上海市长宁区家属支援服务对严重精神障碍患者家属的干预效果研究
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摘要
目的探讨家属支援服务干预对于提高社区严重精神障碍患者的康复效果和改善家属的心理健康状况及家庭负担的作用。方法采取多阶段随机抽样方法,在抽到的2个社区中将符合严重精神障碍诊断标准的患者随机抽取100例患者,随后根据性别、年龄、诊断在其他几个社区中随机匹配100例符合严重精神障碍诊断标准的患者纳入对照组。严格按照患者和家属纳入标准设立对照组和干预组。结果 200组研究对象患者平均年龄(48.27±12.67)岁,家属平均年龄(63.61±13.19)岁。干预后各时点对照组日常生活能力量表(activity dailyliving scale,ADL)评分均高于干预组(均有P<0.05)。干预后各时点对照组社会功能缺陷表(social disability screening schedule,SDSS)评分均高于干预组(均有P<0.05)。干预后各时点干预组与对照康复状态量表(morningside rehabilitation status scale,MRSS)评分差异均无统计学意义(均有P>0.05)。干预后各时点对照组患者家属心理健康状况症状(精神症状)自评量表(self-reporting inventory,SCL-90)评分均高于干预组(均有P<0.05)。干预后各时点对照组家庭负担量表(family burden scale of diseases,FBS)评分均高于干预组(均有P<0.05)。结论本次干预措施确实提高社区严重精神障碍患者康复效果和改善家属心理和家庭负担,应建立一支专业的家属支援服务工作团队。
Objective To explore the effect of family support service intervention on improving the rehabilitation of patients with severe mental disorders in community and the mental health status and family burden of family members. Methods Using multi-stage random sampling method, 100 patients who met the diagnostic criteria of severe mental disorders were randomly selected from two communities, and then 100 patients who met the diagnostic criteria of severe mental disorders were randomly matched according to gender, age and diagnosis in other communities into the control group. The control group and intervention group were set up strictly according to the inclusion criteria of patients and their families. Results The average age of the 200 groups was(48.27±12.67) years, and the average age of the family members was(63.61±13.19) years. After intervention, the activity dailyliving scale(ADL) scores of the control group were higher than those of the intervention group at all time points(all P<0.05). After intervention, the social disability screening schedule(SDSS) scores of the control group were higher than those of the intervention group at all time points(all P<0.05). After intervention, there was no significant difference in the morningside rehabilitation status scale(MRSS) score between the intervention group and the control group at all time points(all P>0.05). After intervention, the SCL-90(self-reporting inventory) scores of the mental health of the family members in the control group were higher than those in the intervention group at all times(all P<0.05). After intervention, the family burden scale of diseases(FBS) scores of the control group were higher than those of the intervention group at all time points(all P<0.05). Conclusions The intervention measures did improve the rehabilitation effect of severe mental disorder patients in community and the psychological and family burden of family members. A professional family support service team should be established.
Objective To explore the effect of family support service intervention on improving the rehabilitation of patients with severe mental disorders in community and the mental health status and family burden of family members. Methods Using multi-stage random sampling method, 100 patients who met the diagnostic criteria of severe mental disorders were randomly selected from two communities, and then 100 patients who met the diagnostic criteria of severe mental disorders were randomly matched according to gender, age and diagnosis in other communities into the control group. The control group and intervention group were set up strictly according to the inclusion criteria of patients and their families. Results The average age of the 200 groups was(48.27±12.67) years, and the average age of the family members was(63.61±13.19) years. After intervention, the activity dailyliving scale(ADL) scores of the control group were higher than those of the intervention group at all time points(all P<0.05). After intervention, the social disability screening schedule(SDSS) scores of the control group were higher than those of the intervention group at all time points(all P<0.05). After intervention, there was no significant difference in the morningside rehabilitation status scale(MRSS) score between the intervention group and the control group at all time points(all P>0.05). After intervention, the SCL-90(self-reporting inventory) scores of the mental health of the family members in the control group were higher than those in the intervention group at all times(all P<0.05). After intervention, the family burden scale of diseases(FBS) scores of the control group were higher than those of the intervention group at all time points(all P<0.05). Conclusions The intervention measures did improve the rehabilitation effect of severe mental disorder patients in community and the psychological and family burden of family members. A professional family support service team should be established.
引文
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[8] 王文强,丁丽君,温程,等. 厦门市18岁及以上人群精神障碍现况调查 [J]. 中华精神科杂志, 2013, 46(1):43-48. DOI: 10.3760/cma.j.issn.1006-7884.2013.01.013. Wang WQ, Ding LJ, Wen C, et al. Survey of mental disorders among people aged 18 years and over in Xiamen [J]. Chinese Journal of Psychiatry, 2013, 46(1):43-48. DOI: 10.3760/cma.j.issn.1006-7884.2013.01.013.
