深圳市宝安区中老年严重精神障碍患者特征及社区管理现状

卢楚虹; 程娟; 卿利; 刘成锋; 苏海云; 林伟权

doi:10.16766/j.cnki.issn.1674-4152.002731

深圳市宝安区中老年严重精神障碍患者特征及社区管理现状

doi: 10.16766/j.cnki.issn.1674-4152.002731

1.
深圳市宝安区慢性病防治院精神卫生科，广东深圳 518000
2.
广州市疾病预防控制中心基本公共卫生部，广东广州 510440

基金项目:

国家自然科学基金项目 72104061

详细信息

通讯作者:
卢楚虹, E-mail: chuhong688@163.com

中图分类号: R749.16
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- 文章访问数: 147
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- PDF下载量: 4
- 被引次数: 0
出版历程
- 收稿日期: 2022-03-15
- 网络出版日期: 2022-12-30

Characteristics and community management status of middle-aged and older adults with severe mental disorders in Baoan district, Shenzhen

1.
Department of Mental Health, Shenzhen Bao'an District Hospital for Chronic Disease Prevention and Cure, Shenzhen, Guangdong 518000, China

摘要

摘要: 目的了解深圳市宝安区中老年严重精神障碍患者的特征和社区管理状况，并探讨影响中老年严重精神障碍患者管理状况的相关因素。方法从深圳市精神卫生防治工作信息管理系统导出截至2021年9月30日宝安区接受管理的年龄≥45岁的中老年严重精神障碍患者的资料。采用logistic回归分析探究中老年严重精神障碍患者管理重要指标(服药依从性、高风险行为)的影响因素。结果共2 096例中老年患者纳入分析。深圳市宝安区中老年严重精神障碍患者以女性为主(1 248例，59.54%)；文化程度偏低，初中及以下文化程度患者占76.00%(1 593例)；在婚患者较多(1 626例，77.58%)；多数以直系亲属作为监护人(1 913例，91.27%)；疾病主要类型为精神分裂症(1 411例，67.32%)；规律服药率为74.81%(1 568例)，高风险行为发生率为8.78%(184例)。多因素logistic回归分析结果显示：低收入家庭(OR=1.608, 95% CI：1.150~2.249)、与直系亲属共同居住(OR=2.060, 95% CI：1.178~3.600)、癫痫所致精神障碍(OR=14.012, 95% CI：5.964~32.923)是中老年患者服药依从性的积极因素；年龄60岁以下(OR=1.913, 95% CI：1.275~2.871)、非在婚(OR=1.868, 95% CI：1.310~2.663)、低收入家庭(OR=1.607, 95% CI：1.071~2.411)、其他类型严重精神障碍(OR=47.838, 95% CI：10.846~210.986)是中老年患者高风险行为的危险因素。结论建议在城市中老年患者管理中根据患者特点采取有针对性的措施，重点关注60岁以下、低收入、非在婚中老年患者。
- 中老年 /
- 严重精神障碍 /
- 社区管理
Abstract: Objective To investigate the characteristics and community management status of middle-aged and elderly patients with severe mental disorders (SMDs) in Bao'an District, Shenzhen City, and explore the related factors affecting management status. Methods The data of middle-aged and elderly patients with severe mental disorders aged ≥ 45 years under management in Bao'an District were extracted from Shenzhen Mental Health Prevention and Control Information Management System as of September 30, 2021. Logistic regression models were used to explore the difference in management indicators (medication compliance and high-risk behaviour) of middle-aged and older adults with SMD. Results A total of 2 096 middle-aged and elderly patients were included in the analysis. Most of the middle-aged and older adults (≥45 years) in Bao'an District, Shenzhen were female, accounting for 59.54% (1 248 cases). Their educational level was low, 76.00%(1 593 cases) of them had a junior high school education or below. Most patients were married, accounting for 77.58% (1 626 cases). Most of them were taken care of by immediate family, accounting for 91.27% (1 913 cases). The main disease type was schizophrenia, accounting for 67.32% (1 411 cases). The rate of regular medication was 74.81% (1 568 cases), and the incidence of high-risk behaviour was 8.78% (184 cases). Low-income (OR=1.608, 95% CI: 1.150-2.249), immediate relatives (OR=2.060, 95% CI: 1.178-3.600) and mental disorders caused by epilepsy (OR=14.012, 95% CI: 5.964-32.923) were positive factors for medication compliance of middle-aged and older adults with SMD. Less than 60 years of age (OR=1.913, 95% CI: 1.275-2.871), being unmarried (OR=1.868, 95% CI: 1.310-2.663), being Low-income (OR=1.607, 95% CI: 1.071-2.411) and being diagnosed with other serious mental disorders (OR=47.838, 95% CI: 10.846-210.986) were risk factors for high-risk behaviours. Conclusion Measures should be adopted according to the characteristics of patients in the management of urban middle-aged and older patients, focusing on middle-aged and elderly patients less than 60 years old, Low-income and unmarried.
- Middle-aged and older adults /
- Severe mental disorders /
- Community management

