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The purpose of this study was to clarify the relationship between the psychological adjustment laryngectomized patients and changes in their working situation.
Methods:
Subjects were recruited from a population of candidates scheduled to undergo laryngectomy for perilaryngeal cancer at the head and neck wards of a Cancer Hospital and three Fukuoka regional Hospitals, which serve residents of Tokyo and south of Tokyo. A total of 27 participated in the study. Surveys were conducted at four times: before surgery (face-to face), and three months, six months, and a year after discharge (by mail).
The measure was the Nottingham Adjustment Scale Laryngectomized Patients version of the Psychological Adjustment Scale, consists of 26 items categorized into seven subscales measuring anxiety and depression, self-esteem, self-efficacy, acceptance of disability (active positive, awareness), attitudes to loss voice who larynx (attitude), and Locus of control (LOC). Each item uses a 4-5 point Likert scale.
Subjects were asked about their occupations, whether they were currently working, and the reason for retirement if they were retired, as well as basic attributes, such as age, gender, family structure, diagnosis, surgical procedure, and psychological problems at discharge such as difficulty swallowing and constipation.
The relationship between psychological adjustment and occupation was evaluated using a repeated measures GLM method. Psychological adjustment was taken as the dependent variable, and occupation the independent variable. Psychological adjustment was rated using a top score of 100 points.
Age, family structure (living alone, or with two, three or more people) were used as adjustment factor variables, confirmed the interaction between occupation and basic characteristic by using the minimum mean square value. Interactions were measured between occupation and age, and the variables of occupation and family structure.
Gender was excluded as a control factor, because only four of the respondents were women.
Results:
The mean age of patients was the 62.9 ± 6.4 years of age, of all respondents 23 patients were male and four were women. In terms of family structure 14 subjects were living with one other person, nine were living with three or more people, and five were living alone. Before surgery, nine subjects were working (33.3%), compared with eight three months after discharge (29.6%), and nine six months after discharge (33.3%), and seven one year after discharge (25.9%). The change in occupational status over time was not significant difference. The retired reasons were loss of voice, the disease and depression for cancer for a year (29.6%).
The patients were diagnosed with hypolarynx cancer (66.7%), who undergo esophageal reconstruction surgery and laryngectomy (81.5%).
All six subscales of the psychological adjustment were not significant between occupations and four times.
Main effect were observed between occupation and self-efficacy (p = .018), families and anxiety/depression (p =.0006) or attitude (p = .04) and gender and LOC (p = .04). Self-efficaccy of the working (47.7 points) was lower than unemployed (70.2 points). Anxiety/depression of two-person households (68.1 points) was lower than living alone (92.1 points). Attitude of three or more-person households (41.6 points) was lower than living alone (92.1 points). LOC of females (43.9 points) was lower than males (59.6 points).
The main interaction was observed as follows.
Anxiety/depression was significantly lower in those working in two-person households (60.3 points), compared with those who were either working or unemployed and living alone (90 points table, p = .027).
Self-esteem in younger working patients was lower than in elderly patients (p <.0001).
Moreover self-efficacy of solitary working patients (47.7 points) was lower than that of solitary unemployed patients (70.2 points, p = .006). In addition, the younger working patients were low (p = .041).
LOC in two-person households working patients (45.5 points) was lower than solitary working patients (62.4 points).
Positive affirmation of acceptance in younger working patients was low (p = .019), two-person households working patients (38.8 points) was lower than solitary unemployed patients (60.9 points, p = .002).
Conclusion: The difference in occupational status over time was not significant. Some of retirees have depression or cancer recurrence. In addition, self-efficacy was particularly low in solitary working patients, while psychological adjustment outcomes were lower in working patients living in two-person households. Patients living alone did not derive a sense of reward from work, while younger patients experienced a decrease in self-esteem. For working patients living in two-person households, there is the possibility of a sense of loss in being able to hold a social role. Also, results suggested that compared with solitary persons, patients living in multiperson households experience more problems, including economic problems, given the responsibility for supporting the family.