家属对社工介入严重精神障碍“一体化”服务的评价

目的调查严重精神障碍家属对由精神专科医院培育孵化精神障碍防控类社会组织介入"医院-社区"一体化服务的状况评价,为后续研究提供依据。方法采用随机抽样,运用自编问卷调查对在长宁区精神卫生中心及社区卫生服务中心门诊就诊的384位患者家属进行调查。结果 43.5%认为社工服务是"政府主导的帮扶工作",对社工服务表示非常满意和满意的为55.2%,满意度较高的依次为"就诊协助"(40.4%)、"心理疏导"(39.7%)、"康复指导"(35.4%);需求主要集中在心理疏导(59.2%)、就诊陪伴(57.6%)、康复指导(54.7%);94.8%今后愿意接受社工服务;回归分析显示,患者病情情况越好,家属对治疗康复情况的满意程度越高,家属越愿意接受社工服务(χ2=62.864,P0.01)。结论家属对社工介入"一体化"服务具有一定认知,大多愿意接受服务,处于基本满意状态,需求主要集中于有助于改善患者治疗康复状况的项目。建议持续加大社区宣传,对于社工针对性地开展专科培训和实训带教,对接需求研制项目并完善评价机制。     

社区老年精神障碍患者精神卫生教育需求调查

目的了解社区老年严重精神障碍患者的精神卫生健康教育现况,为开展社区老年精神卫生教育与卫生服务提供依据。方法以分层随机抽样方法抽取400名在册、病情稳定的老年(≥60岁)精神障碍患者进行调查。根据研究目的自行编制调查问卷,问卷涉及精神疾病知识、药物治疗、抗精神病药的不良反应、居家康复、门诊随访、消极情况的应对、病情复发处理等方面的内容。由调查员面对面询问。结果社区老年严重精神障碍患者的精神卫生相关知识总知晓率为50.25%。不同社会学特征对象的知晓率状况不同;女性的精神卫生相关知识的知晓率高于男性;患者的年龄越大知晓率越低;受教育程度越低其知晓率越低。不同性别和文化程度的老年严重精神障碍患者精神卫生知识的接受途径不同。患者期望接受精神卫生知识教育的前三位途径分别是医务人员、社区讲座和电影电视。结论在开展社区老年严重精神障碍患者健康教育时,需要根据不同的受众采用不同的健康教育方法和手段,才能有效地提高患者的精神卫生相关知识和能力。     

基于需求导向的社区严重精神障碍患者新型健康管理模式研究

社区精神障碍患者是弱势人群,其卫生健康服务需求较为复杂和特殊。本研究梳理了社区精神障碍患者健康管理现况,分析了当前健康管理工作中的不足及薄弱环节,建议立足于家庭医生签约服务,以患者卫生健康需求为导向,积极构建精神及心理卫生服务、躯体疾病防治、社区康复服务和医疗费用管理等为一体的社区精神障碍患者新型健康管理模式。     

广西边境居民健康状况及卫生服务需求分析

[目的]了解和分析广西边境居民健康状况及卫生需求情况,为开展边境农村社区卫生服务提供依据。[方法]用分层整群抽样方法,抽取调查点15周岁以上居民,采用乡村居民健康调查表收集资料。[结果]常见慢性病患病率达24.76%,前3位疾病依次为高血压(14.96%)、消化系统疾病(3.62%)和骨关节病(2.16%)。边境居民存在较多不良生活方式,且接受社区卫生服务的顺应性较差。[结论]广西边境农村社区卫生服务应突出以健康教育为重点,有针对性地开展健康教育活动,提高边境居民接受社区卫生服务的顺应性,针对不同社区人群的需求特点,立足农村社区开展全方位的服务模式,满足不同对象、不同层次人群的卫生需求。     

重庆市社区居民健康状况及卫生需求分析

[目的]了解重庆社区居民基本健康状况及卫生需求,为更好地采取干预措施提供依据. [方法]用重庆市卫生局印制的<居民基线调查表>,对社区15岁以上居民3 081人进行调查. [结果]调查人群中,初中以下文化占56.14%;月收入低于300元的占88.03%;各种慢性疾病患者530人,患病率为17.2%,其中,60岁以上者患病率为46.95%;患病率居前4位的是高血压(6.43%)、慢性支气管炎(2.50%)、冠心病(1.82%)、糖尿病(1.62%);卫生服务需求中需要健康咨询的占82.15%. [结论]60岁以上人群是社区卫生工作重点人群,应对其做好疾病监测工作,引导正确用药和改变不良生活习惯;同时要加强对健康人群进行健康教育工作,不断改善人们生活方式,以达到全面提高社区居民总体健康水平的目的,从而形成适合本地区的社区卫生服务特色.     

