厦门市等地区居民精神障碍流行病学调查及文献资料的研究

Analysis of epidemiological survey data of mental disorders in Xiamen city and other regions residents

目的：通过收集研究多地区居民精神障碍的时点患病率情况和社会人口学特征，探讨影响厦门市居民精神障碍可能的影响因素。方法采用多阶段分层整群随机抽样的方法抽取厦门市12071名年龄≥18岁人群为调查对象，最终10764名完成调查，其中男性4957名，女性5807名，城镇人口8588名，农村人口2176名。用扩展的一般健康问卷进行筛查，然后使用《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）》作为诊断工具，做出有无精神障碍及具体诊断。通过收集山东省、浙江省、青海省、河北省、天水市、承德市和保定市等7地区用相同调查方法和诊断标准的精神障碍流行病学调查资料，将各地居民的精神障碍患病率情况和社会人口学特征与厦门市进行比较，采用卡方检验等统计学方法进行分析。结果厦门市居民精神障碍总的时点患病率仅为3.46%（254/10764），低于其他地区（山东省19.48%，浙江省17.27%，青海省18.04%，河北省16.24%，天水市17.90%，承德市17.71%，保定市13.62%）。厦门市居民常见的精神障碍前5位中不包括在其他地区居民中最为常见的酒精使用障碍。被调查的厦门市居民人口社会学特征与其他地区不同，其中城镇化程度（城市居民占79.78%）高于其他地区（山东省24.91%，χ2=6624.955；浙江省32.95%，χ2=3601.752；青海省23.55%，χ2=4991.289；河北省15.95%，χ2=11547.016；天水市16.05%，χ2=6484.483；承德市15.60%，χ2=2930.811；保定市11.80%，χ2=6973.770，P均〈0.001），享有医疗保险比例（83.06%）高于其他地区（浙江省23.30%，χ2=8868.617；河北省8.68%，χ2=17434.576；天水市11.20%，χ2=10862.305；承德市8.69%，χ2=5884.478；保定市9.54%，χ2=10728.632，P均〈0.001）。结论厦门市居民精神障碍总的时点患病率低于其他地区，可能与城镇化程度较高、居民享有较好的医疗保障和无大量饮酒习惯等因素有关，是否有其他的保护性因素还有待进一步研究探讨。

Objective By comparing the prevalence of mental disorders and social demographic characteristics, to analyze the influencing factors of mental disorders in Xiamen city residents. Method Using multi-stage stratified cluster random sampling, 12 071 subjects aged 18 years and older were identified in Xiamen city. Eventually 10 764 subjects completed the survey, including 4 957 males, 5 807 females, 8 588 urban population and 2 176 rural population. The subjects were screened with the expanded version of GHQ-12, the Structured Clinical Interview for DSM-Ⅳ-TR as a diagnostic tool, and made a determination whether they had mental disorder and specific diagnosis. Result The overall prevalence of mental disorders in Xiamen city was lower than that in other provinces and cities; it was only 3.46%（Shandong province 19.48%, Zhejiang province 17.27%, Qinghai province 18.04%, Hebei province 16.24%, Tianshui city 17.90%, Chengde city 17.71%, Baoding city 13.62%）. The one of most common mental disorders was the alcohol use disorders in various provinces and cities, except in Xiamen city. The constituent ratio of Xiamen residents surveyed was 79.78%for urban, higher than those of other provinces and cities （Shandong province 24.91%,χ2=6 624.955,P〈0.001;Zhejiang province 32.95%,χ2=3 601.752, P〈0.001;Qinghai province 23.55%,χ2=4 991.289,P〈0.001;Hebei province 15.95%,χ2=11 547.016,P〈0.001;Tianshui city 16.05%,χ2=6 484.483,P〈0.001;Chengde city 15.60%,χ2=2 930.811,P〈0.001;Baoding city 11.80%,χ2=6 973.770,P〈0.001）. Most residents of Xiamen enjoyed at least one kind of health insurance （83.06%）, higher than those of other provinces and cities （Zhejiang province 23.30%,χ2=8 868.617,P〈0.001;Hebei province 8.68%,χ2=17 434.576,P〈0.001;Tianshui city 11.20%,χ2=10 862.305, P〈0.001;Chengde city 8.69%,χ2=5 884.478,P〈0.001;Baoding city 9.54%,χ2=10 728.632,P〈0.001）. Conclusion The overall current prevalence of mental disorders in Xiamen city residents was lower than those of other provinces and cities. The reasons may be that there was higher degree of urbanization, better health care, no heavy drinking habits and other factors. There might be other protective factors which need to be further studied.