德国综合性医院医学无法解释的躯体症状患者与其他心理障碍患者的心理治疗服务时长差异性分析

Difference Analysis of Service Length of Psychotherapy between Patients with Medically Unexplained Physical Symptoms and Other Patients with Mental Disorders in A General Hospital of Germany

目的考察德国综合性医院医学无法解释的躯体症状（MUPS）患者与其他心理障碍患者心理治疗服务时长之间的差异性。方法 2014年3月—2015年3月选取德国弗莱堡大学医学中心2006—2010年向心身医学与心理治疗科转诊的住院患者8 695例,其中接受心理治疗的患者6 720例,根据向心身医学与心理治疗科转诊的原因分为3组,其中应对方式问题（Coping）组3 886例、当前的心理症状（CPS）组2 261例、MUPS组573例。采用联络会诊-基本资料记录表（CL-Ba Do）收集患者各心理治疗项目服务时长,以10 min为1个单位。比较3组患者各心理治疗项目服务时长所占比例,并采用一般线性模型单变量检验分析心理治疗服务时长的影响因素。结果 Coping组患者心理治疗服务时长（缺失392例）1-6个单位,共10 873个单位;CPS组患者心理治疗服务时长（缺失491例）1-6个单位,共23 383个单位;MUPS组患者心理治疗服务时长1-6个单位,共2 940个单位。3组患者各心理治疗项目服务时长所占比例比较,差异有统计学意义（P〈0.05）。3组患者心理治疗服务时长分布比较,差异有统计学意义（P〈0.05）;其中MUPS组患者心理治疗服务时长〈9个单位和10-13个单位者所占比例较Coping组和CPS组增多（P〈0.01）。一般线性模型单变量检验结果显示,与CPS组比较,Coping组和MUPS组患者心理治疗服务时长差异无统计学意义（P〉0.05）;各心理治疗项目服务时长对心理治疗服务时长的影响,差异无统计学意义（P〉0.05）;但MUPS组心理相关病史的采集和咨询讨论服务时长对心理治疗服务时长的影响,差异有统计学意义（P〈0.05）。结论德国综合性医院中MUPS患者更易于接受心理相关病史采集服务,说明MUPS患者虽关注躯体不适的感受,但却有较高的潜在获取心理治疗服务的内心需要。

Objective To explore the differences in the service length of psychotherapy between patients with medically unexplained physical symptoms（ MUPS） and other patients with mental disorders in a general hospital of Germany.Methods 8 695 inpatients who referred to the Department of Psychosomatic Medicine and Psychotherapy in the University Medical Center Freiburg from 2006 to 2010 were selected,and 6 720 patients received psychotherapy. According to the reasons of referring to the Department of Psychosomatic Medicine and Psychotherapy,they were divided into three groups——3 886 in problems of coping（ Coping） group,2 261 in current psychological symptoms（ CPS） group and 573 in MUPS group. The service lengths of psychotherapy of patients were collected by adopting Consultation Liaison-Basic Document（ CL-Ba Do）,and10 minutes were taken as a unit. The proportions of each service length of psychotherapy occupied by the patients in the three groups were compared,and the influencing factors of the service length of psychotherapy service were analyzed by general linear model univariate test. Results In the Coping group,the service lengths of psychotherapy of 392 patients were missed,1 to 6units,and totally 10 873 units; the service lengths of psychotherapy of 491 patients in CPS group were missed,1 to 6 units,and totally 23 383 units; none in MUPS group missed their service lengths of psychotherapy,1 to 6 units,and totally 2 940 units. There was significant difference in the proportions of each service length of psychotherapy among the three groups（ P〈0. 05）. There was significant difference in the distribution of service lengths of psychotherapy among the three groups（ P〈0. 05）; the proportion of patients with service lengths of psychotherapy less than 9 units and between 10 to 13 units in MUPS group were more than those in Coping group and CPS group（ P〈0. 01）. The results of general linear model univariate test showed that compared with the CPS group,the differences of service lengths of psychotherapy between patients in Coping group and MUPS group were not significantly different（ P〉0. 05）; all the service lengths of psychotherapy had no significant influence on the service length of psychotherapy（ P〉0. 05）; however,in MUPS group,the service length of collecting medical history of mental-related diseases and consultation and discussion had significant influence on the service length of psychotherapy（ P〈0. 05）. Conclusion It is much easier for the patients with MUPS in the general hospitals in Germany to accept the services of collecting psychological-related medical histories,and this means that although patients with MUPS focus on the feelings of somatic discomfort,they still have inner needs of high potential for obtaining services of psychotherapy.