成都市社区精神卫生服务现状调查

[目的]调查成都市社区精神卫生服务的现状,分析存在的问题,提出在新形势下,加强成都市社区精神卫生服务的具体建议,为促进城市社区精神卫生服务提供参考。[方法]随机抽取成都市2个区,以这2个区的所有社区卫生服务机构作为研究对象。通过问卷调查和深入访谈法收集相关资料。[结果]成都市社区卫生服务机构均开展了精神病患者系统管理和心理咨询服务,但仍处于起步阶段,缺乏相关专业人员,心理咨询服务开展较差,对精神病患者的管理缺乏标准,管理率较低,随访难以开展。[结论]①强调社区资源动员;②重视社区精神卫生的预防;③加强精神卫生人力资源的培养和开发;④尽快出台社区精神卫生服务标准。     

武汉市严重精神障碍患者管理现状

目的了解武汉市严重精神障碍患者的管理现状,为研究制定相应防治措施,进一步加强严重精神障碍管理治疗工作提供决策依据。方法选取截止2015年12月31日武汉市15岁以上常住人口中明确诊断为严重精神障碍的患者为研究对象。通过收集严重精神障碍患者信息,对人口学资料及未治期、病程进行统计分析。结果严重精神障碍患者37 702例,建档率为3.78‰,男女比例为1.15:1;年龄集中在18~44岁(50.26%),其次为45~59岁(33.84%);文化程度以低学历为主(初中及以下);婚姻状况以未婚为主(51.54%);36.46%患者无业或下岗;经济贫困患者占79.01%;61.15%患者病程超过10年,88.09%患者未治期≤2年。结论武汉市在管严重精神障碍患者社会地位及经济状况相对较低,建档率还有待提高,应健全精神卫生服务体系和网络,壮大精神卫生人才队伍,构建精神障碍康复体系,以促进该市精神卫生服务的健康可持续发展。     

北京市某区在册严重精神障碍患者流行病学特征分析

目的了解北京市某区在册严重精神障碍患者流行病学特征。方法严重精神障碍患者信息来源于北京市精神卫生信息管理系统,采用描述性流行病学方法进行分析,组间比较采用卡方检验。结果截至2018-12-31,北京市某区在册严重精神障碍患者6 574例,报告患病率为3.27‰;平均年龄(53.34±15.60)岁,男女性别比为1∶1.04,初中及以下文化程度占77.35%,有严重精神障碍家族史的患者占6.57%,已婚患者占50.26%。其中罹患精神分裂症最多占52.01%,其次为精神发育迟滞伴精神障碍占29.53%。6类严重精神障碍患者发病年龄、起病形式、病程上差异均有统计学意义。结论不同类型的严重精神障碍患者具有不同的流行病学特征,应采取有针对性的社区防控措施,罹患精神分裂症和精神发育迟滞伴精神障碍的在册患者是社区精神卫生防治、康复、管理的主要对象,应早预防、早发现和早治疗,加强综合性社区干预,改善患者社会功能。     

精神障碍患者职业康复研究进展

随着我国精神疾病患病率不断上升，其所带来的经济负担随之增加。促进精神障碍患者回归社会是精神卫生工作的重点，职业康复是精神障碍患者回归社会的重要方式。本文通过对职业康复的概念、精神障碍患者职业康复模式的发展现状及精神障碍患者职业康复影响因素等进行阐述，为精神障碍患者职业康复的研究和发展提供借鉴，并为公共精神卫生服务提供者和决策者整合协调精神障碍人群职业康复的资源提供参考。     

