5.4. Trend analysis and follow-up results
5.4.2. Psychological factors change during follow-up period
5.4.2. Psychological factors change during follow-up period
Table 15. Psychological distress change during hospitalization to 3-month post-discharge Psychological
distress
T0 (N = 53)
T1 (N = 53)
T2 (N = 52)
T3 (N = 51)
Within-subject Effects F(df)
p Bonferroni
Sleep 1.83 ± 1.41 1.43 ± 1.46 1.48 ± 1.48 1.51 ± 1.39 Anxiety 2.60 ± 1.08 1.75 ± 1.14 1.92 ± 1.37 2.12 ± 1.41 Irritability 1.55 ± 1.14 1.08 ± 1.09 1.29 ± 1.35 1.59 ± 1.47 Depression 2.79 ± 1.01 1.89 ± 1.25 1.94 ± 1.42 2.04 ± 1.33 Inferiority 2.19 ± 1.40 1.64 ± 1.35 1.60 ± 1.45 1.82 ± 1.48
BSRS-5 Total score 10.96 ± 3.61 7.79 ± 4.70 8.23 ± 5.61 9.08 ± 5.76 F (3,156) = 6.87 0.00 T0>T1*, T2*
*p<0.05, T0 = 1 week after hospitalization; T1 = 1 week after discharge; T2 = 1 month after discharge; T3 = 3month after discharge, BSRS-5: 5-item Brief Symptoms Rating Scale, the higher the score, the more severe psychological distress levels. The statistics applied intention-to-treat analysis.
T0 = 1 week after hospitalization; T1 = 1 week after discharge; T2 = 1 month after discharge; T3 = 3month after discharge
Figure 10. Psychological distress change in item during hospitalization to 3-month post discharge
T0 = 1 week after hospitalization; T1 = 1 week after discharge; T2 = 1 month after discharge; T3 = 3month after discharge
Figure 11. Psychological distress changes during hospitalization to 3-month post-discharge
0 0.5 1 1.5 2 2.5 3
Sleep Anxiety Irritability Depression Inferiority
Psychological distress change in item
T0 (N = 53) T1 (N = 53) T2 (N = 52) T3 (N = 51)
10.96
7.79 8.23
9.08
0 2 4 6 8 10 12
T0 (N = 53)
T1 (N = 52)
T2 (N = 52)
T3 (N = 51)
Psychological distress change
5.4.2.2. Hopelessness
As seen in Figure 12, during the follow-up period, most participants reported feelings of hopelessness; constant feelings of hopelessness decreased after hospitalization but increased immediately after discharge and up to the final interview. The patients revealed rarely and always hopelessness decreased after treatment in the hospital to one-week post-discharge (from 15.1% to 9.4%, and from 30.2% to 13.2%), then rose to 13.2% and 20.8% at T3. In contrast, patients who sometimes reported hopelessness showed a downward trend from 41.5% (n=22) to 20.8% (n=11). Finally, the feeling of hopelessness total score at T0 was significantly reduced compared to T1, T2, and T3 (p<0.05).
T0 = 1 week after hospitalization; T1 = 1 week after discharge; T2 = 1 month after discharge; T3 = 3month after discharge.
*Within-subject Effects F(3,156) = 7.324 (p<0.01), Bonferroni test T0>T1, T2, T3 (p<0.05).
Figure 12. Hopelessness change during hospitalization to 3-month post-discharge
13.2
37.7
47.2 45.3
15.1
9.4 9.4
13.2
41.5 39.6
30.2
20.8 30.2
13.2 13.2
20.8
0 5 10 15 20 25 30 35 40 45 50
T0 (N = 53)
T1 (N = 53)
T2 (N = 52)
T3 (N = 51)
Hopelessness change*
Not at all Rarely Sometimes Always
5.4.2.3. Resilient coping skills
We observed an upward trend for the total score of resilient coping from T0 to T2, but the trend slightly decreased from T2 to T3 (Figure 13). Among the four resilient coping items, “finding creative means to alter difficult situations” was the item with the lowest mean scores reported by the patients during T0 to T3 (Table 16).
