强迫症患者与正常对照的家庭功能和社会支持的对照研究(英文)

Comparison of family functioning and social support between families with a member who has obsessivecompulsive disorder and control families in Shanghai

背景在强迫症的发生与病情演变中家庭功能起着重要的作用,因而理解强迫症患者的家庭问题类型有助于制定针对性的家庭干预。目的比较强迫症患者及其同住的父母与正常对照及其同住父母的家庭功能和社会支持。方法在同济大学东方医院门诊的32例符合DSM-IV强迫症诊断标准的患者和其同住的父母中的一位以及通过附近居委会招募的31位社区对照者(年龄、受教育程度相匹配)及其同住的父母之一参加了本研究。所有受试者独立填写2个中文版自评量表,即用于评估家庭功能7个维度的McMaster家庭功能评定量表(Family Assessment Device,FAD)以及用于评估主观感受到的来自于家庭成员、朋友以及其他社会支持的领悟社会支持量表(Multidimensional Scale of Perceived Social Support,MSPSS)。结果根据原版量表划分正常与否的分界值,强迫症患者及其父母的FAD所有维度的得分均处于异常范围。除了FAD的情感卷入这一维度,强迫症患者及其父母报告的家庭功能和社会支持都分别低于社区对照及其父母报告的程度。患者与父母在问题解决、沟通和情感介入等3个FAD因子的得分一致性高于社区对照与父母的一致性(p均小于0.001),但行为控制的得分一致性低于对照(p=0.009)。除个别相关系数未达统计学意义外,所有研究对象的MSPSS的4个得分均与FAD的7个得分呈正相关。结论在中国,强迫症类似于其他精神障碍,也是一种广泛影响家庭功能的疾病。治疗强迫症时,需要整合基于家庭的心理社会干预(如家庭治疗)以及基于个体的生物学干预和心理干预。本研究结果发现所有研究对象主观感受到的社会支持与家庭功能密切相关,这凸显了在中国,家庭功能在个体的身份认同与社交网络中的中心地位作用。

Background:Family functioning plays an important role in the etiology and course of obsessive-compulsive disorder (OCD) so understanding the types of problems families with OCD patients have will help in the creation of OCD-specific family interventions.Objective:Compare family functioning and social support of OCD patients and their co-resident parents to that of community controls and their co-resident parents.Methods:Thirty-two psychiatric outpatients at the Affiliated East Hospital of Tongji University (in Shanghai) who met DSM-IV criteria for OCD and one of their co-resident parents and 31 community controls matched for age and years of education with the patients and one of their co-resident parents independently completed Chinese versions of the selfadministered McMaster Family Assessment Device (FAD),which assesses seven dimensions of family functioning,and the Multidimensional Scale of Perceived Social Support (MSPSS),which assesses perceived support from family members,from friends and from other associates.Results:All of the FAD dimension scores for both patients and their parents were in the unhealthy range (based on cut-off scores used in the Western version of the scale).With the exception of the Affective Involvement dimension of the FAD,patients with OCD and their parents reported significantly more poor family functioning and more poor social support than community controls and their parents.The concordance of patients FAD scores and their parents scores was significantly stronger than that of controls and their parents for the Problem Solving,Communication and Affective Involvement dimensions (all p<0.001) but significantly weaker for the Behavioral Control dimension (p=0.009).For all four groups of respondents the four measures of perceived social support were all positively correlated with each of the seven measures of family functioning,though several of the correlation coefficients did not reach statistical significance.Conclusions:OCD,like several other psychiatric illnesses,is an illness that profoundly affects families in China.Interventions for OCD need to integrate family-based psychosocial approaches (e.g.,family therapy) with individual-based biological and psychological interventions.Our finding that perceived social support—from family members and from others—are closely related to family functioning in all types of respondents highlights the central role of families in the personal identity and social networks of individuals in China.