汶川地震受灾地区灾后社区、乡镇卫生院工作者精神卫生服务能力评估

目的:了解汶川受灾地区社区、乡镇卫生院工作者的精神卫生知识掌握情况及精神卫生服务能力,为精神卫生培训提供依据,为我国精神卫生服务体系建设提供科学参考。方法:选取灾后社区、乡镇卫生工作者心理卫生服务技能培训班学员353名为研究样本,回收有效问卷313份。使用自编精神卫生知识评估问卷和精神卫生服务调查表进行评估。自编精神卫生知识评估问卷包含抑郁症、酒精依赖、精神分裂症(阳性症状为主)、创伤后应激障碍和躯体形式障碍5种精神障碍。结果:受灾地区乡镇、社区卫生院工作者对于社区5种精神障碍准确诊断率最高的案例为抑郁症(77.0%),药物处理中位数得分最高的为酒依赖;非药物处理中位数得分最高的是酒依赖和创伤后应激障碍。培训前1月内报告未接诊过精神障碍患者的社区、乡镇卫生院工作者占53.4%。不知道任何1所精神卫生服务机构的卫生院工作者占35.1%;不知道精神科专科会诊的占37.7%;不能邀请精神科专科会诊的占39.6%。结论:汶川地震后,受灾地区的乡镇、社区卫生院工作者精神卫生知识和技能掌握较少,精神卫生服务能力相对弱。     

西山区农村三级定点医疗机构服务质量影响因素分析

目的 探讨参合农民对新农合定点医疗机构服务质量评价的影响因素,为改进其服务质量提供科学依据.方法 2007年1月各采用分层抽样和单纯随机抽样相结合,以问卷方式调查了506名昆明市西山区参合农民对新农合定点医疗机构服务质量的意见和建议.结果 ①县级医院的服务质量与医疗技术水平、服务态度、就医方便、交通等6项有关系;②乡镇卫生院受医疗技术水平、就医方便程度和收费的影响;③村卫生室受医疗技术水平、离家距离的影响.④农民患病后门诊就诊偏向选择省市级医疗机构,选择县级、乡镇级医院就诊的比例明显偏低.结论 各级医疗机构的服务质量的影响因素中,除医疗技术外其余主要影响因素各不相同;西山区县乡级医疗机构布局存在不合理现象.     

汶川震后14个月极重灾区县基层医务人员的心理健康状况

目的:探讨汶川地震14个月后极重灾区县基层医务人员心理健康状态及相关因素。方法:采用方便取样,选取参加卫生部-联合国人口基金会"汶川震后社会心理支持项目"培训与心理干预的6个极重灾区县基层医务人员307人。先用一般状况调查表、心理健康自评问卷(SRQ20)及创伤后应激障碍筛查表(PTSD7)进行调查。然后,对SRQ20≥10分或PTSD7≥4分者均进行国际神经精神科简式访谈问卷(MINI)的抑郁发作和PTSD诊断评估以及自杀倾向评定。结果:SRQ20≥10或PTSD7≥4者81人。在完成MINI抑郁发作诊断评估的51人中,符合目前抑郁发作7人;在完成PTSD诊断评估的61人中,符合PTSD发作7人;两者共病3人。在完成自杀倾向诊断评估的62人中,存在自杀倾向10人。不同性别和年龄组之间的抑郁发作、PTSD和自杀倾向检出率差异均无统计学意义;不同安置点之间的PTSD检出率差异有统计学意义,北川的检出率(40.0%)最高。搬迁次数是灾区基层医务人员精神痛苦的危险因素(OR=1.24)。结论:震后14个月后,极重灾区县基层医务人员仍存在明显的精神痛苦,少数人存在抑郁发作、创伤后应激障碍及自杀倾向。震后多次搬迁可能促使精神痛苦的发生及症状加重。     

2010年中国精神卫生机构和床位资源现状分析

目的:了解中国精神卫生机构和床位资源分布情况,为制定全国性精神卫生服务资源配置规划提供参考。方法:数据来源于卫生部"2010年全国卫生资源与医疗服务调查"和国家精神卫生项目办公室"2010年精神卫生专业机构调查",对其中的精神卫生机构主办单位、管理归属、床位资源等相关数据进行描述性分析。结果:2010年全国共有1650家精神卫生机构,精神科开放床位数228100张。精神科床位主要分布在精神病专科医院中,占总床位数的86.4%;主办单位包括政府部门、企业、个人、事业单位、社会团体等,以政府部门主办为主,占总床位数的88.4%。精神科床位密度全国平均为1.71张/万人,上海和北京最高,西藏自治区精神科床位数为0。全国精神病专科医院床位使用率为92.4%,平均住院日中位数为45 d。结论:全国精神卫生机构主办部门众多,精神卫生床位资源数量不足,地域分布不合理。     

