将WHO《心理健康差距干预指南》应用于中国全科医学服务:一项德尔菲研究  

Adapting the Depression Component of WHO Mental Health Gap Intervention Guide(mhGAP-IG.v2)for Primary Care in Shenzhen,China:a Delphi Study

作　　者：Kendall Searle Grant Blashki Ritsuko Kakuma 杨辉 吕淑荣 李宝琪 肖莹莹 Harry Minas Kendall Searle;Grant Blashki;Ritsuko Kakuma;YANG Hui;LYU Shurong;LI Baoqi;XIAO Yingying;Harry Minas(Global and Cultural Mental Health Unit,Centre for Mental Health,School of Population and Global Health,University of Melbourne,Parkville,VIC 3010,Australia;Nossal Institute for Global Health,University of Melbourne,Melbourne,VIC 3010,Australia;London School of Hygiene and Tropical Medicine,London WC1E 7HTE,England,UK;Monash Institute for Health and Clinical Education,School of Primary Health Care,Monash University,Notting Hill,VIC 3168,Australia;Shenzhen Guangming Hospital of the University of Chinese Academy of Sciences,Bao'an District,Shenzhen 518107,China)

机构地区：[1]VIC 3010 Global and Cultural Mental Health Unit,Centre for Mental Health,School of Population and Global Health,University of Melbourne,Parkville,Australia [2]VIC 3010 Nossal Institute for Global Health,University of Melbourne,Melbourne,Australia [3]WC1E 7HTE London School of Hygiene and Tropical Medicine,London,England,UK [4]VIC 3168 Monash Institute for Health and Clinical Education,School of Primary Health Care,Monash University,Notting Hill,Australia [5]中国科学院大学深圳医院(光明),广东省深圳市518107

出　　处：《中国全科医学》2024年第1期15-26,共12页Chinese General Practice

摘　　要：背景中国全科医生越来越期望能够识别和预防抑郁障碍,但其接受的心理健康培训有限,社区卫生服务中心(CHCs)也缺乏针对抑郁障碍的诊断和服务规范。WHO《心理健康差距干预指南》第2版(mhGAP-IG.v2)是为非心理健康专业人员提供的决策支持工具,可用于评估、管理、随访精神障碍、神经疾病及物质使用障碍患者。鉴于mhGAP-IG.v2的通用性,其在中国的应用应根据抑郁障碍在不同文化下的差异性和中国心理健康系统特点进行调整。方法开展两轮基于网络的德尔菲(Delphi)调查。邀请来自深圳市的全科医生小组对mhGAP-IG.v2中涉及抑郁障碍的199条表述进行五分制的赞同程度打分,即“如要把该表述用在深圳市,是否赞同调整其内容和结构”。如果>80%的全科医生“有些/肯定赞同”调整某表述,则视为全科医生对调整该表述达成共识;如果>80%的全科医生“有些/肯定不赞同”调整某表述,则视为全科医生对不调整该表述达成共识。结果全科医生对79%的表述达成了需要调整的共识,平均得分为4.26分,即全科医生“有些赞同”对mh GAP-IG.v2中涉及抑郁障碍的相关表述进行调整。具体调整建议包括:抑郁评估方法应考虑更广泛的抑郁症状,并考虑病情的发展阶段;增加抑郁筛查工具的使用指南;明确全科医生的作用,以及家庭参与和跨部门服务的转诊途径;药物治疗建议应与中国用药规范保持一致;指南所有章节要强调预防自杀;情境化健康教育;强调“以人为本”的服务方法。全科医生认为,应维持mhGAP-IG.v2中对经历抑郁发作的双相障碍患者的诊断和治疗建议。结论对mhGAP-IG.v2抑郁部分的调整研究反映出对指南的评估应考虑文化和国情背景,包括中国特色的初级卫生保健系统、健康优先领域、治疗可得性,以及多样化的社会心理教育需要。调整后的mhGAP-IG.v2可以给中国全科医学教育�Background Primary care doctors in Shenzhen,China are increasingly expected to identify and prevent depressive disorder;however,they have received limited mental health training and community healthcare centres(CHCs)do not provide standardised protocols for the diagnosis and care of depressive disorder.The World Health Organization's mental health gap intervention guide,version 2(mhGAP-IG.v2)is a decision support tool for non-specialists for the assessment,management and follow-up of mental,neurological and substance use disorders(including depressive disorder).Given that mhGAP-IG.v2 is a generic tool,it requires adaptation to take account of cultural differences in depression presentation and unique characteristics of China's emergent mental health system.Methods A two-round,web-based,Delphi survey was conducted.A panel of primary care doctors from Shenzhen,were invited to score their level of agreement with 199 statements(arranged across 10 domains)proposing changes to the content and structure of mhGAP-IG.v2 for use in Shenzhen.Consensus was predefined as 80%panelists providing a rating of either"somewhat agree/definitely agree",or"definitely disagree/somewhat disagree"on a five-point scale for agreement.Results 79%of statements received consensus with a mean score of 4.26(i.e."somewhat agree").Agreed adaptations for mhGAP-IG.v2 included:an assessment approach which considers a broader spectrum of depression symptoms and reflects the life course of disease;incorporating guidance for screening tool usage;clarifying physicians'roles and including referral pathways for intersectorial care with strong family involvement;aligning drug treatment with national formularies;stronger emphasis of suicide prevention throughout all sections of the guide;contextualizing health education;reflecting a person-centred approach to care.Panelists chose to maintain diagnostic and treatment advice for bipolar patients experiencing a depressive episode as in the current guide.Conclusion An adapted mhGAP-IG.v2 for depression recognis

关 键 词：抑郁障碍 心理健康差距干预指南 德尔菲 调整 概念化 初级保健 跨部门服务 世界卫生组织 中国 深圳 

分 类 号：R749.42[医药卫生—神经病学与精神病学]