In addition, most participants exhibited a low level of resilient coping but with signs of improvement from T0 to T2, then slightly reduced from T2 to T3. The mean score at T0 shows significantly higher mean scores compared to T1, T2, and T3 (p<0.05);
however, the mean score at T1, T2, and T3 shows no significant differences.
T0 = 1 week after hospitalization; T1 = 1 week after discharge; T2 = 1 month after discharge; T3 = 3month after discharge.
Figure 13. Resilient coping skill total score change during hospitalization to 3-month post-discharge
9.02
10.94
12.29 12.08
0 2 4 6 8 10 12 14
T0 (N = 53)
T1 (N = 53)
T2 (N = 52)
T3 (N = 51)
Resilient coping skill change
Table 16. Resilient coping skill change during hospitalization to 3-month post-discharge
Items T0
(N=53)
T1 (N=53)
T2 (N=52)
T3 (N=51)
Within-subject Effects F(df)
p Bonferroni
1. I look for creative ways to alter difficult situations.
2.13±1.30 2.77±1.43 3.12±1.34 2.90±1.47
2. Regardless of what happens to me, I believe I can control my reaction to it.
2.23±1.31 2.79±1.39 3.10±1.49 3.12±1.55
3. I believe that I can grow in positive ways by dealing with difficult situations.
2.26±1.32 2.74±1.32 3.13±1.43 3.10±1.49
4. I actively look for ways to replace the losses I encounter in life.
2.38±1.43 2.64±1.29 2.94±1.49 2.96±1.56
BRCS Total score (range 4-20) 9.02±4.37 10.94±4.89 12.29±5.36 12.08±5.55 F(3,156)=9.54 0.00 T0<T1*,T2*, T3*
*p<0.05, T0 = 1 week after hospitalization; T1 = 1 week after discharge; T2 = 1 month after discharge; T3 = 3month after discharge;
BRCS=Brief resilient coping skill, the higher the score, the better the resilient coping levels. The statistics applied intention-to-treat analysis.
5.4.2.4. Quality of life (EQ-5D-5L and EQ-VAS)
In this domain, while EQ-5D-5L refers to a lower mean score and a better quality of life, EQ-VAS refers to a higher score and better quality of life. Among five aspects of quality of life in EQ-5D-5L, patients complained the most about anxiety/depression and having pain/discomfort during follow-up compared to others (Table 17 and Figure 14). Especially patients reported the most severe feeling anxious and depression at T0 and reduced after discharge one month, then slightly increased from T2 (2.59± 1.36) to T3 (2.68 ± 1.50). During the follow-up, a significant increasing trend in the quality of life could be seen after hospitalization; however, from T1 to T3, the score rose very little (Figure 15). A significant difference was only identified between T0 compared to T1, T2, and T3 for both EQ-5D-5L and EQ-VAS trends (p<0.05).
Table 17. Quality of life change during hospitalization to 3-month post-discharge
Quality of life
T0 (N=53)
T1 (N=53)
T2 (N=52)
T3 (N=51)
Within-subject Effects F(df)
p Bonferroni
Mobility 1.94 ± 0.95 1.68 ± 0.96 1.35 ± 0.59 1.22 ± 0.54 Self-care 1.58 ± 0.82 1.15 ± 0.41 1.12 ± 0.32 1.06 ± 0.24 Usual activities 1.91 ± 1.02 1.72 ± 0.86 1.48 ± 0.73 1.43 ± 0.67 Pain/discomfort 3.02 ± 1.25 2.58 ± 1.08 2.19 ± 1.01 2.10 ± 1.15 Anxiety/depression 3.15 ± 1.41 2.62 ± 1.23 2.59 ± 1.36 2.68 ± 1.50
Total EQ-5D-5L 11.60 ± 3.79 9.75 ± 3.52 8.76 ± 3.06 8.46 ± 3.59 F(3,156)=14.75 0.00 T0>T1*,T2*,T3*
EQ-VAS 46.45±27.33 61.79±21.22 64.15±21.74 64.72±22.41 F(3,156)=12.42 0.00 T0<T1*,T2*,T3*
*p<0.05, T0 = 1 week after hospitalization; T1 = 1 week after discharge; T2 = 1 month after discharge; T3 = 3month after discharge. EQ-5D-5L: the lower the score, the better quality of life, EQ-VAS: the higher the score, the better quality of life.
