Physical disability, perceived dependence and depression in women with osteoarthritis

본 연구는 관절염 환자들의 신체활동에 대한 제한, 이러한 활동에 대한 상대적 의존성 그리고 우울감 사이의 관련성을 매개효과를 밝히고자 연구를 실시하였다. 연구대상자는 지역사회에 거주하는 여성 농업인 중 관절염을 앓고 있다고 응답한 자 중 209명을 임의로 추출하여 설문조사 방식으로 조사하였다. 결과적으로 관절염으로 인한 세 개의 활동영역(개인의 신변활동, 집안일, 거주지에서의 이동성 등)은 활동제한이 우울감에 직접 관련이 있다기 보다는 활동제한으로 인해 의존성이 발생되고 결과적으로 우울감이 발생되는 경로를 보여 의존성을 개선하였을 경우 우울감이 줄어들거나 극복될 수 있으며, 여가생활에 대한 활동제한은 우울감에 직접적인 효과가 있어 관절염환자들의 활동제한 중에서 무엇보다도 여가생활의 제한은 우울감에 직접적인 영향을 주므로 환자들에게서 여가생활을 적극 장려할 수 있는 프로그램 개발이 필요하다. 결론적으로 관절염환자들의 자기관리능력 함양, 보조 기구 지급을 통한 의존성의 개선은 이들 환자들의 우울감 개선이 될 것이다. Objective: This study assessed whether both physical disability and perceived dependence relate to depression or whether perceived dependence in personal care activities, household activities, community mobility and recreational activities is an intermediate step in the relationship between physical disability and depressive symptoms. Methods: Data come from a cross-sectional survey of 209 women, aged 55 or older, with osteoarthritis (OA). Mediation analyses occurred in four step and included logistic regression analyses as outlined by Baron & Kenny. Results: The results from step 1 showed that greater difficulty with each domain of physical disabilities was significantly related to greater perceived dependence. In step 2, greater perceived dependence was significantly associated with greater depressive symptoms in all domains. Step 3 analyses showed that greater physical disabilities in each domain were significantly associated with depression. The final step testing mediation indicated that personal care activities, household activities and community mobility were fully mediated by perceived dependence. That was, once dependence was taken into account, the relationship between physical disabilities and depression was no longer significant. Partial mediation was found for dependence and recreational activity limitations. Conclusion: It is important to take into account the experience of perceived dependence as a mediator in understanding the relationship between disability and depression in the domains of personal care, household, and community mobility. To conclude, these findings point to the importance of taking into account an individual's reaction to their disability rather than just focusing on the severity of disability.