汶川地震受灾地区灾后社区、乡镇卫生院工作者精神卫生服务能力评估
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摘要
目的:了解汶川受灾地区社区、乡镇卫生院工作者的精神卫生知识掌握情况及精神卫生服务能力,为精神卫生培训提供依据,为我国精神卫生服务体系建设提供科学参考。方法:选取灾后社区、乡镇卫生工作者心理卫生服务技能培训班学员353名为研究样本,回收有效问卷313份。使用自编精神卫生知识评估问卷和精神卫生服务调查表进行评估。自编精神卫生知识评估问卷包含抑郁症、酒精依赖、精神分裂症(阳性症状为主)、创伤后应激障碍和躯体形式障碍5种精神障碍。结果:受灾地区乡镇、社区卫生院工作者对于社区5种精神障碍准确诊断率最高的案例为抑郁症(77.0%),药物处理中位数得分最高的为酒依赖;非药物处理中位数得分最高的是酒依赖和创伤后应激障碍。培训前1月内报告未接诊过精神障碍患者的社区、乡镇卫生院工作者占53.4%。不知道任何1所精神卫生服务机构的卫生院工作者占35.1%;不知道精神科专科会诊的占37.7%;不能邀请精神科专科会诊的占39.6%。结论:汶川地震后,受灾地区的乡镇、社区卫生院工作者精神卫生知识和技能掌握较少,精神卫生服务能力相对弱。
Objective:To investigate the capability of basic mental health services of primary health care providers in the Wenchuan earthquake disaster areas which will attribute to improving the mental health services of China.Methods:The self-made knowledge and inventory of basic mental health services scales were used to measure the skills and abilities of primary health care physicians to identify and treat mental illnesses.A total of 313 primary health care physicians were assessed in the Wenchuan disaster area by a questionnaire including knowledge of 5 mental disorders,i.e.,depressive disorders,alcohol dependence,schizophrenia(especially positive symptoms),post-traumatic stress disorders(PTSD) and somatoform disorders.Results:Among the 5 mental health disorders,depressive disorders was the most correctly identified disease(77.0 %).In terms of knowledge of drug based treatments,primary health care providers scored the highest median score for alcohol dependence.For non-drug based treatment,primary health care providers scored highest in their knowledge of PTSD and alcohol dependence.During the month prior to conducting the survey,164(53.4%) primary health workers reported seeing patients with mental health diseases.Over one-third(35.1%) of primary health workers had no knowledge of existing mental health institutions.About 37.7% of primary health workers knew nothing about mental health consultation and 39.6 % reported being unable to receive any mental health consultation.Conclusion:The knowledge and skill of basic mental health services among the primary health care provider may be insufficient in the disaster areas.
Objective:To investigate the capability of basic mental health services of primary health care providers in the Wenchuan earthquake disaster areas which will attribute to improving the mental health services of China.Methods:The self-made knowledge and inventory of basic mental health services scales were used to measure the skills and abilities of primary health care physicians to identify and treat mental illnesses.A total of 313 primary health care physicians were assessed in the Wenchuan disaster area by a questionnaire including knowledge of 5 mental disorders,i.e.,depressive disorders,alcohol dependence,schizophrenia(especially positive symptoms),post-traumatic stress disorders(PTSD) and somatoform disorders.Results:Among the 5 mental health disorders,depressive disorders was the most correctly identified disease(77.0 %).In terms of knowledge of drug based treatments,primary health care providers scored the highest median score for alcohol dependence.For non-drug based treatment,primary health care providers scored highest in their knowledge of PTSD and alcohol dependence.During the month prior to conducting the survey,164(53.4%) primary health workers reported seeing patients with mental health diseases.Over one-third(35.1%) of primary health workers had no knowledge of existing mental health institutions.About 37.7% of primary health workers knew nothing about mental health consultation and 39.6 % reported being unable to receive any mental health consultation.Conclusion:The knowledge and skill of basic mental health services among the primary health care provider may be insufficient in the disaster areas.
引文
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[15]彭红莉,唐秋萍,郝以辉,等.长沙市综合医院门诊就诊者焦虑与抑郁障碍的调查[J].中国临床心理学杂志,2008,16(3):300-301,330.
[16]胡萌,李臻,张顺英,等.抑郁症患者在综合医院误诊分析[J].中国医药,2010,5(2):184-185.
[17]梁红,费立鹏,张艳平,等.发展中国家三城市非精神科门诊医务人员账务抑郁症知识情况的初步调查[J].中国神经精神疾病杂志,2007,33(1):48-50.
[18]吴海苏,徐勇,徐一峰,等.上海市社区医生对老年抑郁症态度和知识的问卷调查[J].上海精神医学,2007,19(6):341-344.
[19]Prins MA,Verhaak PF.M,Van der Meer K,et al.Primary care pa-tients w ith anxiety and depression Need for care from the patient's perspective[J].J Affect Disord,2009,119(1-3):163-171.
[20]Ekers DM,Lovell K,Playle JF,et al.The use of CBT based,brief,facilitated self-help interventions in primary care mental health service provision Evaluation of a10-day training program[J].Clin Effect Nurs,2006,9(1):e88-e96.
