| 题名 | 过敏性鼻炎患者心理健康和工作行为及药物依从性干预 |
| 作者 | 锡琳 |
| 答辩日期 | 2021-01 |
| 文献子类 | 硕士 |
| 授予单位 | 中国科学院大学 |
| 授予地点 | 中国科学院心理研究所 |
| 其他责任者 | 李永娟 |
| 关键词 | 过敏性鼻炎 心身医学 心理健康 工作行为 依从性 |
| 学位名称 | 理学硕士（同等学力硕士） |
| 其他题名 | Mental health and work behavior of allergic rhinitis patients and medication compliance intervention |
| 学位专业 | 应用心理学 |
| 中文摘要 | With the development of psychosomatic medicine and bio-psycho-social medical model, the relationship between physical diseases and mental health has been paid more and more attention by doctors,patients and their families. Allergic Rhinitis (AR) is a chronic disease with increasing morbidity. Its recurrent episodes not only bring patients financial burden and physical pain, but also threaten their mental health and well-being of patients. Therefore, exploring the psychosomatic relationship of AR patients can provide an important basis for doctors to accurately evaluate the psychosomatic state of patients and improve the effectiveness of diagnosis and treatment.Based on the stress theory of psychosomatic medicine, the current study explored the mental health and related effects of patients with allergic rhinitis. Firstly, the mental health of AR patients in China is evaluated from different viewpoint, and the related factors that may affect their mental health are discussed. Symptom Checklist-90 (SCL-90), State-Trait Anxiety Inventory (STAI) and Minnesota Muliphasic Personality Inventory (MMPI) were used to evaluate the mental health of AR patients. Study 1A found that the results of SCL-90 of two AR samples 10 years apart were significantly worse than the existing Chinese norm, mainly reflected in somatization, compulsive symptoms, anxiety, hostility and psychosis, etc. Nasal itching and nasal obstruction were the main clinical symptoms affecting mental health. Study 1B showed that AR combined with asthma is an indepentant factor affecting mental health. The results of STAI study 1C showed that AR type had no correlation with anxiety, but was associated with the severity of rhinitis symptoms. Study 1D showed that nasal obstruction predicted anxiety in AR patients, but not in VMR patients. Study 1E found that the MMPI results of AR patients were significantly different from those of healthy people in terms of suspicious, depression, hysteria, hypomania, social introversion and explicit anxiety, revealing that AR patients had the personality traits of suspicious, exaggerated condition, more anxiety, more irritability and desire to be lone. Study 1 explored the mental health status of AR patients in China from different angles, comprehensively clarified the impact of AR on patients' mental health, which providing empirical evidence for AR psychosomatic medical research and clinical psychosomatic treatment.The second part of the study explored the impact of rhinitis symptoms in seasonal allergic patients on their physical and mental health and work behavior. Specifically, the experienced sampling method was used to collect data.A total of 76 cases of AR rhinitis patients with autumn pollen allergy was invited as the research objects. A 2-week WeChat questionnaire survey was conducted on the network platform during the pollen season and the dynamic change trend of AR patients’ rhinitis symptoms on sleep, mood change and spill over into work were evaluated. The results of multiple paths analysis showed that rhinitis symptoms were significantly aggravated with the increase of pollen concentration, which affected insomnia and a negative mood the next morning, leading to unethical behavior at work. Meanwhile, the results of indirect effect analysis showed that rhinitis symptoms indirectly affected patients' negative mood and unethical behavior of the following day through insomnia. In short, with the dispersal of pollen grains in autumn, AR patients have worse nasal symptoms, resulting in