基于社区精神卫生服务的社区居民心理预警模型的研究
|
摘要
研究目的:
随着社会经济的快速发展和人们生活水平的提高,严重精神疾病患病率和心理行为问题的发生率呈明显上升趋势,精神卫生问题已成为重大的公共卫生问题和突出的社会问题。精神疾病的增加,给社会和家庭造成巨大压力。为了尽可能减少和避免患者精神衰退,有利于心理康复,回归社会,同时减轻家庭和社会负担,社区精神卫生服务应运而生。社区精神卫生服务是一种新的医疗方式,也是社会发展的需要。本课题通过了解社区居民、社区医务人员及社区管理人员精神卫生服务需求,对社区居民心理健康、生活事件、社会支持、应对方式进行研究,建立心理预警模型,分析其相互关系及内在作用机制,为维护和促进社区居民的心理健康提供理论依据。本研究对社区居民心理健康问题的预防和早期干预具有重要的指导意义,并可为我国社区精神卫生服务的管理、相关卫生政策的制定提供科学依据。
研究方法:
1、文献法
通过查阅相关文献资料,为本研究提供基本理论依据。
2、专家咨询
对社区卫生服务人员、有关专家、研究人员等进行咨询,用于设计调查问卷、选择所需心理调查量表。
3、现场调查方法
在武汉市选取4个社区,以入户方式随机抽取18岁以上的成人1167名进行调查。并随机抽取社区医务人员101名、社区管理人员82名进行调查。
4、统计分析方法
采用卡方检验、方差分析、多元线性回归分析、Logistic回归分析、AMOS4结构方程模型等统计方法进行分析。
5、半结构访谈
根据事先确定的问题对社区医疗管理人员进行访谈。
研究内容:
应用设计的社区精神卫生服务需求问卷对社区医务人员、社区管理人员、社区居民进行调查,研究社区精神卫生服务需求的情况,并分析精神卫生服务对社区居民生活工作有影响的因素;对社区卫生管理人员进行访谈;对社区居民作生活事件量表、应对方式、社会支持、症状自评量表(SCL-90)的测试与调查,分析其相互关系,从个体和生活事件角度研究社区居民心理健康的预测因素,从应对方式和生活事件角度研究社区居民心理健康的危险因素和保护因素,对社会支持与生活事件、心理健康之间的关系和作用机制进行研究,构建社区居民心理预警模型;结合精神分析理论、社会学理论、认知理论、心理应激、健康教育等相关理论进行分析。根据上述研究分析,提出我国建立社区精神卫生服务的重要性以及社区居民心理预警机制和防治措施,并构建了适合我国社区精神卫生服务的心理卫生服务模式。
研究结果:
1、大部分社区医务人员、社区管理人员、社区居民认为社区需要有精神卫生服务,不同文化程度、不同性别、不同收入、不同年龄、不同婚姻状况的社区居民对社区精神卫生服务的需求是不相同的。
2、根据SCL-90的筛查结果,发现有心理问题者353人,心理问题总检出率达30.2%。男、女社区居民心理问题检出率分别为26.42%和32.32%,两者比较有显著性差异,女性明显高于男性。社区居民SCL-90评分除了躯体化与焦虑两因子与常模比差异无统计学意义外,其他因子得分差异有统计学意义;不同性别、不同文化、不同年龄、不同婚姻的社区居民在SCL-90评分、应付方式、社会支持方面,某些因子比较差异有统计学意义。
3、社区居民在心理健康、社会支持、应对方式方面进行差异性分析发现,某些因子与婚姻、文化、性别、年龄存在显著交互作用。
4、社区居民生活事件调查发现,在家庭有关问题坏事方面发生最多的事件是家庭经济困难,在工作学习有关问题坏事方面发生最多的事件是工作学习中的压力大,在社交与其他问题坏事方面发生最多的事件是被人误会、错怪、诬告。在家庭有关问题好事方面最多的事件是恋爱或订婚,在工作学习有关问题好事方面最多的事件是开始就业、其次是突出的个人成就。生活事件刺激量评分比较,性别在学习工作方面比较差异有统计学意义,其他方面比较差异无统计学意义;不同婚姻、不同文化、不同年龄的社区居民在某些生活事件方面比较差异有统计学意义。
5、相关分析表明,社区居民家庭有关坏事、工作学习坏事、社交等问题坏事与SCL-90各因子呈正相关,家庭有关好事、工作学习好事与SCL-90某些因子呈正相关。社区居民应对方式中解决问题与客观支持、主观支持、支持利用度、支持总分呈正相关,求助与客观支持、支持利用度、支持总分呈正相关;自责、幻想、合理化与客观支持、主观支持、支持利用度、支持总分呈负相关,退避与客观支持、主观支持、支持总分呈负相关。
6、以SCL-90总分为因变量,生活事件各因子及婚姻、文化、年龄、性别为自变量做多因素逐步回归分析,结果显示文化程度、婚姻状况、家庭问题坏事、工作学习问题坏事、社交及其他问题坏事对心理健康有显著的预测作用(p<0.05)。
7、将心理健康作为因变量(两分类变量:SCL-90因子中有1项或1项以上2分者为1,SCL-90因子分均<2分者为0),应对方式各因子为自变量,进行二项分类Logistic逐步回归多因素分析,结果显示解决问题、自责、幻想被选入模型,其中自责和幻想的OR值最高,为危险因素;解决问题为保护因素。将心理健康作为因变量(两分类变量:SCL-90因子中有1项或1项以上2分者为1,SCL-90因子分均<2分者为0),生活事件各因子为自变量,进行二项分类Logistic逐步回归多因素分析,结果显示家庭有关坏事、工作学习坏事、社交等问题坏事被选入模型,被选入的三个因素均为危险因素。通过预警模型可及时发现有心理问题的社区居民,对他们进行早期预防干预,防止心理疾病的发生。
8、对社区居民生活事件、社会支持与心理健康的结构方程模型进行拟和检验,发现整合模型的各种拟和度指标均高于独立模型,整合模型具有较高的拟和度和稳定性。表明社会支持在生活事件对心理健康的影响方面起着中介调节作用,社会支持不足将有损心理健康。
结论与建议:
生活事件中家庭问题坏事、工作学习问题坏事、社交及其他问题坏事、文化程度、婚姻状况等对社区居民心理健康有预测作用,自责、幻想是心理健康的危险因素,解决问题为心理健康的保护因素;社会支持对生活事件的应激具有较大的调节作用。因此,社区精神卫生服务机构应指导社区居民利用社会支持,在应对方式上多应用解决问题成熟型方式,少自责、幻想;要重视高文化程度及其他婚姻状况人群的心理情况,对生活中出现家庭有关问题坏事、工作学习问题坏事、社交及其他问题坏事的社区居民及时提供心理卫生服务,预防和减少精神疾病的发生。
政府应加强对精神卫生服务的投入,提高社区精神卫生服务专业人员素质,并扩大宣传力度;建立以预防为主,以需求为向导的治疗机制,满足不同人群的精神卫生服务需求;合理配置卫生资源和服务内容,降低医疗费用的支出。
建议社区精神卫生服务机构采用建立心理档案、实施心理测评、早期发现心理问题、及时预防、有效干预等“五位一体”的心理卫生服务模式,给每一位参加心理测试的社区居民建立心理档案,并根据所测指标统计得分,划分为轻度预警、中度预警、重度预警等几种类型。做到心理问题及早发现、及早预防、及早干预。充分利用社区的人、财、物、信息资源,达到精神疾病预防及提高社区居民心理健康的目的。
创新:
本研究在对我国社区精神卫生服务需求、社区居民心理状况、生活事件、社会支持、应对方式、不同群体社区居民特点及关系进行研究的基础上,运用结构方程模型、多元回归及Logistic回归分析,探讨了社区居民心理健康的预测因素、危险因素、保护因素;对社会支持与心理健康、生活事件的作用机制进行了研究;建立了社区居民心理预警模型,通过预警模型可以检测出社区居民的心理健康情况,发现需要心理预防干预的社区居民。提出了在社区精神卫生服务中应构建:心理档案、心理测评、早期发现心理问题、及时预防、有效干预“五位一体”的心理卫生服务模式。
Research purposes:
With the rapid development of social economy and the improvement of people's standard of living, the prevalence of severe mental illness and the incidence of psychological problems have a clear upward trend. The mental health problems have become a major public health problem and outstanding social issues. The increase of mental illness cause tremendous pressure to social and family. In order to minimize and avoid recession of the patients spirit, be propitious to patients’psychological rehabilitation so as to return to society, and reduce the burden of the family and society at the same time, the community mental health services has emerged.
The Community mental health service is not only a new medical treatment, but also the needs of social development. By knowing the needs of community mental health services of the community residents, the community medical staff and the community management, this project studies on the community residents’psychological health, life events, social support and coping style, creat a psychological early-warning model to analyze their mutual relations and internal mechanisms, and provide a theoretical basis to safeguard and promote the psychological health of community residents.
The project is of great important guiding significance for the prevention and early intervention of the psychological health problems among the community residents, and it provides a scientific basis for the management of our community mental health services and the establishment of health policy.
Methods:
1. Literature search
The study regarded theories of spirit analyse, cognitive, psychological stress and sociology as the theoretical foundation, through consulting professional magazines, journals, memoir and on-line information retrieval related literature, and collecting relevant research data of community mental health services, community health services, life events, mental health, social support, coping styles and other both at home and abroad, to provides the basic theoretical framework of the research.