小工业社区职业卫生服务模式效果评估

[目的 ]评估上海桃浦地区试行的小工业社区职业卫生服务模式。 [方法 ]分析接受社区职业卫生服务的10 9家小工业的职业卫生服务现状 ,并通过与基线调查资料对比 ,评估小工业社区职业卫生服务模式的近期效果。 [结果 ]社区职业卫生服务进展顺利 ,接受社区职业卫生签约服务的小工业的各项职业卫生评价指标均显著高于基线调查资料 ,且社区职业卫生服务发展态势良好。 [结论 ]通过分析与评估表明 ,小工业社区职业卫生服务近期效果显著。在目前小工业经济基础较为薄弱的情况下 ,通过社区职业卫生服务 ,能迅速提高小工业职业卫生水平 ,而且社区职业卫生服务适应WTO的需求 ,符合国家的政策导向     

Interorganisational cooperation and its effects on community rehabilitation for people with severe mental disorders in Beijing,China: A case study

A national comprehensive management pilot project for mental health has been implemented in China to provide integrated care for people with severe mental disorders through strengthened cooperation among government organisations and between government and other relevant social organisations. The promotion of community rehabilitation has been included as a key part of this pilot program. The present study took the AD district of Beijing as a case study to examine interorganisational cooperation and its effects on community rehabilitation in a real-world setting. Interviews were conducted with 14 frontline workers, including 7 mental health workers from community health centres and 3 staff and 4 social workers working in rehabilitation centres. Five officials from relevant health and social welfare departments and a social work organisation were also interviewed. Experiences in Beijing revealed that interorganisational cooperation helped to build a multiagency workforce furnished with basic mental health knowledge at the community level, which rendered it possible for frontline workers to provide fundamental follow-up services, pilot the case management model of service provision and increase the provision of psychosocial rehabilitation services within the poorly resourced context of Chinese mental healthcare. Moreover, the engagement of social organisations provided bottom-up pressure to innovate through the active bringing forward of new ideas concerning cooperation and service delivery. However, differences in professional authority and commitment were observed. Health department officials and health professionals seemed to exercise a dominant role as compared to social welfare department officials and social workers. Future policy making should motivate social welfare department officials to improve social care for people with severe mental disorders. Social workers require training to improve their knowledge of mental health matters, and social organisations need greater latitude to strengthen their influence over the development of community rehabilitation services for people with severe mental disorders.     

The relationship between type of mental health provider and met and unmet mental health needs in a nationally representative sample of HIV-positive patients

This study examined mental health service utilization among a nationally representative sample of adults with HIV and psychiatric disorders or perceived need for mental health services. Data are from the HIV Cost and Services Utilization Study (HCSUS) mental health survey (n = 1489) conducted in 1997–1998. Most (70%) needed mental healthcare. Of these, 30% received no mental health services in the previous 6 months, 16% received services from general medical providers (GMPs) only, and 54% used mental health specialists. Clients with perceived need for care were more likely to receive any mental health services and services from mental health specialists (versus GMPs) than clients having mental disorders without perceived need. More patients using specialists versus GMPs received psychotherapeutic medications and psychiatric hospitalizations, controlling for psychiatric symptom severity. The findings underscore that the differential mental health service provision between specialists and GMPs existing in the general population also is present among persons with HIV.     

A community-based approach to evaluation of health outcomes and costs for telepsychiatry in a rural population: preliminary results

A pilot trial was established to support visiting psychiatric services and local public and private practitioners through the use of videoconferencing. The purpose of the trial was to determine whether people in the community received better health-care with telemedicine. A community-based approach was used to evaluate health outcomes, costs, utilization, accessibility, quality and needs for such services in a rural community in Queensland. Over a two-year period data were collected from 124 subjects who met the criteria of having a mental health problem or mental disorder. Nine further subjects refused to participate in the study. Only 32 subjects used videoconferencing to receive mental health services. Preliminary results did not show any significant improvements in wellbeing or quality of life, although the time span was relatively short. However, the results confirmed that the people were no worse off from a consumer or a practitioner perspective from using videoconferencing. Most consumers found that videoconferencing with a psychiatrist moderately or greatly helped them in managing their treatment, with 98% of them preferring to be offered videoconferencing in combination with local services. Overall, videoconferencing is a crucial part of enhancing psychiatry services in rural areas. However, it is not necessarily cost-effective for all consumers, general practitioners, psychiatrists, or the public mental health service.     

