【摘要】：目的:隨著國外從20世紀(jì)50年代開始提倡患者住院治療結(jié)合社區(qū)精神衛(wèi)生服務(wù)體系作為治療精神障礙的新模式,我國在20世紀(jì)90年代提出了精神障礙社區(qū)康復(fù)相關(guān)的問題,但專業(yè)人員短、資金不足等多種原因?qū)е挛覈鐓^(qū)精神衛(wèi)生服務(wù)工作相對于國外發(fā)達(dá)地區(qū)仍顯滯后,使生活在社區(qū)中的患者病情得不到控制,社會(huì)功能低下。致力于幫扶貧困地區(qū)精神障礙患者及家庭的倍慈精神衛(wèi)生發(fā)展項(xiàng)目落戶中國,本研究探討倍慈模式之“生計(jì)活動(dòng)”對我國農(nóng)村地區(qū)精神障礙患者社會(huì)功能的影響,為我國農(nóng)村地區(qū)精神障礙患者的康復(fù)提供新的治療依據(jù)。方法:自2015年6月1日-2015年12月1日期間加入保定市順平縣倍慈精神衛(wèi)生發(fā)展項(xiàng)目的精神障礙和癲癇患者75人作為研究對象,根據(jù)患者是否加入倍慈模式生計(jì)活動(dòng)小組干預(yù),將患者分為研究組與對照組;研究組的患者在持續(xù)服用藥物和定期健康宣教的基礎(chǔ)上成立生計(jì)活動(dòng)小組,提供生產(chǎn)資料進(jìn)行生計(jì)活動(dòng)干預(yù),為期12個(gè)月。對照組提供與干預(yù)組相同頻率的免費(fèi)藥品供應(yīng)和健康宣教,無其他干預(yù)手段,觀察12個(gè)月。在入組時(shí)及12月末采用世界衛(wèi)生組織殘疾評定量表Ⅱ中文版(WHO-DASⅡ)、功能大體評定量表(GAF)、健康調(diào)查問卷(SF-36)、領(lǐng)悟社會(huì)支持量表(PSSS)、精神障礙患者病恥感評估量表、家庭負(fù)擔(dān)訪談問卷(FBIS)、服藥依從性量表和家屬貶低歧視感知量表(PDD)對患者的殘疾狀況、社會(huì)功能、健康狀況、社會(huì)支持情況以及家庭經(jīng)濟(jì)負(fù)擔(dān)等進(jìn)行評估。結(jié)果:最終進(jìn)入結(jié)果分析的患者70例,其中精神分裂癥患者29例、抑郁障礙患者8例、癲癇所致精神障礙患者23例、智力障礙患者10例。干預(yù)前兩組患者及家屬一般情況以及各量表基線評估無顯著性差異。干預(yù)后(1)研究組患者WHO-DASⅡ量表得分明顯降低且與對照組相比差別有顯著統(tǒng)計(jì)學(xué)意義(P0.01);(2)研究組患者GAF功能大體量表得分明顯提高且與對照組相比差別有顯著統(tǒng)計(jì)學(xué)意義(P0.01)(3)研究組患者SF-36健康調(diào)查問卷軀體健康得分明顯提高且與對照組相比差別有顯著統(tǒng)計(jì)學(xué)意義(P0.01),研究組精神健康得分提高且與對照組相比差別有統(tǒng)計(jì)學(xué)意義(P0.05);(4)研究組患者領(lǐng)悟社會(huì)支持量表得分明顯提高且與對照組相比差別有顯著統(tǒng)計(jì)學(xué)意義(P0.01);(5)研究組患者病恥感量表得分降低但與對照組相比差別無統(tǒng)計(jì)學(xué)意義;(6)研究組患者家庭負(fù)擔(dān)量表得分顯著降低且與對照組相比差別有顯著統(tǒng)計(jì)學(xué)意義(P0.01);(7)研究組患者服藥依從性量表得分提高且與對照組相比差別有統(tǒng)計(jì)學(xué)意義(P0.05);(8)研究組患者家屬貶低歧視感知量表得分降低且與對照組相比差別有統(tǒng)計(jì)學(xué)意義(P0.01)。Logistics回歸結(jié)果顯示,患者社會(huì)功能的影響因素為患者家庭收入與患者殘疾程度。患者家庭年收入與患者社會(huì)功能正相關(guān),家庭年收入越高患者社會(huì)功能恢復(fù)程度越好;患者殘疾程度與社會(huì)功能呈負(fù)相關(guān),患者殘疾程度越高提示患者社會(huì)功能恢復(fù)程度越差;而其他因素與患者社會(huì)功能無關(guān)。結(jié)論:倍慈模式之生計(jì)活動(dòng)支持干預(yù)可以降低患者殘疾程度、降低患者病恥感程度、降低患者家庭負(fù)擔(dān)和降低家屬病恥感程度;同時(shí)可以提高患者服藥依從性、提高患者社會(huì)功能、提高患者生活質(zhì)量和提高患者社會(huì)支持水平。患者家庭收入與殘疾程度是患者社會(huì)功能的影響因素。
[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.
【學(xué)位授予單位】：河北大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R473.74

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