insomnia and negative mood, followed by an increase in unethical behaviors at work. Additional analysis found that most of the AR patients showed poor medication compliance. This provides the possibility of taking medication as the target of intervention.In the third part, 96 patients with pollen allergy in spring were recruited and randomly divided into four groups for medication compliance intervention. The interventions of the four groups were as follows: reminding the patients to take medicine, informing the patients of pollen concentration the next day, reminding-informing intervention, and no intervention (control group). The intervention information was sent to the subjects by mobile phone WeChat every night. The patients reported the medicine taking, the nasal cavity cleaning and mask wearing behaviors. The results showed that the group with medication reminder had the better curative effect than other groups. Instead, the pollen information becomes a factor that interferes with the regular medication. It is suggested that the professional reminder medication can improve patients’ medication compliance, while too much information may interfere with medication compliance.In summary, the current study first focuses on the mental health characteristics of patients with allergic rhinitis, and clarifies the effects of allergic disease on mental health. Further, we explore the dynamic negative effects of symptoms in AR patients on mental health and work behavior, through experienced sampling method and path analysis in pollen season. Finally, reminding patients to taking medicine via mobile phone is an effect strategy to improve patient's medication compliance. This study can provide a theoretical basis for doctors to fully understand the physical and mental state of AR patients, and improve the effectiveness of diagnosis and treatment from the perspective of psychosomatic medicine. |
| 英文摘要 | 随着心身医学的发展和生物-心理-社会医学模式的概念深化，躯体疾病与心理之间的关系越来越多得受到医生、患者以及家属的重视。过敏性鼻炎(Allergic Rhinitis, AR)是一种发病率日益升高的慢性疾病，病情反复发作，带给患者经济负担和身体痛苦的同时，还威胁着患者的心理健康和幸福感。因此，探索AR患者的心身关系能够为医生准确评估患者的心身状态、提升诊疗的有效性提供重要基础。本研究基于心身医学的应激理论开展过敏性鼻炎的心理健康及相关研究。具体来讲，第一部分通过不同角度评估我国AR患者的心理健康，探讨可能影响患者心理健康的相关因素。分别运用症状自评量表SCL-90(Symptom Checklist-90, SCL-90)、状态-特质焦虑量表(State-Trait Anxiety Inventory, STAI)和明尼苏达多相人格量表(Minnesota Muliphasic Personality Inventory, MMPI)进行系列研究，研究1A发现，间隔10年的两个AR样本群SCL-90结果均显著差于现有的中国常模，主要体现在躯体化症状、强迫症状、焦虑、敌对以及精神病性等方面，鼻痒和鼻堵是影响心理健康的主要临床症状；研究1B显示是否合并哮喘是影响AR患者心理健康的独立因素；研究1C发现AR患者是否出现焦虑与AR类型无关，而与鼻炎症状的严重程度呈正相关；研究1D比较AR患者与血管运动性鼻炎 (Vasomotor Rhinitis,VMR)的STAI发现，鼻堵症状可预测AR患者的焦虑程度，但不能预测VMR患者的焦虑。研究1E发现AR患者的MMPI人格测试结果在疑病、抑郁量、癔病、轻躁狂、社会内向和外显焦虑方面与健康人有显著差异，揭示AR患者具有疑病心理、夸大病情、更感焦虑、更易激惹和希望独处的人格特质。研究1从不同层面获得了我国AR患者的心理健康状况，全面阐明了AR对患者心理健康影响的具体表现和趋势预测，为AR的心身医学研究提供实证，并为临床开展心身治疗奠定基础。研究第二部分探索了季节性过敏性患者的鼻炎症状对患者身心健康以及工作行为的影响。采用经验取样法研究设计，以76例秋季花粉过敏的AR鼻炎患者为研究对象，通过网络平台在花粉季期间进行了为期两周日记法微信问卷调查，获得AR患者的鼻炎症状对睡眠、心境的改变以及溢出到工作行为的动态变化趋势。多层路径分析发现，随着花粉浓度升高，患者鼻炎症状明显加重；继之引起失眠和第二天早晨的消极心境，导致工作中不道德行为发生。间接效应分析结果显示，鼻炎症状通过失眠对次日消极心境和不道德行为产生间接影响。简言之，随着秋季花粉颗粒的播散AR患者鼻炎症状加重，引起失眠和消极心境，随之增加工作中的不道德行为。进一步分析用药情况发现多数AR患者并没有遵医嘱规范用药，药物依从性差，这为进一步将服药行为作为干预目标提供了可能性。研究第三部分招募春季花粉过敏患者96例并随机分成四组进行服药行为干预。四组干预内容分别为：提醒患者用药、告知患者次日花粉浓度、提醒用药+告知第二天花粉浓度，无干预(控制组)。干预方式为每天晚上通过手机微信将干预信息发送给被试，并请患者报告第二天的用药、清洗鼻腔和戴口罩的执行情况。结果显示单独提醒用药组的患者用药情况最规范，鼻炎症状改善程度最好。而花粉信息反而成为影响患者规律用药、佩戴口罩和清洗鼻腔的干扰因素。表明来自医务人员专业的提醒用药可显著提高患者的治疗依从性，接收过多信息可能干扰患者的用药行为。药物依从性的干预是获得满意疗效的基本保证。同时，借鉴移动医疗手段，验证移动医疗干预是有效的，而干预的内容是保障干预效果的关键点。综上研究，本研究首先关注过敏性鼻炎患者的心理健康状况，阐明过敏性疾病对心理健康的影响。进一步在花粉季节通过经验取样和路径分析，探索AR患者发病对心理健康的动态负面作用、并溢出到工作情境，对工作行为产生消极影响。最后通过手机助推方式干预患者的服药行为，获得提高患者用药依从性的策略和方法。研究能够为医生全面认识AR的身心状态，从心身医学角度提升诊疗的有效性提供理论基础。 |
| 语种 | 中文 |
| 内容类型 | 学位论文 |
| 源URL | [http://ir.psych.ac.cn/handle/311026/41697]  |
| 专题 | 心理研究所_社会与工程心理学研究室 |
| 推荐引用方式 GB/T 7714 | 锡琳. 过敏性鼻炎患者心理健康和工作行为及药物依从性干预[D]. 中国科学院心理研究所. 中国科学院大学. 2021. |
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