1986-2006年唐山地区精神科住院患者年出院人次与病种变化趋势

目的: 了解唐山地区精神科住院患者年出院人次及诊断构成比的变化趋势,为该地区及国内类似地区精神卫生政策发展提供依据.方法: 分析唐山地区全部精神病专科医院1986、1996、2001和2006年出院患者的基本信息和诊断类别及其变化情况.结果: 唐山地区1986、1996、2001和2006各年度出院的精神科住院患者分别为832、1705、2279和3154人次,区间增长近4倍,估计每5年平均增长速度为1.39.出院患者的诊断分布在4个年度间存在不同.精神分裂症的出院诊断构成比有下降趋势,而物质滥用或依赖、癔症和应激相关障碍的比例增加.结论: 唐山地区精神障碍患者住院服务利用在20年间呈快速上升趋势;与县级精神病院相比,市级精神病院提供的住院服务增长显著;物质滥用和老年精神障碍住院治疗需求呈快速上升趋势,但精神分裂症、情感障碍和神经症仍然是精神科住院服务的重点.     

乡镇卫生院对糖尿病病人的心理护理策略

作为基层的医疗机构,乡镇卫生院在农村的医疗事业中(提供基本的预防、治疗以及保健服务)发挥着重要的基础性作用.但是由于硬件设施和护理意识的限制,大多数的糖尿病人选择在家里治疗和休养,但是患者本人通常对该病知之甚少,在加上患病之后承受着较大的心理压力,在家里休养期间通常会出现病情加重的情况.因此,笔者建议,乡镇卫生院的护理人员在向病人讲解糖尿病基本常识的同时,更要注重心理护理在糖尿病患者康复过程中的重要作用.笔者就乡镇卫生院的护理人员对糖尿病病人的心理护理策略展开了相关的分析和探讨.     

地震灾区茂县儿童、中学生震后急性应激心理反应及干预研究

目的探讨地震重灾区茂县儿童和中学生震后急性应激心理反应及干预效果。方法采用了认知疗法、渐进性放松、交互抑制、系统脱敏、深呼吸调整、催眠疗法、冥想放松、危机干预、来访者中心疗法、绘画、做游戏等干预措施,采用来访者自我评估、家庭成员评估和咨询专家自我评估的平均等级为评价标准,采用R id it分析方法。结果前来寻求心理咨询的儿童和中学生的心理问题有7类,直接与地震有关的心理问题有6类,几类与地震直接有关的儿童和中学生震后急性应激心理反应干预效果没有显著性差异(χ2=0.3376,4.32,P=0.8847,0.12),儿童和中学生震后急性应激心理反应心理干预效果比较好。结论要灵活应用心理咨询和心理治疗的各种方法进行心理干预,对突发性地震灾难使儿童和中学生短期产生的几类急性应激心理反应要及时地进行心理干预。     

地震灾后儿童群体性免疫预防实施情况分析

目的及时总结“5．12”汶川大地震灾后甲肝、乙脑疫苗预防接种工作经验，为自然灾害后开展群体性免疫预防工作提供参考。方法按照《江油市地震后甲肝、乙脑预防接种实施方案》开展群体性接种工作。对彰明镇等4个乡镇实施技术指导、现场督导和接种率快速评估。结果4个乡镇甲肝疫苗报告接种率为97．2％（3666／3773），乙脑疫苗报告接种率为99．2％（1389／1400）。快速评估共调查180名儿童，甲肝疫苗接种率为98．1％（155／158），乙脑疫苗接种率为97.3％（73／75）。快速评估结果与报告接种率基本一致。结论本次地震灾后群体性接种活动进展顺利，达到预期指标。灾后开展群体性预防接种需加强调配和培训医务人员，做好接种对象摸底工作．确保安全的接种场所．提供足够疫苗和冷链设备等。     

