Data_Sheet_1_Prevalence of depression and its association with quality of life among guardians of hospitalized psychiatric patients during the COVID-19 pandemic: a network perspective.docx

BackgroundThe COVID-19 pandemic has greatly affected treatment-seeking behaviors of psychiatric patients and their guardians. Barriers to access of mental health services may contribute to adverse mental health consequences, not only for psychiatric patients, but also for their guardians. This study explored the prevalence of depression and its association with quality of life among guardians of hospitalized psychiatric patients during the COVID-19 pandemic.
MethodsThis multi-center, cross-sectional study was conducted in China. Symptoms of depression and anxiety, fatigue level and quality of life (QOL) of guardians were measured with validated Chinese versions of the Patient Health Questionnaire – 9 (PHQ-9), Generalized Anxiety Disorder Scale – 7 (GAD-7), fatigue numeric rating scale (FNRS), and the first two items of the World Health Organization Quality of Life Questionnaire - brief version (WHOQOL-BREF), respectively. Independent correlates of depression were evaluated using multiple logistic regression analysis. Analysis of covariance (ANCOVA) was used to compare global QOL of depressed versus non-depressed guardians. The network structure of depressive symptoms among guardians was constructed using an extended Bayesian Information Criterion (EBIC) model.
ResultsThe prevalence of depression among guardians of hospitalized psychiatric patients was 32.4% (95% CI: 29.7–35.2%). GAD-7 total scores (OR = 1.9, 95% CI: 1.8–2.1) and fatigue (OR = 1.2, 95% CI: 1.1–1.4) were positively correlated with depression among guardians. After controlling for significant correlates of depression, depressed guardians had lower QOL than non-depressed peers did [F(1, 1,101) = 29.24, p < 0.001]. “Loss of energy” (item 4 of the PHQ-9), “concentration difficulties” (item 7 of the PHQ-9) and “sad mood” (item 2 of the PHQ-9) were the most central symptoms in the network model of depression for guardians.
ConclusionAbout one third of guardians of hospitalized psychiatric patients reported depression during the COVID-19 pandemic. Poorer QOL was related to having depression in this sample. In light of their emergence as key central symptoms, “loss of energy,” “concentration problems,” and “sad mood” are potentially useful targets for mental health services designed to support caregivers of psychiatric patients.

背景：新型冠状病毒肺炎（COVID-19）大流行极大地影响了精神疾病患者及其照料者的就医行为。精神卫生服务获取障碍不仅会对精神疾病患者造成不良心理健康后果，也会累及他们的照料者。本研究旨在探究新型冠状病毒肺炎大流行期间，住院精神疾病患者照料者的抑郁患病率及其与生活质量（quality of life, QOL）的关联。

方法：本研究为多中心横断面研究，在中国境内开展。研究人员采用经过效度验证的中文版量表分别评估照料者的相关指标：以患者健康问卷9项版（Patient Health Questionnaire – 9, PHQ-9）评估抑郁症状、广泛性焦虑障碍7项量表（Generalized Anxiety Disorder Scale –7, GAD-7）评估焦虑症状、疲劳数值评定量表（fatigue numeric rating scale, FNRS）评估疲劳程度，并使用世界卫生组织生活质量问卷简版（World Health Organization Quality of Life Questionnaire - brief version, WHOQOL-BREF）的前两个条目评估生活质量（QOL）。采用多重逻辑回归分析评估抑郁的独立影响因素，使用协方差分析（Analysis of covariance, ANCOVA）比较抑郁与非抑郁照料者的总体生活质量。此外，采用扩展贝叶斯信息准则（Extended Bayesian Information Criterion, EBIC）模型构建照料者抑郁症状的网络结构。

结果：住院精神疾病患者照料者的抑郁患病率为32.4%（95%置信区间：29.7%~35.2%）。GAD-7总分（优势比=1.9，95%置信区间：1.8~2.1）与疲劳程度（优势比=1.2，95%置信区间：1.1~1.4）均与照料者的抑郁症状呈正相关。在控制抑郁的显著影响因素后，抑郁照料者的生活质量低于非抑郁照料者[F(1, 1,101)=29.24，p<0.001]。在照料者抑郁症状网络模型中，“精力丧失”（PHQ-9第4项）、“注意力困难”（PHQ-9第7项）与“情绪低落”（PHQ-9第2项）为最核心的症状。

结论：新型冠状病毒肺炎大流行期间，约三分之一的住院精神疾病患者照料者存在抑郁症状。本研究样本显示，较低的生活质量与抑郁症状存在关联。鉴于上述三项症状为抑郁症状网络中的关键核心症状，“精力丧失”“注意力障碍”与“情绪低落”可作为面向精神疾病患者照料者的精神卫生支持服务的潜在干预靶点。