综合医院非精神科临床医师对抑郁焦虑障碍诊疗服务能力现状调查

Survey on the non-psychiatric physician＆#39;s ability of diagnosis and treatment of depression/anxiety disorders in general hospital

目的 调查综合医院非精神科临床医师对抑郁焦虑障碍诊疗能力及精神心理服务资源现状.方法 采用自制问卷对57所综合医院共1 152例非精神科临床医师进行相关调查.问卷内容主要包括：综合医院非精神科临床医师接受精神卫生相关知识培训情况、病例分析.结果 1 152例非精神科临床医师参与调查.596例（51.74％）曾参加过精神病学学习,562例（48.78％）曾参加过医学心理学学习,230例（20.97％）曾参加过健康心理学学习.59例（5.12％）参加过心理治疗培训,255例（22.14％）参加过相关学术讲座.80例（6.94％）非精神科临床医师表示对抑郁焦虑障碍临床表现表示非常了解,对诊断标准及治疗手段非常了解率分别为52例（4.51％）,44例（3.82％）.所有被调查者中,典型病案分析诊断正确者794例（68.9％）例,458例（57.68％）选择药物治疗,764例（96.22％）选择心理治疗,29例（3.65％）选择物理治疗,438例（55.16％）选择包含药物治疗在内联合治疗方案.诊断、治疗均正确者379例,占32.90％.二元Logistic回归分析,结果非精神科临床医师年龄（P=-0.093,Exp（B）=0.911）、工作年限（P=-0.002,Exp（B）=1.080）是影响非精神科临床医师对抑郁焦虑障碍诊断正确性的主要因素.结论 综合医院非精神科临床医师对抑郁焦虑障碍知识有一定基础,识别、诊断治疗率仍较低,不同级别医院之间差异大.

Objective To investigate the status of the non-psychiatrist＇ s diagnostic and therapeutic ability of depression/anxiety disorders in 57 General Hospitals.Methods 1 152 non psychiatric clinicians in 57 general hospitals were surveyed.A custom-made questionnaire included the training of mental health-related knowledge which the general hospital physicians received and typical anxiety/depression case analysis.Results Among 1 521 non-psychiatric clinicians,596 （51.74%） clinicians participated the training of psychiatry,562 （48.78%） participated the training of medical psychology and 230（20.97%） clinicians participated the training of Healthy Psychology.In professional setting,59 （5.12%） clinicians participated the training of psychotherapy,255 （22.14%） clinicians had attended related academic symposiums.80（6.94%） clinicians believed that they understand the clinical display of anxiety/depression disorders,52 （4.51%） clinicians expressed the understanding of diagnostic criteria of anxiety/depression disorders and its treatments,while 44（3.82%） clinicians only possessed the knowledge of anxiety/depression disorder treatment.In the typical case analysis,it revealed that 794 （68.89%） clinicians made accurate diagnosis,458（57.68%）clinicians made a choice of medical treatment,764（96.22%） clinicians chose psychotherapy,29 （3.65%） clinicians applied physical therapy,while 438 （55.16%） clinicians combined drug therapy with one or more other therapeutic methods.Binary logistic regression analysis showed that the age（P=-0.093,Exp（B）=0.911）and work experience（P=-0.002,Exp（B） =1.080）significantly contribute to the diagnostic accuracy of non-psychiatrists.Conclusion The non-therapeutic psychiatric clinicians in general hospitals have certain basic knowledge of depression/anxiety disorders with lower level of diagnosis and treatment diagnosis and treatment.And there is bigger difference among different hospitals.