湖南省浏阳市农村社区精神分裂症患者就诊延误及其影响因素的研究

Delay of help-seeking and the related factors among patients with schizophrenia in a rural sample from Hunan, China

目的探讨农村社区精神分裂症患者就诊延误情况及其影响因素。方法以浏阳市农村社区为研究现场，采用分层整群随机抽样方法，对抽中的3个乡镇共23个行政村≥15岁常住人口61165人进行精神障碍的线索调查，对符合美国精神障碍诊断与统计手册第4版轴Ⅰ障碍定式临床检查患者版中精神分裂症诊断标准的220例患者进行问卷调查。就诊延误定义为出现精神症状后≥2个月的时间没有就诊于医疗机构。结果220例精神分裂症患者中，仅71例（32．3％）在出现明确的精神症状1个月内到医疗机构就诊；129例（58．6％）就诊延误≥2个月，113例（51．4％）≥3个月，104例（47．3％）≥6个月，28例（12．7％）自发病到接受调查之日从未就诊。影响患者就诊延误的主要因素是起病缓慢、首发症状以阴性症状为主、文化程度低和无稳定婚姻关系。结论浏阳市农村社区精神分裂症患者存在严重的就诊延误；针对影响就诊延误的主要因素，应通过健康教育和精神障碍筛查等手段提高精神分裂症患者的就诊率。

Objective To study the extent of delay in help-seeking and its related factors among patients with schizophrenia in rural communities. Methods Twenty-three villages were sampled from Liuyang City using stratified-cluster random sampling techniques. Clues of schizophrenia were identified among 61 165 residents, in which 220 persons were diagnosed as schizophrenia by using the Structured Clinical Interview for DSM-Ⅳ-TR Axis Ⅰ Disorders-Patient Edition （SCID-I/P）. Delay of help-seeking was defined as being delayed 60 days and more to visit a doctor after psychiatric symptoms was notified. Results Among 220 cases with schizophrenia, only 71 （32. 3% ） visited doctors within one month after psychiatric symptoms notified, 129 （ 58.6% ）, 113 （ 51.4% ）, and 104 （47.3%） delayed at least two, three and six months, respectively. Subtle onset, negative symptoms （such as apathy, hypobulia）, lower-level educated, unstable marital and family structure were major risk factors of delay in help seeking. Conclusion Delay in help-seeking in patients with schizophrenia is a serious mental health problem in rural areas. This study implies that targeted health education and scanning for schizophrenia are urgently needed to promote patients with schizophrenia seeking help from medical institutions.