2. Experts consultation
The staff of community Health Service, relational experts, researchers and so on were consuted for the design of survey questionnaires and selecting the scale of the necessary psychological research.
3. Scene investigation method
According to the research purposes, four communities were selected in Wuhan City, 1,167 adults who were over the age of 18 were selected randomly and were investigated in households methods. 101 medical staff and 82 community management staff were selected randomly for the investigation as well.
4. Statistical analysis method
According to the property of the information, the statistical analysis methods were used , such as the chi-square test, multiple linear regression, Logistic regression analysis, AMOS4 structural equation model.
5. Semi-structured interview
This was based on understanding the needs of the mental health to the community residents, community managers and medical staff , in accordance to prior questions to interview community medical management so as to collect and in-depth information and data.
Contents:
Use the designed questionnaire about needs of community mental health service to investigate the community medical staff, the community managers and community residents, to interview community health managers, to test and survey the community residents with Life Event Scale, Coping style, social support and SCL-90; and analysis the relationship and the fuction mechanism of them, to study the prognostic factors, dangerous factors and protective factors on the psychological health; to estable psychological early-warning model of community residents, and combine the related theory to analysis it, such as sociology theory, cognitive theory, psychological stress, health education and so on; to construct the psychological health service model of community mental health services which fits our country.
Results:
1. The majority community medical staff, community managers and community residents thought that the community should have mental health service. There were different needs of the community mental health service in education, gender, incomes, ages, marital.
2. Detective rate of psychological problem: 353 persons were detected with psychological problem according to SCL-90 results. The totle detective rate accounts for 30.2 %. Detection rates of psychological problems of male and female community residents were 10.44% and 19.56%, and there was a significant difference between men and women. Female’s rate is significantly higher than the male’s. By investigating the SCL-90 scor of community residents, the score difference of factors has statistical significance apart from factors of somatization and anxiety with nation-wide norm in China. The result showed that there were significant difference among different sex, cultures, ages and marital of community residents in the certain factors of SCL-90, social support and coping styles.
3. There were significant interactions of certain factors with marriage, culture, gender, age in the psychological health of community residents, social support and coping style.
4. The investigate of life events among community residents found that the most frequent incidents of the worse aspects of family-related problems are economic difficulties, the most frequent incidents of the worse aspects of work and study related problems are work and study pressure, and most frequent incidents of the worst aspects of sociality and other problems are misunderstandings, Cuguai, false accusations. The most frequent incidents of the best aspects of family-related problems are love or engagement. The most frequent incidents of the best aspects of work and study problems are the beginning of employment, followed by the outstanding individual achievement. With the comparison of the scores of life events’stress, there is significant difference sex in the aspects of work and study while others are not. There were significant differences among different marriage, different cultures, different ages community residents in some factors of life events.
5. The bad aspects of community residents’families, work and study, sociality and other problems were positively correlative with the some factors of SCL- 90, while the good aspects of community residents’families, work and study were positively correlative with the some factors of SCL- 90. In community residents’coping styles, the solving problem was positively correlative with the objective support, subjective support and the extent of support use and totle scores of support. The assistance was positively correlative with the objective support, the extent of support use and the total scores of support. While self-accusation, fantasy and rationalization were negatively correlative with the objective support, subjective support, the extent of support use and the total scores of support; and retreat were negatively correlative with the objective support, subjective support and the total scores of support.
6. The result of a multi-factor stepwise regression analysis, with the total score SCL-90 as dependent variable and factors of life events, marriage, culture, age, sex as variables, showed that education degrees, marital status, incidents of family-related bad incidents, bad incidents of work and study, bad incidents of sociality problems have significant prognostic effect on the psychological health (p <0.05).
7. The results of a logistic multi-factor regression analysis by binomial classification, with psychological health as dependent variable (dichotomized variable : SCL-90 factors which has 1 item or above with scores equal or bigger than 2 are valued 1, while thoses with an average score smaller than 2 are valued 0) and all factors of coping style as independen variables, showed that solving the problem, self-accusation and fantasy were modeled, in which the OR scores of fantasy and self-accusation were high and were dangerous factors, while the solving the problem was found to be the protective factors .
The results of a logistic multi-factor regression analysis by binomial classification, with psychological health as dependent variable (dichotomized variable : SCL-90 factors which has 1 item or above with scores equal or bigger than 2 are valued 1, thoses with an average score smaller than 2 are valued 0) and all factors of life events as independen variables, showed that the family-related bad incidents, bad incidents of work and study and bad incidents of sociality problems were modeled, in which three factors were dangerous factors.
We can timely found the community residents of psychological problems through early warning model, and those of community residents can be early prevented and intervented and prevent them having mental diseases.
8. The degree of fitting test to the structure equation model of life events, social support and psychological health of psychological health of community residents found that various of fitting indices of the integrated model were higher than those of the independent model, and the integrated model has higher degrees of fitting and stability. The social support has regulatory effects on the stress of life events to the residents’psychological health.
Conclusion and Suggestion:
With regard to the bad incidents of family problems, work or learning problems, sociality and other problems in life events, educational degrees and marital status have significantly prognostic effect on the psychological health of community residents. The fantasy and self-accusation are the risk factors of psychological health, and solving the problem is the protective factors of psychological health.
The social support has greater regulatory effects on the stress of life events, we should guide community residents to take advantage of social support and make more use of solving the problem, which is a mature way, less self-reproach and illusions as well. The psychological situation of people with higher education and other marital status should be attended importance to. And the community residents which have the bad incidents of family problems, work and learning problems, sociality and other problems should be provided with mental health knowledge, to prevent and reduce their mental diseases.
The community should carry out mental health services actively. While the government should step up investment in mental health services, expand its propaganda efforts, focus on prevention, set up an effective treatment mechanism, improve professional qualities of community mental health services, use demands as guide to meet the needs of different groups of people, reasonably allocating health resources and services, and reduce medical expenses.
Community mental health services should be established the psychological health service model of "five in one", which are psychological files, psychological examination, early detecting psychological problems, the timely prevention and effective intervention. Every community residents who has participate the psychological test should be created a psychological file, and be measured off early warning mild, moderate warning, severe warning in accordance to Statistical score of the tested indexes. And psychological problems should be early detection, early prevention and early intervention.
Our government should attach importance to the community mental health services, increas the investments of community mental health services,improving the professional qualities of community medical staff, the use of community people、money、goods、information resources to reach the goals of prevention of mental illness and promotion of psychological health of community residents.
Innovation:
Base on the research of the needs of community mental health service, psychological status of the community residents, life events, social support, coping styles and different groups of people’s characteristics and relationship in our country, from the view of the establishment of psychological early-warning model of community residents which uses structural equation model, multivariate regression and Logistic regression analysis, we discuss the psychological health forecast factors, dangerous factors and protective factors, and fuction mechanism of social support, mental health and life events. Through the early warning model we can find community residents who need psychological prevention and intervention.
In addition, the research attempts to regard life events as a source of stress, starts from the evaluation of the mental stress response, psychological defense mechanisms and cognitive, by researching life stress of community residents and needs of community mental health service, and combines cognitive behavioral and learning theory ,social science, health education and other disciplines’theories, and puts forward that the community mental health services is low net of the tertiary network of mental illness. The tertiary prevention is of important guiding significance to community mental health service, and health education, health promotion and health advocacy play an important role in the aspect of prevention and cure of the psychological health of community residents. Community mental health services should be established: Psychological files, psychological examination, early detection of psychological problems, the timely prevention and effective intervention, that is "five in one," the psychological health service model.