The statistics applied intention-to-treat analysis.
Figure 14. Quality of life (EQ-5D-5L) change in item during hospitalization to 3-month post-discharge follow-up period
Figure 15. EQ-5D-5L and EQ-VAS change during hospitalization to 3-month post-discharge follow-up period
0 2 4 6 8 10 12
Quality of life (EQ-5D-5L) change in item
T0 (N = 53) T1 (N = 53) T2 (N = 52) T3 (N = 51)
0 10 20 30 40 50 60 70
T 0 ( N = 5 3 )
T 1 ( N = 5 3 )
T 2 ( N = 5 2 )
T 3 ( N = 5 1 ) EQ-5D -5L and EQ -VAS change during
follow - up period
EQ-VAS EQ-5D-5L
5.4.2.5. Self-rated health conditions
Regarding medication adherence, even with high initial ratings among TRD patients, an overall decrease in self-reported adherence was observed after discharge (Figure 16). Notably, the mean score of medication adherence at T3 (8.25 ± 2.84) was lower than the baseline (T0) with 8.26 ± 2.94. In addition, significant differences were found between T1 and T2 compared to T0 (p<0.05) (Table 18).
In our observation, self-efficacy was rated initially low among TRD patients but increased quicker from T0 (4.26 ± 2.71) to T1 (5.68 ± 2.59) and then slowly increased from T1 to T3 (5.94 ± 2.24). Only significant differences were found among T0<T1, T2, and T3 (p<0.05).
Finally, the self-rated recovery level rose shortly after hospitalization and slightly increased from T1 (6.00±2.10) to T2 (6.28±2.18). However, patients showed a small reduction in self-rate recovery from T2 to T3 (6.26±2.19). Significant differences were found among T0<T1, T2, T3 with p<0.05 (Table 18).
Table 18. Self-rated adherence, self-efficacy, and recovery changes during hospitalization to 3-month post-discharge
T0 (N=53)
T1 (N=53)
T2 (N=52)
T3 (N=51)
Within-subject Effects F(df)
p Bonferroni
Adherence 8.26 ± 2.94 9.91 ± 0.69 9.30 ± 1.79 8.25 ± 2.84 F (3,156)=9.04 0.00 T0<T1*, T2*
Self-efficacy 4.26 ± 2.71 5.68 ± 2.59 5.89 ± 2.38 5.94 ± 2.24 F (3,156)=8.53 0.00 T0<T1*, T2*, T3*
Self-rate recovery 4.06 ± 2.71 6.00 ± 2.10 6.28 ±2.18 6.26 ±2.19 F (3,156)=16.76 0.00 T0<T1*, T2*, T3*
*p<0.05, T0 = 1 week after hospitalization; T1 = 1 week after discharge; T2 = 1 month after discharge; T3 = 3month after discharge.
The higher score, the better adherence, self-efficacy, and self-rate recovery. The statistics applied intention-to-treat analysis.
Figure 16. Self-rated adherence, self-efficacy, and recovery change during hospitalization to 3-month post-discharge
5.4.2.6. Family support during follow-up
In our observation, TRD patients showed an average satisfaction score about family support measured by the Family Apgar tool. Overall, the total mean score above 7 is near the moderate family dysfunction threshold. As can be seen in Figure 17, the flat trend from T0 to T4 with no significant difference in the ANOVA repeat measure analysis. At the baseline (T0), the mean scores of Family Apgar among TRD patients were 7.32±2.82. After hospitalization, the mean score slightly reduced to 7.15±2.24 in the T1 interview, then rose slightly to 7.64±2.54 (T2) before decreasing to 7.49±2.74 in T3 (Figure 17).
0 2 4 6 8 10 12
T 0 ( N = 5 3 ) T 1 ( N = 5 3 ) T 2 ( N = 5 2 ) T 3 ( N = 5 1 ) Adherence, s elf -ef f icacy, and recovery
change
Adherence Self-efficacy Recovery
T0 = 1 week after hospitalization; T1 = 1 week after discharge; T2 = 1 month after discharge; T3 = 3month after discharge.
*Within-subject Effects F(3,156) = 0.88 (p>0.05), Bonferroni test (p>0.05)
Figure 17. Family support change during hospitalization to 3-month post-discharge