关爱帮扶综合干预模式对社区精神分裂症患者家庭照护者心理状况及生活质量的影响
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摘要
背景精神分裂症患者家庭照护者在长期照护患者过程中常出现心理压力,生活质量也随之下降,有效的干预措施或可改善照护者的心理状况和生活质量。目的探讨关爱帮扶综合干预模式对社区精神分裂症家庭照护者心理状况及生活质量的影响。方法于2016年3—5月,采用分层整群随机抽样方法,分别在无锡市梁溪区、滨湖区、新吴区、锡山区、惠山区选取已同意纳入社区管理治疗的精神分裂症患者分别40、42、36、38、44例,共计200例,以每例患者的1例主要家庭照护者为研究对象。随机分为对照组(n=100)和观察组(n=100)。对照组给予常规随访管理,观察组采取关爱帮扶综合干预模式,干预时间均为1年。分别在干预前和干预1年后使用焦虑自评量表(SAS)、抑郁自评量表(SDS)、世界卫生组织生活质量测定量表简表(WHOQOL-BRIEF)对家庭照护者的心理状况、生活质量进行评估。结果干预前两组家庭照护者SAS、SDS评分比较,差异无统计学意义(P>0.05);干预后观察组家庭照护者SAS、SDS评分低于对照组,差异有统计学意义(P<0.05)。对照组干预前后家庭照护者SAS、SDS评分比较,差异无统计学意义(P>0.05);观察组干预后家庭照护者SAS、SDS评分低于干预前,差异有统计学意义(P<0.05)。干预前两组家庭照护者WHOQOL-BRIEF生理领域、心理领域、环境领域、社会关系领域得分及总分比较,差异无统计学意义(P>0.05);干预后观察组家庭照护者WHOQOL-BRIEF生理领域、心理领域、环境领域、社会关系领域得分及总分高于对照组,差异有统计学意义(P<0.05)。对照组干预后家庭照护者生理领域得分,观察组干预后家庭照护者WHOQOL-BRIEF生理领域、心理领域、环境领域、社会关系领域得分及总分高于干预前,差异有统计学意义(P<0.05)。结论合理的关爱帮扶综合干预模式,可以缓解社区精神分裂症患者家庭照护者的焦虑、抑郁情绪,提高其生活质量。
Background Family caregivers of schizophrenia often experience psychological stress during long-term care,and the quality of life decreases.Effective interventions may improve the mental condition and quality of life of caregivers.Objective To explore the effect of comprehensive care and support interventions on the psychological status and quality of life of family caregivers of community-dwelling schizophrenic patients.Methods Using stratified and random cluster sampling,from 5 districts of Wuxi City,we selected 200 schizophrenic patients(40,42,36,38,44 from Liangxi District,Binhu District,Xinwu District,Xishan District and Huishan District,respectively) who were provided with community-based management/treatment on the basis of obtaining their informed consent from March to May 2016,then,we sampled one key family caregiver of each patient as the participants.The totaled 200 caregivers were equally randomized into the control group and observation group,receiving one-year conventional follow-up management,one-year comprehensive care and support interventions,respectively.Psychological status and quality of life of both groups were assessed by the Zung Self-Rating Anxiety Scale(SAS),the Zung Self-Rating Depression Scale(SDS) and WHO Quality of Life-BREF(WHOQOL-BREF) before and after intervention.Results(1) After intervention,the mean scores of SAS and SDS changed insignificantly in the control group(P>0.05),but decreased obviously in the observation group(P<0.05).Moreover,both scores were much lower in the observation group than those of the control group(P<0.05) although they were similar in both groups before the intervention(P>0.05).(2)After intervention,the mean scores of the WHOQOL-BREF and its 4 domains(physical health,psychological health,social relationships,and environment) were all increased significantly in the observation group,but only the mean scores of physical health increased significantly in the control group(P<0.05).Moreover,the mean scores of the WHOQOL-BREF and its 4 domains were all higher in the observation group than those of the control group(P<0.05) although they were similar in both groups before the intervention(P>0.05).Conclusion Appropriate comprehensive care and support interventions can alleviate the levels of anxiety and depression,and improve the quality of life of family caregivers of community-dwelling schizophrenic patients.