汶川地震灾后半年及1年都江堰安置点432例群众心理状况对照研究

目的探讨汶川地震半年及1年后,都江堰地震灾区群众的心理健康状况及其变化情况,并探索其心理健康状况变化的可能影响因素。方法采用创伤后应激障碍检查量表平民版（PCP-C）、贝克抑郁自评量表（BDI）、汉密尔顿焦虑量表（HAMA）分别在震后半年和1年对都江堰安置点受灾群众的创伤后应激障碍（PTSD）症状、焦虑及抑郁情绪进行评估,并实施相关的灾后心理健康教育。结果地震灾区群众震后半年及1年的PTSD症状发生率分别为18.3%、6%;抑郁症状发生率为21.6%、8.4%;焦虑症状发生率为19.7%、5.6%。结论震后1年较之震后半年灾区群众PTSD、抑郁及焦虑症状发生率明显降低,该结果可能对研究对象开展心理健康教育及政府、社会、家庭的支持等有关。     

2007-2009年江门市医疗机构法定传染病漏报因素分析

目的了解江门市法定传染病的疫情报告和管理情况,为进一步提高各级医疗单位的传染病疫情报告与管理水平提供科学依据。方法回顾性调查分析江门市2007-2009年法定传染病漏报调查工作记录,按照《全国法定传染病漏报调查方案》对不同级别医疗单位传染病漏报资料进行分析。结果江门市2007-2009年各级医疗单位共查出传染病1985例,漏报80例,漏报率为4.03%。不同年份漏报率差异有统计学意义（P=0.0001）,不同级别医疗机构漏报率差异有统计学意义（P=0.0001）,医疗机构内不同科别法定传染病的漏报率差异有统计学意义（P=0.001）。结论市直属医疗机构漏报率最高,乡镇卫生院次之,应加强市直属和乡镇卫生院的传染病漏报管理工作。     

Psychosocial and health belief variables associated with frequent attendance in primary care

BACKGROUND: The reasons for high use of primary care, and in particular the role of psychosocial factors, remain unclear. METHODS: We identified and interviewed 236 frequent attenders and 420 normal users, matched by age and sex, of a public Health Centre in Granada, Spain. Users were questioned about mental health (GHQ-28), social support (Duke-UNC-11), family dysfunction (family APGAR) and health beliefs (health belief model, locus of health control and medical care expectations). We also measured a set of individual, social and illness variables. RESULTS: Multiple logistic regression analyses showed that mental health was the main factor associated with frequent attender status (odds ratio = 3.1; 2.4-3.9). The association was stronger than that between frequent attender status and perceived illness, and between the former and reported chronic illness. Family dysfunction and perceived susceptibility to and severity of disease were also significantly but more weakly associated with frequent attender status. Affective support was more strongly associated with FA status than was confidant support, but both associations disappeared when mental health and family function were controlled for. CONCLUSIONS: Our findings document the association of psychosocial factors and primary health care use. We suggest that the effective management of mental health problems from a family-based approach may reduce primary health care high use.     

Mental health, family function and obesity in African-American women

CONTEXT: African-American women are disproportionately affected by obesity and its related diseases. How psychological and psychosocial factors that affect this population differ across weight categories remains poorly understood. PURPOSE: To determine whether poor mental health and family functioning are associated with obesity in African-American women. METHODS: African-American women patients aged 21-65 years were interviewed at three primary care centers. Four well-established assessment tools were used to measure general mental and physical health status, family functioning, depressive symptoms and anxiety levels. Demographics, health behaviors and family and personal histories of overweight were assessed. RESULTS: Among 113 patients, after controlling for age and parity, obese women had significantly higher anxiety levels, poorer perception of their physical health, more often were overweight as a child, had overweight parents or siblings and experienced more psychosocial problems in their family growing up, compared to overweight and normal weight women. CONCLUSIONS: The observed findings of poor mental health, perception of physical health and family function in obese African-American women support a need for clinical attention and further study.     

