社区严重精神障碍患者暴力行为的影响因素

The state and influencing factors of violence behavior in patients with severe mental disorders among community

目的探讨社区居家严重精神障碍患者暴力行为发生的现状和影响因素。方法从深圳市精神卫生防治管理信息系统获取严重精神障碍的个案管理数据资料,应用SPSS 23.0软件进行描述性分析,并应用Logistic回归分析暴力行为发生的影响因素。结果深圳市社区居家在管严重精神障碍30 581例,暴力行为发生率为7.6%(2 319/30 581)。多因素Logistic回归分析显示,失业(OR:1.29,95%CI:1.18~1.41)、未服用抗精神病药物(OR:1.19,95%CI:1.03~1.36)、建档前发生暴力行为(OR:2.98,95%CI:2.64~3.36)和社区面访≥5次(OR:2.46,95%CI:2.06~2.94)是暴力行为的危险因素。已婚(OR:0.81,95%CI:0.74~0.90)、诊断精神发育迟滞伴发精神障碍(OR:0.25,95%CI:0.20~0.32)、诊断癫痫所致精神障碍(OR:0.59,95%CI:0.41~0.84)、申请监护补助(OR:0.65,95%CI:0.58~0.72)、申请服药补助(OR:0.65,95%CI:0.59~0.73)、签约家庭医师服务(OR:0.68,95%CI:0.62~0.75)、参加年度健康检查(OR:0.80,95%CI:0.67~0.95)和社区面访(OR1~2次:0.64,95%CI:0.54~0.76;OR3~4次:0.80,95%CI:0.67~0.96)是暴力行为的保护因素。结论社区随访中应加强对严重精神障碍患者暴力行为相关因素的综合评估,尽早进行分级分类管理。

Objective To explore the prevalence and influencing factors of violence behavior in pa-tients with severe mental disorders.Methods The case and follow-up data of the patients with severe mentaldisorders by the end of 2019 were downloaded from the Information Management System of Mental HealthPrevention and Control in Shenzhen.Descriptive statistical analysis was used to describe the distribution ofviolence behavior in patients with severe mental disorders by SPSs 23.0.Logistic regression model was usedfor determining influencing factors associated with violence behavior.Results All of 30581 patients withcommunity dwelling severe mental disorders cases were reported and the rate of violence behavior was 7.6%(2319/30581)in Shenzhen.Multivariate logistic regression showed unemployment(OR:1.29,95%CI:1.18-1.41),not taking antipsychotic drugs(OR:1.19,95%CI:1.03-1.36),past violence(OR:2.98,95%CI:2.64-3.36)and community face-to-face interview more than 5 times per year(OR:2.46,95%CI:2.06-2.94)were risk factors for violence behavior.While married(OR:0.81,95%CI:0.74-0.90),mentalretardation with mental disorders(OR:0.25,95%CI:0.20-0.32),mental disorders caused by epilepsy(OR:0.59,95%CI:0.41-0.84),application for carers allowances(OR:0.65,95%.CI:0.58-0.72),apply forfree medicine(OR:0.65,95%CI:0.59-0.73),participating in family doctor service(OR:0.68,95%CI:0.62-0.75),participate in health examination(OR:0.80,95%CI:0.67-0.95)and community face-to-faceinterview(OR1-2:0.64,95%CI:0.54-0.76;OR3-4:0.80O,95%CI;0.67-0.96)were the protective factors.Conclusions In the community follow-up,comprehensive evaluation of factors related to violent behaviors ofpatients with severe mental disorders should be strengthened,and carry out classification management as soonas possible.