某综合医院住院患者精神障碍患病率、识别率及危险因素调查分析

A cross-sectional study of mental disorders among inpatients in a general hospital

摘要:

目的 了解某综合医院住院患者精神障碍的患病情况和影响因素、识别率及心理干预效果。方法 采用一阶段调查法，调查某综合医院2014 年6 ~ 8 月内科、外科及妇产科等所有非精神病科室597 名住院患者精神障碍的患病率、发病率及危险因素。所得数据采用SPSS 22.0 进行统计分析。结果 ①精神障碍患病率为17.6% ；不同精神障碍患病率依次为：抑郁障碍9.4%、广泛性焦虑障碍3.7%、心境恶劣1.7%、自杀1.2%、轻躁狂发作1.2%、惊恐障碍为0.3%、场所恐惧症为0.5%、社交恐惧症为0.2%、强迫症为1.0%、创伤后应激障碍为2.0%、酒滥用或酒依赖为2.0%、非酒精类精神活性物质使用障碍为0.5%、精神性疾患为0.7%、神经性厌食为0.7%、神经性贪食为0.2%、反社会人格障碍为0.0%。②患病率最高的4 个科室依次为消化内科44.9%、康复科25.0%、老年病房24.1%、神经内科19.0%。③精神障碍患者的识别率为51.4% ；识别率最高的4 个科室依次为神经内科87.5%、神经外科71.4%、呼吸内科60.0%、老年病房53.8%。④多因素Logistic 回归分析显示，科室、居住方式、心理疾病史和就诊意愿为影响因素。结论 ①某综合医院住院患者精神障碍患病率较低，识别率较高。②内科、独居、有过心理疾病史、对精神障碍有负性看法的住院患者为精神障碍的高发人群；对外伤术后的患者应排除是否存在创伤后应激障碍。

Abstract:

Objective To investigate the prevalence and relevant characteristics of mental disorders among the inpatients in a general hospital, and to describe the recognition of the doctors in non-psychiatric departments of a general hospital and the effect of psychological interventions. Methods This was a hospital-based crosssectional study. A stage of investigation was used. Data collection was conducted among the 597 intpatients from non-psychiatric departments from June to August in 2014 using the Mini International Neuropsychiatry Interview (MINI). Univariate and multivariate analyses were performed using SPSS 22.0. Results The occurrence of mental disorders was 17.6%, including depressive disorder (9.4%), generalized anxiety disorder (3.7%), dysthymia (1.7%),suicidality (1.2%), hypomanic episode (1.2%), panic disorder (0.3%), agoraphobia (0.5%), socialphobia (0.2%),obsessive-compulsive disorder (1.0%), posttraumatic stress disorder (2.0%), alcohol abuse and dependence (2.0%), non-alcohol psychoactive substance use disorder (0.5%), psychotic disorder (0.7%), anorexia nervosa (0.7%), bulimia nervosa (0.2%), and antisocial personality disorder (0.0%). The high prevalence was in four departments including Department of Gastroenterology (44.9%), Rehabilitation Department (25.0%), Geriatric Ward (24.1%) and Department of Neurology (19.0%). The discrimination ratio was 51.4%, the four departments with high discrimination ratio included Department of Neurology (87.5%), Department of Neurosurgery (71.4%), Department of Respiratory Medicine (60.0%) and Geriatric Ward (53.8%). The logistic regression results showed the departments, living styles, history of mental illness and treatment will were the independent risk factors. Conclusions It is noticeable that low incidence and high recognization rate of mental disorders have been found in the inpatients of a general hospital. The inpatients of internal medicine in a general hospital, who live along, have a history of mental disorders, or discriminate the psychopath, are prone to get sick with mental disorders. PTSD should be excluded for the inpatients with traumatic injury.