上海市社区精神分裂症患者康复需求及影响因素研究

背景　大多数精神分裂症患者在急性期症状缓解或改善后回归社区康复。我国社区精神卫生资源服务利用率不高，患者满意度低，无法满足患者日益增长的康复需求。目的　了解上海市社区精神分裂症患者的康复需求状况，分析其影响因素，为精神康复的理论研究和实践干预提供依据。方法　于2016年12月—2017年7月采用多阶段分层整群随机抽样方法选取上海市18个区249个居（村）委2 285例社区在册管理的精神分裂症患者进行问卷调查。调查工具包括一般资料调查表、疾病特征与治疗情况调查表、无锡精神分裂症患者康复需求调查问卷。比较不同特征患者康复需求总评分，采用多元线性逐步回归分析精神分裂症患者康复服务需求总得分的影响因素。结果　2 285例患者总需求评分为（2.93±1.07）分，需求评分较高的6个因子从高到低依次为：社会保障（3.57±1.42）分、情绪管理（3.50±1.42）分、治疗依从（3.47±1.43）分、症状管理（3.39±1.39）分、精神卫生知识（3.33±1.34）分、心理社会关怀（3.12±1.49）分。性别、城郊类型、文化程度、居住状况、主要照料者、就业状态、由家人经济供养情况、疾病支出费用、残疾证持有情况、家族史、服药情况、门诊随访情况、精神症状缓解程度不同的患者康复需求总得分比较，差异有统计学意义（P<0.05）。康复总需求得分与年龄、病程呈线性负相关（r值分别为-0.230、-0.139，P<0.05）；康复总需求得分与疾病复发次数、接受过康复服务的项数、服务满意度评分呈线性正相关（r值分别为0.113、0.469、0.330，P<0.05）。多元线性逐步回归分析结果显示：城郊类型、就业状态、家人经济供养情况、疾病支出费用、门诊随访情况、年龄、疾病复发次数、接受过康复服务的项数、康复服务满意度评分是精神分裂症患者康复服务需求总得分的影响因素（P<0.05）。结论　上海市社区精神分裂症患者在多个领域均存在康复需求，城郊类型、就业状态、家人经济供养情况、疾病支出费用、门诊随访情况、年龄、疾病复发次数、接受过康复服务的项数、康复服务满意度评分是精神分裂症患者康复服务需求总得分的影响因素，社会和政府应充分利用现有资源，根据患者情况提供个性化和多样化的服务。

Rehabilitation Needs and Influencing Factors in Community-dwelling Schizophrenia Patients in Shanghai

Background　Most patients with schizophrenia return to the community to continue to recover when the symptoms during an acute schizophrenic episode being relieved or improved.However，in China，the utilization rate of community mental health resources is not high，community-based rehabilitation services can not meet the growing rehabilitation needs of patients，and patients are dissatisfied with such services.Objective　To investigate the rehabilitation needs and influencing factors among community-dwelling schizophrenic patients in Shanghai，providing a basis for theoretical research and implementation of mental health rehabilitation.Methods　From December 2016 to July 2017，a survey was conducted in a multi-stage stratified cluster random sample of 2 285 registered schizophrenic patients receiving community-based mental health management from 249 residential（village）committees in 18 districts of Shanghai.Survey tools include self-developed General Personal Information Questionnaire，and Disease Characteristics and Treatment Questionnaire，and Wuxi version of the Rehabilitation Needs Questionnaire for People with Schizophrenia（PRNQ-S-WX）．The total score of rehabilitation needs was compared by personal characteristics.Influencing factors of rehabilitation needs were analyzed by stepwise multiple linear regression.Results　The mean total score of rehabilitation needs assessed by all the participants was（2.93±1.07）．The top-ranked six factors in terms of mean evaluation score were social security（3.57±1.42），emotional management（3.50±1.42），treatment compliance（3.47±1.43），symptom management（3.39±1.39），mental health knowledge（3.33±1.34），psychosocial care（3.12±1.49）．The total score of rehabilitation needs varied significantly by gender，place of residence（urban or suburban area），education level，living status（independent or not），main caregivers，employment status，financial support from family，mean monthly expenditure on schizophrenia，prevalence of having disability certificate，family history，schizophrenia，medication status，outpatient follow-up and psychiatric symptoms relief（P<0.05）．The total score of rehabilitation needs was negatively correlated with age and duration of schizophrenia（r valuces were -0.230，0.139；P<0.05），but was positively correlated with the number of schizophrenia relapses，the number of rehabilitation services received and the score of service satisfaction（r valuces were 0.113，0.469，0.330；P<0.05）．Stepwise multiple linear regression analysis showed that place of residence，employment status，financial support from family，mean monthly expenditure on schizophrenia，outpatient follow-up，age，number of schizophrenia relapses，number of rehabilitation services received，and satisfaction with rehabilitation services were associated with the rehabilitation needs in schizophrenia patients（P<0.05）．Conclusion　Schizophrenic patients in the community in Shanghai have many various domains of rehabilitation needs.Their rehabilitation needs are influenced by place of residence，employment status，financial support from family，monthly expenditure on schizophrenia，outpatient follow-up status，age，number of schizophrenia relapses，number of rehabilitation services received，and satisfaction level with rehabilitation services.In view of this，social and government departments should make full use of the existing resources to provide personalized and diversified services according to the patient's situation.