对中国四川精神分裂症患者症状、残疾及家庭负担之间关系的横断面调查（英文）

背景:精神分裂症是一种慢性疾病,其致残率高、家庭负担重,但这些因素之间的相互关系仍不清楚,尤其是在绝大多数患者与家人同住的中低等收入国家。目标:评估中国四川省定期门诊精神分裂症患者的症状严重程度、伤残等级与家庭负担情况。方法:共有101例定期门诊的精神分裂症患者纳入研究患者病程中位数为5年。研究采用世界卫生组织残疾评定量表2.0(WHODAS II),阳性和阴性症状量表(PANSS)以及家庭适应、共处、成长、情感和解决指数量表(APGAR)进行评估,对患者的照顾者采用家庭负担会谈量表(FBIS)进行调查。结果:101例患者中,92例与他们的直系亲属住在一起,74例有显著临床残疾,73例失业。残疾等级与症状严重程度(r=0.50,p0.001)、病程(r=0.22,p=0.028)、发病年龄(r=-0.22,p=0.024)以及患者对家庭支持的满意度(r=-0.30,p=0.020)相关。残疾等级也与家庭总体负担相关(r=0.40,p0.001),包括家庭负担的几种亚型:财政负担(r=0.21,p=0.040)、家庭日常的破坏程度(r=0.33,p=0.001)、家庭休闲活动的影响(r=0.31,p=0.001)和家庭互动的质量(r=0.43,p0.001)。逐步多元线性回归分析后有四个因素与残疾等级显著相关:病程、症状严重程度、病人对家庭支持的满意度以及疾病对家庭的总体负担。结论:即使在调整了患者症状严重程度后,患者残疾仍然与家庭负担独立相关。这突出表明了对于精神分裂症这种往往伴随终身的严重的疾病制定治疗方案时不仅要针对症状还应关注残疾情况。在像中国这样的国家,大多数精神分裂症患者与家人同住,家庭负担成为该疾病对社会影响的一个重要组成部分,因此在评估精神分裂症的社会经济影响时应同时测量患者带来的家庭负担。

Cross-sectional survey of the relationship of symptomatology,disability and family burden among patients with schizophrenia in Sichuan,China

Background

Schizophrenia is a chronic condition that leads to high rates of disability and high levels of family burden but the interactive relationship between these variables remains unclear, particularly in low- and middle-income countries where the vast majority of patients live with their families.

Aim

Assess the symptom severity, level of disability, and family burden among clinically stable outpatients with schizophrenia in Sichuan, China.

Methods

A total of 101 clinically stable outpatients with schizophrenia who had a median duration of illness of five years were assessed using the World Health Organization Disability Assessment Scale 2.0 (WHODAS II), the Positive and Negative Syndrome Scale (PANSS) and the Family Adaptation, Partnership, Growth, Affection and Resolve Index scale (APGAR); and their caregivers were surveyed using the Family Burden Interview Schedule (FBIS).

Results

Among the 101 patients, 92 lived with their immediate family members, 74 had clinically significant disability, and 73 were unemployed. The level of disability was associated with the severity of symptoms (r=0.50, p<0.001), duration of illnesses (r=0.22, p=0.028), age of onset (r=-0.22, p=0.024) and patients’ level of satisfaction with family support (r=-0.30, p=0.020). Disability was also associated with the overall level of family burden (r=0.40, p<0.001), and with several subtypes of family burden: financial burden (r=0.21, p=0.040), the degree of disruption in family routines (r=0.33, p=0.001), the effect on family leisure activities (r=0.31, p=0.001) and the quality of family interactions (r=0.43, p< 0.001). Four variables remained significantly associated with the level of disability in the stepwise multivariate linear regression: duration of illness, severity of symptoms, patient satisfaction with family support, and the overall burden of the illness on the family.

Conclusions

Even after adjusting for the severity of patients’ symptoms, patient disability is independently associated with family burden. This highlights the importance of targeting both symptoms and disability in treatment strategies for this severe, often lifelong, condition. In countries like China where most individuals with schizophrenia live with their families, family burden is an important component of the impact of the illness on the community that should be included in measures of the relative social and economic importance of the condition.