随着社会经济的快速发展和人们生活水平的提高,严重精神疾病患病率和心理行为问题的发生率呈明显上升趋势,精神卫生问题已成为重大的公共卫生问题和突出的社会问题。精神疾病的增加,给社会和家庭造成巨大压力。为了尽可能减少和避免患者精神衰退,有利于心理康复,回归社会,同时减轻家庭和社会负担,社区精神卫生服务应运而生。社区精神卫生服务是一种新的医疗方式,也是社会发展的需要。本课题通过了解社区居民、社区医务人员及社区管理人员精神卫生服务需求,对社区居民心理健康、生活事件、社会支持、应对方式进行研究,建立心理预警模型,分析其相互关系及内在作用机制,为维护和促进社区居民的心理健康提供理论依据。本研究对社区居民心理健康问题的预防和早期干预具有重要的指导意义,并可为我国社区精神卫生服务的管理、相关卫生政策的制定提供科学依据。
研究方法:
1、文献法
通过查阅相关文献资料,为本研究提供基本理论依据。
2、专家咨询
对社区卫生服务人员、有关专家、研究人员等进行咨询,用于设计调查问卷、选择所需心理调查量表。
3、现场调查方法
在武汉市选取4个社区,以入户方式随机抽取18岁以上的成人1167名进行调查。并随机抽取社区医务人员101名、社区管理人员82名进行调查。
4、统计分析方法
采用卡方检验、方差分析、多元线性回归分析、Logistic回归分析、AMOS4结构方程模型等统计方法进行分析。
5、半结构访谈
根据事先确定的问题对社区医疗管理人员进行访谈。
研究内容:
应用设计的社区精神卫生服务需求问卷对社区医务人员、社区管理人员、社区居民进行调查,研究社区精神卫生服务需求的情况,并分析精神卫生服务对社区居民生活工作有影响的因素;对社区卫生管理人员进行访谈;对社区居民作生活事件量表、应对方式、社会支持、症状自评量表(SCL-90)的测试与调查,分析其相互关系,从个体和生活事件角度研究社区居民心理健康的预测因素,从应对方式和生活事件角度研究社区居民心理健康的危险因素和保护因素,对社会支持与生活事件、心理健康之间的关系和作用机制进行研究,构建社区居民心理预警模型;结合精神分析理论、社会学理论、认知理论、心理应激、健康教育等相关理论进行分析。根据上述研究分析,提出我国建立社区精神卫生服务的重要性以及社区居民心理预警机制和防治措施,并构建了适合我国社区精神卫生服务的心理卫生服务模式。
研究结果:
1、大部分社区医务人员、社区管理人员、社区居民认为社区需要有精神卫生服务,不同文化程度、不同性别、不同收入、不同年龄、不同婚姻状况的社区居民对社区精神卫生服务的需求是不相同的。
2、根据SCL-90的筛查结果,发现有心理问题者353人,心理问题总检出率达30.2%。男、女社区居民心理问题检出率分别为26.42%和32.32%,两者比较有显著性差异,女性明显高于男性。社区居民SCL-90评分除了躯体化与焦虑两因子与常模比差异无统计学意义外,其他因子得分差异有统计学意义;不同性别、不同文化、不同年龄、不同婚姻的社区居民在SCL-90评分、应付方式、社会支持方面,某些因子比较差异有统计学意义。
3、社区居民在心理健康、社会支持、应对方式方面进行差异性分析发现,某些因子与婚姻、文化、性别、年龄存在显著交互作用。
4、社区居民生活事件调查发现,在家庭有关问题坏事方面发生最多的事件是家庭经济困难,在工作学习有关问题坏事方面发生最多的事件是工作学习中的压力大,在社交与其他问题坏事方面发生最多的事件是被人误会、错怪、诬告。在家庭有关问题好事方面最多的事件是恋爱或订婚,在工作学习有关问题好事方面最多的事件是开始就业、其次是突出的个人成就。生活事件刺激量评分比较,性别在学习工作方面比较差异有统计学意义,其他方面比较差异无统计学意义;不同婚姻、不同文化、不同年龄的社区居民在某些生活事件方面比较差异有统计学意义。
5、相关分析表明,社区居民家庭有关坏事、工作学习坏事、社交等问题坏事与SCL-90各因子呈正相关,家庭有关好事、工作学习好事与SCL-90某些因子呈正相关。社区居民应对方式中解决问题与客观支持、主观支持、支持利用度、支持总分呈正相关,求助与客观支持、支持利用度、支持总分呈正相关;自责、幻想、合理化与客观支持、主观支持、支持利用度、支持总分呈负相关,退避与客观支持、主观支持、支持总分呈负相关。
6、以SCL-90总分为因变量,生活事件各因子及婚姻、文化、年龄、性别为自变量做多因素逐步回归分析,结果显示文化程度、婚姻状况、家庭问题坏事、工作学习问题坏事、社交及其他问题坏事对心理健康有显著的预测作用(p<0.05)。
7、将心理健康作为因变量(两分类变量:SCL-90因子中有1项或1项以上2分者为1,SCL-90因子分均<2分者为0),应对方式各因子为自变量,进行二项分类Logistic逐步回归多因素分析,结果显示解决问题、自责、幻想被选入模型,其中自责和幻想的OR值最高,为危险因素;解决问题为保护因素。将心理健康作为因变量(两分类变量:SCL-90因子中有1项或1项以上2分者为1,SCL-90因子分均<2分者为0),生活事件各因子为自变量,进行二项分类Logistic逐步回归多因素分析,结果显示家庭有关坏事、工作学习坏事、社交等问题坏事被选入模型,被选入的三个因素均为危险因素。通过预警模型可及时发现有心理问题的社区居民,对他们进行早期预防干预,防止心理疾病的发生。
8、对社区居民生活事件、社会支持与心理健康的结构方程模型进行拟和检验,发现整合模型的各种拟和度指标均高于独立模型,整合模型具有较高的拟和度和稳定性。表明社会支持在生活事件对心理健康的影响方面起着中介调节作用,社会支持不足将有损心理健康。
结论与建议:
生活事件中家庭问题坏事、工作学习问题坏事、社交及其他问题坏事、文化程度、婚姻状况等对社区居民心理健康有预测作用,自责、幻想是心理健康的危险因素,解决问题为心理健康的保护因素;社会支持对生活事件的应激具有较大的调节作用。因此,社区精神卫生服务机构应指导社区居民利用社会支持,在应对方式上多应用解决问题成熟型方式,少自责、幻想;要重视高文化程度及其他婚姻状况人群的心理情况,对生活中出现家庭有关问题坏事、工作学习问题坏事、社交及其他问题坏事的社区居民及时提供心理卫生服务,预防和减少精神疾病的发生。
政府应加强对精神卫生服务的投入,提高社区精神卫生服务专业人员素质,并扩大宣传力度;建立以预防为主,以需求为向导的治疗机制,满足不同人群的精神卫生服务需求;合理配置卫生资源和服务内容,降低医疗费用的支出。
建议社区精神卫生服务机构采用建立心理档案、实施心理测评、早期发现心理问题、及时预防、有效干预等“五位一体”的心理卫生服务模式,给每一位参加心理测试的社区居民建立心理档案,并根据所测指标统计得分,划分为轻度预警、中度预警、重度预警等几种类型。做到心理问题及早发现、及早预防、及早干预。充分利用社区的人、财、物、信息资源,达到精神疾病预防及提高社区居民心理健康的目的。
创新:
本研究在对我国社区精神卫生服务需求、社区居民心理状况、生活事件、社会支持、应对方式、不同群体社区居民特点及关系进行研究的基础上,运用结构方程模型、多元回归及Logistic回归分析,探讨了社区居民心理健康的预测因素、危险因素、保护因素;对社会支持与心理健康、生活事件的作用机制进行了研究;建立了社区居民心理预警模型,通过预警模型可以检测出社区居民的心理健康情况,发现需要心理预防干预的社区居民。提出了在社区精神卫生服务中应构建:心理档案、心理测评、早期发现心理问题、及时预防、有效干预“五位一体”的心理卫生服务模式。
Research purposes:
With the rapid development of social economy and the improvement of people's standard of living, the prevalence of severe mental illness and the incidence of psychological problems have a clear upward trend. The mental health problems have become a major public health problem and outstanding social issues. The increase of mental illness cause tremendous pressure to social and family. In order to minimize and avoid recession of the patients spirit, be propitious to patients’psychological rehabilitation so as to return to society, and reduce the burden of the family and society at the same time, the community mental health services has emerged.
The Community mental health service is not only a new medical treatment, but also the needs of social development. By knowing the needs of community mental health services of the community residents, the community medical staff and the community management, this project studies on the community residents’psychological health, life events, social support and coping style, creat a psychological early-warning model to analyze their mutual relations and internal mechanisms, and provide a theoretical basis to safeguard and promote the psychological health of community residents.
The project is of great important guiding significance for the prevention and early intervention of the psychological health problems among the community residents, and it provides a scientific basis for the management of our community mental health services and the establishment of health policy.
Methods:
1. Literature search
The study regarded theories of spirit analyse, cognitive, psychological stress and sociology as the theoretical foundation, through consulting professional magazines, journals, memoir and on-line information retrieval related literature, and collecting relevant research data of community mental health services, community health services, life events, mental health, social support, coping styles and other both at home and abroad, to provides the basic theoretical framework of the research.
2. Experts consultation
The staff of community Health Service, relational experts, researchers and so on were consuted for the design of survey questionnaires and selecting the scale of the necessary psychological research.
3. Scene investigation method
According to the research purposes, four communities were selected in Wuhan City, 1,167 adults who were over the age of 18 were selected randomly and were investigated in households methods. 101 medical staff and 82 community management staff were selected randomly for the investigation as well.
4. Statistical analysis method
According to the property of the information, the statistical analysis methods were used , such as the chi-square test, multiple linear regression, Logistic regression analysis, AMOS4 structural equation model.
5. Semi-structured interview
This was based on understanding the needs of the mental health to the community residents, community managers and medical staff , in accordance to prior questions to interview community medical management so as to collect and in-depth information and data.
Contents:
Use the designed questionnaire about needs of community mental health service to investigate the community medical staff, the community managers and community residents, to interview community health managers, to test and survey the community residents with Life Event Scale, Coping style, social support and SCL-90; and analysis the relationship and the fuction mechanism of them, to study the prognostic factors, dangerous factors and protective factors on the psychological health; to estable psychological early-warning model of community residents, and combine the related theory to analysis it, such as sociology theory, cognitive theory, psychological stress, health education and so on; to construct the psychological health service model of community mental health services which fits our country.
Results:
1. The majority community medical staff, community managers and community residents thought that the community should have mental health service. There were different needs of the community mental health service in education, gender, incomes, ages, marital.
2. Detective rate of psychological problem: 353 persons were detected with psychological problem according to SCL-90 results. The totle detective rate accounts for 30.2 %. Detection rates of psychological problems of male and female community residents were 10.44% and 19.56%, and there was a significant difference between men and women. Female’s rate is significantly higher than the male’s. By investigating the SCL-90 scor of community residents, the score difference of factors has statistical significance apart from factors of somatization and anxiety with nation-wide norm in China. The result showed that there were significant difference among different sex, cultures, ages and marital of community residents in the certain factors of SCL-90, social support and coping styles.
3. There were significant interactions of certain factors with marriage, culture, gender, age in the psychological health of community residents, social support and coping style.
