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Psychol Psychother. 2014 Sep;87(3):324-37. doi: 10.1111/papt.12016. Epub 2013 Oct 14.

Body image disturbance and quality of life in Chinese patients with ankylosing spondylitis.

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Department of Nursing, The Second Affiliated Hospital of Nantong University, Nantong, China; School of Nursing, Nantong University, Nantong, China.



Ankylosing spondylitis (AS) is a painful inflammatory disease of the axial skeleton that can cause body image disturbance (BID) and may lead to psychological changes in AS patients.


This study investigated the effect of AS patient physical and psychological status on BID and quality of life (QOL).


Overall, 112 AS patients (84 males, 28 females; mean age, 32.8 ± 10.8) and 127 healthy age-matched individuals (control group; 78 males, 49 females; mean age, 36.9 ± 12.6) were screened for inclusion in the single-centre study. Multiple instruments assessing physical function, psychological function, body image, and QOL were applied. Multivariate stepwise regression analyses were used to determine factors associated with BID, anxiety, and depression.


Of 103 AS patients and 121 control subjects, AS patients exhibited greater BID-associated social function, social life, and role function impairments (BID Questionnaire [BIDQ] 2.42 vs. 1.02; 2.20 vs. 1.19; 2.54 vs. 0.72, respectively), lower behavioural avoidance (BIDQ 3.07 vs. 3.49), and similar decreases in vitality and mental health (p < .01). Impaired social function predicted anxiety and depression in AS patients. Disease status (daily activity, general health, and pain) and psychological status (BID, anxiety, and depression) predicted poor QOL (p < .05).


BID may play a significant role in causing clinical psychological dysfunction in AS patients, including anxiety and depression. Further research is required to fully assess whether these observations are similar in patients with variant AS severity. BID may be useful in clinical prognostic assessment and AS management.


AS patients investigated in this study exhibited BID. There were significant relationships between the BIDQ, disease and psychological variables, and QOL. Disease status, BID, and anxiety and depression indicated a poor QOL.


ankylosing spondylitis; anxiety; body image disturbance; depression; quality of life

[Indexed for MEDLINE]

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