Impact of the mental health and dynamic referral for oncology (MHADRO) program on oncology patient outcomes,health care utilization,and health provider behaviors: A multi-site randomized control trial

ObjectiveThe MHADRO assesses psychosocial and medical needs, provides tailored feedback reports, and connects patients to mental health providers. This study examined the MHADRO’s effect on patient outcomes, health care utilization, and oncology provider documentation and behaviors.Methods836 patients were part of a multi-site RCT and assessments were conducted at baseline, 2, 6 and 12 months.ResultsThe intervention group engaged in less emergency calls to providers. There were no differences in psychosocial outcomes at follow up assessments. Providers of patients in the intervention group were more likely to: document psychosocial symptoms and history; refer to psychosocial services; encourage support groups; seek psychological evaluations during visits. Patients who agreed to a mental health referral had decreased hospitalizations, increased mental health care interactions, and stronger ratings of counseling potential benefits. This group also reported increased psychosocial distress at all follow-up assessments.ConclusionThe MHADRO may increase access to mental health care, lessen utilization, and improve providers’ management of psychosocial needs, but does not appear to impact overall functioning over time.Practice ImplicationsProviders are encouraged to consider incorporating programs, like the MHADRO, into patient care as they may have the potential to impact screening and management of patients’ psychosocial needs.     

Menopause and determinants of quality of life in women at midlife and beyond: the study of health in pomerania (SHIP)

OBJECTIVE: Determinants of quality of life (QoL) in pre- and postmenopausal women including nonhormonal modulators of QoL in adult women are not well understood; there is an ongoing controversy about the impact of menopause on health-related QoL. We investigated the extent to which diverse mental and physical symptoms are associated with (a) menopausal status; (b) sociodemographic, psychosocial, and lifestyle factors; and (c) menopausal hormone therapy (MHT) in adult women after the German reunification in a region of the former German Democratic Republic. DESIGN: The Study of Health in Pomerania is a cross-sectional, population-based survey. Computer-based structured interviews and self-administered questionnaires were used to capture QoL (Zerssen Symptom List) and sociodemographic parameters, psychosocial, and lifestyle indicators (age, socioeconomic status, abuse, social support, nutrition, body mass index, self-rated health, chronic diseases, and use of MHT) in 1,119 pre- and postmenopausal women with an intact uterus. RESULTS: Analyses suggest that menopausal status was not associated with QoL. MHT was associated with physical, mental, and gastrointestinal symptoms. Age was a significant predictor for cardiopulmonary symptoms and sensory impairment. The relationship between age and both physical and mental complaints was inverse as was the relationship between age and both mood and gastrointestinal symptoms. Age, socioeconomic status, physical and sexual abuse, perceived social support, nutrition, body mass index, self-rated health, chronic diseases, and MHT modulated QoL. CONCLUSIONS: Our findings do not support the hypothesis that QoL is reduced after menopause. Differences between pre- and postmenopausal women can be explained by sociodemographic, psychosocial, and lifestyle factors.     

Addressing mental health issues in primary care: An initial curriculum for medical residents

Objective

Many express concern that modern medicine fails to provide adequate psychosocial and mental health care. Our educational system has not trained the primary care providers who care for most of these patients. Our objective here is to propose a quantum change: prepare residents and students during all years of training so that they are as effective in treating psychosocial and mental health issues as they are medical problems.

Method

We operationalize this objective, following Kern, by developing an intensive 3-year curriculum in psychosocial and mental health care for medical residents based on models with a strong evidence-base.

Results

We report an intensive curriculum that can guide others with similar training interests and also initiate the conversation about how best to prepare residency graduates to provide effective mental health and psychosocial care.

Conclusion

Identifying specific curricula informs education policy-makers of the specific requirements they will need to meet if psychosocial and mental health training are to improve.

Practice Implications

Training residents in mental health will lead to improved care for this very prevalent primary care population.     

Mental health in schools and system restructuring

Because health is not the primary business of schools, a school's response to mental health and psychosocial concerns usually is limited to targeted problems seen as direct barriers to learning. And because resources are sparse, priority is given to problems defined in legislative mandates. As a result, school-based mental health services are available only to a small proportion of the many students who require assistance, and interventions generally are narrowly focused and short-term. To better meet the needs of those served and to serve greater numbers, emerging trends are pushing for restructuring of school-owned services and greater linkage with community resources to develop multifaceted, comprehensive, integrated approaches. This review (a) provides an overview of what schools currently do related to mental health and psychosocial concerns, (b) clarifies key emerging trends, and (c) explores implications for major systemic changes.     

Complexity of GPs' explanations about mental health problems: development, reliability, and validity of a measure.