4. The investigate of life events among community residents found that the most frequent incidents of the worse aspects of family-related problems are economic difficulties, the most frequent incidents of the worse aspects of work and study related problems are work and study pressure, and most frequent incidents of the worst aspects of sociality and other problems are misunderstandings, Cuguai, false accusations. The most frequent incidents of the best aspects of family-related problems are love or engagement. The most frequent incidents of the best aspects of work and study problems are the beginning of employment, followed by the outstanding individual achievement. With the comparison of the scores of life events’stress, there is significant difference sex in the aspects of work and study while others are not. There were significant differences among different marriage, different cultures, different ages community residents in some factors of life events.
5. The bad aspects of community residents’families, work and study, sociality and other problems were positively correlative with the some factors of SCL- 90, while the good aspects of community residents’families, work and study were positively correlative with the some factors of SCL- 90. In community residents’coping styles, the solving problem was positively correlative with the objective support, subjective support and the extent of support use and totle scores of support. The assistance was positively correlative with the objective support, the extent of support use and the total scores of support. While self-accusation, fantasy and rationalization were negatively correlative with the objective support, subjective support, the extent of support use and the total scores of support; and retreat were negatively correlative with the objective support, subjective support and the total scores of support.
6. The result of a multi-factor stepwise regression analysis, with the total score SCL-90 as dependent variable and factors of life events, marriage, culture, age, sex as variables, showed that education degrees, marital status, incidents of family-related bad incidents, bad incidents of work and study, bad incidents of sociality problems have significant prognostic effect on the psychological health (p <0.05).
7. The results of a logistic multi-factor regression analysis by binomial classification, with psychological health as dependent variable (dichotomized variable : SCL-90 factors which has 1 item or above with scores equal or bigger than 2 are valued 1, while thoses with an average score smaller than 2 are valued 0) and all factors of coping style as independen variables, showed that solving the problem, self-accusation and fantasy were modeled, in which the OR scores of fantasy and self-accusation were high and were dangerous factors, while the solving the problem was found to be the protective factors .
The results of a logistic multi-factor regression analysis by binomial classification, with psychological health as dependent variable (dichotomized variable : SCL-90 factors which has 1 item or above with scores equal or bigger than 2 are valued 1, thoses with an average score smaller than 2 are valued 0) and all factors of life events as independen variables, showed that the family-related bad incidents, bad incidents of work and study and bad incidents of sociality problems were modeled, in which three factors were dangerous factors.
We can timely found the community residents of psychological problems through early warning model, and those of community residents can be early prevented and intervented and prevent them having mental diseases.
8. The degree of fitting test to the structure equation model of life events, social support and psychological health of psychological health of community residents found that various of fitting indices of the integrated model were higher than those of the independent model, and the integrated model has higher degrees of fitting and stability. The social support has regulatory effects on the stress of life events to the residents’psychological health.
Conclusion and Suggestion:
With regard to the bad incidents of family problems, work or learning problems, sociality and other problems in life events, educational degrees and marital status have significantly prognostic effect on the psychological health of community residents. The fantasy and self-accusation are the risk factors of psychological health, and solving the problem is the protective factors of psychological health.
The social support has greater regulatory effects on the stress of life events, we should guide community residents to take advantage of social support and make more use of solving the problem, which is a mature way, less self-reproach and illusions as well. The psychological situation of people with higher education and other marital status should be attended importance to. And the community residents which have the bad incidents of family problems, work and learning problems, sociality and other problems should be provided with mental health knowledge, to prevent and reduce their mental diseases.
The community should carry out mental health services actively. While the government should step up investment in mental health services, expand its propaganda efforts, focus on prevention, set up an effective treatment mechanism, improve professional qualities of community mental health services, use demands as guide to meet the needs of different groups of people, reasonably allocating health resources and services, and reduce medical expenses.
Community mental health services should be established the psychological health service model of "five in one", which are psychological files, psychological examination, early detecting psychological problems, the timely prevention and effective intervention. Every community residents who has participate the psychological test should be created a psychological file, and be measured off early warning mild, moderate warning, severe warning in accordance to Statistical score of the tested indexes. And psychological problems should be early detection, early prevention and early intervention.
Our government should attach importance to the community mental health services, increas the investments of community mental health services,improving the professional qualities of community medical staff, the use of community people、money、goods、information resources to reach the goals of prevention of mental illness and promotion of psychological health of community residents.
Innovation:
Base on the research of the needs of community mental health service, psychological status of the community residents, life events, social support, coping styles and different groups of people’s characteristics and relationship in our country, from the view of the establishment of psychological early-warning model of community residents which uses structural equation model, multivariate regression and Logistic regression analysis, we discuss the psychological health forecast factors, dangerous factors and protective factors, and fuction mechanism of social support, mental health and life events. Through the early warning model we can find community residents who need psychological prevention and intervention.
In addition, the research attempts to regard life events as a source of stress, starts from the evaluation of the mental stress response, psychological defense mechanisms and cognitive, by researching life stress of community residents and needs of community mental health service, and combines cognitive behavioral and learning theory ,social science, health education and other disciplines’theories, and puts forward that the community mental health services is low net of the tertiary network of mental illness. The tertiary prevention is of important guiding significance to community mental health service, and health education, health promotion and health advocacy play an important role in the aspect of prevention and cure of the psychological health of community residents. Community mental health services should be established: Psychological files, psychological examination, early detection of psychological problems, the timely prevention and effective intervention, that is "five in one," the psychological health service model.
引文
1.许毅,胡少华.精神卫生:我国公共卫生事业面临的严峻挑战[J].中华预防医学杂志,2005,39(4):228
2.汪润炎,陈丽华.精神卫生纳入公共卫生体系是发展精神卫生事业的重要保证[J].医学与社会,2005,18(1):25-27
3. Gao J.,Tang S,Tolhurst R.,and rao K.Changing access to health services in urban China:Implications for equity[J].Health Policy and Planning,2001,12(4):302—312
4. Phillips M.R.The transformation of China’s mental health services[J] The China Journa1.1998,39:1- 36
5.施侣元主编.流行病学[M].北京:人民卫生出版社,2003.252
6.潘忠德,沈文龙,张国芳.社区精神卫生的发展概况与展望[J].中国民康医学杂志,2005,17(6)308-309
7.甘一方.积极开展社区精神卫生服务是全科医师的重要职责[J].中华全科医师杂志,2003.2(3)129.
8. United States Public Health Service Office of the Surgeon Genera1. Mental Health: Culture.Race.and Ethnicity:A Supplement to mental Health: A report of the Surgeon General
9. Farmer,E.M.Z ,Mustillo,S.,Burns.B.,& costello, E.J.(2003).The epidemiology of mental health programs and service use in youth:Results from the Great Smoky Moun-taias Study,In United States Public Health Service 0ffice of the Surgeon General(1999), Mental Hea1th:A Report of the Surgeon Genera1. Rockville, MD: Department of Health and Human Services, U.S.Public Health service
10. World Health Organization.(2001).The World Health Report 2001一Mental Health: New Understanding, New Hope.Geveva:World Health 0rganiz2mtion
11. Institute of Medicine (2002).Reducing Suicide:A National Imperative.Washigton, DC: National Academies Press.Hoyert,D.L.,Arias,E.,Smith,B.L ,Murphy,S.L.,& Kochanek,K.D.(2001).Deaths:Final Data for 1999. National Vital Statistics Report.49.1一ll3
12. Beck,A.J.,& Harrison.P.M.(2001).Prisoners in 2000 (Rep.No.NCJ 188207) .Washington. DC:U.S.Department of Justice.Bureau of Justice Statistics
13. Wisconsin Department of Health and Family Service Bureau of Community Mental Health(2001) .2001 Annual Report for Intigrated Services projects.medison.WI:The Children Come First Advisory committee
14. Snyder,H.N.& sickmund,M.(1999)。Jurenih Ofenders and Victims:1999 National Report.Washington.DC:Office of Juvenile Justice and Delinquency Prevention
15. Lyons,J,S.,Baerger,D.R.,Quigley.J.E.,& Griffin.E.(2001).Mental health service needs of Juvenile ofenders:A comparison of detention, incarceraion, and treatmentsettings.Children’s Services:Social Policy,Research,and Practice.4 69-85
16. Hoult J,Rosen A,Reynolds I.Community oriented treatment compared psychiartric hospital orientament.Soc Sci Med1984;18(11):1005-11
17. Hambridge JA,Rosen A.Assertive community treatment for the seriously mentally ill in Suburban Sydney:a programmedescripton and evalution.Aust NZ J Psychiat 1994;28:438-45.
18. Marsella AJ. Toward a”globa-community psychology”meeting the need of changing word [J]. Am Psych,1998,53(12): 1282-91.
19.宋修珍,孔临萍燕炯等.我国社区精神卫生服务的现状及对策[J].山西医科大学学报,2004,35(1)85-87
20.崔承英,谷广臣,张国平.农村社区精神卫生工作的现状和对策[J].中国农村卫生事业管理,2000,20(8):56.
