Published online Oct 19, 2023. doi: 10.5498/wjp.v13.i10.793
Peer-review started: August 8, 2023
First decision: August 24, 2023
Revised: September 2, 2023
Accepted: September 11, 2023
Article in press: September 11, 2023
Published online: October 19, 2023
Processing time: 65 Days and 2.1 Hours
Acute cerebral infarction (ACI) is characterized by a high incidence of morbidity, disability, recurrence, death and heavy economic burden, and has become a disea
To understand the elements that affect the mental health of patients who have suffered an ACI.
A questionnaire survey was conducted among patients with ACI admitted to three tertiary hospitals (Quanzhou First Hospital, Fuqing City Hospital Affiliated to Fujian Medical University, and the 900 Hospital of the Joint Service Support Force of the People’s Liberation Army of China) in Fujian Province from January 2022 to December 2022 using the convenience sampling method. ACI inpatients who met the inclusion criteria were selected. Informed consent was obtained from the patients before the investigation, and a face-to-face questionnaire survey was conducted using a unified scale. The questionnaire included a general situation questionnaire, Zung’s self-rating depression scale and Zung’s self-rating anxiety scale. All questionnaires were checked by two researchers and then the data were input and sorted using Excel software. The general situation of patients with ACI was analyzed by descriptive statistics, the influence of variables on mental health by the independent sample t test and variance analysis, and the influencing factors on psychological distress were analyzed by multiple stepwise regression.
The average age of the 220 patients with ACI was 68.64 ± 10.74 years, including 142 males and 78 females. Most of the patients were between 60 and 74 years old, the majority had high school or technical secondary school edu
Long disease course and female patients with ACI were more likely to have psychological problems such as a high incidence of emotional disorders. These groups require more attention and counseling.
Core Tip: In recent years, research on acute cerebral infarction has not only focused on the effects of the infarction on the body, but also the psychological effects. In this study, we found that long disease course may be the main factor leading to psychological problems in patients, and female patients with a high incidence of emotional disorders are more likely to have psychological problems. Such groups require more attention and psychological counseling.
- Citation: Chen QQ, Lin FM, Chen DH, Ye YM, Gong GM, Chen FF, Huang SF, Peng SL. Analysis of mental health status and related factors in patients with acute cerebral infarction. World J Psychiatry 2023; 13(10): 793-802
- URL: https://www.wjgnet.com/2220-3206/full/v13/i10/793.htm
- DOI: https://dx.doi.org/10.5498/wjp.v13.i10.793
Acute cerebral infarction (ACI) has become a disease of concern in global researchers due to its high incidence of mor
From January 2022 to December 2022, a questionnaire survey was conducted in patients with ACI admitted to three tertiary hospitals in Fujian Province (Quanzhou First Hospital, Fuqing City Hospital Affiliated to Fujian Medical University, and the 900 Hospital of the Joint Service Support Force of the People’s Liberation Army of China).
Inclusion criteria were: (1) Diagnosis consistent with that in the Chinese acute stroke clinical research consensus; (2) High research compliance; (3) Basic listening and speaking ability; and (4) Patients with a temporary stable condition and clear consciousness.
Exclusion criteria were: (1) Patients with language communication, cognitive, hearing or mental disorders; (2) Those with severe respiratory failure, malignant tumor, liver, renal, and cardiac dysfunction; and (3) Incomplete clinical data or participation in other research.
All patients with ACI who met the inclusion requirements were included in the study. Before the investigation, consent was obtained from the subjects and the informed consent was signed. A unified scale was used to conduct a face-to-face questionnaire survey. Those with good reading and writing ability completed the questionnaire. If the patients had difficulty in completing the questionnaire, the researcher used a unified guidance language to describe the questions. When the patient understood the questions, the survey was completed according to the patient’s opinions. The researcher collected and checked the questionnaires, and corrected any errors.
This questionnaire included demographic characteristics (gender, age, education level, marital status, medical insurance type, inpatient caregivers, smoking history, etc.) and disease-related data (course of disease, type of stroke, number of strokes, past chronic disease status, etc).
