综合医院心理咨询门诊中学生心理健康调查

目的:调查研究综合医院心理咨询门诊中学生心理健康状况及其特点。方法:对104例中学生来访者采用心理健康诊断测验(MHT),对不同性别、年级、城乡及独生子女非独生子女分别进行比较。结果:走进心理咨询室的中学生MHT总量表分有明显心理障碍的检出率为9.62%,咨询问题以非医学问题为主共计73例(70.19%)。女生在恐怖倾向得分高于男生(t=-2.045;P0.05),初中生在身体症状及冲动倾向上高于高中生(t=2.066,2.660;P0.05),农村学生在学习焦虑上高于城市学生(t=-2.032;P0.05),独生子女在孤独倾向上高于非独生子女(t=2.230;P0.05),总分及其他分量表得分差异均无统计学意义(P0.05)。结论:来综合医院心理咨询门诊的中学生,性别、年级、城乡来源及是否独生子女,其心理健康状况呈现一定的差异。     

996例门诊心理咨询者心理测验结果分析

目的了解综合性医院心理咨询就诊者的心理测验特点及影响因素.方法对门诊心理咨询的初诊者进行心理测验和分析.结果发现大多为城市女性居民,青壮年,工人,高中以下者.绝大多数属于医学问题(91.8%),其中以神经症为多(59.6%):较常见症状为抑郁(3.18分)、焦虑(2.35分)和强迫(2.33分);以N型人格及E内向人格占多数.结论门诊心理咨询者中多数有医学问题,心理测验是心理咨询者中的重要手段.     

4123例心理咨询者就诊状况分析

目的 为了加强心理疾病的预防,使人民群众发生心理卫生问题能得到及时合理的心理咨询、指导和治疗。方法 根据CCMD—2—R诊断标准,对4123人次求询者的资料进行分析,采用自评量表和SCL—90、SAS、SDS、瑞文、注意力测定、EPQ,对来访者心理特征作客观的评论。结果 第一年与第二年心理测验情况比较(自评量表和心理测验问卷测定,异常率64．9％)无显著差异。第一年与第二年常见的求询问题比较(情绪问题49％,儿童青少年问题14．7％．精神病问题14．19,6．人际关系6％．婚姻恋爱问题4．39,6．其它咨询问题12％)。不同年龄阶段最常见的咨询问题比较(学习问题咨询以20岁以下年龄组为主．恋爱问题咨询以20～29岁年龄组为主．精神病问题咨询以20～39岁年龄组为主．情绪问题以30～69岁年龄组为主,人际关系问题咨询以30～39岁年龄组为主)。求询者满意度达96％。结论 各种心理测验的异常率高达64．9％．提示求询者存在着不同程度的心理问题．最常见的求询问题为情绪问题。心理咨询有效解决人们的心理问题．作为区精神卫生中心专科门诊的补充．扩大精神卫生服务范围是非常必要和重要的。     

综合医院心理科儿童青少年就诊情况分析

目的通过对综合医院心理科18岁以下儿童青少年就诊情况分析,了解就诊者的分布特点以及疾病分布特征。方法资料来自2004～2007年某综合医院医学心理科785例18岁以下儿童青少年就诊者。根据ICD-10诊断标准,对就诊的相关情况进行分析。结果就诊者中男女比例为1.42:1,各个年龄段中女童的比例均较男童少。就诊者中情绪障碍(37.06%)、适应障碍(9.74%)、关系问题(9.36%)、精神分裂症(8.80%)为前4位就诊疾病种类;不同年龄、不同性别就诊者的疾病构成是有差异的。结论综合医院心理门诊就诊的儿童青少年与儿童心理咨询门诊就诊者的年龄分布存在差异;并且综合医院患者在不同种疾病分类中,表现出性别差异。     