21.吴均林周指明陈智聪等.社区居民心理卫生服务需求初探[J].中华临床医药,2004,5(7)37-39
22. Rabkin J,Struening EL.Life events,stress,and illness science, 1979:194;1013
23. Bandelow B, Charomo Torrent A, Wedekind D, et al. Early traumatic life events,parental rearing styles, family history of mental disorders, and birth risk farental rearing styles, family history of mental disoeders, and birth risk factors in patients with social anxiety disorder[J].Eur Arch Psychiatry Clin Neurosci,2004,12
24.O’Sullivan C. The psychosocial determinants of depression: alifespan perspective [J].J Nerv Ment Dis, 2004,192(9):585-594
25.Scheller Gilkey G, Moynes K, Gooper I, et al. Early life stress and PTSD symptoms in patients with comorbid schizophrenia and substance abuse[J].Schizophr Res, 2004,69(2-3):167-174
26. Foley DL, Eaves LJ, Wormley B,et al. Childhood adversity monoamine oxidase a genotype, and risk for conduct disorder[J].Arch Gen Psychiatry,2004,61:738-744
27. Monroe S M, Simons A D.Diathesis-stress theories in the context of life stress research: implications for the depressive disorders. Pchological Bullrtin, 1991, 110(3):406-425. .
28.Jacqueline B P, David M F. Assessment of depression. In: Bellack, A. S., Hersen, M. Behavioral Assessment A Practical Handbook(4thed). Allyn & Bacon, 1998, 211-223
29. Kessler R C. The effects of stressful life events on depression. Annual Review of psychology, 1997,48:191-211
30.刘贤臣,马登岱.生活事件、应对方式与青少年抑郁的相关研究[J].中国临床心理学杂志,1997,5(3)166-167
31. Lazarus RS,Folkman S.Stress,Appraisal and Coping.New York:springer.1984
32. Ruffin CL.Stress and health: little hassles vs maor life events.Australian Psychologist,1993,28(30):201-208
33. Ventura J, Nuechterlein KL,et al. Self-efficacy and neurocognition may be related to coping responses in recent-onset schizophrenia[J]. Schizophr Res, 2004, 69(2-3):343-352
34. Gibin S, Clare L, Livingston G, et al. Psychosocial correlates of late-onset psychosis: life experiences, cognitive schemas, and attitudes to ageing[J]. Int J Geriatr Psychiatry, 2004,19(7):611-623
35. Ferrando M, Andre Y, Galdon MJ, et al. Psychological variables andtemporomandibular disorders: distress, coping, and personality[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Eendod, 2004, 98(2):153-160
36. Stewart SH, Mitchell TL, Wright KD, et al. The relations of PTSD symptoms to alcohol use and coping drinking in volunteers who responded to the Swissair Flight 111 airline dirline disaster[J].J Anxiety Disord, 2004,18(1):51-68
37. Edwards JR, Cooper CL. Research in stress coping and health-theoretical and methodological issues. Psychological Medicine, 1998,18:15-20
38. Andrews G.Life event stress, social support, coping style, and risk of psycho logical impairment. J Nerv Ment Dis, 1978, 166:307-316
39.Kim JM, Sewart R, Shin IS,et al. Lifetime urban/rural residence, social support and late-life depression in Korea[J]. Int J Geriatr Psychiatry, 2004, 19(9):843-851
40. Torgrud LJ, Walker JR, Murray L, et al. Deficits in perceived social support associater with generalized social phobia[J]. Cogn Behav Ther, 2004, 33(2):87-96
41. Aviram RB, Hellerstein DJ, Gerson J,et al.Adapting supportive psychotherapy for individuals with Borderline personality disorder who self-injure or attempt suicide[J].J Psychiatr Pract,2004,10(3):145-155
42. Droes RM, Meiland F, Schmitz M. Effect of combined support for people with dementia and carers versus regular day care on behaviour and mood or persons with dementia: results from a multicentre implementation study[J].Int J Geriatr Psychiatry,2004,19(7):673-684
43. Barrera,M. Distinctions between social support concepts, measures and models. American Journal of Community Psychology,1986,14:413-445
44. Dunked-Schetter, C., & Bennett, T.L. Differentiating the cognitive and behavioral aspects of social support. In; I. G. Sarason, B. R. Sarason, & G. R. Pierce (Eds.). Social support: an interactional view. New York: Wiley, 1990:267-296
45. Brissette, I., Scheier, M. F., & Carver, C. S. The role of optimism in social network development, coping, and psychological adjustment during a life transition. Journal ofPersonality and Social Psychology, 2002,82:102-111
46. Levendosky, A. A., Huth-Bocks, A., & Semel, M. A., Adolescent peer relationships and mental health functioning in families with domestic violence. Journal of Clinical Child and Adolescent Psychology, 2002, 31:206-218
47. Wu, T., & Serper, M.R. Social support and psychopathology in homeless patients presenting for emergency psychiatric treatment Journal of Clinical Psychology,1999,55:1127-1133
48. Wong, Daniel F K. Difficulties and patterns of social support of mature college students in Hong Kong:implications for student guidance and counseling services. British Journal of Guidance & Counselling, 197,25(3):377
49.Florian, Victor; Mikulincer, Mario. Effects of adult attachment style on the perception and search for social support. Journal of Psychology, 1995,129(6):66
50. Nan lin, Alfred Dean, Walter. Social support, life events and depression, 1986
51. Avison W R, Gotlib IH. Stress and mental health contemporary issues and prospects for the future [M]. New York: Plenum Press, 1994:23-36
52.杨莉,胡竹箐.上大学前、后生活事件与大学生心理健康的关系研究[J].心理科学, 2005,28(5)1223-1226
53.李茹.军校医学生生活事件、应付方式与心理健康的相关分析[J].中国临床心理学杂志,2004:12(2):165
54.董晓倩.高二学生应激性生活事件和焦虑情绪的相关性研究[J].中国健康心理学杂志,2005:13(1):57
55.陈爽冀国峰.职业驾驶员心理应激及其相关变量分析[J].中国心理卫生杂志, 2002, 16 (12 )822-824
56.钟霞,姜乾金,钱丽菊等.医务人员压力反应与社会支持、生活事件、应对方式的相关研究[J].中国临床心理学杂志,2005,13(1)70-72
57.李红政,雷美英,刘练红.生活事件在新兵个性、应付方式、社会支持及心理症状关系模型中的作用[J].第四军医大学学报,2006; 27 (4):355-358
58.金华,吴文源,张明园.中国正常人scl-90评定结果的初步分析[J].中国神经精神疾病杂志, 1986,12(5):260-263
59.汪向东,王希林,马弘等.心理卫生评定量表手册(增订版)[M].北京:中国心理卫生杂志社,1999,33-131
60.姜乾金.护理心理学[M].杭州:浙江大学出版社2006,12-127
61.潘蕴倩.心理学基础[M].北京:人民卫生出版社1999,59-83
62.田本淳.健康教育与健康促进实用方法[M].北京北京大学医学出版社, 2005,16-357
63.梁宝勇.精神压力、应对与健康[M].北京:教育科学出版社,2006,1-11,39-66
64.吴均林,林大熙.医学心理学教程[M].北京:高等教育出版社, 2005,78-124.
