“安全屋”家庭教育对社区精神分裂症患者症状的影响

Impact of"safe shelter"family education on mental health status of community-based schizophrenic patients

目的:探索适合在中国社区精神分裂症患者家庭开展的“安全屋”家庭教育措施,以改善患者症状、及时发现其症状恶化,并评价其有效性。方法:在中国东、中、西部4个城市的42个社区纳入298户康复期精神分裂症患者家庭,分为干预组(150户)和对照组(148户)。两组分别接受“安全屋”家庭教育和社区常规管理,为期12个月。干预组患者家庭在“安全屋”的支持下,每个月对患者复发(恶化)征兆至少进行一次分析,并根据结果采取对应措施。在基线时和第12月末由社区精神卫生防治医生使用临床总体印象量表(CGI)进行评估,主要结局指标为干预组与对照组干预前后病情严重度指数(SI)值变化的差异。结果:干预12个月后,患者CGI-SI得分和基线相比均降低[患者组(2.8±0.7) vs.(2.1±1.0),对照组(2.8±1.1) vs.(2.5±1.2),均P<0.05],且干预前后CGI-SI差值干预组大于对照组0.3分(P<0.001);总体进步(GI)两组第12个月末得分后均低于基线值(均P<0.05);第12个月末干预组疗效指数(EI)得分高于基线值(P<0.05),而对照组第12个月末得分与基线时相比差异无统计学意义(P>0.05)。结论:“安全屋”家庭教育可以有效改善疾病状况,巩固治疗疗效,避免复发、保持康复状态。

Objective:To explore suitable family education measures for community-based schizophrenia patients in China for improving patients'symptoms and detecting deterioration of symptoms in time,and evaluate the intervention's effects.Methods:This study was conducted in 4 cities in eastern,central and western China.A total of 298 families of patients from 42 communities were recruited based on the inclusion criteria.Totally 150 families and 148 families were enrolled in the intervention group and the control group randomly.The intervention group received a family education based on social cognitive theory,namely"safe shelter",and the control group got a routine management program in the community for 12 months.With the support of the"safe shelter",the families of patients in the intervention group assessed the early signs of relapse(worsening)at least once a month,and took corresponding measures according to the score.At baseline and at the end of the 12th month,using the Clinical Global Impression(CGI)scale,the community mental health workers evaluated severity of illness(SI),global improvement(GI)and efficacy Index(EI).The primary outcome was the difference of two groups'CGI-SI score changes between the end of the 12th month and baseline.Results:Before and after the intervention,the CGI-SI scores in the intervention group[(2.8±0.7)vs.(2.1±1.0)]and the control group[(2.8±1.1)vs.(2.5±1.2)]were both significantly reduced(Ps<0.05),and the changes were significantly 0.3 larger in the intervention group than in the control group(P<0.001).The CGI-GI scores were significant decreased in both of the intervention group and the control group(Ps<0.05).Compared with the baseline,the CGI-EI scores were significantly increased at the end of the 12th month in the intervention group(P<0.05),while no statistical difference was found in the control group(P>0.05).Conclusion:The family education could effectively improve the disease symptoms,consolidate the therapeutic effect,avoid relapse and maintain the state of recovery.