积极性社区干预对精神分裂症患者疗效及家庭经济负担的影响
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摘要
[目的]评估积极性社区干预对精神分裂症患者疗效及其家庭经济的影响。[方法]120例符合入组标准的社区慢性精神分裂症患者,随机分为研究组和对照组,研究组予积极性社区干预,对照组提供常规的社区精神卫生服务,随访观察1年。分别于干预开始前、干预1年末进行"阳性与阴性症状量表(PANSS)""生活质量综合评定问卷-74(成人用)(GQOLI-74)""社会功能缺陷筛选量表(SDSS)"评定,并采用自制疾病经济花费调查表比较治疗1年期间两组患者的医疗费用和其他经济损失情况。[结果]干预1年末,研究组PANSS、GQOLI-74、SDSS评分与对照组比较,差异有统计学意义(t=5.036,P=0.000;t=3.309,P=0.001;t=2.408,P=0.011)。研究组患者复发1例(1.7%),对照组复发11例(18.3%),两组差异有统计学意义(χ2=7.50,P=0.01)。研究组1年中因精神疾病造成的家庭经济损失低于对照组,差异具有统计学意义(Z=2.517,P=0.012)。[结论]积极性社区干预能有效改善慢性精神分裂症患者的临床症状,提高生活质量和社会功能,减轻患者家庭经济负担。
[Objective] To evaluate the effects of assertive community intervention on patients with schizophrenia and family economic burden. [Methods] Patients(n=120) with chronic schizophrenia and meeting study recruitment requirements were randomly assigned to a study group(with assertive community intervention) and a control group(with regular community mental health service). All the patients were followed up for one year. Positive and Negative Syndrome Scale(PANSS), Generic Quality of Life Inventory(GQOLI-74), and Social Disability Screening Schedule(SDSS) were assessed before and after the oneyear intervention. Self-administered form on disease burden was also used to compare the medical expense and other economic loss of the two groups. [Results] At the end of the one-year intervention, there were statistical differences in the score averages of PANSS, GQOLI-74, and SDSS between the intervention group and the control group(t=5.036, P=0.000; t=3.309, P=0.001; t=2.408, P=0.011). One case relapsed in the intervention group(1.7%), whereas 11 cases did in the control group(18.3%)(χ2=7.50, P=0.01).The economic loss related to schizophrenia in the intervention group was lower than that in the control group(Z=2.517, P=0.012). [Conclusion] Assertive community intervention shows significant improvement in clinical symptoms, quality of life, and social function and reducing the family economic burden of patients with schizophrenia.
[Objective] To evaluate the effects of assertive community intervention on patients with schizophrenia and family economic burden. [Methods] Patients(n=120) with chronic schizophrenia and meeting study recruitment requirements were randomly assigned to a study group(with assertive community intervention) and a control group(with regular community mental health service). All the patients were followed up for one year. Positive and Negative Syndrome Scale(PANSS), Generic Quality of Life Inventory(GQOLI-74), and Social Disability Screening Schedule(SDSS) were assessed before and after the oneyear intervention. Self-administered form on disease burden was also used to compare the medical expense and other economic loss of the two groups. [Results] At the end of the one-year intervention, there were statistical differences in the score averages of PANSS, GQOLI-74, and SDSS between the intervention group and the control group(t=5.036, P=0.000; t=3.309, P=0.001; t=2.408, P=0.011). One case relapsed in the intervention group(1.7%), whereas 11 cases did in the control group(18.3%)(χ2=7.50, P=0.01).The economic loss related to schizophrenia in the intervention group was lower than that in the control group(Z=2.517, P=0.012). [Conclusion] Assertive community intervention shows significant improvement in clinical symptoms, quality of life, and social function and reducing the family economic burden of patients with schizophrenia.
引文
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[10]Killaspy H,Bebbington P,Blizard R,et al.The REACT study:randomised evaluation of assertive community treatment in north London[J].BMJ,2006,332(7545):815-820.
[11]张毅宏,金冬,张翔,等.社区家庭干预在精神分裂症患者康复工作中的研究[J].中国公共卫生管理,2006,22(3):266-268.
[12]Kurzban S,Davis L,Brekke J S.Vocational,social,and cognitive rehabilitation for individuals diagnosed with schizophrenia[J].Curr Psychiatry Rep,2010,12(6):345-355.
[13]Salize H J.Costs of schizophrenia—what we know(not)?[J].Psychiatr Prax,2001,28(suppl 1):S21-28.
[14]石捷,陶建青,曾强,等.家庭治疗对精神分裂症的社会功能和生存质量影响的经济学评价[J].中国临床康复,2006,34(9):18-21.
[15]傅伟忠,张明,秦虹云,等.社区综合康复对慢性分裂症的疗效及初步卫生经济学评价[J].中国康复理论与实践,2013,19(9):813-816.
[16]程晓明.经济卫生学[M].3版.北京:人民卫生出版社,2012:216-221.
[2]季卫东,周国权,黄佩蓉,等.发展中国社区精神卫生服务体系的思考[J].中国卫生资源,2011,14(4):245-247.
[3]陈彦方.中国精神障碍分类与诊断标准[M].3版.济南:山东科学技术出版社,2001:75-78.
[4]司天梅,杨建中,舒良,等.阴性和阳性症状量表(PANSS,中文版)的信效度研究[J].中国心理卫生杂志,2004,18(1):45-47.
[5]张作记.行为医学量表手册[M].中国行为医学科学,2005:355-359.
[6]张明园.精神科评定量表手册[M].长沙:湖南科学技术出版社,2003:163-166.
[7]Kopelowicz A,Liberman R P.Integrating treatment with rehabilitation for persons with major mental illness[J].Psychiatr Serv,2003,54(11):1491-1498.
[8]周建芳,薛志强,张少平,等.精神分裂症患者社区干预的效果评价[J].环境与职业医学,2008,25(3):275-277.
[9]傅伟忠,张明,秦虹云,等.社区综合康复模式对慢性精神分裂症患者疗效评估[J].上海预防医学,2013,25(3):113-116.
[10]Killaspy H,Bebbington P,Blizard R,et al.The REACT study:randomised evaluation of assertive community treatment in north London[J].BMJ,2006,332(7545):815-820.
[11]张毅宏,金冬,张翔,等.社区家庭干预在精神分裂症患者康复工作中的研究[J].中国公共卫生管理,2006,22(3):266-268.
[12]Kurzban S,Davis L,Brekke J S.Vocational,social,and cognitive rehabilitation for individuals diagnosed with schizophrenia[J].Curr Psychiatry Rep,2010,12(6):345-355.
[13]Salize H J.Costs of schizophrenia—what we know(not)?[J].Psychiatr Prax,2001,28(suppl 1):S21-28.
[14]石捷,陶建青,曾强,等.家庭治疗对精神分裂症的社会功能和生存质量影响的经济学评价[J].中国临床康复,2006,34(9):18-21.
[15]傅伟忠,张明,秦虹云,等.社区综合康复对慢性分裂症的疗效及初步卫生经济学评价[J].中国康复理论与实践,2013,19(9):813-816.
[16]程晓明.经济卫生学[M].3版.北京:人民卫生出版社,2012:216-221.