[9] 栗克清,崔泽,崔利军,等. 河北省精神障碍的现况调查 [J]. 中华精神科杂志, 2007,40(1):36-40. DOI:10.3760/j.issn:1006-7884.2007.01.009. Li KQ, Cui Z, Cui LJ, et al. Investigation of mental disorders in Hebei Province [J]. Chinese Journal of Psychiatry, 2007,40(1):36-40. DOI:10.3760/j.issn:1006-7884.2007.01.009.
[10] 戚圣香,王志勇,洪忻,等. 南京市重性精神疾病患者生命质量及影响因素研究 [J]. 中华疾病控制杂志, 2016, 20(4):353-356. DOI:10.16462/j.cnki.zhjbkz.2016.04.008. Qi SX, Wang ZY, Hong X, et al. Study on quality of life and influencing factors of patients with severe mental illness in Nanjing [J]. Chin J Dis Control Prev, 2016, 20(4):353-356. DOI:10.16462/j.cnki.zhjbkz.2016.04.008.
[11] 陈正,粟幼嵩,李则挚,等. 住院精神分裂症患者亲属照料者的心理状况调查评估 [J].中国医药导报, 2011,8(36):140-142. DOI: 10.3969/j.issn.1673-7210.2011.36.059. Chen Z, Su YS, Li ZZ, et al. Psychological status of relatives and caregivers of inpatients with schizophrenia [J]. China Medical Herald, 2011,8(36):140-142. DOI: 10.3969/j.issn.1673-7210.2011.36.059.
[12] 张琼婷,陈浩,鞠康,等. 上海市长宁区社区精神障碍患者家属监护状况的横断面评估 [J]. 上海精神医学, 2015(1):18-26. DOI: 10.11919/j.issn.1002-0829.214094. Zhang QT, Chen H, Ju K, et al. Cross-sectional assessment of guardianship status of family members of community mental disorder patients in Changning District, Shanghai [J]. Shanghai Archives of Psychiatry, 2015(1):18-26. DOI: 10.11919/j.issn.1002-0829.214094.
[13] 张倬秋,邓红,陈颖,等. 对中国四川精神分裂症患者症状、残疾及家庭负担之间关系的横断面调查 [J]. 上海精神医学, 2014(1):22-29. DOI:10.3969/j.issn.1002-0829.2014.01.004. Zhang NQ, Deng H, Chen Y, et al. Cross-sectional study on the relationship between symptoms, disability and family burden of schizophrenics in Sichuan, China [J]. Shanghai Archives of Psychiatry, 2014(1):22-29. DOI: 10.3969/j.issn.1002-0829.2014.01.004.
[14] 李凤玲,高诚,李秀玲. 综合干预对慢性精神分裂症病人社会功能缺陷的影响 [J].护理研究,2004,18(16):1411-1412. DOI:10.3969/j.issn.1009-6493.2004.16.001. Li FL, Gao C, Li XL. The effect of comprehensive intervention on social function deficiency of chronic schizophrenia patients [J]. Chinese Nursing research, 2004,18(16):1411-1412. DOI: 10.3969/j.issn.1009-6493.2004.16.001.
[15] 王乐辉,郭红利,王振铎,等. 慢性精神分裂症的社区家庭防治、康复研究 [J]. 中国全科医学,2002, 5(9):733-737. DOI: 10.3969/j.issn.1007-9572.2002.09.028. Wang LH, Guo HL, Wang ZD, et al. Community-based family prevention and rehabilitation of chronic schizophrenia [J]. Chinese General Practice, 2002,5(9):733-737. DOI: 10.3969/j.issn.1007-9572.2002.09.028.
[2] Lefley HP. Family burden and family stigma in major mental illness [J]. Am Psychol, 1989, 44(3):556-560. DOI: 10.1037//0003-066X.44.3.556.
[3] Lasalvia A, Zoppei S, Bortel V. Global pattern of experienced and anticipated discrimination reported by people with major depressive disorder: a cross-section at survey [J]. Lancet, 2015, 385(9965):330-330. DOI: 10.1016/S0140-6736(15)60120-9.
[4] Chatterjee S, Naik S, John S, et al. Effectiveness of a community-based intervention for people with schizophrenia and their caregivers in India: a randomised controlled trial [J]. Lancet, 2014, 383(9926):1385-1394. DOI: 10.1016/S0140-6736(13)62629-X.
[5] Barbato A, Bajoni A, Rapisarda F, et al. Quality assessment of mental health care by people with severe mental disorders: a participatory research project [J]. Community Mental Health Journal, 2014, 50(4):402-408. DOI: 10.1007/s10597-013-9667-6.
