吉林大学学报(医学版) ›› 2021, Vol. 47 ›› Issue (5): 1298-1305.doi: 10.13481/j.1671-587X.20210531

• 调查研究 • 上一篇    下一篇

广东省严重精神障碍现况调查及其社区与医院患者临床和流行病学特征比较

陈东1,周娜2,张欣2,陶晓宇1,谭文艳3,林海程3,王诗镔3,蒲丽媛4,高文会4,金丽娜4,于雅琴1,5()   

  1. 1.澳门科技大学医学院公共卫生系,澳门特别行政区 999078
    2.澳门科技大学药学院药理教研室,澳门特别行政区 999078
    3.广东省人民医院 广东省医学科学院 广东省精神卫生中心公共卫生事业科,广东 广州 510080
    4.吉林大学公共卫生学院流行病与卫生统计学教研室,吉林 长春 130021
    5.珠海科技学院健康学院预防医学教研室,广东 珠海 519041
  • 收稿日期:2021-02-22 出版日期:2021-09-28 发布日期:2021-10-26
  • 通讯作者: 于雅琴 E-mail:yuyaqin5540@163.com
  • 作者简介:陈 东(1979-),男,江苏省南通市人,在读博士研究生,主要从事精神障碍疾病分析和治疗方面的研究。
  • 基金资助:
    广东省卫健委医学科学技术研究基金项目(C2018026)

Survey of status of severe mental disorders and comparison of clinical and epidemiological characteristics between community and hospital patients in Guangdong Province

Dong CHEN1,Na ZHOU2,Xin ZHANG2,Xiaoyu TAO1,Wenyan TAN3,Haicheng LIN3,Shibin WANG3,Liyuan PU4,Wenhui GAO4,Lina JIN4,Yaqin YU1,5()   

  1. 1.Department of Public Health,Faculty of Medicine,Macau University of Science and Technology,Macao Special Administrative Region 999078,China
    2.Department of Pharmacology,School of Pharmacy,Macau University of Science and Technology,Macao Special Administrative Region 999078,China
    3.Department of Public Health,Guangdong Mental Health Center,Guangdong Provincial People’s Hospital,Guangzhou 510080,China
    4.Department of Epidemiology and Health Statistics,School of Public Health,Jilin University,Changchun 130021,China
    5.Department of Preventive Medicine,School of Health,Zhuhai University of Science and Technology,Zhuhai 519041,China
  • Received:2021-02-22 Online:2021-09-28 Published:2021-10-26
  • Contact: Yaqin YU E-mail:yuyaqin5540@163.com

摘要: 目的

了解广东省严重精神障碍社区居住患者的一般人口学特征、临床症状及生活状态,并分析其与医院患者之间的差异,为进一步开展严重精神障碍管理治疗工作提供依据。

方法

于2018年12月—2019年2月,采用多阶段分层抽样的方法对广东省下辖11个地级市中精神卫生机构(精神卫生专科机构及社区卫生服务中心)住院或管理的6 886例严重精神障碍患者开展调查。

结果

与住院患者比较,社区居住患者一般人口学特征、临床症状以及生活状态的分布差异有统计学意义(P<0.05)。住院患者在<18岁、18~44岁以及≥60岁年龄段构成比均高于社区居住患者(P<0.05),而在45~59年龄段构成比低于社区患者(P<0.05);住院患者中男性构成比高于社区患者(P<0.05),而女性患者构成比低于社区患者(P<0.05)。社区患者中已婚同居者构成比较高(P<0.05),而住院患者中未婚者构成比较高(P<0.05),社区居住患者文化程度水平在小学及以下构成比高于住院患者(P<0.05);社区居住患者出现幻觉、交流困难、猜疑、喜怒无常、行为怪异、兴奋话多、伤人毁物、悲观厌世、无故外走、自娱嬉笑和孤僻懒散等临床症状的构成比以及既往总住院次数均低于住院患者(P<0.05),但首发年龄和患病总持续时间均高于住院患者(P<0.05);对2种来源患者的生活状态进行多因素Logistic回归分析,社区居住患者吸烟[OR(95%CI)=1.968(1.436~2.696)]、现在饮酒[OR(95%CI)=1.776(1.105~3.105)]、危险性评估等级[OR(95%CI)=10.197(4.053~25.654)]和实际睡眠时长[OR(95%CI)=1.855(1.375~2.502)]的构成比均高于住院患者(P<0.05)。社区居住患者锻炼频率低于1~2次/周[OR(95%CI)=0.566(0.425~0.755)]和目前正在被关锁[OR(95%CI)=0.205(0.070~0.600)]的构成比均低于住院患者(P<0.05)。

