成都市农村社区精神分裂症患者犯罪行为的危险因素

Risk factors of criminal behavior in persons with schizophrenia in a rural Chinese community

目的:探讨农村社区中精神分裂症患者犯罪行为的发生率及其相关因素。方法:对成都市新津县农村社区中510例精神分裂症患者的犯罪行为及其临床症状、社会功能、治疗、照管等情况进行了14年(1994-2008年)的随访调查。调查工具包括精神现况检查第9版(Present State Examination,PSE-9)、社会功能缺陷筛查表(Social Disability Screening Schedule,SDSS),以及阳性与阴性症状量表(Positive and Negative Syndrome,PANSS)等。结果:在14年的随访调查中有489例患者(95.9%)完成了随访。随访患者终身犯罪行为的发生率为13.5%。犯罪行为在未婚(19.1%)、较年轻[平均年龄(41.2±16.6)岁]、发病年龄较早的精神分裂症患者[平均发病年龄(28.4±10.4)岁]中较常发生。随访资料中,患者家庭经济状况较差(16.6%)、缺乏监护照管人(28.6%)、无家可归(25.0%),及PANSS总分(68.7±28.7)和阳性(14.1±7.4)、阴性(19.3±10.2)分较高的患者中犯罪行为的发生率较高(P<0.05)。结论:精神分裂症患者的犯罪行为在农村社区中较为常见,其影响因素是多方面的。在制定社区精神卫生服务政策、提供精神卫生服务及家庭干预时,应考虑社区中精神分裂症患者的犯罪行为及其危险因素(如患者的婚姻、家庭及监护照管状态、社会支持系统等)。

Objective： To examine the prevalence and risk factors of criminal behavior among persons with schizophrenia in a rural area. Methods： A 14-year prospective follow-up study （ 1994 - 2008 ） was conducted on criminal behavior, clinical symptoms, social functioning, treatment and caring status among 510 persons with schizophrenia in Xinjin County, Chengdu. The instruments included the Present State Examination （ PSE-9 ）, So- cial Disability Screening Schedule （ SDSS ）, and Positive and Negative Syndrome （ PANSS ） . Results： Totally 489 patients { 95.9% ） were followed up. The life-time prevalence of criminal behavior among these patients was 13.5%. Criminal behavior was more likely to happen among the persons who were unmarried （ 19. 1% ）, younger [ {41.2 ±16.6） years old], and had earlier onset age [ {28.4 ±10. 4） years old] . In the follow-up data, the rates of patients＇criminal behavior were relatively higher among these patients who had poor family economic status （ 16. 6% ） , no caregiver （ 28. 6% ） , homelessness （ 25.0% ） , and higher positive （ 14. 1 ± 7.4 ） , negative （ 19. 3 ±10. 2） and total scores {68. 7 ±28.7） of PANSS （P 〈0. 05 ） . Conclusion： The criminal behavior in pa- tients with schizophrenia is common in rural areas and may be affected by multi-factors. The risk factors of criminal behavior in persons with schizophrenia, such as their marriage, family intervention and social support services, should be considered for community mental health policy making, community mental health services and family in- terventions.