精神分裂症患者长期住院的影响因素分析

Influencing factors of long-term hospitalization in patients with schizophrenia

目的分析精神分裂症患者长期住院(住院时间≥1年)的影响因素,为当地医院精神卫生事业转型提供临床依据。方法采用整群抽样方法,纳入南京医科大学附属无锡市精神卫生中心2018—2019年住院的475例精神分裂症患者为研究对象,将住院时间≥1年者纳入长期住院组,将<1年者纳入短期住院组。从电子病历系统中获取患者一般资料和住院信息,并进行评估性访谈,比较两组的人口学和临床特征,采用Logistic回归模型分析长期住院的影响因素。结果长期住院组患者251例,占用医院总床位的17.92%,以男性(64.1%,161/251)、单身(82.1%,206/251)、城镇户口(76.5%,192/251)、医保付费(95.2%,239/251)、病程>5年(96.8%,243/251)、偏执型分裂症(57.0%,143/251)为主要特征。多因素回归分析结果显示,精神分裂症长期住院的影响因素包括病程(OR=6.178,95%CI:2.216~17.227)、总体功能评定量表总分(OR=5.484,95%CI:3.023~9.950)、家庭照料者(OR=5.044,95%CI:2.747~9.262)、医疗付费方式(OR=4.029,95%CI:1.662~9.770)、年龄(OR=3.349,95%CI:1.962~5.714)、自知力与治疗态度问卷得分(OR=2.939,95%CI:1.657~5.213)、婚姻状况(OR=2.544,95%CI:1.376~4.703)。结论精神分裂症患者长期住院受多方面因素的影响,主要与病程、总体功能、自知力、家庭照料者、医保付费及人口学因素密切相关,需要家庭、医院、社会共同协作以改善精神障碍患者住院结局。

Objective To analyze influencing factors of long-term hospitalization(hospitalization time≥1 year)in patients with schizophrenia,so as to provide clinical evidence for the transformation of mental health services in local hospitals.Methods A total of 475 patients with schizophrenia who were hospitalized in Wuxi Mental Health Center Affiliated to Nanjing Medical University from 2018 to 2019 were included in the study by cluster sampling.Patients with hospitalization time greater than or equal to 1 year were included in the long-term hospitalization group and those with hospitalization time less than 1 year were included in the short-term hospitalization group.General patient information and hospitalization information were obtained from the electronic medical record system,and evaluative interviews were conducted to compare demographic and clinical characteristics of the two groups.Logistic regression model was used to analyze the influencing factors of long-term hospitalization.Results There were 251 patients in long-term hospitalization group,occupying 17.92%of the total hospital beds.The main characteristics were male(64.1%,161/251),single(82.1%,206/251),urban registered residence(76.5%,192/251),medical insurance payment(95.2%,239/251),disease course over 5 years(96.8%,243/251)and paranoid schizophrenia(57.0%,143/251).Multivariate regression analysis showed that the influencing factors of long-term hospitalization for schizophrenia included the course of disease(OR=6.178,95%CI:2.216-17.227),the score of Global Assessment of Function(OR=5.484,95%CI:3.023-9.950),family caregivers(OR=5.044,95%CI:2.747-9.262),medical payment(OR=4.029,95%CI:1.662-9.770),age(OR=3.349,95%CI:1.962-5.714),the score of Insight and Treatment Attitudes Questionnaire(OR=2.939,95%CI:1.657-5.213)and marital status(OR=2.544,95%CI:1.376-4.703).Conclusions The long-term hospitalization of patients with schizophrenia is affected by many factors,mainly related to the course of the disease,overall function,insight,family caregivers,medical insurance payment and demographic factors.It requires the collaboration of families,hospitals and society to improve hospital outcomes for patients with mental disorders.