Background Family caregivers of schizophrenia often experience psychological stress during long-term care,and the quality of life decreases.Effective interventions may improve the mental condition and quality of life of caregivers.Objective To explore the effect of comprehensive care and support interventions on the psychological status and quality of life of family caregivers of community-dwelling schizophrenic patients.Methods Using stratified and random cluster sampling,from 5 districts of Wuxi City,we selected 200 schizophrenic patients(40,42,36,38,44 from Liangxi District,Binhu District,Xinwu District,Xishan District and Huishan District,respectively) who were provided with community-based management/treatment on the basis of obtaining their informed consent from March to May 2016,then,we sampled one key family caregiver of each patient as the participants.The totaled 200 caregivers were equally randomized into the control group and observation group,receiving one-year conventional follow-up management,one-year comprehensive care and support interventions,respectively.Psychological status and quality of life of both groups were assessed by the Zung Self-Rating Anxiety Scale(SAS),the Zung Self-Rating Depression Scale(SDS) and WHO Quality of Life-BREF(WHOQOL-BREF) before and after intervention.Results(1) After intervention,the mean scores of SAS and SDS changed insignificantly in the control group(P>0.05),but decreased obviously in the observation group(P<0.05).Moreover,both scores were much lower in the observation group than those of the control group(P<0.05) although they were similar in both groups before the intervention(P>0.05).(2)After intervention,the mean scores of the WHOQOL-BREF and its 4 domains(physical health,psychological health,social relationships,and environment) were all increased significantly in the observation group,but only the mean scores of physical health increased significantly in the control group(P<0.05).Moreover,the mean scores of the WHOQOL-BREF and its 4 domains were all higher in the observation group than those of the control group(P<0.05) although they were similar in both groups before the intervention(P>0.05).Conclusion Appropriate comprehensive care and support interventions can alleviate the levels of anxiety and depression,and improve the quality of life of family caregivers of community-dwelling schizophrenic patients.
引文
[1]KRAUTGARTNER M,UNGER A,G?ESSLER R,et al.Minor relatives of schizophrenia patients:burden and needs[J].Neuropsychiatr,2007,21(4):267-274.
[2]范肖冬,汪向东,于欣,等.ICD-10精神与行为障碍分类:临床描述与诊断要点[M].北京:人民卫生出版社,1993.
[3]戴晓阳.常用心理评估量表手册[M].北京:人民军医出版社,2010.
[4]方积乾.生存质量测定方法及应用[M].北京:北京医科大学出版社,2000.
[5]骆敏灵,熊卫,马旻,等.精神分裂症患者原生家庭互动模式的定性研究[J].中国心理卫生杂志,2014,28(11):840-845.DOI:10.3969/j.issn.1000-6729.2014.11.008.LUO M L,XIONG W,MA M,et al.A qualitative research on family interaction patterns in original family of patients with schizophrenia[J].Chinese Mental Health Journal,2014,28(11):840-845.DOI:10.3969/j.issn.1000-6729.2014.11.008.
[6]杨雀屏,张国富,李达,等.社区综合康复对精神分裂症总体疗效的影响[J].中国康复理论与实践,2013,19(9):809-812.DOI:10.3969/j.issn.1006-9771.2013.09.003.YANG Q P,ZHANG G F,LI D,et al.Effects of communitybased rehabilitation on schizophrenia[J].Chin J Rehabil Theory Pract,2013,19(9):809-812.DOI:10.3969/j.issn.1006-9771.2013.09.003.
[7]杜蕾,张赛,金光辉,等.主动式社区治疗的国外应用现状及其对我国精神疾病社区管理的启示[J].中国全科医学,2011,14(19):2141-2144.DOI:10.3969/j.issn.1007-9572.2011.19.008.DU L,ZHANG S,JIN G H,et al.Applications of assertive community treatment in China and abroad and inspiration on community management of mental illness in China[J].Chinese General Practice,2011,14(19):2141-2144.DOI:10.3969/j.issn.1007-9572.2011.19.008.
[8]姜珺,李志武,康瑞莹,等.改良式“重返社区技能训练”对社区精神分裂症患者症状、认知及社会功能的干预效果研究[J].中国全科医学,2018,21(4):475-479.DOI:10.3969/j.issn.1007-9572.2018.04.022.JIANG J,LI Z W,KANG R Y,et al.Study on the effect of improved"returning community skills training"on the symptoms,cognition and social function of community schizophrenia patients[J].Chinese General Practice,2018,21(4):475-479.DOI:10.3969/j.issn.1007-9572.2018.04.022.
