个案管理对社区严重精神障碍患者社会功能及就业率的影响

Effects of case management on social function and employment rate of patients with severe mental disorders in community

目的 分析个案管理对社区严重精神障碍患者社会功能及就业率的效果。方法 从中山市南朗镇选取符合研究标准的严重精神障碍患者45 例作为个案管理组，根据经济和人口匹配原则，从中山民众镇随机抽取45 例严重精神障碍患者作为基础管理组。个案管理组患者接受社区个案管理，基础管理组患者接受国家要求提供的基础管理服务。对两组患者跟踪随访两年，采用临床总体印象量表（CGI）和个人与社会表现量表（PSP）在入组时、第2 年及第3 年进行评估，同时统计每年的就业人数。结果 经重复测量方差分析，CGI-SI组间主效应、时间主效应差异有统计学意义（F分别为7.65、10.99， P＜ 0.01），PSP组间主效应、时间主效应以及两者交互效应差异有统计学意义（F 分别为16.82、10.00、 13.74，P ＜ 0.01）。入组时两组CGI-SI、PSP及就业率差异无统计学意义，第2 年两组PSP差异有统计学意义（F=8.85，P=0.004），第3 年两组CGI-SI、CGI-GI、PSP及就业率差异有统计学意义（F 分别为21.53、 26.69、31.91，P＜ 0.01；χ2=6.61，P＜ 0.01），个案管理组优于基础管理组。结论 个案管理可以改善社区严重精神障碍患者的病情，提升社会功能，提高就业率。

Objective To analyze the effects of case management on social function and employment rate of patients with severe mental disorders in community. Methods A total of 45 patients with severe mental disorders met the criteria in Nanlang town where community case management were provided were recruited in the case management group. According to the matching principle of economy and population, another 45 patients with severe mental disorders in Minzhong town were selected into basic management group. Patients of the case management group received community case management, and the patients of the basic management group received basic management services provided by the government. The patients of two groups had been followed up for two years. The Clinical General Impression scale（ CGI） and the Individual and Social Performance scale（ PSP） were used to assess patients at the time of admission, the second year and the third year, and the annual number of employed persons was also counted. Results The repeated-measurement analysis of variance showed statistical significance in the differences of the CGI-SI intergroup main effect and time main effect（ F=7.65,10.99; P 〈 0.01）. The differences among group main effect, time main effect and interaction effect were statistically significant in the scores of PSP（ F=16.82,10.00,13.74;P〈 0.01）. There was no statistical difference in the scores of CGI-SI, PSP and the employment rate between two groups on admission, and in PSP on the second year（ F=8.85,P=0.004）. There were significant difference in the scores of CGI-SI,CGI-GI,PSP and the employment rate between two groups in the third year（ F=21.53,26.69,31.91,6.61,P 〈 0.01;χ2=6.61, P〈 0.01）. Conclusions Case management can improve the conditions of patients with severe mental disorders in community, enhance social function and improve the employment rate.