Analysis On Relations Of Clinical Characteristics,Depression And Personality Of Patients With Ankylosing Spondylitis

ObjectiveTo investigate the status and characteristics of depression,clinical symptoms,personality traits and quality of life(QoL)in patients with ankylosing spondylitis(AS),and analyze related factors of depressive mood and the relationship between depression,disease,personality and QoL,so as to provide a theoretical basis for the identification and intervention of patients with ankylosing spondylitis and depression comorbidity,but also to provide support for reasonable use of drugs to relieve patients' pain and improve the level of physical and mental health.MethodsA total of 411 patients diagnosed with AS in related outpatients of three grade A tertiary hospitals were researched from August 2015 to May 2016,including 329 males and 82 females.The Self-rating Depression Scale(SDS),Eysenck Personality Questionnaire(EPQ)and World Health Organization Quality of Life(WHOQOL-BREF)were used to assess depression,personality traits and QoL of the patients.Demographic characteristic data(such as gender,age,monthly family income,profession,education level,etc.),disease duration,morning stiffness,HLA-B27,fingertip-to-floor distance,Erythrocyte Sedimentation Rate(ESR),C-reactive Protein(CRP),and Bath AS Metrology Index(BASMI)were collected.The Visual Analog Scale(VAS),Bath AS Functional Index and Disease Activity Index(BASFI and BASDAI)were estimated subjective pain and clinical parameter.Then the study analyzed the factors that affected patients' depression and the relationship between these various factors.Results1.AS patients aged from 16 to 56 years old.The youth patients aged from 16 to 34 years old accounted for 77.1%.The patients who were in the state of disease activity and poor functional status accounted for 58.9% and 15.8%.50.6% and 51.8% of patients would feel nocturnal pain and total back pain obviously.2.Patients' average score of SDS was(47.46±10.54),which was higher than the Chinese Norm of SDS(t=9.67,P<0.001).34.5% of patients were with depression state.The score of SDS and the detection rate of depression in females was higher than those in males(P<0.05).With the increase of age and the decrease of education level,the scores of depression and detection rate of patients were increased(P<0.05).Compared with these patients whose family income were more than 2000 yuan per mouth,the SDS score and the depression detection rate among patients with less than 2000 yuan family income were higher(P<0.001).The SDS score of patients engaged in agriculture was highest(P<0.001).3.Scores of all clinical parameters of the patients with depression were higher than those with non-depression(P<0.05).Compared with patients with normal parameters,the depression detection rates of patients with abnormal ESR and CRP,disease activity,poor functional status,or obvious nocturnal pain and total back pain were higher(P<0.05 or 0.001).4.Scores of Psychoticism(EPQ-P)and Extraversion(EPQ-E)of patients with depression were less than the Chinese Norm.On the contrary,the score of Neuroticism(EPQ-N)was higher(P<0.001).The score of EPQ-P of patients with depression was lower than that without depression,while these scores of EPQ-N and EPQ-E were higher(P<0.001).5.The score of Physical(PH)was lower than the Chinese Norm(P<0.01).And scores of all WHOQOL-BREF dimensions of patients with depression were higher than those without depressive state(P<0.001).6.SDS score and clinical parameters were correlated positively(r=0.11~0.54).It was associated with scores of EPQ-P and EPQ-E positively(r=0.24 and 0.61),while EPQ-N negatively(r=0.38).The subjective clinical parameters such as nocturnal pain,total back pain,BASDAI and BASFI were associated with EPQ-E negatively(r=0.25~0.33),and EPQ-N positively(r=0.34~0.43).7.In hierarchic multiple regression analysis,the clinical parameters and psychological variables contributed significantly to the variance in SDS scores,adding an additional 21.0% and 37.0% to the overall R2 beyond that accounted for by demographic variables,resulting in a final R2 of 62.0%.Multivariate Logistic regression analysis showed that age,BASDAI,and EPQ-N were the risk factors for patients with depression(OR=1.06,1.10 and 1.14,P<0.01),while family income and PS were protective factors(OR=0.44 and 0.70,P<0.05).Moreover,depression was the risk factor for obvious nocturnal pain(OR=1.04,P<0.05).Psychological variables contributed significantly to the variance in VAS of nocturnal pain and total back pain(R2=33.0% and 42.0%)which were lower than those of clinical parameters.Conclusions1.The prevalence of depression in AS patients is higher than it is generally thought to be,and the ages,family income,disease activity and Neuroticism have significant effect on depression.2.Clinical symptoms interact with depression,and depression is the risk factor for patients with nocturnal pain.Meanwhile pain is also affected by psychological factors.3.Personality traits of patients who accompany by depression belong to high psychoticism,introversion and high neuroticism.Moreover,subjective clinical characteristics,such as pain BASDAI and BASFI,are more closely related to Extraversion and Neuroticism.4.QoL of AS patients is still acceptable,however,the physiological QoL is poor,and the QoL is worse if patients are accompanied with depression.And psychological of QoL is the protective factor for depression.5.It is important that the patient's depression,personality and other psychological factors should be appreciated,and reasonable drug and psychological interventions should be made to improve patients' level of physical and mental health.