主动性社区治疗对分裂症患者自杀风险的影响及机制

The Mechanism of Assertive Community Treatment Effects on the Suicidality in Schizophrenia Patients

目的:探讨主动性社区治疗对精神分裂症患者自杀风险的影响及其机制。方法:随机抽取的社区精神分裂症患者114例分为主动性社区治疗组(n=43)和对照组(n=71),对主动性社区治疗组进行6个月的主动性社区治疗,入组前及治疗6个月后比较两组患者社会支持、临床症状和自杀风险,分析影响患者自杀风险的因素。结果:主动性社区治疗组6个月后客观支持得分、支持利用度得分高于对照组,阳性因子、兴奋敌对因子、焦虑抑郁因子和自杀风险得分均低于对照组。干预后患者的支持利用度和焦虑抑郁症状与其自杀风险相关。患者是否参与主动性社区干预以及首次测量的主观支持、焦虑抑郁症状、自杀风险与患者6个月后自杀风险相关。结论:主动性社区治疗可以提高患者社会支持、减轻临床症状和自杀风险,干预后患者的支持利用度和焦虑抑郁症状与其自杀风险相关。主动性社区治疗、干预前的主观支持、焦虑抑郁因子和自杀风险可预测患者6个月后的自杀风险。

Objective： To explore the mechanism of the Assertive Community Treatment effects on the suicidality in schizophrenia patients. Methods： 114 community schizophrenia patients were chosen randomly and divided into Assertive Community Treatment group（n=43） and Control group（n=71）, Assertive Community Treatment group had an assertive community treatment for 6 months. We compared the social supports, clinical symptoms and suicidality between before and after treatment. Results： The score of Objective support scale, Utilization of support scale in Assertive Community Treatment group were higher than control group（P〈0.05） while the score of positive factor, Excitement- hostile factor, Anxiety-Depression factor and suicidality were lower than control group（P〈0.05）, the score of Utilization of support scale, Anxiety-Depression factor were related to the suicidality in patients. Assertive community treatment, the score of subjective support scale, Anxiety-Depression factor, suicidality prior to intervention were related to the suicidality in 6 months. Conclusion： Assertive community treatment improved social support of and reduced clinic symptoms and suicidality in schizophrenia patients, The Utilization of support and anxiety/depression are related with suicide risk in patients after intervention. Assertive community treatment, subjective support, anxiety/depression, suicidality prior to intervention are important factors predicting suicidality after intervention in 6 months.