河北省精神障碍患者的就诊情况调查

Medical visits of patients with mental disorders in Hebei Province

目的了解河北省精神疾病患者的就诊情况。方法本研究为河北省精神疾病流行病学调查的部分资料。以美国《精神障碍诊断与统计手册》（DSM-Ⅳ）为诊断标准，用《DSM-Ⅳ轴Ⅰ障碍用临床定式检查》（SCID—I／P）作为诊断工具。对筛选出存在精神障碍的患者进行了自制的精神卫生服务利用问卷调查。结果共取得有效问卷1826例，曾就诊过者有233例，就诊率为12．76％。在一般资料方面，农村，城镇户口、年龄、婚姻情况及就业情况对就诊率有影响（P〈0．01）。其中符合心境障碍、精神病分裂症和其他精神病性障碍、物质使用障碍、焦虑障碍、躯体形式障碍和进食障碍的诊断患者就诊率分别为15．32％（95／620）、66．18％（90／136）、1．75％（7／400）、5．72％（37／647）、17．39％（4／23）；病种之间就诊率差异有统计学意义（x2=425．068，P〈0．01）。就诊患者首发症状排在前3位的是焦虑抑郁、失眠、幻觉妄想。首次就诊时，到精神卫生机构就诊的患者仅为5．6％。结论大部分有精神卫生服务需求的人未能得到相应的精神卫生服务，目前的精神卫生服务仅能为小部分人群利用，提示河北省精神卫生服务利用水平较低，精神卫生服务现状不容乐观。

Objective To understand the situation of medical visit in patients with mental illness in Hebei Province. Methods This study was part of the epidemiological investigation of mental disorders in Hebei Province. The ＂Structured Clinical Interview for DSM- Ⅳ ＂ （SCID- I /P） was used as a diagnostic tool with the diagnostic criteria of ＂diagnostic and statistical manual of mental disorders in the United States＂ （DSM- Ⅳ ）. The self-made questionnaire on mental health services utilization was carried out in patients with mental disorders. Results Among the 1 826 cases of effective questionnaire, there were 233 patients had been with mental health service, with a visiting rate of 12.76%. In general information, rural/urban household registration, age, marital status and employment situation had an impact on the visiting rate （P 〈 0.01）. The visiting rates of patients with mood disorders, psychiatric schizophrenia and other psychiatric disorders, substance use disorders, anxiety disorders, somatoform disorder and eating disorders were respectively 15.32%（95/620）, 66.18%（90/136）, 1.75%（7/400）, 5.72%（37/647）and 17.39%（4/23）. The difference of visiting rate among different diseases was statistically significant （ X 2=425-068, P 〈 0.01）. The top three of the patients who came to the clinic were anxious and depress, insomniac and delusional. For the first visit, only 5.6% of patients came to the mental health facility. Conclusions Most people with mental health service demand failed to get the corresponding mental health services. The current mental health services can only be used by a small group of people, which indicates that the utilization level of mental health services in Hebei is relatively low, and the current situation of mental health services is not optimistic.