严重精神障碍患者及家属拒绝参与社区管理治疗服务网络原因的质性研究

Qualitative study on the reasons why patients with severe mental disorders and their family members refuse to participate in the community management and treatment service network

目的探讨严重精神障碍患者及家属拒绝参与社区管理治疗服务网络的原因。方法采用描述性质性研究,对2018年1-5月在成都市某三甲精神专科医院住院治疗的12例严重精神障碍患者及7名家属进行半结构式访谈,应用内容分析法,并通过Nvivo 10.0软件整理分析资料。结果影响严重精神障碍患者及家属拒绝参与社区管理治疗网络的5个主题有:患者及家属不良认知,涵盖对严重精神障碍疾病相关认知不足和对社区管理治疗服务网络理解有误2个亚主题;患者及家属消极情感,包括严重的病耻感、患者及家属信任感缺失2个亚主题;患者及家属实际需求未被满足;患者内向性人格特质;患者与家庭主要照顾者间决策对弈。结论加强宣传、充分保护患者及家属隐私、消除疑虑、打造专业精防团队、提供多样化社区管理治疗服务网络、抓住拒绝参与社区管理治疗服务网络患者及家属“拉力”相关因素可帮助提高严重精神障碍患者及家属参与社区管理治疗服务网络积极性。

Objective To explore the reasons why patients with severe mental disorders and their family members refuse to participate in the community management and treatment service network.Methods Totally 12 patients with severe mental disorders hospitalized and 7 family members in a ClassⅢGrade A psychiatric hospital in Chengdu between January and May 2018 received semi-structural interviews using descriptive qualitative research methods.The content analysis and Nvivo 10.0 were used to organize and analyze the interview materials.Results The five themes that affected refusal of patients with severe mental disorders and their family members to participate in the community management and treatment network were:poor perception of the patients,which covered the sub-themes of insufficient awareness of severe mental disorders and incorrect understanding of the community management and treatment service network;negative emotions of the patients and their family members,including the sub-themes of severe feelings of stigma and lack of trust;the patients and their family members actual needs were not met;the introverted personality traits of the patients;the decision-making game between the patients and the main caregiver of the family.Conclusions Strengthening publicity,fully protecting the privacy of the patients,eliminating doubts,building a professional psychiatric prevention team,providing a diverse community management and treatment service network,and grasping the relevant drivers for the patient's refusal to participate in the community management and treatment service network can help enhance the enthusiasm of patients with severe mental disorders and their family members to participate in the community management and treatment service network.