Care patterns and Traditional Chinese Medicine constitution as factors of depression and anxiety in patients with systemic sclerosis: A cross-sectional study during the COVID-19 pandemic

Qi Kong; Li-Ming Chen; Zong-Hao Dai; Yun-Zhe Tang; Yu-Yang Zhou; Wen-Zhen Tu; Yin-Huan Zhao; Jia-Qian Zhang

doi:10.3389/fnint.2023.1052683

Care patterns and Traditional Chinese Medicine constitution as factors of depression and anxiety in patients with systemic sclerosis: A cross-sectional study during the COVID-19 pandemic

Front Integr Neurosci. 2023 Feb 14:17:1052683. doi: 10.3389/fnint.2023.1052683. eCollection 2023.

Authors

Qi Kong^{1

2}, Li-Ming Chen^{1

3}, Zong-Hao Dai^{1

4}, Yun-Zhe Tang^{1

3}, Yu-Yang Zhou⁵, Wen-Zhen Tu⁶, Yin-Huan Zhao⁶, Jia-Qian Zhang^{1

6}

Affiliations

¹ Scientific Innovation Volunteer Team of Rare Diseases, Shanghai TCM-Integrated Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
² Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
³ Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
⁴ Department of Vascular Diseases, Shanghai TCM-Integrated Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
⁵ School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
⁶ Department of Rheumatology, Shanghai TCM-Integrated Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.

Abstract

Objective: Care patterns and Traditional Chinese Medicine (TCM) constitution affects the emotion and health of patients with systemic sclerosis (SSc) while the prevalence of COVID-19 may aggravate such patients' emotion and health. We investigated the depression and anxiety levels of patients with SSc during the pandemic to identify the correlation between care patterns, TCM constitution, and patients' emotion.

Materials and methods: This was a cross-sectional study. Patients with SSc and healthy individuals were surveyed using the patient health questionnaire-9, generalized anxiety disorder-7, and constitution in Chinese medicine questionnaire and a modified care pattern questionnaire. Factors correlated with depression and anxiety were screened using univariate and multivariate logistic regression analyses.

Results: A total of 273 patients with SSc and 111 healthy individuals were included in the analysis. The proportion of patients with SSc who were depressed was 74.36%, who had anxiety was 51.65%, and who experienced disease progression during the pandemic was 36.99%. The proportion of income reduction in the online group (56.19%) was higher than that in the hospital group (33.33%) (P = 0.001). Qi-deficiency [adjusted odds ratio (OR) = 2.250] and Qi-stagnation (adjusted OR = 3.824) constitutions were significantly associated with depression. Remote work during the outbreak (adjusted OR = 1.920), decrease in income (adjusted OR = 3.556), and disease progression (P = 0.030) were associated with the occurrence of depression.

Conclusion: Chinese patients with SSc have a high prevalence of depression and anxiety. The COVID-19 pandemic has changed the care patterns of Chinese patients with SSc, and work, income, disease progression, and change of medications were correlates of depression or anxiety in patients with SSc. Qi-stagnation and Qi-deficiency constitutions were associated with depression, and Qi-stagnation constitution was associated with anxiety in patients with SSc.

Trial registration: http://www.chictr.org.cn/showproj.aspx?proj=62301, identifier ChiCTR2000038796.

Keywords: Scleroderma; TCM constitution; anxiety; care patterns; depression; suicidal ideation; systemic sclerosis.

Grants and funding

The present study was supported by the Educational Science Research and Cultivation Project (Grant No. 2018jykx02); PeiRan Plan Projects (Grant No. JY611.27.01.06) of Shanghai University of Traditional Chinese Medicine; Research Project of Shanghai Municipal Health Care Commission (Grant No. 20204Y0410); and the Hongkou District Famous TCM Doctor Zhao Yin-Huan Academic Experience Transmission Studio (Grant No. 2018GYQY039). Basic and clinical research funding for rheumatology of Shanghai TCM-Integrated Hospital (Grant No. 2018YN001).