中国2014-2019年精神卫生医疗机构抑郁症和精神分裂症患者就诊和出院情况分析

Outpatient visits and hospital discharges of depression and schizophrenia patients in mental health facilities,2014-2019:a sampling survey across China

目的了解中国2014-2019年精神卫生医疗机构抑郁症和精神分裂症患者就诊和出院情况,为我国精神卫生服务配置提供政策依据。方法于2020年11月-2021年2月采用分层抽样方法在中国内地31个省(自治区、直辖市)和新疆生产建设兵团共抽取46家省级和36家地市级精神卫生医疗机构调查2014年1月1日-2019年12月31日精神科门诊就诊患者和出院患者年度总人次数以及诊断中包含抑郁症/精神分裂症患者就诊人次数和出院人次数等。结果最终纳入分析的74家精神卫生医疗机构中,省级精神卫生医疗机构40家(54.05%),地市级精神卫生医疗机构34家(45.95%);精神专科医院45家(60.81%),综合医院精神科29家(39.19%)。中国2014-2019年精神卫生医疗机构抑郁症就诊患者占精神科门诊就诊患者的比例总体呈升高趋势(χ_(趋势)^(2)=144209.17,P<0.001),从2014年的4.28%升高至2019年的7.63%;精神分裂症就诊患者占精神科门诊就诊患者的比例总体呈下降趋势(χ_(趋势)^(2)=73411.23,P<0.001),从2014年的13.34%下降至2019年的10.53%;抑郁症出院患者占精神科出院患者的比例总体呈升高趋势(χ_(趋势)^(2)=3754.42,P<0.001),从2014年的4.92%升高至2019年的7.10%;精神分裂症出院患者占精神科出院患者的比例总体呈下降趋势(χ_(趋势)^(2)=1573.79,P<0.001),从2014年的18.87%下降至2019年的16.82%。不同级别精神卫生医疗机构比较,2014、2015、2016、2017、2018、2019年省级精神卫生医疗机构抑郁症就诊患者占精神科门诊就诊患者的比例均高于地市级精神卫生医疗机构,精神分裂症就诊患者占精神科门诊就诊患者的比例均低于地市级精神卫生医疗机构,省级精神卫生医疗机构抑郁症和精神分裂症出院患者占精神科出院患者的比例均低于地市级精神卫生医疗机构(均P<0.001)。不同类别精神卫生医疗机构比较,2014、2015、2016、2017、2018、2019年精神专科医院中抑郁症、精神分裂症就诊患者和出院患者占精神科门诊就诊患者和出院患者的比例均高于综合医院精神科(均P<0.001)。结论中国2014-2019年精神卫生医疗机构抑郁症患者就诊和出院人次数占比均呈升高趋势,而精神分裂症患者就诊和出院人次数占比均呈下降趋势,应加强对抑郁症等常见精神障碍服务利用的资源配置。

Objective To examine person-times and proportion of outpatient visits and hospital discharges for depression and schizophrenia patients in mental health facilities across China during 2014–2019 for providing evidence to improve the allocation of mental health services in China.Methods Using stratified sampling,we conducted a survey among 46 provincial-and 36 prefecture-level mental health facilities in 31 provincial-level administrative divisions across China from November 2020 to February 2021.A self-designed questionnaire was used to collect the facilities'data on outpatient visits and hospital discharges for all patients and those diagnosed with depression and schizophrenia(with the International Statistical Classification of Diseases and Related Health Problems,10th Revision[ICD-10]codes of F32and F33)during the period from 2014 through 2019.Results Eligible responses were collected from 74 mental health facilities,in which,40(54.05%)were at provincial-level and 34(45.95%)at prefecture-level,including 45 psychiatric hospitals and 29 psychiatric departments in general hospitals.During the period from 2014 to 2019 for all the facilities surveyed,significant increase was observed in the proportion of outpatient visits(person-times)by depression patients against all other patients(4.28%to 7.63%,χ_(trend)^(2)=144209.17;P<0.001)and in the proportion of hospital discharges(person-times)of depression patients against all other patients(4.92%to 7.10%,χ_(trend)^(2)=3754.42;P<0.001);but there was significant decrease in the proportion of outpatient visits by schizophrenia patients(13.34%to 10.53%,χ_(trend)^(2)=73411.23;P<0.001)and in the proportion of hospital discharges of schizophrenia patients(18.87%to 16.82%,χ_(trend)^(2)=1573.79;P<0.001).Throughout the 6-year period compared to those for the facilities at prefecture-level,all the annual proportion of the outpatient visits by depression patients were significantly higher for the facilities at provincial-level but the annual proportion of the outpatient visits by schizophrenia patients were significantly lower(all P<0.001);all the annual proportion of hospital discharges of both depression and schizophrenia patients were significantly lower for the facilities at provincial-level(all P<0.001).When compared to those for the psychiatry departments of general hospitals,all the annual proportions of outpatient visits by depression and schizophrenia patients and all the annual proportions of hospital discharges of depression and schizophrenia patients were significantly higher for the psychiatric hospitals over the 6-year period(all P<0.001).Conclusion During the period from 2014 to 2019 for the mental health facilities in China,the annual proportions of depression patients′outpatient visits and hospital discharges showed an increasing trend but those of schizophrenia patients′showed a decreasing trend.The study results should be concerned in allocation of health resources for mental healthcare.