To evaluate potential anxiety and depression, the Chinese versions of Zung’s self-rating depression scale (SDS) and Zung’s self-rating anxiety scale (SAS) were utilized. The commonly used SAS and SDS measures are quick and practical tools for assessing respondents’ signs of anxiety and depression, and they have strong reliability and validity in the Chinese population. Each scale has 20 items that are rated on a scale of 1 to 4 to evaluate the assertions (rarely, occa
All questionnaires were checked by two researchers, and then Excel software was used for data entry and collation. The SPSS26.0 program was utilized for data analysis. Descriptive statistical analysis was used for the general situation of patients with ACI. The independent sample t test and variance analysis were used to analyze the influence of each variable on mental health. Multiple stepwise regression analysis was used to analyze the influencing factors of psychological distress. P < 0.05 was considered statistically significant.
Demographic characteristics of the 220 patients with ACI (Table 1).
Characteristics | Classification | n | Constituent ratio |
Gender | Male | 142 | 64.5% |
Female | 78 | 35.5% | |
Age (yr) | ≤ 59 | 49 | 22.3% |
60-74 | 94 | 42.7% | |
≥ 74 | 77 | 35.0% | |
Degree of education | Primary school and below | 39 | 17.7% |
Junior middle school | 54 | 24.5% | |
High school/technical secondary school | 91 | 41.4% | |
College degree or above | 36 | 16.4% | |
Marital status | Married | 134 | 60.9% |
Bereft of one’s spouse | 26 | 11.8% | |
Divorce or other | 60 | 27.3% | |
Living situation | Live with parents | 10 | 4.5% |
Live with children | 41 | 18.6% | |
Live with partner | 108 | 49.1% | |
Living alone | 61 | 27.7% | |
Domicile | City | 114 | 51.8% |
Village | 106 | 48.2% | |
Monthly profit (yuan) | ≤ 1000 | 17 | 7.7% |
1001-3000 | 75 | 34.1% | |
3001-5000 | 76 | 34.5% | |
≥ 5001 | 52 | 23.6% | |
Medical insurance type | Medical insurance for urban employees | 63 | 28.6% |
Medical insurance for urban residents | 40 | 18.2% | |
New rural cooperative | 95 | 43.2% | |
Self-paying | 22 | 10.0% | |
Caregiver | Parents | 11 | 5.0% |
Spouse | 114 | 51.8% | |
Children | 76 | 34.5% | |
Other | 19 | 8.6% | |
History of smoking | No | 105 | 47.7% |
Yes | 115 | 52.3% |
The disease course, frequency of onset, history of hypertension, history of diabetes, history of coronary heart disease, and history of chronic diseases patients with ACI was counted (Table 2).
Factors | Classification | n | Constituent ratio |
Course of disease | 1-6 mo | 96 | 43.64% |
7-12 mo | 73 | 33.18% | |
1-2 yr | 36 | 16.36% | |
More than 2 yr | 15 | 6.82% | |
Number of ACIs | One | 122 | 55.45% |
More than two | 98 | 44.55% | |
History of hypertension | Yes | 132 | 60.00% |
No | 88 | 40.00% | |
History of diabetes | Yes | 117 | 53.18% |
No | 103 | 46.82% | |
History of coronary heart disease | Yes | 109 | 49.55% |
No | 111 | 50.45% | |
Number of previous chronic diseases | 0 | 17 | 7.73% |
1 | 75 | 34.09% | |
2 | 101 | 45.91% | |
3 | 27 | 12.27% | |
Informed status of ACI | Fully informed | 97 | 44.09% |
Partially informed | 73 | 33.18% | |
Completely uninformed | 50 | 22.73% |
Among the 220 patients with ACI in this survey, 122 had depression, including 73 cases of mild depression, 39 cases of moderate depression, and 10 cases of severe depression. One hundred and sixty-three cases had anxiety, including 65 cases of mild anxiety, 61 cases of moderate anxiety, and 37 cases of severe anxiety (Table 3).
Factors | Classification | Number | Constituent ratio | mean ± SD |
SDS | Without | 93 | 42.27% | 43.31 ± 7.49 |
M | 73 | 33.18% | 57.29 ± 2.74 | |
M | 39 | 17.73% | 66.51 ± 2.68 | |
S | 10 | 4.55% | 76.30 ± 1.64 | |
SAS | Without | 57 | 25.91% | 43.09 ± 8.86 |
M | 65 | 29.55% | 52.85 ± 10.03 | |
M | 61 | 27.73% | 60.38 ± 8.28 | |
S | 37 | 16.82% | 75.92 ± 4.97 |
The SAS score and SDS score of ACI patients were used as dependent variables, and gender, age, occupation, education level, marital status, living conditions, place of residence, personal monthly income, type of medical insurance, inpatient nursing staff, and smoking history were used as independent variables for univariate analysis. The results showed that gender, age, living conditions and smoking history were the main factors affecting the SAS score of ACI patients. Age, living conditions and personal monthly income were the main factors affecting the SDS score of ACI patients (Table 4).
