自我管理团体模式对社区精神分裂症患者社会功能的干预

Intervention effect of self-management group model on social function of patients with schizophrenia in community

目的:探讨自我管理团体模式干预对社区精神分裂症患者社会功能的介入效果。方法:选择上海市某区日间康复中心稳定期精神分裂症患者110例,随机分干预组和对照组各55例。除药物治疗外,对照组只接受日间康复中心提供的工娱活动及社区常规随访,干预组在上述常规服务外接受结构化的自我管理团体服务。干预按地缘分5个团体分组分批次完成,每个团体每周1节,共10节。在干预前及干预第5周、第10周及干预结束2个月后,对两组样本进行阳性和阴性症状量表(PANSS)、社会功能缺陷筛选量表(SDSS)和精神分裂症患者自我管理量表(SSMIS)评估,比较两组患者的病情、社会功能和自我管理能力情况。结果:至研究结束,干预组完成52例,对照组完成53例。研究前后,干预组在PANSS、SDSS和SSMIS的服药依从、药物管理、利用资源及支持、自我效能维度的评分差异均有统计学意义(P<0.05),对照组仅在PANSS阴性症状及SSMIS的服药依从、精神症状管理、维持日常生活及社会功能评分上前后差异有统计学意义(P<0.05)。重复测量方差分析结果显示,研究前后,两组的PANSS量表评分在时间效应、分组效应与时间效应的交互作用有统计学意义(F=28.14,10.28;P<0.001),在组间效应无统计学意义(P>0.05)。两组的SDSS量表评分仅在时间效应有统计学意义(F=5.57,P<0.01)。两组的SSMIS量表评分在时间效应、分组效应与时间效应的交互作用有统计学意义(F=12.99,5.83;P<0.01)。简单效应分析结果显示,干预组PANSS、SDSS评分随着干预时间的增长而下降,SSMIS量表评分随着干预时间增长而上升(均P<0.05)。以组别为自变量的干预效应分析表明,干预组与对照组仅在干预第10周的PANSS总分差异及在干预2个月后的PANSS及SDSS总分差异有统计学意义(P<0.05)。结论:运用自我管理团体模式有助于社区精神分裂症患者改善精神症状与社会功能,提升疾病自我管理能力。

Objective:To explore the effect of self-management group model on social function of patients with schizophrenia in community.Methods:A total of 110 cases of stable schizophrenia patients selected from a daytime rehabilitation center in a district of Shanghai,were randomly divided into an intervention group and a control group,with 55 cases in each group.Apart from medication treatment,the control group only received occupational and recreational activities provided by the daytime rehabilitation center and routine community follow-up,while the intervention group received structured self-management group services in addition to the aforementioned regular services.The intervention was divided into 5 groups by area,with each group having one session per week,totaling 10 sessions.Before the intervention and at the 5th and 10th weeks of the intervention,as well as two months after the intervention ended,both groups were assessed using the Positive and Negative Syndrome Scale(PANSS),the Social Dysfunction Screening Scale(SDSS),and the Schizophrenia Self-Management Inventory(SSMIS)to compare the condition,social function,and self-management abilities of the patients in both groups.Results:By the end of the study,the intervention group completed 52 cases,and the control group completed 53 cases.Before and after the study,the intervention group showed statistically significant differences in PANSS,SDSS,and medication adherence,medication management,resource and support utilization,and self-efficacy dimensions on the SSMIS(P<0.05),while the control group showed statistically significant differences only in the negative symptoms of PANSS and medication adherence,symptom management,daily life maintenance,and social function scores on the SSMIS(P<0.05).Repeated measures analysis of variance showed that before and after the study,the PANSS scale scores of both groups were statistically significant in terms of time effect,group effect,and the interaction between group and time effects(F=28.14,10.28;P<0.001),with no statistical significance in the group effect(P>0.05).The SDSS scale scores of both groups were statistically significant only in the time effect(F=5.57,P<0.01).The SSMIS scale scores of both groups were statistically significant in terms of time effect,group effect,and the interaction between group and time effects(F=12.99,5.83;P<0.01).Simple effect analysis showed that the PANSS and SDSS scores of the intervention group decreased with the increase of intervention time,while the SSMIS scale scores increased with the intervention time(all P<0.05).Intervention effect analysis with group as the independent variable indicated that there were statistically significant differences in the total PANSS scores between the intervention and control groups at the 10th week of intervention,and in the total PANSS and SDSS scores two months after the intervention(P<0.05).Conclusion:The use of self-management group model helps patients with schizophrenia in the community to improve their mental symptoms and social functions,and enhances their ability to manage their illness.