BACKGROUND: How GPs understand mental health problems determines their treatment choices; however, measures describing GPs' thinking about such problems are not currently available. AIM: To develop a measure of the complexity of GP explanations of common mental health problems and to pilot its reliability and validity. DESIGN OF STUDY: A qualitative development of the measure, followed by inter-rater reliability and validation pilot studies. SETTING: General practices in North London. METHOD: Vignettes of simulated consultations with patients with mental health problems were videotaped, and an anchored measure of complexity of psychosocial explanation in response to these vignettes was developed. Six GPs, four psychologists, and two lay people viewed the vignettes. Their responses were rated for complexity, both using the anchored measure and independently by two experts in primary care mental health. In a second reliability and revalidation study, responses of 50 GPs to two vignettes were rated for complexity. The GPs also completed a questionnaire to determine their interest and training in mental health, and they completed the Depression Attitudes Questionnaire. RESULTS: Inter-rater reliability of the measure of complexity of explanation in both pilot studies was satisfactory (intraclass correlation coefficient = 0.78 and 0.72). The measure correlated with expert opinion as to what constitutes a complex explanation, and the responses of psychologists, GPs, and lay people differed in measured complexity. GPs with higher complexity scores had greater interest, more training in mental health, and more positive attitudes to depression. CONCLUSION: Results suggest that the complexity of GPs' psychosocial explanations about common mental health problems can be reliably and validly assessed by this new standardised measure.     

Feelings of professional fulfilment and exhaustion in mental health personnel: the importance of organisational and individual factors

BACKGROUND: Mental health personnel are at high risk for mental illness, burnout and suicide. Previous studies of this group of professionals have indicated the importance of organisational factors in explaining burnout, or exhaustion, and work satisfaction. This study looks more systematically at the contribution of organisational and individual factors to work-related exhaustion and to professional fulfillment, an expanded version of job satisfaction. METHODS: A cross-sectional study of 1, 051 psychiatrists and mental health nurses in the city of Stockholm was carried out by postal questionnaire with a previously validated instrument. Multiple and logistic regressions were used to identify predictors of exhaustion and professional fulfillment. RESULTS: Organisational characteristics were found to be more important than individual characteristics in predicting exhaustion and professional fulfillment in mental health professionals. CONCLUSIONS: The results indicate that the psychosocial work environment and well-being of mental health professionals can be improved by concentrating on organisational factors such as efficiency, personal development and goal quality.     

汶川地震后部分极重灾区人群对心理社会支持的需求

目的:了解汶川地震后部分极重灾区的受灾群众接受心理社会支持服务的情况及其需求,为灾后精神卫生和心理社会支持服务提供参考信息。方法:震后9个月,对138名来自北川县及安县的受灾群众,采用自编问卷结合访谈进行现场调查。结果:(1)74.6%的灾民希望得到心理帮助,51.4%听说过"心理"、"心理援助"或"心理干预"说法,但仅有34.1%实际接受过心理帮助。(2)接受过心理帮助者认为"帮助很大"的比例更高(23.4%vs.8.4%,P=0.002),灾民得到心理帮助的次数与其对心理帮助的印象呈负相关(r=-0.28,P=0.001)。(3)灾民认为最有用的心理帮助依次为交谈(27.7%)、提供心理支持(23.4%)、了解关心的问题和需要(17.0%)。(4)自从地震以来的9个月和最近的1个月,灾民报告对其心理造成影响的前4位问题为住房问题、失去亲人、生活经济来源问题和就业问题。结论:随着获得心理帮助次数的增多,灾民对心理帮助的印象评价趋向于更好;大部分受灾群众对心理社会支持服务的需求不能得到满足,有必要不断加强基层卫生服务工作者的能力建设,提高服务可及性。卫生部门之内和之外的各种心理社会支持措施应当相互加强且彼此促进,并能针对不同人群的特点和需求。     

The impact of beliefs about mental health problems and coping on outcome in schizophrenia

BACKGROUND: Using the theoretical framework of the Self Regulation Model (SRM), many studies have demonstrated that beliefs individuals hold about their physical health problems are important in predicting health outcomes. This study tested the SRM in the context of a mental health problem, schizophrenia. METHOD: One hundred and twenty-four people with a diagnosis of schizophrenia were assessed on measures of symptom severity, beliefs about their mental health problems, coping and appraisal of outcome at two time points, 6 months apart. RESULTS: Using multivariate analyses and controlling for severity of symptoms, beliefs about mental health were found to be significant predictors of outcome. Beliefs about greater negative consequences were the strongest and most consistent predictors of a poorer outcome in both cross-sectional and longitudinal analyses. CONCLUSIONS: These results suggest that the SRM is a promising model for mental health problems and may highlight important areas for development in clinical, and especially psychosocial interventions.