Factors | Classification | SAS (mean ± SD) | F/t value | P value | SDS (mean ± SD) | F/t value | P value |
Gender | Male | 54.74 ± 11.05 | 8.5771 | 0.004 | 52.36 ± 11.31 | 0.2931 | 0.589 |
Female | 62.5 ± 13.63 | 57.59 ± 11.78 | |||||
Age (yr) | ≤ 59 | 51.33 ± 12.67 | 10.504 | < 0.001 | 49.35 ± 11.18 | 8.878 | < 0.001 |
60-74 | 57.49 ± 11.42 | 53.67 ± 11.39 | |||||
≥ 74 | 61.42 ± 12.38 | 57.97 ± 11.34 | |||||
Degree of education | Primary school and below | 58.05 ± 12.82 | 0.494 | 0.687 | 55.38 ± 13.83 | 1.096 | 0.352 |
Junior middle school | 58.3 ± 11.05 | 53.15 ± 10.13 | |||||
High school/technical secondary school | 57.67 ± 13.43 | 55.33 ± 11.25 | |||||
College degree or above | 55.22 ± 12.36 | 51.72 ± 12.60 | |||||
Marital status | Married | 57.51 ± 12.32 | 1.687 | 0.188 | 53.88 ± 11.88 | 1.559 | 0.213 |
Bereft of one’s spouse | 61.23 ± 12.30 | 57.96 ± 9.28 | |||||
Divorce or other | 55.83 ± 13.04 | 53.33 ± 12.18 | |||||
Living situation | Live with parents | 48.00 ± 10.71 | 3.849 | 0.01 | 44.40 ± 11.32 | 3.923 | 0.009 |
Live with children | 61.83 ± 10.76 | 57.88 ± 11.32 | 2.4 | ||||
Live with partner | 57.36 ± 12.82 | 53.61 ± 11.99 | 3.4 | ||||
Living alone | 56.36 ± 12.61 | 54.43 ± 10.72 | |||||
Domicile | City | 55.97 ± 12.30 | 3.4941 | 0.063 | 54.18 ± 11.05 | 0.0021 | 0.96 |
Village | 59.12 ± 12.69 | 54.25 ± 12.46 | |||||
Monthly profit (yuan) | ≤ 1000 | 56.35 ± 12.52 | 1.9 | 0.131 | 50.00 ± 15.36 | 2.845 | 0.039 |
1001-3000 | 56.57 ± 11.94 | 54.13 ± 12.24 | |||||
3001-5000 | 60.17 ± 12.45 | 56.88 ± 10.45 | |||||
≥ 5001 | 55.27 ± 13.26 | 51.81 ± 10.76 | |||||
Medical insurance type | Medical insurance for urban employees | 57.25 ± 13.46 | 1.245 | 0.294 | 55.60 ± 10.69 | 1.063 | 0.366 |
Medical insurance for urban residents | 54.3 ± 11.02 | 51.43 ± 11.08 | |||||
New rural cooperative | 58.78 ± 12.79 | 54.40 ± 12.64 | |||||
Self-paying | 58.41 ± 11.14 | 54.50 ± 11.53 | |||||
Caregiver | Parents | 48.55 ± 5.09 | 2.189 | 0.09 | 51.36 ± 12.75 | 1.012 | 0.388 |
Spouse | 58.00 ± 13.10 | 53.80 ± 11.29 | |||||
Children | 58.41 ± 11.36 | 55.84 ± 12.41 | |||||
Other | 55.95 ± 15.26 | 51.84 ± 10.81 | |||||
History of smoking | No | 55.63 ± 12.16 | 5.4221 | 0.021 | 53.39 ± 11.91 | 1.1861 | 0.277 |
Yes | 59.53 ± 12.77 | 55.11 ± 11.51 |
The SAS score and SDS score of stroke patients were used as dependent variables, and the duration of disease, number of strokes, history of hypertension, history of diabetes, history of coronary heart disease, number of previous chronic diseases, and knowledge were used as independent variables for univariate analysis. The results showed that the course of disease, chronic history and the number of previous chronic diseases were the main factors affecting the SAS score of ACI patients. The course of disease and the status of knowledge of the disease were the main factors affecting the SDS score of patients with ACI (Table 5).
