“以奖代补”政策实施下社区高风险严重精神障碍患者的监护情况调查  

A survey on the monitoring of high-risk patients with severe mental disorders in the community under the policy of“replacing compensation with awards”

作　　者：熊金霞[1] 茅荣杰 张伟波 徐韦云[1] 陈优[3] 孙莉[4] 汪作为[1] XIONG Jinxia;MAO Rongjie;ZHANG Weibo(Hongkou District Mental Health Center,Shanghai 200083,China)

机构地区：[1]上海市虹口区精神卫生中心,上海市200083 [2]上海交通大学医学院附属精神卫生中心 [3]上海市杨浦区精神卫生中心 [4]上海市普陀区精神卫生中心

出　　处：《精神医学杂志》2020年第3期195-199,共5页Journal of Psychiatry

基　　金：上海市卫健委面上项目(编号:201940201);上海市医学重点专科建设计划(编号:ZK2019A06);上海市“科技创新行动计划”临床医学领域项目(编号:19411950800);上海交通大学中国医院发展研究院科研课题计划资助(编号:CHDI-2019-B-20);上海市虹口区卫健委医学课题(编号:虹卫1803-09)。

摘　　要：目的了解“以奖代补”政策下社区高风险严重精神障碍患者的监护情况,并探析社区高风险严重精神障碍患者监护责任落实的影响因素。方法以上海市虹口区、杨浦区、普陀区已纳入“以奖代补”实施政策下的169例社区严重精神障碍患者做为研究对象,自编问卷收集患者社会人口学资料、疾病诊断、治疗等内容;自制家庭监护访谈提纲,收集监护人基本信息及在监护过程中的心理感受,了解监护人的监护动机。结果单因素分析发现,与患者的关系、监护人健康状况、遵医行为、是否共同居住分类不同的患者,其治疗情况比较差异有统计学意义(P<0.05);多因素分析发现,监护人的遵医行为差,遵医行为一般是影响患者治疗情况的主要因素(P<0.05);监护访谈结果显示,监护照料过程中多数监护人在经济负担、日常生活、家庭娱乐、身体状况及心理状况等五个维度均受到一定的影响,尤其是心理方面承受着巨大的心理压力。结论监护人健康、遵医行为、与患者的关系、是否共同居住、监护人心理感受均是社区高风险严重精神障碍患者监护责任落实的影响因素。Objective To understand the guardianship of patients with severe mental disorders in the community under the policy of“replacing compensation with awards”,and to explore the influencing factors of guardianship responsibility of high-risk patients with severe mental disorders in the community.Methods A total of 169 patients with severe mental disorders in the community who had been included in the implementation policy of“replacing compensation with awards”in Hongkou,Yangpu and Putuo districts of Shanghai were selected,and their social demographic data,disease diagnosis and treatment were collected through self-designed questionnaire.The self-made interview outline of family monitoring was used to collect basic information of guardians and their psychological feelings in the process of guardianship,to understand guardianship motivation of guardians.Results Single factor analysis showed that there were statistically significant differences in the treatment of patients among different guardians’conditions including different relationship with patients,different health conditions,different compliance behaviors and whether they lived together with patients(P<0.05).Multiple factor analysis showed that poor and general compliance behaviors of guardians were the main influencing factor for the treatment of patients(P<0.05).The results of monitoring interviews showed that most guardians were affected in five dimensions:economic burden,daily life,family entertainment,physical condition and psychological condition in the process of guardianship,and they bore great psychological pressures especially.Conclusion The health of guardians,compliance behavior,relationship with patients,whether they live together or not,and guardians’psychological feelings are the influencing factors of guardianship responsibility implementation of high-risk patients with severe mental disorders.

关 键 词：严重精神障碍 社区 监护情况 高风险 影响因素 

分 类 号：R749[医药卫生—神经病学与精神病学]