The Investigation Of Life Quality And Influence Factors Among 5 Common STD Patients In 3 Cities Of China

Background Sexually transmitted diseases (STDs) remain an important public health issue in the world and China. STDs have an impact on the patients’ life quality through damaging patients’ physical and psychological health, because of its special route of transmission, ethical and social sensitivity. Existed researches assessing life quality of STDs patients mainly focused on genital herpes and genital warts, while fewly involved in syphilis, gonorrhoeae and genital chlamydia infection, and there was absent of the special scale being suitable for all kinds of STDs. The key scientific problems in this article were to develop an STD-specific scale, and to evaluate 5 common STD patients’ life quality and its influence factors.Objectives By applying the generic scale, specific scale and self-designed life quality questionnaire, we aimed to investigate life quality and influence factors among 5 common STD patients in order to provide recommendations for improving patients’ life quality and clinical services, and to prepare the evidence for developing STD-specific scale suitable for our country in the future.Methods Medical outcomes study 12-item short-form health survey (SF-12) (the generic scale), dermatology life quality index (DLQI) (the specific scale), hospital anxiety depression scale (HAD), medical coping modes questionnaire (MCMQ), family social support questionnaire and self-designed STD quality of life questionnaire(QOL-STD) were adopted to investigate life quality and influence factors among 5 common STD patients, including syphilis, gonorrhoeae, genital chlamydia infection, genital herpes and genital warts. SPSS 19, Stata 12, MLwiN 2.28 softwares were employed to analyze data including scale scoring, reliability and validity, factorial analysis, multilevel regression model, multiple linear regression and Logistic regression analysis. Finally, we evaluated the life quality and influence factors in 5 STDs patients and the effectiveness of QOL-STD.Results A total of 875 eligible patients were enrolled at STD clinics in Nanjing, Shenyang and Guangzhou, and the qualified questionnaires collected were 849(97.03%). Of these, the patients of syphilis, gonorrhoeae, genital chlamydia infection, genital herpes, genital warts and more than 2 STDs were 233(27.44%), 24(2.83%),123(14.49%),156(18.37%),295(34.75%) and 18(2.12%), respectively. Except for the sub-scale of confrontation and avoidance strategy of MCMQ and the physical component summary of SF-12 scale, all other scales had a good reliability (Cronbach a>0.7) and content validity (the Spearman correlation coefficient>0.5).The results of data analysis from DLQI showed that the mean score among 5 common STD patients was 9.66±5.46 and the average negative effect on life quality was "moderate". The proportions of the 5 STDs patients suffering from little, mild, moderate, serious and extremely serious affect on their life quality were 7.30%, 18.26%,30.39%,41.70% and 2.36% respectively. The difference in scoring of life quality among 3 cities was statistically significant(Guangzhou>Shenyang>Nanjing) (P=0.002), and there was also significant difference in scoring among 5 STDs(the patients with viral STDs such as genital herpes and genital warts> ones with the bacterial STDs such as syphilis, gonorrhoeae and chlamydia infection)(P=0.000). In multiple linear regression and multilevel linear regression model, the proportion of total variance that could be interpreted accounted for 30.07% and 31.05% in life quality respectively. The multilevel model regression analysis showed that lower life quality was associated with following factors:female, disease relapse, perceived severity of the disease, disclosure to family members, reduced contact with friends, the higher confrontation and resignation strategy scoring, and less family&social support.The results of data analysis from SF-12 showed that the physical and mental component summary scores of SF-12 scale among 5 common STD patients were 50.00±6.79 and 50.00±9.41, respectively (being similar to the norm in China and other countries, such as Chengdu residents with 51.2±6.6 and 49.9±7.7 for the physical and mental component summary scores of SF-12 scale, respectively). The proportions of total variance that could be interpreted were poor (accounting for 13.13% and 22.94% in physical and mental component of life quality respectively).The results from hospital anxiety depression scale revealed that the prevalence of anxiety and depression status among 5 common STD patients were 55.71% and 51.00%, respectively. There was statistically significant difference in anxiety status among 5 STDs(P=0.000), however there was not statistically significant in the depression status(P=0.554). The multiple Logistic regression model showed that major influence factors of anxiety included disease relapse(OR=2.02,95%CI: 1.42-2.87), reduced contact with friends(OR=2.18,95%CI:1.43-3.30), the higher resignation strategy scores(OR=1.06,95%CI:1.05-1.08), less family&social support(OR=1.01,95%CI:1.01-1.02), perceived severity of the disease(OR=5.05, 95%CI:1.74-14.6), and major influence factors of depression included disease relapse(OR=1.58,95%CI:1.15～2.18), reduced contact with friends(OR=2.01, 95%CI:1.38-2.94), the higher resignation strategy scores (OR=1.04,95%CI: 1.03-1.05), less family&social support(OR=1.01,95%CI:1.01-1.03), being married (OR=1.52,95%CI:1.06-2.18) and lower income(OR=2.11,95%CI:1.11-4.02).The self-designed QOL-STD was fully evaluated, the Cronbach a was 0.870 indicating a good reliability, the Spearman correlation coefificients between each item and total score were more than 0.5 and were statistically significant with a good content validity(P<0.01). One principal component was extracted that explained 46.98% of the variance with a good constructing validity. The correlation coefficient between the self-designed scale and DLQI scale was 0.716 and there was statistically significant (P=0.000), which indicated good criterion validity. The proportion of total variance that could be interpreted for the self-designed QOL-STD was higer than ones for DLQI and SF-12 scales.In accordance to the correlation with DLQI scale, we determined the grade of life quality for the self-designed QOL-STD. The evaluation of the self-designed QOL-STD showed that the mean score among 5 STDs patients was 23.06±7.76, the average effect on life quality was "moderate". The proportions of the 5 STDs patients suffering from little, mild, moderate, serious and extremely serious affect on their life quality were 6.47%,12.01%,42.99%,34.39% and 4.12% respectively. In multiple linear regression and multilevel linear regression model, the proportion of total variance that could be interpreted accounted for 32.50% and 33.165% in life quality respectively, which were higher than DLQI scale. The results of multilevel model regression analysis from QOL-STD scale showed that the influence factors among 5 STDs patients were basically consistent with the specific scale of DLQI.Conclusions The overall quality of life among 5 common STDs patients was poor with high prevalence of anxiety and depression symptoms. In STD services, the clinician should pay closely attention to the psychological problems from STD patients, especially in anxiety and depression positive patients, strengthen the psychological counseling and health education, encourage STD patiens to communicate with family and friends. Targeted interventions should be focused on STD patients who are female, have relapse disease and the higher avoidance and resignation strategy. Meanwhile, the clinician should communicate with the relatives of STD patient served, who should understand and support the patients.It should be more careful with examing the quality of life among STDs patients when adopting generic scale, and the corresponding specific scales should be used as far as possible. The self-designed QOL-STD with a good reliability and validity was better than the generic and specific scale(SF-12 and DLQI). However, there was only one dimension for the QOL-STD scale by factorial analysis, it suggested items should be expanded in the future.