Factors | Classification | SAS (mean ± SD) | F/t/Welch value | P value | SDS (mean ± SD) | F/t/Welch value | P value |
Course of disease | 1-6 mo | 47.66 ± 9.80 | 72.127 | < 0.001 | 46.36 ± 10.63 | 56.8352 | < 0.001 |
7-12 mo | 62.97 ± 7.48 | 59.12 ± 7.83 | |||||
1-2 yr | 68.17 ± 9.99 | 58.81 ± 8.51 | |||||
More than 2 yr | 68.13 ± 6.55 | 69.53 ± 5.76 | |||||
Number of ACIs | One | 56.63 ± 13.34 | 1.2861 | 0.258 | 53.10 ± 13.18 | 2.6741 | 0.103 |
More than two | 58.56 ± 11.48 | 55.60 ± 9.50 | |||||
History of hypertension | Yes | 57.11 ± 12.28 | 0.3091 | 0.579 | 53.86 ± 11.60 | 0.2931 | 0.589 |
No | 58.07 ± 13.01 | 54.74 ± 11.96 | |||||
History of diabetes | Yes | 57.14 ± 13.01 | 0.1981 | 0.657 | 54.09 ± 10.83 | 0.031 | 0.863 |
No | 57.89 ± 12.07 | 54.36 ± 12.72 | |||||
History of coronary heart disease | Yes | 57.02 ± 12.43 | 0.3051 | 0.581 | 54.36 ± 11.54 | 0.0331 | 0.857 |
No | 57.95 ± 12.72 | 54.07 ± 11.96 | |||||
Number of previous chronic diseases | 0 | 64.94 ± 12.36 | 2.595 | 0.050 | 59.53 ± 10.33 | 2.277 | 0.081 |
1 | 55.73 ± 12.07 | 52.09 ± 13.20 | |||||
2 | 57.76 ± 12.34 | 55.13 ± 10.78 | |||||
3 | 56.67 ± 13.67 | 53.33 ± 10.71 | |||||
Informed status of ACI | Fully informed | 57.04 ± 12.63 | 2.444 | 0.089 | 55.14 ± 11.22 | 5.161 | 0.006 |
Partially informed | 55.84 ± 11.99 | 50.88 ± 12.02 | |||||
Completely uninformed | 60.78 ± 12.87 | 57.28 ± 11.31 |
The data obtained from this survey were analyzed by stepwise regression analysis, the SAS score in patients with ACI was used as the dependent variable, and the variables that showed statistically significant SAS scores in the patient data (gender, age, location, disease course, number of chronic diseases, and smoking history) as independent variables. The findings demonstrated that gender and progression of the illness were factors in the regression model (Table 6).
Variable | B | SE | Beta | t value | P value | 95%CI |
Constant | 29.551 | 2.164 | 13.654 | < 0.001 | 25.286-33.817 | |
Course of disease | 8.918 | 0.638 | 0.658 | 13.981 | < 0.001 | 7.661-10.176 |
Sex | 8.356 | 1.232 | 0.319 | 6.781 | < 0.001 | 5.928-10.785 |
The data obtained from this survey were analyzed by stepwise regression analysis, the SDS score in patients with ACI was used as the dependent variable, and the variables that showed statistically significant SAS scores in the patient data (age, place of residence, disease course, personal monthly income, and disease awareness) as independent variables. The findings demonstrated that the disease course was a factor in the regression equation (Table 7).
Variable | B | SE | Beta | t value | P value | 95%CI |
Constant | 41.149 | 1.457 | 28.252 | < 0.001 | 38.279-44.02 | |
Course of disease | 8.769 | 0.7 | 0.647 | 12.524 | < 0.001 | 7.389-10.149 |
ACI is a sudden cerebrovascular disease. It is an acute attack when the patient’s brain is blocked by blood vessels such as coronary arteries[6,7]. Due to the close connection between the cerebrovascular and central nervous system, patients with ACI often have a poor prognosis. Even after treatment, neurological dysfunction may persist. Some patients are prone to unpleasant feelings such as depression and anxiety during the onset of the disease, and then sleep disorders, neurasthenia and other symptoms, such psychological changes may be related to the occurrence of nerve defects[8-10]. In recent years, the study of ACI has not only focused on the effects on the body, but psychological effects have received more and more attention[11-13]. Patients with anxiety and depression often have a poor prognosis, longer recovery time and are more likely to relapse[13,14]. Therefore, this study analyzed the influencing factors on mental health in patients with ACI, with the hope of identifying the key factors affecting mental health.