65.冯丽云,王宇中,吴国华等.生活事件因素对青年学生心理健康水平影响的探讨[J].中国公共卫生,2000,16 (1):4一6
66.廖全明.中国人心理健康现状研究进展[J].中国公共卫生,2007,23(5):556-557
67.胡佩诚,宋燕华.心理卫生和精神疾病护理[M].北京:北京医科大学出版社, 1999,37-38
68.Shigemi J, Mino Y, Isuda T, et al. The relationship between job stress and mental health at work. Ind Health, 1997,35:29-35
69. Fujino Y, Mizoue T, Izumi, et al. Job stress and mental health among permanent night workers. J Occup Health, 2001,43:301-306
70.顾杏元,龚幼龙主编.社会医学[M].第十四版,上海:复旦大学出版社,2004,114
71.丁锦红,王净.在校大学生社会支持状况研究[J].首都师范大学学报(社会科学版),2000,132(1):114-116
72. Colen SA, Wils TA.Stress, social support and the buffering hypothesis.Psychological Bulletun,1985,8(2):310-357
73. Eric Stice, Jennifer Ragan, Patrick Randall. Prospective Relations Between Social Support and Depression: Differential Direction of Effects for Parent and Peer Support?Journal of Abnormal Psychology, 2004,113(1):155-159
74. Grant I, Patterson TL. Social Supports in Relation to Physical Health and Symptoms of Depression in the Elderly. The American Journal of Psychiatry, 188,145(10):1254-1258
75. Kimiko Hashimoto, Hiroshi Kurita, Takashi Harataniet al.Direct and buffering effects of social support on depressive symptoms of the elderly with home help. Psychiatry and Clinical Neurosciences,1999,53:95-100
76. Kendler KS, Myers J, Prescott CA. Sex differences in the relationship between social support and risk for major depression: a longitudinal study of opposite-sex twin pairs. The American Journal of Psychiatry, 2005, 162(2):250-255
77. Joff PE, Bast BA. Coping and defense in relation to accommodation among asanple of blindman. J nerv Ment Dis, 1978, 166:537-552
78. Neuferld RWT.Advances in the Investigation of Psychological Stress. Pub. Willy Series on Health Psychology. 1989.217-218
79. Vitaliano PP,Maiuro RD, Russo J. et al.Raw versus relative scores in the assessment of coping strategies. Journal of behavioral Mdeicine.1987,10(1):1-18
80.候杰泰,温忠麟,成子娟.结构方程模型及其应用[M].北京教育科学出版社, 2005,154-161
81. Lazarus RS.Stress, appraisal and coping coping capacities. In a scientific debate: How to define and research stress. National Institute of Mental Health, Center for Prevention Research. Washington, DC: Us Department of Health and Human Services, Public Health Service,1985
82. Hamberger LK, Lohr JM. Stress and stress management: Research and applications. New York:Springer,1984
83. Bailey JM, Bhagat RS. Meaning and measurement of stressors in the work environment: an evaluation. In SV. Kasl & CL. Cooper (Eds.), Stress and health: Issues in research methodology. Chichester: John Wiley & Sons,1987
84. Bunnk BP,Peeters MCW. Stress at work, social support and companionship: Towards an event-contin ent recording approach. Work and Stress, 1994, 8:177-190
85. Cartwright S, Cooper C. Managing Workplace Stress.London: Sage Publications, 1997
86. Karasek RA, Theorell T. Healthy work: Stress, productivity and the reconstruction of working life. New York: Basic Books, 1990
87. Cooper DP, O’Driscoll M. Organizational Stress: A Review and Critique of Theory , Research and Applications. Thousand Oaks,CA: Sage,2001
88. Holmes TH, et al. The social readjustment rating scale. Journal of Psychosom Research, 167,11:213-21893. Rabkin J, Struening EL. Life events, stress, and illness science, 1979:194;1013-1020
89. Bolger N, Zuckerman A. A framework for studying personality in the stress process. Journal of Personality & Socoal Psychology, 1995, 69(5):890-902
90. Sarason JG. Et al: Assessing the impact of Life change: development of life experiences survey J of consulting and clinical Psychology 1978, 46:932
91. Thoits PA: Dimensions of life events that influence psychological distress: an evaluation and synthesis of the literature. In: Kaplan H. et (eds):Psychological Stress, Ist ed. New York, Acdemic Press. 1983: 33-103
92. Kessler RC.Price RH. Wootman CB: Social factors in psychopathology: stress. Social support and coping process. Ann Rev Psychology 1985: 36: 531-572
93. Durkleim. E. Suicide: A Sociological Study: New Youk. Fress. 1950
94. House JS. Landis KR. Umberson D: Social relations and health, Science 1988: 241: 640-545
95. Goyne JC. Downey G: Stress, Social support and the coping process. Ann Rev Psychology 1991:42:401-426
96.张少伟,陈景武.公共卫生事业预警及应急处理机制问题探讨[J].国际医药卫生导报,卫生管理版(公共卫生), 2004,16(9)27-29
97.余凤苹,徐勇.疾病监测及早期预警信息的收集应用及管理[J],中国公共卫生管理,2005,21(3)195-197
98.朱月龙.心理健康-细说心理疾病[M].北京:海潮出版社,2007,3-11
99.李继坪.社区护理[M].北京人民卫生出版社,2004:38
100.陈学诗.心理卫生应与社区精神卫生相结合[J].上海精神医学,2002;14:104
1.龚幼龙主编.社会医学[M].北京:人民卫生出版社,2000,154-155
2.潘忠德,沈文龙,张国芳社区精神卫生的发展与展望中国民康医学杂志[J],2005,17(6)308-309
3.宋修珍孔临萍燕炯等我国社区精神卫生服务的现状及对策[J].山西医科大学学报2004,35(1)85-87
4.甘一方积极开展社区精神卫生服务是全科医师的重要职责[J].中华全科医师杂志2003.2(3)129.
5. Hoult J,Rosen A,Reynolds I.Community oriented treatment compared psychiartric hospital orientament.Soc Sci Med1984;18(11):1005-11
6. Hambridge JA,Rosen A.Assertive community treatment for the seriously mentally ill in Suburban Sydney:a programmedescripton and evalution.Aust NZ J Psychiat 1994;28:438-45.
7.梁春莲.美国精神疾病的社区治疗[J].临床精神医学杂志,1998,8(1):50
8. Julian Leff(冉茂盛译).社区精神卫生服务在英国的发展[J].中国民政医学杂志,1996,8(1):42
9.李欣.比利时社区精神卫生服务概况[J].中国医院管理,2000,20(12)
10.阎美琴摘译.瑞典的社区精神保健护理[J].国外精神护理学分册,1999,16(9):433
11.邹义壮Jacques Dubuis Denis Leguray Eric Malapert Jean Dalery法国精神卫生的分区化服务模式[J].临床进上医学杂志,2000,10(4),247
12.许艳玲.香港精神科社区康复服务[J].现代康复,2001,5(7):112~113.
13.向孟泽,冉茂盛.中国社区精神医学的现状和展望[J].四川精神卫生,1995,8(4):271.
14.崔承英,谷广臣,张国平.农村社区精神卫生工作的现状和对策[J].中国农村卫生事业管理,2000,20(8):56.
15. Marsella AJ. Toward a”globa-community psychology”meeting the need of changing word [J]. Am Psych,1998,53(12): 1282-91.
16.黄雪薇。中国特色的社区心理咨询初探[J].河南职工医学院学报,1999,11(1):51
17.吴均林周指明巫云辉等.城市社区心理卫生服务现状研究[J].中国公共卫生管理,2004,20(4)389-390
18.陈红.心理护理是社区精神病人康复的重要因素[J].山东精神医学,1997,10(4):67
19.杨凤池.社区心理卫生服务模式的探索[J].中国全科医学2002.5(11)20
20. Rabkin J,Struening EL.Life events,stress,and illness science, 1979:194;1013
21. Kessler RC. The Effect of Stressful Life Events on Depression. Annual Review of Psychology,1997,48:191
22. Lazarus RS. From Psychological Stress to the Emotions:A History of Changing Outlooks. Annual Review of Psychology,1993,44:2
23.韦有华,汤盛钦.几种主要的应激理论模型及其评价[J].心理科学,1998:(5)
24.汤宝勇等.关于应付的一些思考与实证研究;Ⅰ.应付的概念模型与效果.Ⅱ.应付方式的评定、分离与估计[J].中国心理学杂志。1997:(7)
25. Saposky R M. Why stress is bad for your brain? Science,1996,273 (5276):749-750
26. Holmes T H,Rahe R H. The social readjustment rating scale. Psychosom. Res.1967,11(2):213-218
27. Gadzella B M. Student-Life Stress Inventory:Identification of and Reactions to Stressors'. Psychological Reports,1994,74(2):395-402
28.李茹.军校医学生生活事件、应付方式与心理健康的相关分析[J].中国临床心理学杂志,2004:12(2):165
29.井世杰.初中生的生活事件、应对方式与不良情绪的结构模型研究[J].中国临床心理学杂志,2004;12(3)256-257
30.董晓倩.高二学生应激性生活事件和焦虑情绪的相关性研究[J].中国健康心理学杂志,2005:13(1):57
31.程虹娟.对大学生社会支持的调查研究[J].中国临床心理学杂志,2005;13(3):
32.张巧明.对中学生应付方式的调查研究[J].中国健康心理学杂志,2006;14(3):286
33.井世杰.初中学生日常生活事件的应急强度与心理健康关系的研究[J].青年研究,2000,(5):22
34.吴均林主编.医学心理学教程[M].北京:高等教育出版社,2001,78-82
35.卢祖洵主编.社会医学[M].北京:科技出版社,2003,86-88
36. Folkman S.,Lazarus R. S. Appraisal,coping, health status and psychological symptom. Journal of Personality &Social Psychology, 1986,50:571-579
37.梁宝勇,郭良才等。关于应付的一些思考与实证研究I:应付的概念模式与效果估计[J].中国临床心理杂志,1999,7(3):188-190
38.张林,车文博等,大学生心理压力应对方式特点的研究[J].心理科学,2005,28(1);36
39.陈学诗.心理卫生应与社区精神卫生相结合[J].上海精神医学,2002;14:104
2.汪润炎,陈丽华.精神卫生纳入公共卫生体系是发展精神卫生事业的重要保证[J].医学与社会,2005,18(1):25-27
3. Gao J.,Tang S,Tolhurst R.,and rao K.Changing access to health services in urban China:Implications for equity[J].Health Policy and Planning,2001,12(4):302—312
4. Phillips M.R.The transformation of China’s mental health services[J] The China Journa1.1998,39:1- 36
5.施侣元主编.流行病学[M].北京:人民卫生出版社,2003.252
6.潘忠德,沈文龙,张国芳.社区精神卫生的发展概况与展望[J].中国民康医学杂志,2005,17(6)308-309
7.甘一方.积极开展社区精神卫生服务是全科医师的重要职责[J].中华全科医师杂志,2003.2(3)129.
8. United States Public Health Service Office of the Surgeon Genera1. Mental Health: Culture.Race.and Ethnicity:A Supplement to mental Health: A report of the Surgeon General
9. Farmer,E.M.Z ,Mustillo,S.,Burns.B.,& costello, E.J.(2003).The epidemiology of mental health programs and service use in youth:Results from the Great Smoky Moun-taias Study,In United States Public Health Service 0ffice of the Surgeon General(1999), Mental Hea1th:A Report of the Surgeon Genera1. Rockville, MD: Department of Health and Human Services, U.S.Public Health service
10. World Health Organization.(2001).The World Health Report 2001一Mental Health: New Understanding, New Hope.Geveva:World Health 0rganiz2mtion
11. Institute of Medicine (2002).Reducing Suicide:A National Imperative.Washigton, DC: National Academies Press.Hoyert,D.L.,Arias,E.,Smith,B.L ,Murphy,S.L.,& Kochanek,K.D.(2001).Deaths:Final Data for 1999. National Vital Statistics Report.49.1一ll3
12. Beck,A.J.,& Harrison.P.M.(2001).Prisoners in 2000 (Rep.No.NCJ 188207) .Washington. DC:U.S.Department of Justice.Bureau of Justice Statistics
13. Wisconsin Department of Health and Family Service Bureau of Community Mental Health(2001) .2001 Annual Report for Intigrated Services projects.medison.WI:The Children Come First Advisory committee
14. Snyder,H.N.& sickmund,M.(1999)。Jurenih Ofenders and Victims:1999 National Report.Washington.DC:Office of Juvenile Justice and Delinquency Prevention
15. Lyons,J,S.,Baerger,D.R.,Quigley.J.E.,& Griffin.E.(2001).Mental health service needs of Juvenile ofenders:A comparison of detention, incarceraion, and treatmentsettings.Children’s Services:Social Policy,Research,and Practice.4 69-85
16. Hoult J,Rosen A,Reynolds I.Community oriented treatment compared psychiartric hospital orientament.Soc Sci Med1984;18(11):1005-11
17. Hambridge JA,Rosen A.Assertive community treatment for the seriously mentally ill in Suburban Sydney:a programmedescripton and evalution.Aust NZ J Psychiat 1994;28:438-45.
