2007-2013中国精神残疾治疗康复变化趋势

Trend of treatment and rehabilitation rates among people with psychiatric disability from 2007 to 2013 in China

目的:本研究通过分析2006年第二次全国残疾人抽样调查和2007-2013年全国残疾人监测研究数据,描述历年有精神残疾者接受治疗和康复的情况,并通过纵向比较历年治疗康复率,总结精神残疾人接受治疗康复的变化趋势。方法:2007-2013年全国残疾人监测研究是在2006年第二次全国残疾人抽样调查的基础上进行的每年一次的追踪调查。2006年第二次全国残疾人抽样调查在全国734个县抽取有代表性的样本2 526 145人,首先通过筛查发现疑似残疾人,然后由精神科医生依据ICD-10和WHO DAS II标准,将患精神障碍持续一年以上未痊愈,存在认知、情感和行为障碍,影响其日常生活和社会参与,WHO DAS II得分≥52分者,诊断为精神残疾。自2007至2013年,全国残疾人监测研究每年在第二次全国残疾人抽样调查的734个样本县中每个县抽取1~2个调查小区,通过入户填写问卷的方式调查生活在小区中残疾人的生活、治疗康复、教育、就业等方面的状况及变化情况。结果:分析发现有精神残疾者接受治疗康复率大幅上升,自2007至2013年,≤17岁有精神残疾的儿童接受治疗训练率从23.5%上升至43.9%,≥18岁有精神残疾者接受治疗率从49.5%上升至66.9%,接受康复率从21.8%上升至58.7%。但是,关于治疗康复效果,历年调查中认为效果"一般"的有精神残疾者均远远多于认为效果"好"或者"较好"者。并且≥18岁有精神残疾者治疗康复的形式多为药物治疗、心理治疗以及日间照料与托养;参加工疗、农疗和职业劳动技能训练者相对较少。结论:从2007到2013年的几年里,我们国家精神残疾治疗康复服务的覆盖率大幅提高。未来在继续增加治疗康复服务覆盖率的同时,需关注如何提高治疗康复质量。

Objective： To describe health service use and trend of treatment and rehabilitation rates among people with psychiatric disability from 2007 to 2013. Methods： Data collected by the 2006 Second China National Sample Survey and the 2007 - 2013 National Disability Monitoring Survey were utilized and analyzed. The 2006 National Sample Survey on Disabilities investigated 2 526 145 non-institutionalized representative civilians in 734 counties across China's Mainland. Psychiatric disability was diagnosed by clinical psychiatrists according to ICD-10 and WHO DAS II criteria. The 2007 to 2013 National Disability Monitoring Survey selected 1 to 2 study sites among each of the 734 study counties that had been investigated by the Second China National Sample Survey. Information on living conditions, health service use, education and employment were recorded. Results： The data showed that treatment and rehabilitation rates for people with psychiatric disability had largely increased from 2007 to 2013 among adults aged 18 years or older, with the treatment and rehabilitation rates from 49. 52% and 21.8% to 66. 9% and 58.7% respectively, and the rates among those with 17 years or younger from 23.5% to 43.9%. However, with regard to the effect of the treatment and rehabilitation services, a much larger proportion of people with psychiatric disability reported that the effect was ＂soso＂ instead of ＂good＂ or ＂very good＂. In addition, among those who received rehabilitation service, most received day care or psychotherapy service, only less than 8% participated work therapy, farming therapy or working skill trainings. Conclusion： The results suggest treatment and rehabilitation rates among people with psychiatric disability are largely increased from 2007 to 2013, while the quality of the service needs further attention.