Comprehensive Psychological Interventions Study Among The Elderly With Tuberculosis In Communities Of Hubei Province

Objective:Investigate the prevalence of anxiety and depression among the elderly with tuberculosis in communities of Hubei Province.And we conduct comprehensive psychological interventions in study population and assess its efficacy as well as analyze associated risk factors,aiming at helping improve their psychological health.Methods:We adopt systematic sampling technique to select the elderly TB patients as study population from Wuhan and comparable controlled Enshi area TB registration system respectively.Subjects from Wuhan were allocated to intervention group,instead the others matched by gender and age were severed as control group.Based on the Health Action Process Approach（HAPA）framework,the individuals in intervention group accept comprehensive psychological interventions as well as health promotion;the objects in control group,however,only accept routine health promotion.Self-rating anxiety scale（SAS）and self-rating depression scale（SDS）are respectively applied to measure each intervention effect.Meanwhile,simple factor comparison,linear regression,multilevel models and Pearson coefficient methods are used for evaluating the efficacy and analyzing variables’relationship.Results:1.Epidemiological characteristics distribution of the elderly with tuberculosisMen are nearly 60%,the 65-and 70-year old age are the largest proportion,degree of literacy are dominated by primary and secondary school respectively in both group.And TB knowledge rate is 29.3%.There are no significant difference between the two groups（P>0.05）.2.Mental health status and associated influencing factorsBefore the comprehensive interventions,the baseline prevalence of anxiety is53.0%among the whole objects;59.0%for the intervention group and 50.0%for the control respectively.The baseline prevalence of depression is 78.6%among the whole objects;85.3%for the intervention and 75.5%for the control respectively.The treatment stage has a significantly negative effect on anxiety,?=-0.129,p<0.001;for depression,gender（?=-0.119,p=0.002）,age（?=-0.083,p=0.024）,as well as tuberculosis knowledge（?=-0.074,p=0.043）all significantly affect it.3.Main external symptoms among the elderly with tuberculosisAmong the elderly with tuberculosis,the“full of bad feelings for future”,“feeling of tiredness”,”feeling of restlessness”are main symptoms for anxiety;the“negative attitude toward life”,“interests and hobbies loss”,“low sleep quality”are main for depression.And,the correlation coefficient between anxiety and depression ranges from 0.32863 to 0.43611,p<0.001.4.Efficacy assessment of the comprehensive interventions via multilevel modelsAfter the comprehensive interventions,the prevalence of two groups all declined,9.9%for anxiety and 24.6%for depression respectively among the intervention group;27.1%for anxiety and 45.1%for depression respectively among the control group.Nevertheless,compared with the control,the prevalence in intervention group all dropped more,i.e.anxiety(?_group*time=-0.79,p<0.01)and depression(?_group*time=-1.13,p<0.001).Therefore,treatment stage significantly affects the intervention efficacy（?=-3.23,p<0.05）,patients at initial treatment stage are more serious.Conclusions:The mental health status of elders with tuberculosis is not well at baseline,the study objects all have relatively high prevalence of anxiety and depression symptoms.Also,they all have relatively bad knowledge of tuberculosis.Specifically,in terms of anxiety,individuals at preliminary stage are more serious;female individuals and individuals with no TB knowledge are more serious for depression.The correlation between anxiety and depression symptoms is significant to some extent,and main symptoms are vulnerable to stimulate,feeling of restlessness and bad sleep quality.The comprehensive interventions can remarkably help improve their mental health as well as alleviate their mental stress.