倍慈模式之生计活动对农村地区精神障碍患者社会功能的影响

发布时间：2018-07-16 17:42

【摘要】：目的:随着国外从20世纪50年代开始提倡患者住院治疗结合社区精神卫生服务体系作为治疗精神障碍的新模式,我国在20世纪90年代提出了精神障碍社区康复相关的问题,但专业人员短、资金不足等多种原因导致我国社区精神卫生服务工作相对于国外发达地区仍显滞后,使生活在社区中的患者病情得不到控制,社会功能低下。致力于帮扶贫困地区精神障碍患者及家庭的倍慈精神卫生发展项目落户中国,本研究探讨倍慈模式之“生计活动”对我国农村地区精神障碍患者社会功能的影响,为我国农村地区精神障碍患者的康复提供新的治疗依据。方法:自2015年6月1日-2015年12月1日期间加入保定市顺平县倍慈精神卫生发展项目的精神障碍和癫痫患者75人作为研究对象,根据患者是否加入倍慈模式生计活动小组干预,将患者分为研究组与对照组;研究组的患者在持续服用药物和定期健康宣教的基础上成立生计活动小组,提供生产资料进行生计活动干预,为期12个月。对照组提供与干预组相同频率的免费药品供应和健康宣教,无其他干预手段,观察12个月。在入组时及12月末采用世界卫生组织残疾评定量表Ⅱ中文版(WHO-DASⅡ)、功能大体评定量表(GAF)、健康调查问卷(SF-36)、领悟社会支持量表(PSSS)、精神障碍患者病耻感评估量表、家庭负担访谈问卷(FBIS)、服药依从性量表和家属贬低歧视感知量表(PDD)对患者的残疾状况、社会功能、健康状况、社会支持情况以及家庭经济负担等进行评估。结果:最终进入结果分析的患者70例,其中精神分裂症患者29例、抑郁障碍患者8例、癫痫所致精神障碍患者23例、智力障碍患者10例。干预前两组患者及家属一般情况以及各量表基线评估无显著性差异。干预后(1)研究组患者WHO-DASⅡ量表得分明显降低且与对照组相比差别有显著统计学意义(P0.01);(2)研究组患者GAF功能大体量表得分明显提高且与对照组相比差别有显著统计学意义(P0.01)(3)研究组患者SF-36健康调查问卷躯体健康得分明显提高且与对照组相比差别有显著统计学意义(P0.01),研究组精神健康得分提高且与对照组相比差别有统计学意义(P0.05);(4)研究组患者领悟社会支持量表得分明显提高且与对照组相比差别有显著统计学意义(P0.01);(5)研究组患者病耻感量表得分降低但与对照组相比差别无统计学意义;(6)研究组患者家庭负担量表得分显著降低且与对照组相比差别有显著统计学意义(P0.01);(7)研究组患者服药依从性量表得分提高且与对照组相比差别有统计学意义(P0.05);(8)研究组患者家属贬低歧视感知量表得分降低且与对照组相比差别有统计学意义(P0.01)。Logistics回归结果显示,患者社会功能的影响因素为患者家庭收入与患者残疾程度。患者家庭年收入与患者社会功能正相关,家庭年收入越高患者社会功能恢复程度越好;患者残疾程度与社会功能呈负相关,患者残疾程度越高提示患者社会功能恢复程度越差;而其他因素与患者社会功能无关。结论:倍慈模式之生计活动支持干预可以降低患者残疾程度、降低患者病耻感程度、降低患者家庭负担和降低家属病耻感程度;同时可以提高患者服药依从性、提高患者社会功能、提高患者生活质量和提高患者社会支持水平。患者家庭收入与残疾程度是患者社会功能的影响因素。
[Abstract]:Objective: with the promotion of patients' hospitalization and community mental health service system as a new model for mental disorders from 1950s, our country put forward the problems related to mental disorder community rehabilitation in 1990s, but many reasons such as short professional staff and insufficient funds lead to community mental health service in our country. The work is still lagging behind the developed countries in foreign countries, which makes the patients living in the community less control and the social function is low. The influence of the social function of the patients provides a new treatment basis for the rehabilitation of mental disorders in rural areas of China. Methods: from June 1, 2015 -2015 year December 1st, the mental disorders and 75 people with epilepsy were selected as the research object in the Baoding Shunping county "double kindness mental health development project". The patients were divided into the study group and the control group. The patients in the study group set up a livelihood activity group on the basis of continuous medication and regular health education. The group provided the production data for 12 months. The control group provided free drug supply and health education with the same frequency as the intervention group. For 12 months, the Chinese version of the WHO Disability Assessment Scale II (WHO-DAS II), the functional gross Assessment Scale (GAF), the health questionnaire (SF-36), the perceived social support scale (PSSS), the mental disorder assessment scale (PSSS), the family burden questionnaire (FBIS), the Compliance Scale and the drug compliance scale were used in the group and the end of 12 month. To evaluate the disability status, social function, health status, social support and family economic burden of the patient's disparage discrimination scale (PDD). Results: 70 patients were finally entered into the result analysis, including 29 schizophrenic patients, 8 depressive disorder patients, 23 patients with mental disorders caused by epilepsy, and mental disorders. There were 10 cases. There was no significant difference between the general situation of the two groups of patients and their families before the intervention. The scores of WHO-DAS II scale of the patients in the study group were significantly lower and compared with the control group (P0.01). (2) the score of the large body scale in the study group was significantly higher than that of the control group, and the difference was poor compared with the control group. There was no significant statistical significance (P0.01) (3) the body health score of the SF-36 health questionnaire in the study group was significantly increased and compared with the control group (P0.01), the mental health score of the study group was improved and the difference was statistically significant (P0.05) compared with the control group (P0.05); (4) the study group was aware of the social support scale score. There was significant difference in the difference between the control group and the control group (P0.01); (5) there was no significant difference between the study group and the control group, but (6) the score of the family burden scale of the patients in the study group was significantly lower and compared with the control group (P0.01); (7) the patients in the study group took the medicine. There was a significant difference in the score of Compliance Scale and compared with the control group (P0.05); (8) the scores of the family members of the patients in the study group were reduced and the difference was statistically significant compared with the control group (P0.01).Logistics regression results showed that the influence factors of the social function of the patients were the family income and the degree of disability of the patients. The annual income of the patient is positively related to the social function of the patient, the higher the family income is, the better the social function recovery is, the degree of disability of the patient is negatively related to the social function, the higher the degree of disability suggests, the worse the social function of the patient is, and the other factors are not related to the social function of the patient. Dynamic support intervention can reduce the degree of disability, reduce the degree of stigma, reduce the family burden and reduce the degree of family stigma; at the same time, it can improve the compliance of the patients, improve the social function of the patients, improve the quality of life and the level of social support for the patients. The family income and the degree of disability of the patients are the patients' society. Factors affecting the function of the meeting.
【学位授予单位】：河北大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.74

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