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| 四川省泸州市严重精神障碍患者病情影响因素分析 |
| Management Status and Influencing Factors of Disease Progression in Patients with Severe Mental Disorders: A Cross-Sectional Study in Luzhou, Sichuan Province, China |
| 投稿时间：2024-08-13 修订日期：2025-03-18 |
| DOI： |
| 中文关键词: 严重精神障碍 管理指标 服药依从性 病情波动 |
| 英文关键词:Severe mental illness Management indicators Medication adherence Symptom fluctuations |
| 基金项目:基金项目：泸州市科技计划资助（项目名称：川南地区严重精神障碍患者现状分析，项目编号：2022-ZRK-186） |
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| 中文摘要: |
| 【摘要】 背景 严重精神障碍是致残率高、疾病负担重的重大公共卫生问题，已引起国家高度重视，并被纳入公共卫生项目管理体系。然而，关于川南地区的泸州市严重精神障碍患者的疾病管理现状及其病情影响因素的可信性证据有限，尤其是年龄、户籍、经济状况、服药依从性及社区康复等因素的潜在影响尚不清楚。 目的 了解泸州市严重精神障碍管理现状，并分析在管严重精神障碍患者病情的潜在影响因素，以期为制定在管严重精神障碍患者病情管理措施提供参考。方法 于2023年3月提取2017年12月—2022年12月四川省精神卫生服务综合管理平台中泸州市接受严重精神障碍管理的患者数据，收集患者接受精神卫生服务的情况和病情情况。对泸州市严重精神障碍管理指标变动情况进行趋势分析，采用Logistic回归分析严重精神障碍患者病情的影响因素。 结果 本研究共纳入20 232名患者。2017年泸州市严重精神障碍患者病情稳定率、规范管理率分别为94.89%、79.36%，2022年增长到95.33%、96.92%。规律服药率从2018年的34.42%增长到2022年的86.81%。。2022年精神分裂症患者规律服药率为71.80%，偏执性精神病规律服药率55.26%，分裂情感性精神病规律服药率51.43%。年龄18~39岁（OR=0.613，95% CI：0.409~0.918）、40~65岁（OR=0.615，95% CI：0.407~0.931）、城市（OR=0.587，95% CI：0.478~0.720）、规律服药（OR=0.826，95% CI：0.702~0.973）是病情稳定的保护性因素；经济状况困难（OR=1.712，95% CI：1.436~2.040）、非关爱帮扶对象（OR=1.928，95% CI：1.694~2.193）、未参加社区康复（OR=2.255，95% CI：1.930~2.634）、间断服药（OR=3.893，95% CI：2.548~5.946）是病情波动的危险因素。 结论 泸州市严重精神障碍各项管理指标逐年提升，年龄、户籍、经济状况、服药依从性以及社区康复是严重精神障碍患者病情波动的影响因素。 |
| 英文摘要: |
| 【Abstract】 Background Severe mental disorders represent a major public health challenge characterized by high disability rates and substantial disease burden, which has garnered significant national attention and prompted their inclusion in public health project management systems. However, credible evidence regarding the current status of disease management and factors influencing clinical outcomes among patients with severe mental disorders in Luzhou City, located in the southern Sichuan region, remains limited. Specifically, the potential impacts of variables such as age, household registration status, socioeconomic conditions, medication adherence, and community-based rehabilitation on disease progression and management outcomes have yet to be comprehensively elucidated. Objective This study aims to investigate the current management status of severe mental disorders in Luzhou City, Sichuan Province, and analyze potential influencing factors of clinical outcomes among patients under standardized care. The findings are expected to provide evidence-based insights for developing targeted management strategies to optimize clinical interventions for this patient population. Methods In March 2023, patient data from December 2017 to December 2022 were extracted from the Sichuan Provincial Mental Health Service Integrated Management Platform, focusing on individuals with severe mental disorders under standardized care in Luzhou City. Data collection encompassed psychiatric service utilization and clinical status. Trend analysis was conducted to evaluate temporal changes in key management indicators for severe mental disorders in Luzhou City. Logistic regression analysis was employed to identify factors influencing the clinical outcomes of these patients. Results This study enrolled a total of 20,232 patients. In Luzhou City, the stabilization rate and standardized management rate of severe mental disorders were 94.89% and 79.36% in 2017, respectively, which increased to 95.33% and 96.92% by 2022. The regular medication adherence rate rose from 34.42% in 2018 to 86.81% in 2022. In 2022, the regular medication adherence rates were 71.80% for schizophrenia, 55.26% for paranoid psychosis, and 51.43% for schizoaffective disorder.Multivariate analysis identified the following protective factors for disease stabilization:Age 18–39 years (OR = 0.613, 95% CI: 0.409–0.918)；Age 40–65 years (OR = 0.615, 95% CI: 0.407–0.931)；Urban residence (OR = 0.587, 95% CI: 0.478–0.720)；Regular medication adherence (OR = 0.826, 95% CI: 0.702–0.973).Risk factors for disease fluctuation included:Financial hardship (OR = 1.712, 95% CI: 1.436–2.040)；Non-inclusion in care-support programs (OR = 1.928, 95% CI: 1.694–2.193)；Non-participation in community rehabilitation (OR = 2.255, 95% CI: 1.930–2.634)；Intermittent medication adherence (OR = 3.893, 95% CI: 2.548–5.946). Conclusion Luzhou City demonstratedyear-over-year enhancement in key management metrics for severe mental disorders. Multivariable analysis identified age, household registration status, socioeconomic status, medication adherence, and community-based rehabilitation as significant determinants of clinical instability among patients with severe mental disorders. |
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