深圳市社区严重精神障碍不服药患者发生暴力行为的影响因素分析

Analysis of influencing factors of violent behaviors among unmedicated patients with severe mental disorders in Shenzhen

目的分析深圳市社区严重精神障碍不服药患者暴力行为发生的相关因素。方法利用深圳市精神卫生防治工作信息管理系统收集严重精神障碍患者个案资料和随访资料,描述分析不服药患者暴力行为的发生现状,应用Logistic回归模型分析其影响因素。结果3163例社区严重精神障碍不服药患者中9.1%(288/3163)的患者发生暴力行为。多元Logisitic回归分析显示,急性起病(OR=1.589,95%CI 1.181~2.139)为暴力行为发生的危险因素;有共同居住者(OR=0.596,95%CI 0.410~0.867)、精神发育迟滞伴发精神障碍(OR=0.432,95%CI 0.199~0.938)、申请监护补助(OR=0.440,95%CI 0.319~0.606)、签约家庭医师服务(OR=0.642,95%CI 0.492~0.838)和社区面访(OR1-2次=0.633,95%CI 0.466~0.861;OR3-4次=0.546,95%CI 0.368~0.811)为暴力行为发生的保护因素。结论急性起病的严重精神障碍不服药患者暴力行为发生率较高。提升社区精神卫生综合服务水平,制定有针对性的干预措施,有助于降低社区严重精神障碍不服药患者暴力行为的发生。

Objective This study aims to examine the incidence and risk factors of violent behaviors in community-dwelling unmedicated patients with severe mental disorders in Shenzhen.Methods The baseline and follow-up data of unmedicated patients with severe mental disorders were collected from the Information Management System of Mental Health Prevention and Control in Shenzhen.The incidence of violent behaviors in unmedicated patients was described.The influencing factors of violent behaviors were analyzed using logistic regression model.Results A total of 3163 patients were included.The incidence of violent behaviors was 9.1%(288/3163)in 2019.Multivariate logistic regression analysis showed that having an acute illness onset(OR=1.589,95%CI 1.181-2.139)was the risk factor of violent behaviors,while having cohabitants(OR=0.596,95%CI 0.410-0.867),being diagnosed as mental retardation comorbid with psychotic disorders(OR=0.432,95%CI 0.199-0.938),having application for carers allowances(OR=0.440,95%CI 0.319-0.606),and participating in family doctor services(OR=0.642,95%CI 0.492-0.838)and community face-to-face interviews during 2019(OR(1-2 times vs.0 times)=0.633,95%CI 0.466-0.861;OR(3-4 times vs.0 times)=0.546,95%CI 0.368-0.811)were the protective factors.Conclusions The incidence of violent behaviors is high in unmedicated patients with severe mental disorders with acute illness onset.The improvement of comprehensive level of community mental health services and the development of targeted intervention measures would help to reduce the occurrence of violent behaviors among unmedicated patients with severe mental disorders in the community.