社会歧视对门诊精神分裂症患者服药依从性的影响

Social stigma in outpatients with schizophrenia and its impact on medication adherence

目的：探讨社会歧视对精神分裂症患者依从性的影响。方法：选择本院门诊复诊的精神分裂症患者178名,收集服药相关信息,并用精神疾病内化污名量表（internalized stigma of mental illness scale,ISMI）评测社会歧视情况,用等级Logistic回归分析社会歧视与依从性的关联。结果：178名患者信息中,完全依从、部分依从和不依从率分别为43.3%、31.5%和25.2%。3组患者在ISMI价值否定、歧视体验和生活无意义等3个维度的得分上存在明显差异,不依从者得分最高。等级Logistic回归分析表明价值否定（OR=1.72,95%CI：1.37～2.07）、歧视体验（OR=2.89,95%CI：2.56～3.32）和生活无意义（OR=2.11,95%CI：1.68～2.54）3个维度的得分与依从性存在明显关联。校正年龄、文化程度和居住地等混杂因素后,3个维度仍表现出明显的独立作用。结论：精神分裂症患者服药依从性差,社会歧视是影响依从性的重要因素。消除社会歧视可能是改善服药依从性的有效措施。

Objective：To explore the influence of social stigma on the adherence of schizophrenic patients. Methods： Choose 178 schizophrenia patients with return outpationt visits in our hospital,collect information related to the medication, adopt internalized stigma of mental illness scale （ISMI） to evaluate social stigma,and use hierarchical logistic regression correlation to analyze social stig- ma and adherence. Results： In the information of 178 patients, the complete compliance,partial compliance and non compliance rate were 43.3% ,31.5% and 25.2% respectively. The 3 groups of patients in the ISMI value of the negative, discrimination experience and life meaningless, there were significant differences in the scores of 3 dimensions, non compliance with the highest score. An obvious rela- tionship between self-denial （ OR = 1.72,95 % CI：1.37 - 2.07 ） , discrimination experience （ OR = 2.89,95 % CI ： 2.56 - 3.32 ） and nonsense of daily life （ OR = 2.11,95 % CI： 1.68 - 2.54） and medication adherence was observed through ordinal logistic analysis. Af- ter adjustment for confounders like age,education and residential area,three subscales still showed significant role in predicting adher- ence. Conclusion：The medication adherence rate is low in patients with schizophrenia and social stigma is a significant factor impacting on adherence. Elimination of social stigma may be an effective measure to improve the medication adherence.