[21]Vicnte B,Kohn R,Levav I,et al.Training primary care physicians in Chile in the diagnosis and treatment of depression[J].J Affect Disord,2007,98(1-2):121-127.
[22]Heideman JMC,Laurant MGH,Wensing M,et al.Improving pri-mary mental health care Impact of a nationw ide program[J].Health Policy,2007,81(2):146-154.
[23]Liu SI,Lu RB,Lee MB.Non-psychiatric Physicians'Know ledge,Attitudes and Behavior tow ard Depression[J].J Formos Med As-sociat,2008,107(12):921-31.
[24]赵永忠,原天岗,肖传实,等.综合医院精神卫生培训前后精神科会诊比较[J].中国行为医学科学,2003,12(4):402-403.
[2]Grievink L,Van der Velden PG,Stellate RK,et al.A longitudinal comparative study of the physical and mental health problems of af-fected residents of the firew ork disaster Enschede,the Nehterlands[J].Public Health,2007,121(5):367-374.
[3]Yang YK,Yeh TL,Chen CC,et al.Psychiatric morbidity and postt-raumatic symptoms among earthquake victims in primary care clin-ics[J].Gen Hosp Psychiatry,2003,25(4):253-261.
[4]Yule W,Bolton D,Udw in O,et al.The long-term psychological effects of disaster experience in adolescence:I.The incidence and course of PTSD[J].J Child Psychol Psychiatry,2000,41(4):503-511.
[5]Schonfeld DJ,Gurw itch RH.Addressing Disaster Mental Health Needs of Children Practical Guidance for Pediatric Emergency Health Care Providers[J].Disaster Ment Health Needs Children,2009,10(3):208-215.
[6]赵高锋,杨彦春,张树森,等.地震极重灾区780名受灾群众心理状况调查[J].中国循证医学,2008,8(10):815-819.
[7]张丽霞,原岩波,王泽荣,等.汶川地震1个月内不同受灾群体心理应激状况调查[J].中国心理卫生杂志,2010,24(2):157-158.
[8]Boscarino JA,Adams RE,Figley CR.Mental health service use1-year after the World Trade Center disaster implications for mental health care[J].Gen Hosp Psychiatry,2004,26(5):346-358.
[9]Sundran S,Karim ME,Ladrido-lgnacio L,et al.Psychosocial re-sponses to disaster An Asian perspective[J].Asian J Psychiatry,2008,1(1):7-14.
[10]Kurihara T,Kato M,Sakamoto S,et al.Public attitudes tow ards the mental ill:a cross-cultural study betw een Bail and Tokyo[J].Psy-chiatry Clin Neurosci,2000,54(5):547-52.
[11]李飞,肖水源,黄志平,等.中国三城市精神健康素养调查[J].中国心理卫生杂志,2009,23(12):883-887.
[12]中华医学会精神科分会.中国精神障碍分类与诊断标准(第三版)[M].济南:山东科学技术出版社,2001.
[13]刘万里,薛茜,曹明芹,等.用SPSS实现完全随机设计多组比较秩和检验的多重比较[J].地方病通报,2007,22(2):27-29.
[14]World Health Organization.WHO report:Improving health systemsand services for mental health[R].WHO,2009.
[15]彭红莉,唐秋萍,郝以辉,等.长沙市综合医院门诊就诊者焦虑与抑郁障碍的调查[J].中国临床心理学杂志,2008,16(3):300-301,330.
[16]胡萌,李臻,张顺英,等.抑郁症患者在综合医院误诊分析[J].中国医药,2010,5(2):184-185.
[17]梁红,费立鹏,张艳平,等.发展中国家三城市非精神科门诊医务人员账务抑郁症知识情况的初步调查[J].中国神经精神疾病杂志,2007,33(1):48-50.
[18]吴海苏,徐勇,徐一峰,等.上海市社区医生对老年抑郁症态度和知识的问卷调查[J].上海精神医学,2007,19(6):341-344.
[19]Prins MA,Verhaak PF.M,Van der Meer K,et al.Primary care pa-tients w ith anxiety and depression Need for care from the patient's perspective[J].J Affect Disord,2009,119(1-3):163-171.
[20]Ekers DM,Lovell K,Playle JF,et al.The use of CBT based,brief,facilitated self-help interventions in primary care mental health service provision Evaluation of a10-day training program[J].Clin Effect Nurs,2006,9(1):e88-e96.
[21]Vicnte B,Kohn R,Levav I,et al.Training primary care physicians in Chile in the diagnosis and treatment of depression[J].J Affect Disord,2007,98(1-2):121-127.
[22]Heideman JMC,Laurant MGH,Wensing M,et al.Improving pri-mary mental health care Impact of a nationw ide program[J].Health Policy,2007,81(2):146-154.
[23]Liu SI,Lu RB,Lee MB.Non-psychiatric Physicians'Know ledge,Attitudes and Behavior tow ard Depression[J].J Formos Med As-sociat,2008,107(12):921-31.
[24]赵永忠,原天岗,肖传实,等.综合医院精神卫生培训前后精神科会诊比较[J].中国行为医学科学,2003,12(4):402-403.
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