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。

Capability of basic mental health services of primary health care providers in Wenchuan earthquake disaster areas

Objective:To investigate the capability of basic mental health services of primary health care providers in the Wenchuan earthquake disaster areas which will attribute to improving the mental health services of China.Methods:The self-made knowledge and inventory of basic mental health services scales were used to measure the skills and abilities of primary health care physicians to identify and treat mental illnesses.A total of 313 primary health care physicians were assessed in the Wenchuan disaster area by a questionnaire including knowledge of 5 mental disorders,i.e.,depressive disorders,alcohol dependence,schizophrenia(especially positive symptoms),post-traumatic stress disorders(PTSD) and somatoform disorders.Results:Among the 5 mental health disorders,depressive disorders was the most correctly identified disease(77.0 %).In terms of knowledge of drug based treatments,primary health care providers scored the highest median score for alcohol dependence.For non-drug based treatment,primary health care providers scored highest in their knowledge of PTSD and alcohol dependence.During the month prior to conducting the survey,164(53.4%) primary health workers reported seeing patients with mental health diseases.Over one-third(35.1%) of primary health workers had no knowledge of existing mental health institutions.About 37.7% of primary health workers knew nothing about mental health consultation and 39.6 % reported being unable to receive any mental health consultation.Conclusion:The knowledge and skill of basic mental health services among the primary health care provider may be insufficient in the disaster areas.