赌博障碍的心理行为特征与健康相关服务体系

Psychological and behavioral characteristics of gambling disorder and related health service system

目的探讨赌博障碍的心理行为特征,以构建相关的健康服务体系。方法基于《国际疾病分类第十一次修订本》(ICD-11)和《国际功能、残疾和健康分类》(ICF)分析赌博障碍的心理行为特征和功能影响。系统分析世界卫生组织心理健康政策文件与赌博障碍的健康相关服务内容,包括《2013-2030精神卫生综合行动计划》《mhGAP干预指南2.0版》《联合国精神健康与人权行动计划》《可持续发展目标(SDGs)》,基于《健康服务体系中的康复》构建赌博障碍的健康服务体系。结果赌博障碍的主要特征包括控制受损、逐渐加大赌注(耐受性增加)、多次失败的戒赌尝试、利用赌博逃避现实压力,以及赌博行为对个人生活、家庭和社交功能的持续负面影响;功能上表现为注意力、决策力和情绪功能下降,导致工作效率和社交关系恶化。环境是影响行为的重要因素:家庭和社会支持系统可以促进赌博障碍的康复,而赌博场所和经济社会压力等则会加剧成瘾行为。针对赌博障碍的主要健康相关服务包括预防、干预、康复与健康促进,健康服务体系覆盖领导与治理、资金保障、心理健康工作者培养、服务提供、医疗产品与技术应用、卫生信息系统支持6个领域。结论赌博障碍主要表现为注意力、决策力和情绪功能障碍,工作效率低下和社交关系障碍,环境因素发挥着重要的作用。针对赌博障碍的健康相关服务涉及预防、干预、康复与健康促进4个环节。健康服务体系覆盖领导力与治理、资金保障、心理健康工作者培养、服务提供、医疗产品与技术应用、卫生信息系统支持6个领域。

Objective To investigate the psychological and behavioral manifestations of gambling disorder and its implications for health services.Methods International Classification of Diseases,11th Revision(ICD-11)and International Classification of Functioning,Disability and Health(ICF)were employed to analyze the psychological,behavioral and functional impacts of gambling disorder.World Health Organization(WHO)mental health policy documents and gambling disorderrelated health services were systematically reviewed,encompassing Comprehensive Mental Health Action Plan 2013-2030,mhGAP Intervention Guide 2.0,UN Mental Health and Human Rights Action Plan and Sustainable Development Goals(SDGs).A health service system tailored for gambling disorder was constructed,drawing up-on the WHO Rehabilitation in Health Systems framework.Results Gambling disorders primarily characterized with impaired control,escalating bets(tolerance),repeated unsuccessful attempts to quit,gambling as an escape mechanism,and the persistent detrimental effects of gambling on personal,familial and social functioning.Individuals with gambling disorder impaired in attention,decision-making and emotional regulation,leading to poor work performance and social relationship.Environmental factors were very important that family and social support systems fostered recovery,while gambling environments,socioeconomic pressures and other adverse factors exacerbated addiction.The WHO health service for gambling disorder included prevention,intervention,treatment,rehabilitation and health promotion.The health service system included six building blocks:leadership and governance,financing,mental health workforce development,service delivery,medical products and technologies,and health information systems.Conclusion Gambling disorder may impair attention,decision-making and emotional function,and diminish work productivity and social relationship.Environmental factors play a pivotal role.Health-related services for gambling disorder should encompass prevention,treatment,rehabilitation and health promotion,necessitating a comprehensive health service system addressing leadership and governance,financing,workforce,service delivery,medical products and technologies,and health information systems.