The Survey Of Body Image Disturbance In Chinese Patients With Ankylosing Spondylitis

ObjectivePhysiologic deficiencies usually led to the patients’ Body Image Disturbance(BID), following the changes of recognition, affection, etc. BID was closely related to anxiety, depression and life quality. This study aimed to construct the Chinese version of BID survey scales and investigate Chinese AS patients’ BID and its relationship with mentation, morbid state, and life quality. AS patients’ sexual problem and possible causes were also studied. MethodsTranslation, retroversion, culture adjustment and the test of validity and reliability were conducted on BIDQ rating scale. 103 patients diagnosed with AS and 121 healthy controls were enrolled in the study. The data were collected by using the Chinese version of BIDQ, SAS, SDS, BASDAI, BASFI, BASMI, HAQ, VAS and SF-36. Results1. CVI of Chinese BIDQ was 0.915. Total Cronbach’s α of BIDQ was 0.87. The Cronbach’s α of each item was between 0.730 and 0.899. The revised Chinese version of BIDQ had high validity and reliability in the assessment of AS patients.2. Among the AS patients, 8.4%(n=19) had anxiety symptoms and 31.2%(n=33) had depression symptoms, both of which were higher than the controls.(6.6%,n=8;14.9%,n=18)(P<0.05) The life quality of AS patients was lower than that of the controls. The differences were observed in 6 dimensions(PF、RP、BP、GH、SF、RE) of SF-36,while no statistic discrepancy was observed in VT and MH between the AS patients and the controls. The score of anxiety in AS patients was highly related with BASDAI(P=0.0003), VAS(P<0.0001), HAQ(P =0.0081)and 7 dimensions of SF-36 with SF excluded.(P<0.05)The score of depression was highly related with BASDAI(P=0.0013), VAS(P=0.0001) and 8 dimensions of SF-36. The BASDAI(P=0.0001)and VAS(P =0.0063) of AS patients with anxiety(SAS≥53) were significantly higher than those without anxiety.(SAS<53) The BASDAI(P=0.0116), BASFI(P =0.0235) and VAS(P =0.0336) of AS patients with depression(SDS≥50) were higher than those without depression.(SDS<50) Anxiety had no obvious influence on the life quality of AS patients, but the life quality of AS patients with depression was prominently lower than those without depression.(P<0.05) GH(P =0.018) and BP(P =0.043), 2 dimensions of SF-36, and VAS(P<0.0001) were two main causes of anxiety in AS patients. The controls cared about their body(34.13%) and skin(32.21%) most, while AS patients focused more on the figure change caused by the disease.(58.8%) The abilities of study, social contact, and work were significantly reduced by the BID of AS patients. Avoidance behaviors were more watched among AS patients. Compared with the controls, no statistic discrepancy was observed in the attention on appearance and negative affects. The decreasing social and vocational abilities resulted from BID were the main causes of anxiety and depression in AS patients. Through stepwise regression analysis of 8 dimensions of SF-36, we found that PF was most related to the function and health index; PR was most related to function index, psychological abnormality due to attention on appearance, pain, and decreasing social and vocational abilities; BP was most related to health and pain index; GH was most related to function index, depression, psychological abnormality due to attention on appearance, and anxiety; VT was most related to attention on appearance, function index, decreasing social and vocational abilities, and avoidance behaviors resulted from BID; RE was most related to function index and depression; MH was most related to disease activity index and frustration resulted from BID; while no independent factor was related to SF.3. In AS patients, 51.1%(51/103) of sexual relationship with mates were affected, with a degree of 1.7±2.1;in the controls, 47.1%(57/121) were affect, with 1.3±1.8. Between AS patients and the controls, no statistic discrepancy was watched in the incidence rate and degree of sexual relationship.(P≥0.05) 56.3%(58/108) of AS patients had sexual dysfunction symptom, and the mean value was 1.6.(SD=1.9) 29.8%(36/121) of the controls had this symptom, and the mean value was 0.7.(SD=1.3) Both of the incidence rate and degree of sexual dysfunction were distinctively higher than those of the controls.(29.8%,0.7±1.3)( P<0.05) The sexual relationship between AS patients and their mates were notablely related with BASDAI(P=0.0180), BASFI(P=0.0006), HAQ(P=0.0005), SAS(P=0.0143), BIDQ(BIDQ2 excluded, P<0.05), RP(P=0.0324), GH(P=0.0003) and MH(P=0.0383). The sexual function was closely related with age(P=0.0292), BASDAI(P=0.0058), BASFI(P=0.0261), BASMI(P=0.0435), SAS(P=0.0059), BIDQ3(P<0.05), GH(P=0.0192). BASDAI(P=0.019), mental stress induced by BID, BIDQ3(P=0.007), and the BID damage to social contract. BIDQ4(P<0.0001) contributed most to the damaged relationship between AS patients and their mates. BASMI(P=0.048), BIDQ4(P<0.0001) and BASFI(P=0.043) were the main causes of the sexual dysfunction in AS patients. ConclusionThe revised Chinese version of BIDQ had high validity and reliability in the assessment of AS patients, and was applicable in China.Compared with the controls, AS patients had higher incidence rates of anxiety and depression, and lower qualities of life. BID and sexual problems prevailed among AS patients. Obvious correlations could be watched among BID, anxiety, depression, morbid state, and life quality. Therefore, during the diagnose of AS, medical staff should pay attention to patients’ physical and physiological health and their Body Image Disturbance, and provide effective solutions.