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表 1 中老年严重精神障碍患者服药依从性、高风险行为影响因素的单因素分析

Table 1. Single factor analysis of medication compliance and high-risk behavior in middle-aged and older adults with severe mental disorders

项目	例数	服药依从性				高风险行为
项目	例数	是(n=1 568)	否(n=528)	统计量	P值	是(n=184)	否(n=1 912)	统计量	P值
年龄[例(%)]				2.391^a	0.122			12.089^a	0.001
＜60岁	1 500	1 136(75.73)	364(24.27)			152(10.13)	1 348(89.87)
≥60岁	596	432(72.48)	164(27.52)			32(5.37)	564(94.63)
性别[例(%)]				3.948^a	0.047			7.624^a	0.006
男性	848	615(72.52)	233(27.48)			92(10.85)	756(89.15)
女性	1 248	953(76.36)	295(23.64)			92(7.37)	1 156(92.63)
文化程度[例(%)]				19.790^a	＜0.001			7.559^a	0.056
小学及以下	863	603(69.87)	260(30.13)			60(6.95)	803(93.05)
初中	730	577(79.04)	153(20.96)			68(9.32)	662(90.68)
高中/专科	440	341(77.50)	99(22.50)			48(10.91)	392(89.09)
本科及以上	63	47(74.60)	16(25.40)			8(12.70)	55(87.30)
婚姻[例(%)]				6.792^a	0.009			6.466^a	0.011
非在婚	470	330(70.21)	140(29.79)			55(11.70)	415(88.30)
在婚	1 626	1 238(76.14)	388(23.86)			129(7.93)	1 497(92.07)
低收入家庭[例(%)]				11.286^a	0.001			5.554^a	0.018
是	290	240(82.76)	50(17.24)			36(12.41)	254(87.59)
否	1 806	1 328(73.53)	478(26.47)			148(8.19)	1 658(91.81)
监护人[例(%)]				18.192^a	＜0.001			1.138^a	0.566
直系亲属	1 913	1 455(76.06)	458(23.94)			169(8.83)	1 744(91.17)
亲戚朋友及其他	124	76(61.29)	48(38.71)			12(9.68)	112(90.32)
无	59	37(62.71)	22(37.29)			3(5.08)	56(94.92)
疾病类型[例(%)]				195.460^a	＜0.001			112.856^a	＜0.001
精神分裂症	1 411	1 121(79.45)	290(20.55)			96(6.80)	1 315(93.20)
双相情感障碍	312	240(76.92)	72(23.08)			41(13.14)	271(86.86)
偏执性精神病	40	20(50.00)	20(50.00)			8(20.00)	32(80.00)
癫痫所致精神障碍	52	44(84.62)	8(15.38)			3(5.77)	49(94.23)
分裂情感性障碍	74	59(79.73)	15(20.27)			4(5.41)	70(94.59)
精神发育迟滞伴发精神障碍	127	34(26.77)	93(73.23)			2(1.57)	125(98.43)
其他	80	50(62.50)	30(37.50)			30(37.50)	50(62.50)
病程[M(P₂₅, P₇₅), 年]	2 096	14.00(7.00, 23.00)	14.00(8.00, 29.75)	-2.843^b	0.004	13.00(6.00, 21.00)	14.00(7.00, 25.00)	2.549^b	0.011
精神疾病家族史[例(%)]				1.460^a	0.227			1.244^a	0.265
是	82	66(80.49)	16(19.51)			10(12.20)	72(87.80)
否	2 014	1 502(74.58)	512(25.42)			174(8.64)	1 840(91.36)
服药依从性[例(%)]								2.765^a	0.096
规律	1 568					147(9.38)	1 421(90.63)
不规律	528					37(7.01)	491(92.99)
注：^a为χ²值，^b为Z值。

