| Background Rheumatoid arthritis (RA) is a chronic disease that causes inflame-mation of the joints and the surrounding tissues. Patients suffering from severe chronic disorders that are accompanied by pain, disability, and disfigurement are at greater risk of experiencing emotional disturbances. The influence of psychosocial factors on disease processes in all kind of physical and psychosomatic diseases has been well known with the development of medical model. RA has a more frequent occurrence in women at the age of childbearing when women often express special characteristics of their own. During this period women will experience marriage, pregnancy, childbirth, parenting and menopause and so on. Confronted with RA, women will be more susceptible to psychopathological symptoms. So it is important for clinicians to consider the psychological status of the female RA patients, as well as their physical status, in order to more effectively deal with RA. Clinicians feel the signhificant impact of the psychosocial factors on RA patients through their clinical experiences; however, they rarely examine such aspects in routine clinical practice. China’s Mental Health Plan (2002-2010) pointed out researches on women particular psychological behavior problems and mental disorders should be strengthened, and effective strategies and interventions should be carried out actively.Objective To investigate the mental health of the female RA patients; to determine the spectrum of personality (neuroticism, extrovision, psychoticism) of them; to research about the deficit of emotional regulation in female RA patients to indicate that these patients have alexithymic characteristics, as revealed by the Toronto Alexithymia Scale (TAS-20); to investigate the the relationship between the personality characteristics(EPQ-RSC and TAS-20) and mental health; to study respectively the relationship between the psychological factors (personalistic and psychopathological) and the clinical features(duration, pain degree, DAS28, joint malformation, CRP, ESR and RF). It has great practical benefits to the psychological intervention of patients with RA.Method108female patients with rheumatoid arthritis (RA group) and98healthy women (control group) were randomly enrolled and assessed with the symptom checklist-90(SCL-90), EPQ-R Short Scale(EPQ-RSC), Chinese version of the20-item Toronto Alexithymia Scale (TAS-20) and Visual analogy scale (VAS). Disease duration, pain degree, TJC, SJC, ESR, CRP and DAS28of the patients were also recorded and calculated. All data were entered into the computer to create an database and processed by SPSS17.0statistical analysis software. The measurement data are analyzed by variance and the comparison among groups of enumeration data are tested by t tests or chi-square tests. Pearson correlation analysis was used to analyze the association between mental status and clinical symptoms. It is considered to be statistically significant when the difference is p<0.05.Results1.The results about SCL-901.1The comparison of RA patients with normal controls in SCL-90:The total score and somatization, interpersonal sensitivity, depression, anxiety, hostility and paranoid ideation factors score from the female RA were significantly higher than those of control groups (p<0.05～p<0.01), especially in the factor of depression;1.2The differences among three age groups:there were significant differences in the score of almost all factors between the eldest group and the young group, except the obsession-compulsion factor. The factor scores of somatization and anxiety in in the eldest group were significant higher than those of the elder group.1.3The differences among different educational groups:the factor scores of somatization, obsession-compulsion, depression, anxiety and paranoid in primary educational group were significant higher than those of university educational group.1.4The differences among different disease duration groups:the factor scores of somatization, depression and paranoid in the above5years group were significant higher than those of the below1year group. 1.5The differences between with and without deformed joints groups:there were significant statistical differences in the factor scores of somatization, interpersonal sensitivity, depression, anxiety and paranoid between two groups.2. The results about EPQ-RSC2.1The comparison of RA patients with normal controls in EPQ-RSC:the score of E dimension in RA group was significant lower than control group, while the score of N dimension in RA group was significant higher than the control group.2.2The comparison of SCL-90in the high E dimension score group with the low E dimension score group in RA patients:there were significant difference between the high E dimension group and the low group in the score of depression factor.2.3The comparison of SCL-90in the high N dimension score group with the low N dimension score group in RA patients:the factor scores of obsession-compulsion, depression, anxiety and paranoid in the high N dimension score group were significant higher than those in the low one.3. The results about TAS-20.3.1The comparison of RA patients with normal controls in TAS-20:The TAS-20total score, Tfl and Tf3factors score of the female RA patients were significantly higher than those of the control group.3.2The comparison of SCL-90in the high TAS-20score group with the low one in RA patients:There were three factors obsession-compulsion, depression and anxiety being different between the higher TAS-20total score group and the lower one. However, the obsession-compulsion, depression, anxiety and phobias factors scores of the higher Tfl score group were significantly higher than those of the lower one; The higher Tf3score group was significantly different from the lower one in obsession-compulsion, interpersonal sensitivity, depression, hostility and paranoid factors.3.3The comparison of TAS-20in the high SCL-90score group with the low one in RA patients:Tf1factor score of higher SCL-90total score group was significant higher than that of the lower one.4. Correlation analysis between the personality and SCL-90in RA patients. 4.1Correlation analysis between EPQ-RSC and SCL-90in RA patients: Significant positive correlation was found between N dimension and obsession-compulsion, depression, anxiety and paranoid factors of SCL-90.4.2Correlation analysis between TAS-20and SCL-90in RA patients:Correlation analysis showed significantly positive correlation between Tfl factor and somatization, obsession-compulsion, depression, anxiety and paranoid factors of SCL-90, also between Tf3factor and obsession-compulsion, interpersonal sensitivity, phobias and paranoid factors, as well as between total score and obsession-compulsion, depression, anxiety and paranoid factors.5. Correlation analysis between the psychological factors and clinical indications in RA patients.5.1Correlation analysis between EPQ-RSC and clinical indications:There were significantly positive correlation between N dimension and pain degree and DAS28.5.2Correlation analysis between TAS-20and clinical indications:There were significantly positive correlation of the pain degree with the TAS total score and factor score of Tf1, Tf2, Tf3, as well as of the DAS28and CRP respectively with the TAS total score and factor score of Tf1.5.3Correlation analysis between SCL-90and clinical indications:The duration was positively correlated with depression and paranoid factors; the pain degree had a positive relationship with somatization and depression factors; DAS28was positively correlated to anxiety and depression factors; CRP had a positive relationship with depression factor.Conclusion1. The female RA patients had serious problems in mental health, especially those with elder age, poor education, longer duration and deformed joints urgely needed effective psychological interventions.2. The female RA patients represented introversion and emotional instability in personality characteristics. They were also difficult to experience and express their emotions in an obviously alexithymia state.3. The personality factors (neuroticism dimension of EPQ-RSC,Tfl and Tf3 factors of TAS-20) had closer relationship with the mental health in female RA patients.4. The personality factors (neuroticism dimension of EPQ-RSC,Tfl and Tf3factors of TAS-20) also had relationship with the clinical indications (duration, pain degree, DAS28and CRP).5. Psychological assessment should be carried out as early as possible, and psychological intervention and therapy should be acted on time to prevent the mental problems in female RA patients.. |
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