Study On The Self-rating Anxiety And Its Affecting Factors In Rural Patients With Pulmonary Tuberculosis

BackgroundAccording to the estimates of World Health Organization,there are 8.4 million new tuberculosis(TB) patients in the world each year,of which 95 percent are in developing countries.And the TB deaths each year are 2 million,of which 98 percent occur in developing countries.75 percent of TB patients are between 15 and 50 years old,which brought a heavy financial burden and economic loss to the patients' family and our society as well.China is one of the 22 countries with the highest burden of tuberculosis in the world,and the number of TB patients is the second one all over the world.It is estimated that nearly 500 millions people have infected tubercle bacillus and the number of prevalent TB patients is about 5 million.Among these patients,about 80 percent are distributed in the rural areas,and those poor areas are even more serious. TB has become one of the major diseases which lead to rural poverty and many families were came back to poor because of TB,TB has been one of the main reasons of restraining the economic and social development in rural area.In a word,rural area has been the primary field of battling for TB.Under the modern biology-psychology-society medical model,people pay more attention to the role of psychological factors on the occurrence,development and recuperation of disease.At present,most of the domestic researchers have used SCL-90 questionnaire to examine the mental health status of TB patients and found that psychological problems existed commonly among TB patients.But those researches were mainly focused on inpatients,or especially on special population of TB patients such as students,floating population and so on,less researches were about mental health status of rural patients with pulmonary tuberculosis especially anxiety, and researches on affecting factors about mental health status especially about anxiety is seldom seen.ObjectivesThe main aim of the study is to analyze the general situation of patients with pulmonary tuberculosis,learn about the occurrence rate of anxiety and relevant factors affecting the occurrence of anxiety,and thus provide basic information to the making of clinical and community psychological treatment and intervention measures,and also provide experience and guide to Shandong Province and other areas with similar situation as well.The specific objectives of the study include:●To learn about the basic socio-economical characters of rural patients with pulmonary tuberculosis;●To analyze the status of self-rating anxiety of patients;●To examine the difference of occurrence of anxiety of different patients;●To find out relevant factors which can affect the occurrence of anxiety;and●Put forward relative political suggestions on clinical and community psychological treatment and intervention measures to rural patients with pulmonary tuberculosis based on above results.MethodsAccording to the GDP per capita,six counties from three cities with different social and economic development levels were randomly chosen by the stratified-cluster sampling method.And then six towns with different social and economic development levels were randomly chosen in each county of those.All the patients with pulmonary tuberculosis registered from Oct 1^st,2006 to Sep 30^th,2007 in the 36 towns were investigated and interviewed using Questionnaire on Situation of Rural Patients with Pulmonary Tuberculosis and Self-rating Anxiety Scale(SAS).The data was collected by members of Instituted of Social Medicine and Health Service Management,Shandong University.In this study,819 patients were interviewed and 798 valid questionnaires which account for 97.4 percent of all questionnaires were taken back.The data was put into the computer and proofreaded and any problems of data were corrected before the analysis of data.All the analysis procedures were done using SPSS 13.0 software.According to the type of data and the aim of the study, descriptive statistics analysis,comparative analysis,univariate and multivariate analysis such as Logistic regression method were used in the research.Main results:1.The lowest score of SAS was 25.0 and the highest one was 83.4,the average score of SAS of patients with pulmonary tuberculosis in this study was(34.9±9.3), which was much higher than that of normal standard of the whole nation.2.The occurrence rate of anxiety of the pulmonary tuberculosis patients was 7.6 percent and 2 percent of the patients had a severe anxiety.3.Results of univariate analysis showed out factors than could affect the occurrence of anxiety of patients with pulmonary tuberculosis include:patients' educational level,types of treatment of patients,income level,self-evaluated family economic status,the family having debt or not,if their family was certificated as poor by the government or not,the family suffered a catastrophic health care payment or not,if they knew the preferential policy of the government to patients with pulmonary tuberculosis or not,the change of social network,self-evaluation and response of patients themselves,et al.4.Results of Logistic regression analysis indicated that low income,family being certificated as poor by the government,famlilies' attitude changed after they knew the state of family member's pulmonary tuberculosis,the patients excessively depend on their families after been sicken,patients having idea of committing suicide,not tell others about his state of pulmonary tuberculosis,were all risk factors of anxiety of rural patients.Conclusions and suggestions1.The mental health status of rural residents with pulmonary tuberculosis was much poor.Effective and valid psychological interventions might be carried out either in clinical treatment,nursing or in community management of TB.At the same time, we should pay more attention to implement and stenthen the psychological work to improve the health staus of rural residents.2.Factors influencing the occurrence of anxiety were much extensive.Relevant health organizations,health staffs and the family members of the patients should work together to provide effective help to the patients,including psychological intervention, impactful social support and economic support,and thus help the patients to be recovered earlier.3.Economic factor was one of the most important factors that could affect the occurrence of anxiety of rural patients.Strategies might be carried out to reduce the medical cost of pulmonary tuberculosis patients;particularly,the NCMS should establish special compensative policy to the rural patients according to the particularity of pulmonary tuberculosis and thus reduce the economic burden really and truly.4.The re-treated rualr patients had a higher occurrence rate of anxiety than those of being treated for the first time.The re-treated rural patients should be paid more attention and given much more economic supports as well as psychological interventions.