结论

广东省严重精神障碍社区居住患者较易发生幻觉、交流困难、猜疑、喜怒无常和行为怪异等临床症状以及吸烟、饮酒等不良行为。应加强针对社区居住严重精神障碍患者的治疗管理,特别是综合干预,平衡发展社区与医院的服务功能。

关键词: 严重精神障碍, 社区患者, 住院患者, 流行病学, 现况研究

Abstract: Objective

To understand the general demographics, clinical symptoms and living conditions of the patients living in communities with severe mental disorders in Guangdong Province,to analyze the differences between them and inpatients, and to provide a basis for the further management and treatment of severe mental disorders.

Methods

From December 2018 to February 2019, 6 886 patients with severe mental disorders hospitalized or managed in mental health institutions (specialized mental health institutions and community health service centers) in 11 prefecture-level cities under the jurisdiction of Guangdong Province were investigated by multi-stage stratified sampling method.

Results

Compared with the inpatients, the distribution differences in the general demographic characteristics, clinical symptoms and living status of the patients living in the community were statistically significant (P<0.05). The composition ratio of inpatients at <18 years old, 18-44 years old and ≥60 years old were higher than those of the community residents, while the composition ratio of inpatients at 45-59 years old was lower than that of community patients (P<0.05). The composition ratio of male inpatients was higher than that of community patients, while the composition ratio of female patients was lower than that of community patients (P<0.05).The community patients were more married cohabitation, and the inpatients unmarried accounted for a higher proportion (P<0.05); the community patients with education level below primary school accounted for a higher proportion than the inpatients (P<0.05);the proportions of hallucinations, difficulty in communication, suspicion, motility,strange behaviors, excited talking,destroying things, pessimism, going out for no reason, self-amusement,solitude and lazy and other clinical symptoms in the patients living in community as well as the total number of hospitalization in the past were lower than the inpatients(P<0.05), but the first age and the total duration of illness were higher than the inpatients (P<0.05).The multivariate Logistic analysis of the patients from the two sources showed that the proportions of smoking [OR (95%CI)=1.968(1.436-2.696)],drinking[OR(95%CI)=1.776(1.105-3.105)],risk assessment level [OR(95%CI)=10.197(4.053-25.654)] and actual sleep frequency [OR(95%CI) = 1.855 (1.375-2.502)]of the patients living in the communities were higher than those of the inpatients(P<0.05).The proportions of frequency of exercising less than 1-2 times a week [OR(95%CI)=0.205(0.070-0.600)] and being locked up [OR(95%CI)= 0.566(0.425-0.755)] in the patients living in communities were lower than those of the inpatients(P<0.05).

Conclusion

The patients with severe mental disorders living in community in Guangdong Province are more likely to have hallucinations, communication difficulties, suspicion, moodiness, strange behavior and other clinical symptoms, as well as the bad behaviors such as smoking and drinking. In the future, behavioral intervention should be strengthened for the patients with severe mental disorders in the community, and the service functions of the community and the hospital should be balanced.

Key words: severe mental disorders, community patients, inpatients, epidemiology, cross-sectional study

中图分类号: 

  • R749