[9]林慧,梁祖光,梁飘,等.重性精神病患者及其家属病耻感调查与干预[J].中国全科医学,2014,17(13):1551-1553.DOI:10.3969/j.issn.1007-9572.2014.13.026.LIN H,LIANG Z G,LIANG P,et al.Severe mental illness stigma investigation and intervention[J].Chinese General Practice,2014,17(13):1551-1553.DOI:10.3969/j.issn.1007-9572.2014.13.026.
[10]李艳玲,袁菊梅,苗杰,等.北京地区全科团队管理重性精神疾病的效果评估[J].中国全科医学,2015,18(34):4174-4178.DOI:10.3969/j.issn.1007-9572.2015.34.006.LI Y L,YUAN J M,MIAO J,et al.GP team manages severe mental disorders:effect evaluation in Beijing[J].Chinese General Practice,2015,18(34):4174-4178.DOI:10.3969/j.issn.1007-9572.2015.34.006.
[11]RUUD T,FLAGE K B,KOLBJ?RNSRUD O B,et al.A twoyear multidisciplinary training program for the frontline workforce in community treatment of severe mental illness[J].Psychiatr Serv,2016,67(1):7-9.DOI:10.1176/appi.ps.201500199.
[12]WEIMAND B M,HEDELIN B,S?LLSTR?M C,et al.Burden and health in relatives of persons with severe mental illness:a Norwegian cross-sectional study[J].Issues Ment Health Nurs,2010,31(12):804-815.DOI:10.3109/01612840.2010.520819.
[13]刘晓亲,龚定宏.社区慢性精神分裂症患者家庭照护者认知团体心理治疗的近期与远期干预效果研究[J].中国全科医学,2018,21(7):867-873.DOI:10.3969/j.issn.1007-9572.2018.07.023.LIU X Q,GONG D H.Short-term effects and long-term effects of group psychotherapy on family caregivers of patients with chronic schizophrenia in community[J].Chinese General Practice,2018,21(7):867-873.DOI:10.3969/j.issn.1007-9572.2018.07.023.
[14]NASR T,KAUSAR R.Psychoeducation and the family burden in schizophrenia:a randomized controlled trial[J].Ann Gen Psychiatry,2009,8(1):17.DOI:10.1186/1744-859X-8-17.
[15]郭正军,郭玉敏,姚丰菊,等.社区综合干预模式对精神分裂症患者康复效果的影响研究[J].中国全科医学,2018,21(4):471-475.DOI:10.3969/j.issn.1007-9572.2018.04.021.GUO Z J,GUO Y M,YAO F J,et al.Effects of community-based comprehensive intervention on the rehabilitation of schizophrenia patients[J].Chinese General Practice,2018,21(4):471-475.DOI:10.3969/j.issn.1007-9572.2018.04.021.
[16]MITSONIS C,VOUSSOURA E,DIMOPOULOS N,et al.Factors associated with caregiver psychological distress in chronic schizophrenia[J].Soc Psychiatry Psychiatr Epidemiol,2017,23(1):114-117.DOI:10.3969/j.issn.1006-9771.2017.01.027.
[2]范肖冬,汪向东,于欣,等.ICD-10精神与行为障碍分类:临床描述与诊断要点[M].北京:人民卫生出版社,1993.
[3]戴晓阳.常用心理评估量表手册[M].北京:人民军医出版社,2010.
[4]方积乾.生存质量测定方法及应用[M].北京:北京医科大学出版社,2000.
[5]骆敏灵,熊卫,马旻,等.精神分裂症患者原生家庭互动模式的定性研究[J].中国心理卫生杂志,2014,28(11):840-845.DOI:10.3969/j.issn.1000-6729.2014.11.008.LUO M L,XIONG W,MA M,et al.A qualitative research on family interaction patterns in original family of patients with schizophrenia[J].Chinese Mental Health Journal,2014,28(11):840-845.DOI:10.3969/j.issn.1000-6729.2014.11.008.
[6]杨雀屏,张国富,李达,等.社区综合康复对精神分裂症总体疗效的影响[J].中国康复理论与实践,2013,19(9):809-812.DOI:10.3969/j.issn.1006-9771.2013.09.003.YANG Q P,ZHANG G F,LI D,et al.Effects of communitybased rehabilitation on schizophrenia[J].Chin J Rehabil Theory Pract,2013,19(9):809-812.DOI:10.3969/j.issn.1006-9771.2013.09.003.