[6] 仇晓艳,牛昕,汤爱娣,等. 长宁区精神疾病的流行病学特征分析及应对策略 [J]. 中华疾病控制杂志, 2014, 18(1):25-28. Qiu XY, Niu X, Tang AD, et al. Epidemiological characteristics and coping strategies of mental disorders in Changning District [J]. Chin J Dis Control Prev, 2014, 18(1):25-28.
[7] 仇剑崟,王祖承,谢斌. 上海社区居民心理健康状况调查 [J]. 上海精神医学, 2006, 18(2):65-68. DOI: 10.3969/j.issn.1002-0829.2006.02.001. Qiu JZ, Wang ZC, Xie B. Mental health survey of community residents in Shanghai [J]. Shanghai Archives of Psychiatry, 2006, 18(2):65-68. DOI: 10.3969/j.issn.1002-0829.2006.02.001.
[8] 王文强,丁丽君,温程,等. 厦门市18岁及以上人群精神障碍现况调查 [J]. 中华精神科杂志, 2013, 46(1):43-48. DOI: 10.3760/cma.j.issn.1006-7884.2013.01.013. Wang WQ, Ding LJ, Wen C, et al. Survey of mental disorders among people aged 18 years and over in Xiamen [J]. Chinese Journal of Psychiatry, 2013, 46(1):43-48. DOI: 10.3760/cma.j.issn.1006-7884.2013.01.013.
[9] 栗克清,崔泽,崔利军,等. 河北省精神障碍的现况调查 [J]. 中华精神科杂志, 2007,40(1):36-40. DOI:10.3760/j.issn:1006-7884.2007.01.009. Li KQ, Cui Z, Cui LJ, et al. Investigation of mental disorders in Hebei Province [J]. Chinese Journal of Psychiatry, 2007,40(1):36-40. DOI:10.3760/j.issn:1006-7884.2007.01.009.
[10] 戚圣香,王志勇,洪忻,等. 南京市重性精神疾病患者生命质量及影响因素研究 [J]. 中华疾病控制杂志, 2016, 20(4):353-356. DOI:10.16462/j.cnki.zhjbkz.2016.04.008. Qi SX, Wang ZY, Hong X, et al. Study on quality of life and influencing factors of patients with severe mental illness in Nanjing [J]. Chin J Dis Control Prev, 2016, 20(4):353-356. DOI:10.16462/j.cnki.zhjbkz.2016.04.008.
[11] 陈正,粟幼嵩,李则挚,等. 住院精神分裂症患者亲属照料者的心理状况调查评估 [J].中国医药导报, 2011,8(36):140-142. DOI: 10.3969/j.issn.1673-7210.2011.36.059. Chen Z, Su YS, Li ZZ, et al. Psychological status of relatives and caregivers of inpatients with schizophrenia [J]. China Medical Herald, 2011,8(36):140-142. DOI: 10.3969/j.issn.1673-7210.2011.36.059.
[12] 张琼婷,陈浩,鞠康,等. 上海市长宁区社区精神障碍患者家属监护状况的横断面评估 [J]. 上海精神医学, 2015(1):18-26. DOI: 10.11919/j.issn.1002-0829.214094. Zhang QT, Chen H, Ju K, et al. Cross-sectional assessment of guardianship status of family members of community mental disorder patients in Changning District, Shanghai [J]. Shanghai Archives of Psychiatry, 2015(1):18-26. DOI: 10.11919/j.issn.1002-0829.214094.
[13] 张倬秋,邓红,陈颖,等. 对中国四川精神分裂症患者症状、残疾及家庭负担之间关系的横断面调查 [J]. 上海精神医学, 2014(1):22-29. DOI:10.3969/j.issn.1002-0829.2014.01.004. Zhang NQ, Deng H, Chen Y, et al. Cross-sectional study on the relationship between symptoms, disability and family burden of schizophrenics in Sichuan, China [J]. Shanghai Archives of Psychiatry, 2014(1):22-29. DOI: 10.3969/j.issn.1002-0829.2014.01.004.
[14] 李凤玲,高诚,李秀玲. 综合干预对慢性精神分裂症病人社会功能缺陷的影响 [J].护理研究,2004,18(16):1411-1412. DOI:10.3969/j.issn.1009-6493.2004.16.001. Li FL, Gao C, Li XL. The effect of comprehensive intervention on social function deficiency of chronic schizophrenia patients [J]. Chinese Nursing research, 2004,18(16):1411-1412. DOI: 10.3969/j.issn.1009-6493.2004.16.001.
[15] 王乐辉,郭红利,王振铎,等. 慢性精神分裂症的社区家庭防治、康复研究 [J]. 中国全科医学,2002, 5(9):733-737. DOI: 10.3969/j.issn.1007-9572.2002.09.028. Wang LH, Guo HL, Wang ZD, et al. Community-based family prevention and rehabilitation of chronic schizophrenia [J]. Chinese General Practice, 2002,5(9):733-737. DOI: 10.3969/j.issn.1007-9572.2002.09.028.
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