广州市妇幼医疗机构医护人员对产后心理行为问题的识别情况

目的了解广州市妇幼医疗机构的医护人员对产妇产后心理行为问题的识别处理情况和相关因素。方法采用分层随机整群抽样方法,选取广州市8家妇幼医疗机构产科的245位医护人员(医师95位,护士150位)和精神专科机构(广州市精神病医院)的59位精神卫生专业人员(医师22位,护士37位),分别完成孕产妇常见心理行为问题病例分析中有关产后抑郁症患者和精神分裂症患者的识别和处理问卷。采用χ2检验和精确概率法统计妇幼机构医护人员和精神卫生专业人员的问卷答案正确率比较,采用独立样本的t检验比较妇幼机构医护人员和精神卫生专业人员的问卷得分;采用单元及多元线性回归(后退法)探寻问卷得分的影响因素。结果两组医生正确识别产后抑郁无显著性差异(94.74%vs.100%,P=0.582),妇幼机构护士低于精神卫生专业护士(86.67%vs 100%,χ2=4.216,P=0.040);正确识别精神分裂症妇幼机构医护人员低于精神卫生专业人员(医师为16.84%vs 72.73%,χ2=28.077,P<0.001;护士为6.67%vs 43.24%,χ2=33.170,P<0.001);对两个病做出转入精神专科住院的正确处理方面;妇幼机构医护人员差于精神卫生专业人员,且差异有显著性(抑郁症病例:医师为24.21%vs86.36%,χ2=29.988,P<0.001,护士为10%vs 62.16%,χ2=49.874,P<0.001;精神分裂症病例:医师为32.63%vs 90.91%,χ2=22.727,P<0.001,护士为17.33%vs 67.67%,χ2=37.759,P<0.001)。精神卫生专业人员对抑郁症病例和精神分裂症病例的问卷得分及总分均高于妇幼机构医护人员;精神专科机构、医师、培训是抑郁症问卷得分的影响因素(β=0.338、0.218、0.152,t=6.168、4.282、2.756,P均≤0.01),精神专科机构、综合医院、医师、培训是分裂症问卷得分的影响因素(β=0.460、0.119、0.241、0.133,t=8.109、2.263、4.974、2.520,P均≤0.05)。结论妇幼医疗机构医护人员对产妇产后心理行为问题识别处理能力不足,未达到国家精神卫生规划要求。

Recognition of Postpartum Psycho-behavior Problems among Medical Staff From Maternity and Child Medical Institutions in Guangzhou

Objective To investigate the recognition and treatment of postpartum psycho-behavior problems among clinicians and nurses serving in the maternity and child treatment institutions in Guangzhou.Methods From Oct to Dec 2010,using stratified cluster randomization method,245 medical personnel(95 clinicians and 150 nurses)from 8 maternity and child treatment institutions,and 59 mental health professionals(22 clinicians and 37 nurses)from Guangzhou psychiatric hospital were paired and administered with "maternal psycho-behavior problems analyis questionnaire"(including 2 cases:postpartum depression and schizophrenia).According to the answers of the questionnaire,comparative analyses(Chi-square test)on the answers were made between medical personnel and mental health professionals.Multiple linear regression analysis was made to identify factors related with score of questionnaire.Results There was no significant difference in the correct rates of recognition of postpartum depression between clinicians in two groups(94.74%vs.100%,P=0.582).The correct rates of recognition of postpartum depression from medical nurses were statistically lower than those of mental health nurses(86.67%vs.100%,χ2=4.216,P=0.040).The correct rates of recognition of postpartum schizophrenia from medical personnel were statistically lower than those of mental health professionals(Case schizophrenia:The correct rates of clinician were 16.84%vs.72.73%,χ2=22.727,P<0.001;those of nurse were 6.67%vs.43.24%,χ2=37.759,P<0.001).The correct rates of treatment of psycho-behavior problems from medical personnel were statistically lower than those of mental health professionals between case postpartum depression and case schizophrenia.(case postpartum depression:The correct rates of clinician were 24.21%vs.86.36%,χ2=29.988,P<0.001,of nurse were 10%vs.62.16%.χ2=49.874,P<0.001;case schizophrenia:The correct rates of clinician were 32.63%vs.90.91%,χ2=22.727,P<0.001,of nurse were 17.33%vs.67.67%,χ2=37.759,P<0.001).The scores of questionnaire of case postpartum depression,case schizophrenia and total from medical personnel were statistically lower than those of mental health professionals(P<0.001).Mental health institution,clinician and training of mental health knowledge became the impact factors of the scores of questionnaire of postpartum depression sample(standardized regression coefficients were 0.338,0.218 and 0.152,the values of t were 6.168,4.282 and 2.756,respectively.P<0.01).Mental health institution,general hospital,clinician and training of mental health knowledge became the impact factors of the scores of questionnaire of schizophrenia sample(standardized regression coefficients were 0.460,0.119,0.241 and 0.133,the values of t were 8.109,2.263,4.974 and 2.520,respectively.P<0.05).Conclusion The clinicians and nurses in maternity and child treatment institutions are not fully capable of recognizing and treatment with postpartum psycho-behavior problems.