[7]杜蕾,张赛,金光辉,等.主动式社区治疗的国外应用现状及其对我国精神疾病社区管理的启示[J].中国全科医学,2011,14(19):2141-2144.DOI:10.3969/j.issn.1007-9572.2011.19.008.DU L,ZHANG S,JIN G H,et al.Applications of assertive community treatment in China and abroad and inspiration on community management of mental illness in China[J].Chinese General Practice,2011,14(19):2141-2144.DOI:10.3969/j.issn.1007-9572.2011.19.008.
[8]姜珺,李志武,康瑞莹,等.改良式“重返社区技能训练”对社区精神分裂症患者症状、认知及社会功能的干预效果研究[J].中国全科医学,2018,21(4):475-479.DOI:10.3969/j.issn.1007-9572.2018.04.022.JIANG J,LI Z W,KANG R Y,et al.Study on the effect of improved"returning community skills training"on the symptoms,cognition and social function of community schizophrenia patients[J].Chinese General Practice,2018,21(4):475-479.DOI:10.3969/j.issn.1007-9572.2018.04.022.
[9]林慧,梁祖光,梁飘,等.重性精神病患者及其家属病耻感调查与干预[J].中国全科医学,2014,17(13):1551-1553.DOI:10.3969/j.issn.1007-9572.2014.13.026.LIN H,LIANG Z G,LIANG P,et al.Severe mental illness stigma investigation and intervention[J].Chinese General Practice,2014,17(13):1551-1553.DOI:10.3969/j.issn.1007-9572.2014.13.026.
[10]李艳玲,袁菊梅,苗杰,等.北京地区全科团队管理重性精神疾病的效果评估[J].中国全科医学,2015,18(34):4174-4178.DOI:10.3969/j.issn.1007-9572.2015.34.006.LI Y L,YUAN J M,MIAO J,et al.GP team manages severe mental disorders:effect evaluation in Beijing[J].Chinese General Practice,2015,18(34):4174-4178.DOI:10.3969/j.issn.1007-9572.2015.34.006.
[11]RUUD T,FLAGE K B,KOLBJ?RNSRUD O B,et al.A twoyear multidisciplinary training program for the frontline workforce in community treatment of severe mental illness[J].Psychiatr Serv,2016,67(1):7-9.DOI:10.1176/appi.ps.201500199.
[12]WEIMAND B M,HEDELIN B,S?LLSTR?M C,et al.Burden and health in relatives of persons with severe mental illness:a Norwegian cross-sectional study[J].Issues Ment Health Nurs,2010,31(12):804-815.DOI:10.3109/01612840.2010.520819.
[13]刘晓亲,龚定宏.社区慢性精神分裂症患者家庭照护者认知团体心理治疗的近期与远期干预效果研究[J].中国全科医学,2018,21(7):867-873.DOI:10.3969/j.issn.1007-9572.2018.07.023.LIU X Q,GONG D H.Short-term effects and long-term effects of group psychotherapy on family caregivers of patients with chronic schizophrenia in community[J].Chinese General Practice,2018,21(7):867-873.DOI:10.3969/j.issn.1007-9572.2018.07.023.
[14]NASR T,KAUSAR R.Psychoeducation and the family burden in schizophrenia:a randomized controlled trial[J].Ann Gen Psychiatry,2009,8(1):17.DOI:10.1186/1744-859X-8-17.
[15]郭正军,郭玉敏,姚丰菊,等.社区综合干预模式对精神分裂症患者康复效果的影响研究[J].中国全科医学,2018,21(4):471-475.DOI:10.3969/j.issn.1007-9572.2018.04.021.GUO Z J,GUO Y M,YAO F J,et al.Effects of community-based comprehensive intervention on the rehabilitation of schizophrenia patients[J].Chinese General Practice,2018,21(4):471-475.DOI:10.3969/j.issn.1007-9572.2018.04.021.
[16]MITSONIS C,VOUSSOURA E,DIMOPOULOS N,et al.Factors associated with caregiver psychological distress in chronic schizophrenia[J].Soc Psychiatry Psychiatr Epidemiol,2017,23(1):114-117.DOI:10.3969/j.issn.1006-9771.2017.01.027.