从近两年132例青少年心理咨询得到的启示

目的 了解青少年学生的心理问题和心理障碍，以及对其进行心理咨询的重要意义。方法 从门诊详细记录的案例进行统计分析。结果 132例青少年学生采访者的心理问题和心理障碍占前四位的是：学习问题（占74．2％）、行为问题（占18．9％）、青春期适应不良（占15．9％）和人际关系问题（占7．6％）。还有2人是偏执性精神病（占1.5％）。结论 对青少年学生进行心理咨询很有必要，来访者有咨询动机很重要，重视第一次会谈，同理心的重要作用，明确诊断，做好记录，寻找主题和切入点，折衷整合治疗是必然的趋势。     

县级综合医院心理咨询分析

卫生部精神卫生八五规划(草案)中,已要求在县级以上综合医院中设立精神卫生或心理咨询科[1]。有关综合医院开展心理咨询工作报道较多。为给同级医院开展此项工作提供借鉴,现将我院开展此项工作的有关情况报告如下。1资料与方法我院于1997年6月开设心理咨询门诊(全周门诊)。接诊者为高年资精神科主治医师(同时接诊门诊普内病人)。采取“一对一”方式会谈,收集相关病史。作体格检查、精神检查及必要的实验室检查,合作者作EPQ和SCL-90测验,诊断依据CCMD-2-R。合作者建立病历由医生管理。从1997年6月～1999年有400余人来诊,建立病历有273人…     

昆明市金星社区居民心理咨询知晓率调查

目的了解社区居民对心理咨询的知晓率,为开展心理卫生服务作决策依据。方法采用现场调查方法,使用自行设计的心理咨询知晓率调查问卷,共20条问题,由志愿者自己填写问卷。结果受访者女性多于男性,年龄多在40～59岁(71.43%),初中及初中以上的文化居多,多为退休及无工作的低收入者。59.52%主要通过报刊、书籍了解心理咨询,40.48%承认自己存在不同程度的心理问题,认为子女教育(26.19%),社会适应(19.05%)是当前最感到困惑和痛苦的问题,但愿接受心理咨询的人不多,47.6%认为现在寻求心理咨询不方便。多愿接受谈心式的心理咨询(40.48%),57.14%认为心理咨询师应由心理专业人员担任。结论居民有心理卫生保健的需求,但对心理咨询的认识不足,心理卫生的宣传和教育亟待加强。     

心理咨询师培训班成员对心理咨询态度的研究

目的了解参加心理咨询师培训班人群对心理咨询的态度。方法用自行编制的心理咨询态度调查问卷调查了参加心理咨询师培训班的138名学员及185名普通大众。结果心理咨询师培训班学员与普通大众对心理咨询的总体态度得分差异有统计学意义(χ2=287.118,P=0.000);在各个维度上表现为:①对心理咨询职业前景的认识态度差异显著(2χ=440.071,P=0.000);②对主动求询的态度无显著差异(2χ=334.083,P=0.099);③对隐私保护的态度显著差异(2χ=311.921,P=0.000)。结论参加心理咨询培训的学员对心理咨询的总体态度比普通大众积极,主要表现在对心理咨询职业前景和对隐私保护态度上。     

与未成年人相关的心理咨询与治疗的保密原则

保密原则对心理咨询/治疗有重大的影响,在未成年人心理咨询或治疗时这一伦理议题尤为突出。本文将从法律层面、未成年来访者自主权、父母或监护人的权利等方面了解青少年(未成年人)心理咨询与治疗中的保密原则,深入探讨其限制及与成人咨询保密原则的差别。从事青少年心理咨询的咨询师或治疗师可能会面对保密相关的伦理困境,本文为他们提供相关的伦理信息和职业信息,并有助于尽早制定出适用于未成年来访者的伦理守则。     

精神科门诊就诊青少年特征及心理健康状况

目的:了解精神科门诊就诊青少年的特征及心理健康状况,为心理问题青少年求助现状分析提供依据。方法:对2014年9月—2015年9月来川北医学院附属医院精神科门诊就诊的青少年689人进行回顾分析,并对所评定的症状自评量表(SCL-90)结果进行分析。结果:就诊青少年中在校学生占71.7%,显著高于非学生人群(χ~2=2.595,P=0.000);其中高中生占62.6%,初中生占25.3%,其他学生占10.9%。青少年中有341人存在中度以上心理问题,占总人数的49.5%,包括52.2%的学生和42.6%的非学生;学生和非学生青少年中度以上心理问题检出占前3位的分别为:敌对、强迫、抑郁和抑郁、敌对、人际关系敏感;学生人群强迫症状和敌对因子得分显著高于非学生人群(t=2.408,P=0.016;t=2.632,P=0.009);女生抑郁程度较男生更严重(t=2.352,P=0.019);就诊青少年SCL-90各因子均分均显著高于国内青少年常模(t=9.290~18.416,P0.001)。结论:精神科就诊青少年以中学生为主,且多为心理问题较严重的个体,故应加强心理健康知识的宣讲,引导更多有心理问题的青少年对专业心理卫生资源的利用,促进其身心健康。     

Risk Factors of Discharged Against Medical Advice among Adolescents Self-inflicted Injury and Attempted Suicide in the Korean Emergency Department

Suicide is a leading cause of death among Korean adolescents. Many suicide attempting adolescents often are discharged against medical advice in the emergency department. The aim of the present study was to determine the risk factors for discharge against medical advice (DAMA) after self-inflicted injury or attempted suicide in the emergency department. We extracted data on adolescents (10-19 yr old) from the national emergency department information system; we used data from 2007 and 2011. A total of 6,394 adolescents visited EDs after self-inflicted injury or attempted suicide. Among these patients, the median age was 17 yr (Interquatile range, 15-18 yr), 83.2% were between 15-19 yr of age, and 63.3% were female. Poisoning was the most common method of attempted suicide, while hanging and fall were the most common methods of fatality. The rate of DAMA from the ED was 22.8%. Independent risk factors for DAMA included female gender (odds ratio [OR], 1.49), older age adolescents (OR, 1.96), residence in a metropolitan/large city area (OR, 1.49), and discharge at night (OR, 1.38). These risk factors should be considered in establishing management and counseling plans for patients discharged against medical advice by community services and EDs.

Graphical Abstract

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Benefits of off-campus education for students in the health sciences: a text-mining analysis

Background

Hospital doctors face constantly increasing workloads. Besides caring for patients, their duties also comprise the education of future colleagues. The aim of this study was to objectively investigate whether the workload arising from increased patient care interferes with student supervision and is associated with more non-medical activities of final-year medical students.

Methods

A total of 54 final-year students were asked to keep a diary of their daily activities over a three-week period at the beginning of their internship in Internal Medicine. Students categorized their activities ?C both medical and non-medical - according to whether they had: (1) only watched, (2) assisted the ward resident, (3) performed the activity themselves under supervision of the ward resident, or (4) performed the activity without supervision. The activities reported on a particular day were matched with a ward specific workload-index derived from the hospital information system, including the number of patients treated on the corresponding ward on that day, a correction factor according to the patient comorbidity complexity level (PCCL), and the number of admissions and discharges. Both students and ward residents were blinded to the study question.

Results

A total of 32 diaries (59 %, 442 recorded working days) were handed back. Overall, the students reported 1.2?±?1.3 supervised, 1.8 ±1.6 medical and 3.6?±?1.7 non-medical activities per day. The more supervised activities were reported, the more the number of reported medical activities increased (p?<?.0001). No relationship between the ward specific workload and number of medical activities could be shown.

Conclusions

There was a significant association between ward doctors?? supervision of students and the number of medical activities performed by medical students. The workload had no significant effect on supervision or the number of medical or non-medical activities of final-year students.     

Cell phone e-mail as a means to collect information on pregnancy and delivery: a pilot study in Japan.

BACKGROUND: The diffusion of cell phones is 91.9% in Japan. Especially, cell phone e-mail is now widely used as a media source in Japan. The authors of this research have been engaged in collecting basic data to establish a system for providing improved health information on pregnancy and delivery through cell phones for pregnant women and their family members. OBJECTIVE: In this study, we classified the trends of health information of pregnancy and delivery in which people desire to obtain through cell phone based on the characteristics of the information and, of each classification we revealed the generic characteristic (age, gender, gestational weeks and any other children), any social support, the types of cell phones or/and computers and their related use. METHODS: Anonymous questionnaires were distributed to the participants of delivery preparation workshops held at two places in the northern parts of Kyushu Area to collect data. The cell phone e-mail usage trends were measured by four-rated scales. To classify the characteristics of the information, a Principal Factor Analysis was conducted. To find out correlation between the information classified and the generic characteristics, Mann-Whitney's U-test was conducted. RESULTS: Out of two hundred and fifteen (215) respondents including 117 pregnant women and 98 husbands, 208 respondents possessed cell phones. Regarding the health information of pregnancy and delivery desired to obtain through cell phone e-mail, two factors, namely "medical information" and "non-medical information" have derived. Those who did not possess computers tended to use their cell phone e-mail to obtain both "medical information" (P = .002) and "non-medical information" (P = .02). While those who use cell phone e-mail almost everyday tended to use cell phone e-mail for obtaining "non-medical information" (P = .02). CONCLUSION: This study indicated that providing medical information and non-medical information through cell phone e-mail is an essential service, especially in Japan, where the diffusion of cell phones is far higher than that of computers.     

Satisfaction with genetic counseling: dimensions and measurement

Patient satisfaction has become a significant issue in evaluating medical care, although it has been largely neglected in genetic counseling. A 32-item questionnaire was designed to examine patient satisfaction and was administered to 76 clients in a genetic counseling center, and 56 parents attending a pediatric outpatient clinic (the control group). Factor analysis showed 3 dimensions to satisfaction with genetic counseling: instrumental, affective, and procedural. The general level of satisfaction was found to be lower in the genetic counseling group than in the control group. This finding was interpreted as expressing basic properties of genetic counseling. The most important determinant of satisfaction in both groups was satisfaction with the content of information provided in counseling. Some affective and procedural aspects of genetic counseling were found more satisfying, and more important in determining genetic clients' general sense of satisfaction, as compared to the control subjects.     

The assessment of depressive patients' involvement in decision making in audio-taped primary care consultations

OBJECTIVE: In primary care of depression treatment options such as antidepressants, counseling and psychotherapy are reasonable. Patient involvement could foster adherence and clinical outcome. However, there is a lack of empirical information about the extent to which general practitioners involve patients in decision making processes in this condition, and about the consultation time spent for distinct decision making tasks. METHODS: Twenty general practice consultations with depressive patients prior to a treatment decision were audio-taped and transcribed. Patient involvement in decision making was assessed with the OPTION-scale and durations of decision making stages were measured. RESULTS: Mean duration of consultations was 16 min, 6s. The mean of the OPTION-items were between 0.0 and 26.9, in a scale range from 0 to 100. Overall, 78.6% of the consultation time was spent for the step "problem definition" (12 min, 42 s). CONCLUSION: Very low levels of patient involvement in medical decisions were observed in consultations about depression. Physicians used the majority of their time for the definition of the patient's medical problem. PRACTICE IMPLICATIONS: To improve treatment decision making in this condition, general practitioners should enhance their decision making competences and be more aware of the time spent in each decision making stage.     

Enquiring minds want to know: topics requested by users of a children's health information website

OBJECTIVE: To investigate health information needs of users of a health information website for children and young people. METHODS: A prospective analysis was conducted of unsolicited information requests to the Children First for Health (www.childrenfirst.nhs.uk) website, an NHS-run health and hospital online information resource for children, young people and families. All specific and general enquiries were recorded prospectively and coded according to health topic, age of the enquirer and web pages accessed. RESULTS: There were 2865 (62%) general health information and 924 (21%) specific enquiries received over an 18-month period (6.3 enquiries per day). More general enquiries were received about adolescent (64%) than children's (36%) health issues. The most common topics were psychosocial issues, hospital and health services, and normal growth and development. Only 1% of requests for information related to smoking, alcohol and drugs. CONCLUSION: Children and adolescents are active users of the Internet for health information. The results of this study highlight the health topics that are of greatest interest to children and young people. PRACTICE IMPLICATIONS: The findings provide objective data on health information topics of interest to UK children and young people and can be used to guide development of health information aimed at UK youth.     

Genetic counseling and reproductive uncertainty

Of 836 fertile women seeking genetic counseling, 544 (65%) reported that their major reason for doing so was to obtain information to help in deciding if they should have a child. Thirty-four percent of these 836 women entered counseling uncertain about undertaking a pregnancy in the next 2 years. After counseling, 28% of the 836 had uncertain pregnancy intentions. These included 66% of those who were uncertain and 11% of those who were reproductively certain before counseling. Stepwise logistic regression identified the following as independently and significantly associated with reproductive uncertainty after counseling: 1) uncertainty before counseling; 2) uncertainty about ideal family size; 3) concern about the effects of an affected child on the client's social life; 4) perceived serious problems caring for a child with a birth defect now living at home; and 5) new concerns raised in counseling. Reproductive uncertainty after counseling was not related to characteristics of the risked birth defect, level of risk, treatment potential, or client learning of medical and genetic facts. These data suggest that genetic counseling will not eliminate reproductive uncertainty for many clients, because this uncertainty is related to factors mainly outside the usual scope of counseling.     

General practitioner teaching in the community: a study of their teaching experience and interest in undergraduate teaching in the future.

BACKGROUND: In line with the General Medical Council (GMC) recommendations for undergraduate teaching, many medical schools are implementing new programmes of community-based teaching. Little is known about the enthusiasm of general practitioners (GPs) for, or their ability to undertake, an additional teaching role. AIM: To assess the reservoir of teaching experience among GPs and, in particular, their undergraduate teaching experience, their views on the rewards and problems of teaching, their interest in teaching in the future, and their needs for support. METHOD: Postal questionnaire sent to all 417 GP principals with Lambeth, Southwark, and Lewisham family health service authorities (FHSAs) in January 1995. RESULTS: We achieved a 74% (310/417) response rate. A total of 86% (261/303) of GPs have some sort of teaching experience in their current practice. A large number of medical and non-medical subjects are already being taught. Overall, 75% (228/303) of GPs had experience of undergraduate teaching. Only 13% (41/303) had no teaching experience of any kind. Very few responders felt that teaching was best done in hospital. Different rewards and problems of teaching were perceived by undergraduate teaching GPs and other GPs. There was a high level of interest in undergraduate teaching in the future and a demand for a variety of support measures from medical schools. CONCLUSIONS: New community-based programmes are likely to receive support from GPs, but the vital issues of time, adequate financial reward, and teacher training must be addressed by medical schools if large-scale changes in undergraduate teaching are to be achieved.     

The perceived care needs of breast cancer patients in Korea

By analyzing the data of 459 patients who completed the Supportive Care Needs Survey (SCNS), the prevalence, medical and non-medical predictors of unmet needs were investigated. Breast cancer patients in Korea experienced high levels of unmet needs across the needs domains, particularly in the health system and information domain (56.9%). Various medical and non-medical variables were identified as significant predictors of unmet needs in each domain. By multivariate analyses, several predictors were identified across the domains including; less education (< or = 9 years) in the psychologic, chemotherapy, short post-surgical interval, and less education in the physical and daily living, younger age (< 50 years) in the sexuality, larger tumor size (> 2 cm) and younger age in the health system and information, and more education (> or = 13 years) in the care and support domain. The results of this study suggest medical professional should consider the complexity and dynamics of meeting patients' needs in providing supportive care services.