Associations between psychological outcomes and leaking were assessed withttests and Pearson correlations.ResultsParticipants (N= 28) had been living with fistula for an average of 11 years. Baseline psychological distress was high, and decreased significantly at follow-up. Participants who self-reported continued incontinence at follow-up endorsed significantly higher PTSD and depression symptoms than those who reported being cured, and severity of leaking was associated with psychological distress.ConclusionsFistula patients experience improvements in mental health at 3 months after discharge, but these improvements are curtailed when women experience residual leaking. Given the rate of stress incontinence following surgery, it is important to prepare fistula patients for the possibility of incomplete cure and help them develop appropriate coping strategies.