18. Marsella AJ. Toward a”globa-community psychology”meeting the need of changing word [J]. Am Psych,1998,53(12): 1282-91.
19.宋修珍,孔临萍燕炯等.我国社区精神卫生服务的现状及对策[J].山西医科大学学报,2004,35(1)85-87
20.崔承英,谷广臣,张国平.农村社区精神卫生工作的现状和对策[J].中国农村卫生事业管理,2000,20(8):56.
21.吴均林周指明陈智聪等.社区居民心理卫生服务需求初探[J].中华临床医药,2004,5(7)37-39
22. Rabkin J,Struening EL.Life events,stress,and illness science, 1979:194;1013
23. Bandelow B, Charomo Torrent A, Wedekind D, et al. Early traumatic life events,parental rearing styles, family history of mental disorders, and birth risk farental rearing styles, family history of mental disoeders, and birth risk factors in patients with social anxiety disorder[J].Eur Arch Psychiatry Clin Neurosci,2004,12
24.O’Sullivan C. The psychosocial determinants of depression: alifespan perspective [J].J Nerv Ment Dis, 2004,192(9):585-594
25.Scheller Gilkey G, Moynes K, Gooper I, et al. Early life stress and PTSD symptoms in patients with comorbid schizophrenia and substance abuse[J].Schizophr Res, 2004,69(2-3):167-174
26. Foley DL, Eaves LJ, Wormley B,et al. Childhood adversity monoamine oxidase a genotype, and risk for conduct disorder[J].Arch Gen Psychiatry,2004,61:738-744
27. Monroe S M, Simons A D.Diathesis-stress theories in the context of life stress research: implications for the depressive disorders. Pchological Bullrtin, 1991, 110(3):406-425. .
28.Jacqueline B P, David M F. Assessment of depression. In: Bellack, A. S., Hersen, M. Behavioral Assessment A Practical Handbook(4thed). Allyn & Bacon, 1998, 211-223
29. Kessler R C. The effects of stressful life events on depression. Annual Review of psychology, 1997,48:191-211
30.刘贤臣,马登岱.生活事件、应对方式与青少年抑郁的相关研究[J].中国临床心理学杂志,1997,5(3)166-167
31. Lazarus RS,Folkman S.Stress,Appraisal and Coping.New York:springer.1984
32. Ruffin CL.Stress and health: little hassles vs maor life events.Australian Psychologist,1993,28(30):201-208
33. Ventura J, Nuechterlein KL,et al. Self-efficacy and neurocognition may be related to coping responses in recent-onset schizophrenia[J]. Schizophr Res, 2004, 69(2-3):343-352
34. Gibin S, Clare L, Livingston G, et al. Psychosocial correlates of late-onset psychosis: life experiences, cognitive schemas, and attitudes to ageing[J]. Int J Geriatr Psychiatry, 2004,19(7):611-623
35. Ferrando M, Andre Y, Galdon MJ, et al. Psychological variables andtemporomandibular disorders: distress, coping, and personality[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Eendod, 2004, 98(2):153-160
36. Stewart SH, Mitchell TL, Wright KD, et al. The relations of PTSD symptoms to alcohol use and coping drinking in volunteers who responded to the Swissair Flight 111 airline dirline disaster[J].J Anxiety Disord, 2004,18(1):51-68
37. Edwards JR, Cooper CL. Research in stress coping and health-theoretical and methodological issues. Psychological Medicine, 1998,18:15-20
38. Andrews G.Life event stress, social support, coping style, and risk of psycho logical impairment. J Nerv Ment Dis, 1978, 166:307-316
39.Kim JM, Sewart R, Shin IS,et al. Lifetime urban/rural residence, social support and late-life depression in Korea[J]. Int J Geriatr Psychiatry, 2004, 19(9):843-851
40. Torgrud LJ, Walker JR, Murray L, et al. Deficits in perceived social support associater with generalized social phobia[J]. Cogn Behav Ther, 2004, 33(2):87-96
41. Aviram RB, Hellerstein DJ, Gerson J,et al.Adapting supportive psychotherapy for individuals with Borderline personality disorder who self-injure or attempt suicide[J].J Psychiatr Pract,2004,10(3):145-155
42. Droes RM, Meiland F, Schmitz M. Effect of combined support for people with dementia and carers versus regular day care on behaviour and mood or persons with dementia: results from a multicentre implementation study[J].Int J Geriatr Psychiatry,2004,19(7):673-684
43. Barrera,M. Distinctions between social support concepts, measures and models. American Journal of Community Psychology,1986,14:413-445
44. Dunked-Schetter, C., & Bennett, T.L. Differentiating the cognitive and behavioral aspects of social support. In; I. G. Sarason, B. R. Sarason, & G. R. Pierce (Eds.). Social support: an interactional view. New York: Wiley, 1990:267-296
45. Brissette, I., Scheier, M. F., & Carver, C. S. The role of optimism in social network development, coping, and psychological adjustment during a life transition. Journal ofPersonality and Social Psychology, 2002,82:102-111
46. Levendosky, A. A., Huth-Bocks, A., & Semel, M. A., Adolescent peer relationships and mental health functioning in families with domestic violence. Journal of Clinical Child and Adolescent Psychology, 2002, 31:206-218
47. Wu, T., & Serper, M.R. Social support and psychopathology in homeless patients presenting for emergency psychiatric treatment Journal of Clinical Psychology,1999,55:1127-1133
48. Wong, Daniel F K. Difficulties and patterns of social support of mature college students in Hong Kong:implications for student guidance and counseling services. British Journal of Guidance & Counselling, 197,25(3):377
49.Florian, Victor; Mikulincer, Mario. Effects of adult attachment style on the perception and search for social support. Journal of Psychology, 1995,129(6):66
50. Nan lin, Alfred Dean, Walter. Social support, life events and depression, 1986
51. Avison W R, Gotlib IH. Stress and mental health contemporary issues and prospects for the future [M]. New York: Plenum Press, 1994:23-36
52.杨莉,胡竹箐.上大学前、后生活事件与大学生心理健康的关系研究[J].心理科学, 2005,28(5)1223-1226
53.李茹.军校医学生生活事件、应付方式与心理健康的相关分析[J].中国临床心理学杂志,2004:12(2):165
54.董晓倩.高二学生应激性生活事件和焦虑情绪的相关性研究[J].中国健康心理学杂志,2005:13(1):57
55.陈爽冀国峰.职业驾驶员心理应激及其相关变量分析[J].中国心理卫生杂志, 2002, 16 (12 )822-824
56.钟霞,姜乾金,钱丽菊等.医务人员压力反应与社会支持、生活事件、应对方式的相关研究[J].中国临床心理学杂志,2005,13(1)70-72
57.李红政,雷美英,刘练红.生活事件在新兵个性、应付方式、社会支持及心理症状关系模型中的作用[J].第四军医大学学报,2006; 27 (4):355-358
58.金华,吴文源,张明园.中国正常人scl-90评定结果的初步分析[J].中国神经精神疾病杂志, 1986,12(5):260-263
59.汪向东,王希林,马弘等.心理卫生评定量表手册(增订版)[M].北京:中国心理卫生杂志社,1999,33-131
60.姜乾金.护理心理学[M].杭州:浙江大学出版社2006,12-127
61.潘蕴倩.心理学基础[M].北京:人民卫生出版社1999,59-83
62.田本淳.健康教育与健康促进实用方法[M].北京北京大学医学出版社, 2005,16-357
63.梁宝勇.精神压力、应对与健康[M].北京:教育科学出版社,2006,1-11,39-66
64.吴均林,林大熙.医学心理学教程[M].北京:高等教育出版社, 2005,78-124.