Health service utilization for eating disorders: findings from a community-based study

BACKGROUND: Prior use of health services was examined in a community sample of women with bulimic-type eating disorders. METHOD: Participants (n = 159) completed a structured interview for the assessment of eating disorder psychopathology as well as questions concerning treatment-seeking and type of treatment received. RESULTS: Whereas a minority (40.3%) of participants had received treatment for an eating problem, most had received treatment for a general mental health problem (74.2%) and/or weight loss (72.8%), and all had used one or more self-help treatments. Where treatment was received for an eating or general mental health problem, this was from a primary care practitioner in the vast majority of cases. Only half of those participants who reported marked impairment associated with an eating problem had ever received treatment for such a problem and less than one in five had received such treatment from a mental health professional. CONCLUSION: Women with bulimic-type eating disorders rarely receive treatment for an eating problem, but frequently receive treatment for a general mental health problem and/or for weight loss. The findings underscore the importance of programs designed to improve the detection and management of eating disorders in primary care.     

改良家庭干预技术对慢性严重精神障碍患者干预效果观察

目的：观察应用改良家庭干预技术对社区慢性严重精神障碍患者的康复效果,创新社区精神障碍管理服务模式,为社区的精神病防治与康复提供科学的理论依据。方法：随机抽取40例社区慢性严重精神障碍患者,随机分成两组：实验组应用改良家庭干预技术（每15 d1次）;对照组采用目前实施的国家基本公共卫生服务基础干预模式（每月1次）。每15d为一个评估时点,共7个时点,采用简明精神量表（BPRS）评价两组患者精神病症状,采用社会功能评估量表（SDSS）评价其社会功能,两个量表的指标值分别叠加作为康复效果评价。比较两组患者BPRS、SDSS评分及康复效果评价指标值。结果：实验组在1时点与2时点的BPRS评分与0时点的差异无统计学意义（P>0.05）,3～6时点的BPRS评分低于0时点,且低于同期的对照组（t值分别为4.333 0,4.615 3,5.261 4和5.771 1,P<0.05）。实验组3～6时点的康复效果评分均低于同期的对照组（t值分别为3.824 7,4.092 3,4.907 5和5.598 9,P<0.01）。结论：改良家庭干预技术能使社区慢性严重精神障碍患者的康复获益,...     

Prevalence of anxiety, depression, and substance use disorders in an urban general medicine practice

BACKGROUND: Most research on the prevalence of mental disorders in primary care has been conducted in practices that serve middle- and upper-income patients. OBJECTIVE: To determine the prevalence of major mental disorders in a primary care practice that serves a predominantly low-income immigrant patient population. DESIGN: Cross-sectional survey; criterion standard. SETTING: Urban general medicine practice. PARTICIPANTS: Systematic sample of consecutive adult patients with scheduled appointments. Of 1266 approached eligible patients, 1007 (80%) participated. MAIN OUTCOME MEASURES: PRIME-MD Patient Health Questionnaire major depression, generalized anxiety disorder, panic disorder, alcohol use disorder, and suicidal ideation; drug use disorder; functional status; work loss; family distress; and mental health treatment. RESULTS: Major depression (18. 9%), generalized anxiety (14.8%), panic (8.3%), and substance use (7. 9%) disorders and suicidal ideation (7.1%) were highly prevalent. Many patients had more than 1 disorder (range, 36.3% [substance use disorder] to 76.9% [panic disorder]). In multivariate analyses, each disorder was significantly associated with an increase in impairment after controlling for demographic characteristics, perceived health, and the other disorders. A minority of patients with each disorder (range, 22.5% [substance use disorder] to 46.4% [panic disorder]) reported receiving mental health treatment in the last month. CONCLUSIONS: Clinically significant depression, anxiety, substance use, and suicidal ideation are quite common in this practice and associated with significant functional impairment. Primary care practices that serve poor urban immigrant populations have a critical need to provide access to mental health services. Arch Fam Med. 2000;9:876-883     

Die Versorgungssituation psychischer Störungen in Deutschland Eine klinisch-epidemiologische Abschätzung anhand des Bundes-Gesundheitssurveys 1998