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表 2 Logistic回归分析中各变量赋值方法

Table 2. Variable assignment method in logistic regression analysis

变量	赋值方法
性别	女性=1，男性=2
年龄	≥60岁=1，＜60岁=2
婚姻	在婚=1，非在婚=2
文化程度	小学及以下=1，初中=2，高中/专科=3，本科及以上=4
低收入家庭	否=1，是=2
病程	连续变量，以实际值赋值
监护人	无=(0，0)，直系亲属=(1, 0)，亲戚朋友及其他=(0，1)
疾病类型	精神发育迟滞伴发精神障碍=(0, 0, 0, 0, 0, 0)，精神分裂症=(1, 0, 0, 0, 0, 0)，双相情感障碍=(0, 1, 0, 0, 0, 0)，偏执性精神病=(0, 0, 1, 0, 0, 0)，癫痫所致精神障碍=(0, 0, 0, 1, 0, 0)，分裂情感性障碍=(0, 0, 0, 0, 1, 0)，其他=(0, 0, 0, 0, 0, 1)
规律服药	否=0，是=1
高风险行为	否=0，是=1

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表 3 中老年严重精神障碍患者服药依从性影响因素的logistic回归分析

Table 3. Logistic regression analysis of influencing factors of medication compliance in middle-aged and older adults with severe mental disorders

变量	B	SE	Wald χ²	P值	OR(95% CI)
低收入家庭	0.475	0.171	7.705	0.006	1.608(1.150~2.249)
监护人
直系亲属	0.722	0.285	6.428	0.011	2.060(1.178~3.600)
亲戚朋友及其他	0.175	0.344	0.259	0.611	1.192(0.607~2.340)
疾病诊断
精神分裂症	2.320	0.212	119.432	＜0.001	10.179(6.714~15.432)
双相情感障碍	2.236	0.244	83.688	＜0.001	9.359(5.796~15.112)
偏执性精神病	1.002	0.377	7.066	0.008	2.725(1.301~5.707)
癫痫所致精神障碍	2.640	0.436	36.687	＜0.001	14.012(5.964~32.923)
分裂情感性障碍	2.329	0.354	43.396	＜0.001	10.272(5.137~20.543)
其他	1.453	0.308	22.283	＜0.001	4.277(2.339~7.819)

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表 4 中老年严重精神障碍患者高风险行为影响因素的logistic回归分析

Table 4. Logistic regression analysis of influencing factors of high-risk behaviors in middle-aged and older adults with severe mental disorders

变量	B	SE	Wald χ²	P值	OR(95% CI)
年龄＜60岁	0.649	0.207	9.815	0.002	1.913(1.275~2.871)
非在婚	0.625	0.181	11.933	0.001	1.868(1.310~2.663)
低收入家庭	0.474	0.207	5.243	0.022	1.607(1.071~2.411)
疾病诊断
精神分裂症	1.697	0.725	5.486	0.019	5.459(1.319~22.593)
双相情感障碍	2.554	0.739	11.953	0.001	12.863(3.023~54.734)
偏执性精神病	3.136	0.824	14.479	＜0.001	23.008(4.575~115.709)
癫痫所致精神障碍	1.482	0.936	2.506	0.113	4.400(0.703~27.544)
分裂情感性障碍	1.464	0.885	2.739	0.098	4.324(0.763~24.489)
其他	3.868	0.757	26.296	＜0.001	47.838(10.846~210.986)

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