基层医疗机构急性应激障碍晤谈式心理危机干预效果评价

Effect evaluation of Acute Stress Disorder Interview psychological crisis intervention in primary health care institutions

目的基层医疗卫生机构主要包括社区卫生服务中心和站点、乡镇卫生院和村卫生室,这些机构的心理健康医疗资源相对匮乏,发生突发事件时往往难以正确处理。本研究旨在探讨突发应激事件对基层医疗机构工作人员心理健康影响以及运用紧急事件应激晤谈方法开展团体心理危机干预效果,为基层医疗机构发生类似事件或医务人员的集体心理建设提供参考。方法选取2018-07-07-08成都市武侯区玉林社区卫生服务中心工作人员中自愿报名参加团体心理危机干预的66人为研究对象,分别在干预前及干预后采用斯坦福-急性应激反应问卷(Stanford-acute stress response questionnaire,SASRQ)进行测评,干预前后效果比较采用配对检验。结果共有66人纳入研究,其中女性(90.90%)、医生组(25.76%)及护理组(40.91%)人数较多。阳性症状筛查结果显示,干预前研究对象共有38人(57.58%)出现一种或多种阳性症状,干预后阳性症状人数减至25人(37.88%),差异有统计学意义,χ~2=6.857,P=0.007。干预后SASRQ总分及各项因子得分降低,差异有统计学意义,P<0.001。结论在基层医疗机构里发生突发应激事件会对员工的身心健康造成较大影响,运用紧急事件应激晤谈形式展开团体心理危机干预,能快速有效地减少应激反应症状,降低应激反应程度。

OBJECTIVE Primary health care institutions mainly include community health service centers and stations,township health centers and village clinics.These institutions have relatively scarce mental health medical resources,and it is often difficult for them to deal with emergencies.The purpose of this study was to explore the effect of sudden stress events on the mental health of staff in primary health care institutions and the effect of group psychological crisis interventions by critical incident stress debriefing(CISD),therefore,it provides a reference for similar incidents in primary health care institutions or the collective psychological construction of medical staff.METHODS A total of 66 people who volunteered to participate in the group psychological crisis intervention were selected from the members of Yulin Community Health Service Center in Chengdu on July 7 and 8,2018.The evaluation was carried out,and the paired test was used to compare the effects before and after the intervention.The Stanford-acute stress response questionnaire(SASRQ)was used for before and after the intervention,and the paired test was used to compare the effects before and after the intervention.RESULTS A total of 66 people were included in the study,including women(90.90%),doctors(25.76%)and nursing groups(40.91%).Positive symptom screening showed that 38(57.58%)of the subjects had one or more positive symptoms before the intervention,the number of positive symptoms decreased to 25(37.88%)after intervention,the difference was statistically significant(χ~2=6.857,P=0.007).After the intervention,the total score of SASRQ and the scores of various factors decreased,and the differences were statistically significant(P<0.001).CONCLUSIONS The emergencies in primary medical institutions have a great impact on the physical and mental health of staff.Using CISD to carry group psychological crisis can reduce their stress response symptoms and degree of stress response quickly and effectively.