Data from the German Health Interview and Examination Survey, Mental Health Supplement (N=4181) reveal that 32% (15,6 million people) of the adult population between 18 and 65 years of age suffer from one or more mental disorders. Among those only 36% receive treatment which also varies in type, duration, and adequacy. The proportion of cases receiving “adequate evidence- based treatments” was estimated to be about 10%. Lowest treatment rates were found for somatoform disorders and substance abuses, highest for psychotic disorders, panic disorder, generalised anxiety disorder, and dysthymia. The data reveal substantial regional differences with regard to treatment rates (e.g. lower rates in regions without universities or institutions offering postgraduate mental health education). The paper concludes that, depending on the diagnosis, a considerable degree of unmet medical needs exist for the majority of people affected by mental disorders. No evidence was found for an excessive supply of health care for the patients suffering from mental disorders or for treatments without an existing clinical need.     

Caring for depressed patients in rural communities: general practitioners' attitudes, needs and relationships with mental health services

OBJECTIVE: To examine the needs and practices of rural GPs and their relationships with local acute mental health services, particularly in the provision of care to depressed patients. DESIGN: Postal survey. SETTING: Rural general practices. SUBJECTS: Ninety-nine GPs (63 males, 36 females) from the Hunter Valley region of NSW, Australia. MAIN OUTCOME MEASURES: GPs' self-reported contact rates, confidence, needs and beliefs. RESULTS: Depression was the most commonly seen mental disorder, with an average of 1.44 patients per GP per month referred to local acute mental health services, most commonly for suicidality. The preferred form of feedback after the referral of a depressed patient was a follow-up letter, while the most requested type of patient management support was cognitive behavioural therapy (CBT) groups. GPs were most confident in recognising depression, compared to other mental disorders except anxiety, and they were most confident in treating depression, compared to all other mental disorders. The most common barrier to providing care for depressed patients was reported to be 'time constraints' on GPs. CONCLUSIONS: The challenge for mental health services is to develop ways to collaborate more effectively with GPs in the provision of psychological services for depressed patients in rural communities.     

上海精神卫生服务的现状与前瞻

目的了解社区老年严重精神障碍患者的日常生活能力和社会支持现状,为社区照护与卫生服务提供依据。方法随机抽取400名社区在册老年严重精神障碍患者,采用日常生活能力量表(ADL)、社会支持评定量表(SSRS)进行现况调查和专题小组讨论。结果社区老年严重精神障碍患者ADL筛查发现,功能有明显障碍者为34.25%,性别间无显著差异(P＞0.05),年龄和受教育程度间有差异(P＜0.01)。共患多种慢性躯体疾病者ADL功能受损增多;社会支持评定总得分为(31.81±3.82)、客观支持得分为(7.10±2.09)、主观支持得分为(16.81±2.74)、支持的利用度得分为(7.84±2.07),低于社区一般老年人群(P＜0.01),不同居住状况者社会支持评定得分差异有统计学意义(P＜0.01);专题小组讨论印证了上述调查结果。结论社区老年精神障碍患者日常生活功能受损严重、社会支持评定结果低,应重视这些脆弱人群的日常生活功能的维护和康复,并提供相应的社会支持。     

Child Anxiety Disorders in Public Systems of Care: Comorbidity and Service Utilization

Little is known about mental health service use among children with anxiety disorders, and even less is known about these children in public sectors of care. In this study, 1,715 children were randomly sampled from one of five public service systems. Psychiatric diagnoses were assessed with a structured interview, and standardized measures were used to assess mental health service utilization. Data from a subsample (n = 779) of youth with psychiatric disorders were analyzed. Analyses revealed that comorbidity among children with anxiety disorders was substantially higher than general population estimates. Approximately 26% of children with anxiety had a comorbid mood disorder, and 62% had a disruptive behavior disorder. Among children with anxiety disorders, those who had comorbid conditions were more likely to receive inpatient services than those without comorbidity. Comorbidity, caregiver strain, and service sector were associated with inpatient and nonspecialty service use in this group. Findings underscore the substantial comorbidity among children with anxiety disorders in public sectors of care and the potential need to adapt evidence-based interventions to meet the complex and multiple needs of these children.