重庆市城乡老年人精神卫生状况及其影响因素比较分析

Status and influencing factors of mental health in urban and rural elderly in Chongqing

目的比较分析重庆市城乡老年人的精神卫生状况及其影响因素。方法采用多级分层随机抽样方法,抽取60岁及以上的重庆市城乡常住人口1 845人进行调查;以精神病筛选表、乙醇依赖筛查量表、老年认知评定问卷(ECAQ)、老年抑郁量表(GDS)筛选出可疑精神病阳性者,并根据DSM-Ⅳ和CCMD-3诊断标准进行复查诊断;对无精神病者,应用症状自评量表(SCL-90)、日常生活能力量表(ADL)、社会支持评定量表(SSRS)、艾森克人格问卷简式量表(EPQ-RSC)进行心理测试。结果 (1)精神病筛选阳性率为23.04%,现患病率为18.43%,分别诊断为乙醇所致精神障碍(9.21%)、心境障碍(4.34%)、器质性精神障碍(4.06%)、精神分裂症及其他精神病性障碍(0.81%)等。城乡患病率差异有统计学意义(机构:19.11%与8.24%,χ2=10.79;家庭:15.11%与21.83%,χ2=7.88,均P<0.01)。(2)1 398名非精神病老人中,总体心理健康问题检出率为13.73%,其中农村组的SCL-90、GDS及ECAQ筛查阳性率均显著高于城市组(17.17%与10.06%,χ2=14.27;38.23%与16.42%,χ2=337.73;13.43%与4.44%,χ2=943.20,均P<0.05)。(3)40%的城乡老年人生活活动能力不同程度下降,城市组有明显障碍者多于农村组(9.58%与5.15%,P<0.05)。(4)回归分析显示,神经质及认知水平分别对城市老年人的心理健康及生活能力影响最明显,养老方式与农村老年人心理健康及生活活动能力均密切相关。结论城乡老年人的心理健康状况及日常生活活动能力均有明显差异,分别实施针对性心理社会干预及加快农村养老体制改革措施,有助于提高整个老年群体生活质量。

Objective To compare and analyze health status of urban and rural old people,and its influencing factors.Methods Multi-stage stratified random sampling method was used to investigate 1 845people at least 60 years old in urban and rural resident population of Chongqing.Suspicious psychosis patients were screened out by Psychiatric Screening Table,MAST,ECAQ,GDS,and rechecked according to DSM-IV and CCMD-3.For non-psychiatric patients,psychological tests by SCL-90,ADL,SSRS and EPQ-RSC were utilized.Results（1）Psychiatric screening positive rate was 23.04%,with current prevalence of 18.43%,including alcohol-induced mental disorders（9.21%）,mood disorders（4.34%）,organic mental disorders（4.06%）,schizophrenia and other psychotic disorders（0.81%）.Significant difference between urban and rural prevalence（agency：19.11% vs.8.24%,χ2=10.79;family：15.11%vs.21.83%,χ2=7.88,P0.01）.（2）In 1 398non-psychotic elderly,the detection rate of overall mental health problems was 13.73%,and SCL,GDS and ECAQ positive screening rate in rural group was significantly higher than urban group（17.17%vs.10.06%,χ2=14.27;38.23%vs.16.42%,χ2=337.73;13.43%vs.4.44%,χ2= 943.20,P0.05）.（3）The activity of 40% of urban and rural older were decreased to varying degrees.Urban group was significantly impaired than rural group（9.58% vs.5.15%,P0.05）.（4）Regression analysis showed that neuroticism and cognitive levels were the most obvious influencing factors on older people＇s mental health and urban life skills respectively.Pension way was closely associated with both mental health and living ability of rural elderly.Conclusion There might be significant differences between urban and rural old people on mental health status and activities of daily living.Targeted psychosocial interventions and accelerating rural pension reform measures might be contribute to improve the quality of life in elderly.