The SAS score and SDS score in the 220 patients with ACI included in this study were statistically significant. The total SAS score was 57.49 ± 12.56, which was significantly higher than the standard cut-off value. The total SDS score was 54.21 ± 11.73, which was significantly higher than the standard cut-off value, indicating that psychological problems are common in patients with ACI in China. The results of univariate analysis showed that gender, age, residence, course of disease, number of chronic diseases and smoking history were the primary elements influencing the anxiety score in patients with ACI. Age, living conditions, monthly income, course of disease and knowledge of ACI were primary elements influencing the depression score in patients with ACI. The analysis results showed that female patients had more severe anxiety than male patients. The levels of anxiety and depression increased with age. Similar to previous research results, a possible reason for this is that women and the elderly belong to a high-risk group with emotional disorders[15-17], and psychological problems are more likely to occur after ACI. The SAS and SDS scores of patients living with their children were higher, which matched the outcomes of earlier studies[18,19]. This may be because patients living with their children often need to take care of their families, and the lack of ability regarding family care after infarction leads to serious anxiety. The longer the disease course, the higher the SAS and SDS scores in patients, which matched the outcomes of earlier studies[20,21], and might be the result of an aggravation of psychological pro
The limitation of this study is that the sample size is too small to fully analyze more factors affecting the mental health status of ACI patients. In future studies, we will continue to collect data of ACI patients, and further evaluate the key factors affecting the mental health of ACI patients in a more comprehensive way, as well as the mediating and regulating effects of other influencing factors.
In summary, patients with ACI generally have psychological issues including despair and anxiety. A long disease course may be the main factor leading to psychological problems in patients, and female patients are more likely to have psychological problems such as a high incidence of emotional disorders. Such groups require more attention and psychological counseling.
Acute cerebral infarction (ACI) is a sudden cerebrovascular disease. ACI occurs when the patient’s brain is blocked by coronary arteries and other blood vessels, resulting in ischemia and hypoxia. Even after receiving treatment, there may be persistent neurological dysfunction. Patients with anxiety and depression tend to have a poor prognosis, take longer to recover and are more likely to relapse.
This study analyzed the factors affecting the mental health of patients with ACI, with the hope of identifying the key fac
The object of this study is to improve the mental health status of patients with ACI, and pave the way for early clinical intervention.
A questionnaire survey was conducted among patients with ACI admitted to three tertiary hospitals in Fujian Province from January 2022 to December 2022 using the convenience sampling method. Patients with ACI who were inpatients and met the inclusion criteria were selected. A face-to-face questionnaire survey was conducted using a unified scale. To evaluate potential signs of anxiety and depression, the Zung’s self-rating depression scale and Zung’s self-rating anxiety scale were used. All questionnaires were checked by two researchers and then the data were input and sorted using Excel software. The general situation of ACI patients was analyzed by descriptive statistics, the influence of variables on mental health by the independent sample t test and variance analysis, and the influencing factors on psychological distress were analyzed by multiple stepwise regression.
Univariate analysis showed that gender, age, residence, course of disease, number of previous chronic diseases and smoking history were the main factors affecting anxiety scores in ACI patients. Age, living conditions, monthly income, course of disease and knowledge of ACI were the main factors affecting the depression score in ACI patients. According to the results of the multivariate analysis, the course of disease and gender were the key factors affecting the anxiety score, and the course of disease was also the key factor affecting the depression score.
Patients with ACI generally have psychological issues including depression and anxiety. A long disease course may be the main factor leading to psychological problems in patients, and female patients are more likely to have psychological problems such as a high incidence of emotional disorders. Such groups require more attention and psychological coun
More patient records should be collected to more comprehensively evaluate the key factors affecting the mental health of patients with ACI.
Provenance and peer review: Unsolicited article; Externally peer reviewed.
Peer-review model: Single blind
Specialty type: Psychiatry
Country/Territory of origin: China
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P-Reviewer: Leff RA, United States; Pergolizzi S, Italy S-Editor: Wang JJ L-Editor: A P-Editor: Wang JJ
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