JMIR Publications

ABSTRACT

Background:

In the Chinese Ministry of Health statistics for the past 10 years, the otorhinolaryngology department is the one with the highest rates of doctor killings and injuries. From 2011 to 2014, a total of 4 chief otolaryngologists were killed with a knife by patients in China. Therefore, it is imperative to strictly follow the "biological-psychological-social" international medical model, and to have a comprehensive understanding of the association between allergic rhinitis (AR) and psychological disorders, so as to attract the attention and care from the otolaryngologists. However, most of the relevant existing literatures are one-on-one retrospective analyses or targeted meta-analyses of AR with psychological disorders like irritability, depression and anxiety, while the "multi-hospital + interdisciplinary" multiple regression analyses are scarce. To this end, this study makes the following 3 innovations by inviting the 5 most renowned hospitals, both Chinese and Western, in China's Chengdu and integrating 3 perspectives of otolaryngology, psychology and psychiatry: 1.A comprehensive intra-group comparison is made on the study group. The 9 classification criteria for intra-group comparison are derived from the preliminary questionnaire survey, which are the factors most likely to cause psychological disorders among AR patients that are preferentially screened by the authors. 2.Inter-group comparison is performed between the study group and the Chinese norm to derive 4 positive factors most associated with the patients' psychological disorders. 3.VAS scale is used to score the 4 AR symptoms of nasal itching, sneezing, clear discharge and nasal congestion, which are then subjected to the one-on-one partial correlation analysis separately with the 4 positive factors of psychological disorders. Frankly, the results of this study are not optimistic, which stress that the otolaryngologists should provide AR patients with warmer human care and more professional predictive aids, especially in China's current medical context.

Objective:

In the Chinese Ministry of Health statistics for the past 10 years, the otorhinolaryngology department is the one with the highest rates of doctor killings and injuries. From 2011 to 2014, a total of 4 chief otolaryngologists were killed with a knife by patients in China. Therefore, it is imperative to strictly follow the "biological-psychological-social" international medical model, and to have a comprehensive understanding of the association between allergic rhinitis (AR) and psychological disorders, so as to attract the attention and care from the otolaryngologists.

Methods:

To precisely identify the psychological disorders of patients with AR who were diagnosed and treated in the 5 most renowned hospitals in Chengdu (in China) over the past 5 years using 10 classification methods. 1. The self-reporting inventory 90 (SCL-90) was used to group and score the mental state of 827 strictly screened AR patients according to 9 classification criteria: gender, BMI, age, marital status, monthly salary, disease duration, living environment (urban or rural), education level and working environment (indoors or outdoors). Then, the scores were compared within groups. 2. Inter-group comparison was made between the study group and the Chinese norm, and the positive factors for psychological disorders were extracted. 3. Four symptoms in the study group, i.e. nasal itching, sneezing, clear discharge and nasal congestion, were scored on the visual analogue scale (VAS). 4. Partial correlation analysis was performed between the positive factors in 2 and the symptom scores in 3 by multiple regression statistical method. 5. SPSS 19.0 software was used to carry out statistical analysis.

Results:

1. Among 827 patients, 124 (15.0%) had no mental health impairments, 176 (21.3%) had mild impairments, 474 (57.3%) had mild to moderate impairments, 41 (5.0%) had moderate to severe impairments, and 12 (1.4%) had severe impairments. 2. The whole average score of SCL-90 of 827 patients was 2.64 ± 0.25, which corresponded to the mild to moderate mental health impairments. 3. The 827 patients scored significantly higher for 4 positive factors: depression, anxiety, psychosis and others (sleep, diet). 4. Depression was positively correlated with sneezing and clear discharge, anxiety was positively correlated with nasal itching and congestion, psychosis was positively correlated with nasal itching and sneezing, and others (sleep, diet) were positively correlated with clear discharge and nasal congestion. 5. Women scored higher (in a statistical sense, the same below) than man for somatization (Z = -5.10, P = 0.03), interpersonal sensitivity (Z = -5.51, P = 0.00), depression (Z = -4.86, P = 0.04), others (sleep, diet, Z = -5.28, P = 0.01). 6. The abnormal BMI group scored higher for obsessive-compulsive symptoms (t = 4.10, P = 0.03), paranoia (t = 5.29, P = 0.01). 7. Patients aged < 44 years scored higher for interpersonal sensitivity (t = 5.06, P = 0.00), while those aged ≥ 45 years scored higher for somatization (t = 5.22, P = 0.02), others (sleep, diet, t = 5.10, P = 0.03). 8. The unmarried group scored higher for psychotic (Z = 4.66, P = 0.02), while the married group scored higher for anxiety (Z = 4.48, P = 0.04), others (sleep, diet, Z =5.17, P = 0.00). 9. Those monthly salary < average scored higher for interpersonal sensitivity (Z = -4.93, P = 0.02), while those monthly salary > average scored higher for paranoid (Z = -4.02, P = 0.04). 10. Those disease durations < 13 years scored higher for others (sleep, diet, Z = 5.44, P = 0.00), while those disease durations ≥ 13 years scored higher for depression (Z = 4.98, P = 0.02). 11. Urban patients scored higher for somatization (t = 4.88, P = 0.04), obsessive-compulsive symptoms (t = 5.25, P = 0.01), interpersonal sensitivity (t = 4.57, P = 0.04), depression (t = 5.91, P = 0.00), anxiety (t = 5.09, P = 0.02), psychosis (t = 4.63, P = 0.04), others (sleep, diet, t = 5.55, P = 0.00). 12. The "senior high school and above" group scored higher for somatization (Z = -4.82, P = 0.03), interpersonal sensitivity (Z = -4.90, P = 0.03), others (sleep, diet, Z = -4.64, P = 0.04). 13. Indoor laborers scored higher for somatization (Z = 5.31, P = 0.01), interpersonal sensitivity (Z = 5.79, P = 0.00), psychosis (Z = 4.89, P = 0.04), others (sleep, diet, Z = 5.00, P = 0.03), while outdoor laborers scored higher for obsessive-compulsive symptoms (Z = 4.96, P = 0.04), anxiety (Z = 6.22, P = 0.00), hostility (Z = 5.08, P = 0.03).

Conclusions:

AR patients have mild to moderate mental health impairments, of whom women, those with abnormal BMI, age ≥ 45 years, monthly salary < 5110 yuan, disease duration < 13 years, residing in urban areas, high school and above education and indoor laborers are at high risk and require more care, follow-up and comprehensive therapy from otolaryngologists.