65.冯丽云,王宇中,吴国华等.生活事件因素对青年学生心理健康水平影响的探讨[J].中国公共卫生,2000,16 (1):4一6
66.廖全明.中国人心理健康现状研究进展[J].中国公共卫生,2007,23(5):556-557
67.胡佩诚,宋燕华.心理卫生和精神疾病护理[M].北京:北京医科大学出版社, 1999,37-38
68.Shigemi J, Mino Y, Isuda T, et al. The relationship between job stress and mental health at work. Ind Health, 1997,35:29-35
69. Fujino Y, Mizoue T, Izumi, et al. Job stress and mental health among permanent night workers. J Occup Health, 2001,43:301-306
70.顾杏元,龚幼龙主编.社会医学[M].第十四版,上海:复旦大学出版社,2004,114
71.丁锦红,王净.在校大学生社会支持状况研究[J].首都师范大学学报(社会科学版),2000,132(1):114-116
72. Colen SA, Wils TA.Stress, social support and the buffering hypothesis.Psychological Bulletun,1985,8(2):310-357
73. Eric Stice, Jennifer Ragan, Patrick Randall. Prospective Relations Between Social Support and Depression: Differential Direction of Effects for Parent and Peer Support?Journal of Abnormal Psychology, 2004,113(1):155-159
74. Grant I, Patterson TL. Social Supports in Relation to Physical Health and Symptoms of Depression in the Elderly. The American Journal of Psychiatry, 188,145(10):1254-1258
75. Kimiko Hashimoto, Hiroshi Kurita, Takashi Harataniet al.Direct and buffering effects of social support on depressive symptoms of the elderly with home help. Psychiatry and Clinical Neurosciences,1999,53:95-100
76. Kendler KS, Myers J, Prescott CA. Sex differences in the relationship between social support and risk for major depression: a longitudinal study of opposite-sex twin pairs. The American Journal of Psychiatry, 2005, 162(2):250-255
77. Joff PE, Bast BA. Coping and defense in relation to accommodation among asanple of blindman. J nerv Ment Dis, 1978, 166:537-552
78. Neuferld RWT.Advances in the Investigation of Psychological Stress. Pub. Willy Series on Health Psychology. 1989.217-218
79. Vitaliano PP,Maiuro RD, Russo J. et al.Raw versus relative scores in the assessment of coping strategies. Journal of behavioral Mdeicine.1987,10(1):1-18
80.候杰泰,温忠麟,成子娟.结构方程模型及其应用[M].北京教育科学出版社, 2005,154-161
81. Lazarus RS.Stress, appraisal and coping coping capacities. In a scientific debate: How to define and research stress. National Institute of Mental Health, Center for Prevention Research. Washington, DC: Us Department of Health and Human Services, Public Health Service,1985
82. Hamberger LK, Lohr JM. Stress and stress management: Research and applications. New York:Springer,1984
83. Bailey JM, Bhagat RS. Meaning and measurement of stressors in the work environment: an evaluation. In SV. Kasl & CL. Cooper (Eds.), Stress and health: Issues in research methodology. Chichester: John Wiley & Sons,1987
84. Bunnk BP,Peeters MCW. Stress at work, social support and companionship: Towards an event-contin ent recording approach. Work and Stress, 1994, 8:177-190
85. Cartwright S, Cooper C. Managing Workplace Stress.London: Sage Publications, 1997
86. Karasek RA, Theorell T. Healthy work: Stress, productivity and the reconstruction of working life. New York: Basic Books, 1990
87. Cooper DP, O’Driscoll M. Organizational Stress: A Review and Critique of Theory , Research and Applications. Thousand Oaks,CA: Sage,2001
88. Holmes TH, et al. The social readjustment rating scale. Journal of Psychosom Research, 167,11:213-21893. Rabkin J, Struening EL. Life events, stress, and illness science, 1979:194;1013-1020
89. Bolger N, Zuckerman A. A framework for studying personality in the stress process. Journal of Personality & Socoal Psychology, 1995, 69(5):890-902
90. Sarason JG. Et al: Assessing the impact of Life change: development of life experiences survey J of consulting and clinical Psychology 1978, 46:932
91. Thoits PA: Dimensions of life events that influence psychological distress: an evaluation and synthesis of the literature. In: Kaplan H. et (eds):Psychological Stress, Ist ed. New York, Acdemic Press. 1983: 33-103
92. Kessler RC.Price RH. Wootman CB: Social factors in psychopathology: stress. Social support and coping process. Ann Rev Psychology 1985: 36: 531-572
93. Durkleim. E. Suicide: A Sociological Study: New Youk. Fress. 1950
94. House JS. Landis KR. Umberson D: Social relations and health, Science 1988: 241: 640-545
95. Goyne JC. Downey G: Stress, Social support and the coping process. Ann Rev Psychology 1991:42:401-426
96.张少伟,陈景武.公共卫生事业预警及应急处理机制问题探讨[J].国际医药卫生导报,卫生管理版(公共卫生), 2004,16(9)27-29
97.余凤苹,徐勇.疾病监测及早期预警信息的收集应用及管理[J],中国公共卫生管理,2005,21(3)195-197
98.朱月龙.心理健康-细说心理疾病[M].北京:海潮出版社,2007,3-11
99.李继坪.社区护理[M].北京人民卫生出版社,2004:38
100.陈学诗.心理卫生应与社区精神卫生相结合[J].上海精神医学,2002;14:104
1.龚幼龙主编.社会医学[M].北京:人民卫生出版社,2000,154-155
2.潘忠德,沈文龙,张国芳社区精神卫生的发展与展望中国民康医学杂志[J],2005,17(6)308-309
3.宋修珍孔临萍燕炯等我国社区精神卫生服务的现状及对策[J].山西医科大学学报2004,35(1)85-87
4.甘一方积极开展社区精神卫生服务是全科医师的重要职责[J].中华全科医师杂志2003.2(3)129.
5. Hoult J,Rosen A,Reynolds I.Community oriented treatment compared psychiartric hospital orientament.Soc Sci Med1984;18(11):1005-11
6. Hambridge JA,Rosen A.Assertive community treatment for the seriously mentally ill in Suburban Sydney:a programmedescripton and evalution.Aust NZ J Psychiat 1994;28:438-45.
7.梁春莲.美国精神疾病的社区治疗[J].临床精神医学杂志,1998,8(1):50
8. Julian Leff(冉茂盛译).社区精神卫生服务在英国的发展[J].中国民政医学杂志,1996,8(1):42
9.李欣.比利时社区精神卫生服务概况[J].中国医院管理,2000,20(12)
10.阎美琴摘译.瑞典的社区精神保健护理[J].国外精神护理学分册,1999,16(9):433
11.邹义壮Jacques Dubuis Denis Leguray Eric Malapert Jean Dalery法国精神卫生的分区化服务模式[J].临床进上医学杂志,2000,10(4),247
12.许艳玲.香港精神科社区康复服务[J].现代康复,2001,5(7):112~113.
13.向孟泽,冉茂盛.中国社区精神医学的现状和展望[J].四川精神卫生,1995,8(4):271.
14.崔承英,谷广臣,张国平.农村社区精神卫生工作的现状和对策[J].中国农村卫生事业管理,2000,20(8):56.
15. Marsella AJ. Toward a”globa-community psychology”meeting the need of changing word [J]. Am Psych,1998,53(12): 1282-91.
16.黄雪薇。中国特色的社区心理咨询初探[J].河南职工医学院学报,1999,11(1):51
17.吴均林周指明巫云辉等.城市社区心理卫生服务现状研究[J].中国公共卫生管理,2004,20(4)389-390
18.陈红.心理护理是社区精神病人康复的重要因素[J].山东精神医学,1997,10(4):67
19.杨凤池.社区心理卫生服务模式的探索[J].中国全科医学2002.5(11)20
20. Rabkin J,Struening EL.Life events,stress,and illness science, 1979:194;1013
21. Kessler RC. The Effect of Stressful Life Events on Depression. Annual Review of Psychology,1997,48:191
22. Lazarus RS. From Psychological Stress to the Emotions:A History of Changing Outlooks. Annual Review of Psychology,1993,44:2
23.韦有华,汤盛钦.几种主要的应激理论模型及其评价[J].心理科学,1998:(5)
24.汤宝勇等.关于应付的一些思考与实证研究;Ⅰ.应付的概念模型与效果.Ⅱ.应付方式的评定、分离与估计[J].中国心理学杂志。1997:(7)
25. Saposky R M. Why stress is bad for your brain? Science,1996,273 (5276):749-750
26. Holmes T H,Rahe R H. The social readjustment rating scale. Psychosom. Res.1967,11(2):213-218
27. Gadzella B M. Student-Life Stress Inventory:Identification of and Reactions to Stressors'. Psychological Reports,1994,74(2):395-402
28.李茹.军校医学生生活事件、应付方式与心理健康的相关分析[J].中国临床心理学杂志,2004:12(2):165
29.井世杰.初中生的生活事件、应对方式与不良情绪的结构模型研究[J].中国临床心理学杂志,2004;12(3)256-257
30.董晓倩.高二学生应激性生活事件和焦虑情绪的相关性研究[J].中国健康心理学杂志,2005:13(1):57
31.程虹娟.对大学生社会支持的调查研究[J].中国临床心理学杂志,2005;13(3):
32.张巧明.对中学生应付方式的调查研究[J].中国健康心理学杂志,2006;14(3):286
33.井世杰.初中学生日常生活事件的应急强度与心理健康关系的研究[J].青年研究,2000,(5):22
34.吴均林主编.医学心理学教程[M].北京:高等教育出版社,2001,78-82
35.卢祖洵主编.社会医学[M].北京:科技出版社,2003,86-88
36. Folkman S.,Lazarus R. S. Appraisal,coping, health status and psychological symptom. Journal of Personality &Social Psychology, 1986,50:571-579
37.梁宝勇,郭良才等。关于应付的一些思考与实证研究I:应付的概念模式与效果估计[J].中国临床心理杂志,1999,7(3):188-190
38.张林,车文博等,大学生心理压力应对方式特点的研究[J].心理科学,2005,28(1);36
39.陈学诗.心理卫生应与社区精神卫生相结合[J].上海精神医学,2002;14:104
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |