无锡市社区严重精神障碍患者服药依从性及其影响因素研究

背景　遵医嘱服药是患者病情稳定和全面康复的基本保障，服药率是社区严重精神障碍患者管理治疗工作质量的核心指标。了解本地区居家患者的药物治疗现状并提出改进措施，对促进社区精神卫生服务质量的有效提升具有重要意义。目的　了解无锡市社区严重精神障碍患者服药依从性及其影响因素，探讨进一步提高患者服药率的有效措施。方法　采用多阶段整群抽样法，对无锡市12个街道/乡镇的1 285例严重精神障碍患者进行问卷调查。调查工具包括服药依从性问卷（自行设计）、自知力与治疗态度问卷及精神障碍患者病耻感评估量表。共1 220例患者完成全部调查，有效应答率为94.94%。采用多因素Logistic回归分析患者服药依从性的影响因素。结果　无锡市社区严重精神障碍患者的服药依从率为75.33%（919/1 220），其中精神分裂症、双相情感障碍、分裂情感性障碍、偏执性精神障碍、精神发育迟滞伴发精神障碍、癫痫所致精神障碍服药依从率分别为78.56%（667/849）、75.49%（154/204）、69.57%（16/23）、47.06%（8/17）、35.71%（25/70）、85.96%（49/57）。不同文化程度、婚姻状况、家庭经济、监护人关系、监护人对疾病认知、疾病诊断、病程、住院次数、是否参加社区健康讲座、家庭与精神专科医院距离、自知力与治疗态度评分、病耻感水平患者服药依从率比较，差异均有统计学意义（P<0.05）。多因素Logistic回归分析结果显示，文化程度、监护人对疾病认知、疾病类型、病程、住院次数、是否参加健康讲座、家庭离精神专科医院距离、自知力与态度评分、病耻感水平9个因素为社区严重精神障碍患者服药依从性的影响因素（P<0.05）。结论　无锡市社区严重精神障碍患者服药依从性有待提高，增设精神卫生服务网点、重点关注精神发育迟滞及新发病患者、加强健康宣教、消除病耻感是提高服药依从性的有效措施。

Investigation on Medication Compliance of Patients with Severe Mental Disorders and Its Influencing Factors in the Community of Wuxi

Background　Medication compliance is the basic guarantee for the stable condition and comprehensive rehabilitation of patients，and the medication-taking rate is the core indicator to evaluate the quality of the management and treatment of patients with severe mental disorders in the community.As a professional institution of mental health，it is of great significance to understand the current status of drug treatment for patients at home in the region and propose effective measures to promote the quality of community mental health services.Objective　To investigate the medication compliance of patients with severe mental disorders and its influencing factors in the community of Wuxi，and to explore effective measures to further improve patients' medication-taking rate.Methods　A multi-stage cluster sampling method was used to conduct a questionnaire survey on the medication compliance of 1 285 patients with severe mental disorders in 12 streets/townships of Wuxi.The survey tools included Medication Compliance Questionnaire（self-designed），Insight and Treatment Attitude Questionnaire（ITAQ），and Scale of Stigma in People with Mental Illness（SSPMI）.A total of 1 220 patients completed all questionnaires，and the effective response rate was 94.94%.Multivariate logistic regression analysis was adopted to explore the factors associated with patients' drug compliance.Results　The medication compliance rate of patients with severe mental disorders was 75.33%（919/1 220）.The compliance rates of patients with schizophrenia，bipolar affective disorder，schizoaffective disorder，paranoid mental disorder，mental retardation accompanied by mental disorder and epilepsy were 78.56%（667/849），75.49%（154/204），69.57%（16/23），47.06%（8/17），35.71%（25/70），and 85.96%（49/57），respectively.Compliance rates differed significantly among patients with different education levels，marital status，family economy，guardians and their awareness of mental illness，types of the disease，course of disease，times of hospitalization，participating in community health lectures or not，distance between home and psychiatric hospitals，ITAQ scores，and levels of stigma（P<0.05）.Multivariate Logistic regression analysis showed that nine factors，including education level，guardian's awareness of mental illness，types of the disease，course of disease，times of hospitalization，whether to participate in health lectures，distance between home and psychiatric hospitals，ITAQ score，and level of stigma，were the influencing factors of medication-taking rate of community patients with severe mental disorders（P<0.05）.Conclusion　The medication compliance of patients with severe mental disorders in the community of Wuxi needs to be improved.To increase the medication-taking rate，establishing more mental health service centers，focusing on patients with mental retardation and new-onset patients，strengthening health publicity and education，and eliminating disease stigma are effective measures.