精神障碍非自愿住院患者胁迫体验 及其影响因素
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上海市科学技术委员会科研计划项目(19411950800);上海市精神心理疾病临床医学研 究中心(19MC1911100)


Perception of coercion and its influencing factors of involuntary inpatients with mental disorders
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    摘要:

    目的 初步调查精神障碍非自愿住院患者在入院过程以及住院期间的胁迫体验感知,并 探讨其影响因素。方法 选择2017 年3— 8 月于上海交通大学医学院附属精神卫生中心徐汇院区 的6 个封闭病房内根据《精神卫生法》第三十条要求入住的254 例精神障碍非自愿住院患者,在入院 后的第3 周采用自编的基本情况调查表、简明精神病量表(BPRS)、MacArthur 入院体验主观胁迫分量表 (MPCS)、胁迫体验问卷(CES) 进行问卷调查。根据本次入院前是否征求过本人意见将所有患者分为征求 意见组(115 例)与未征求意见组(139 例)。应用SPSS 22.0 软件进行统计学分析,组间比较采用独立样本 Mann-Whitney 检验或Kruskal-Wallis 检验、χ2 检验, 采用Bonferroni 法校正显著性水平的事后两两比较。 采用相关分析了解MPCS、CES 与BPRS 症状得分的相关性,采用回归分析探索胁迫体验得分的影响因 素。结果 (1)相对精神科的封闭环境,患者的胁迫体验更多源于自我选择和决定权的受限。(2)入院 时未征求意见组患者较征求意见组患者在MPCS 总分[4.00(2.00,5.00)分比1.00(0,2.00)分,Z=8.592, P< 0.01]、CES 量表总分[52.00(39.00,81.00)分比44.00(34.00,56.00)分,Z=3.236,P< 0.01]及维度分 [权利限制13.00(9.00,27.00)分比9.00(9.00,15.00)分,Z=3.746,P< 0.01;被动14.00(10.00,24.00)分比 12.00(9.00,18.00)分,Z=2.861,P< 0.01;负性环境9.00(6.00,13.00)分比8.00(6.00,10.00)分,Z=2.000, P< 0.05;负性反应4.00(2.00,6.00)分比3.00(2.00,5.00)分,Z=2.706,P< 0.01)]上得分更高。(3)入院 前未征求意见、公安机关送诊、教育程度高是MPCS总分的影响因素(F=25.076,P<0.01),经历约束措施、 BPRS 思维障碍严重和入院时胁迫体验高是CES 总分的影响因素(F=5.135,P< 0.01)。结论 精神障碍 患者在入院和住院过程中存在一定胁迫体验,这种主观负性体验与多种因素有关,临床上应多加关注, 并采取针对性措施降低患者对胁迫的感知。

    Abstract:

    Objective To investigate the perceived coercion of involuntary inpatients with mental disorders in the process of admission and during hospitalization, and to explore its influencing factors. Methods A total of 254 involuntary inpatients with mental disorders were selected from 6 closed wards of Xuhui district branch of Shanghai Mental Health Center affiliated to Shanghai Jiao Tong University School of Medicine, from March to August 2017 according to Article 30 of the "Mental Health Law". During the third week after admission, self-compiled basic information questionnaire, Brief Psychiatric Rating Scale( BPRS),MacArthur Perceived Coercion Scale( MPCS), and Coercion Experience Scale( CES) were used to investigate the enrolled inpatients. All the patients were divided into two groups according to whether they had solicited their opinions before admission. There were 115 cases in solicitation group and 139 cases in non-solicitation group. SPSS 22.0 software was used for statistical analysis. Independent sample Mann-Whitney test, Kruskal- Wallis test and Chi-square test were used for inter group comparison. Bonferroni method was used to correct the post event pairwise comparison of significance level. Correlation analysis was used to understand the correlation between MPCs, CES and BPRS symptom score, and regression analysis was used to explore the influencing factors of coercion score. Results (1) Compared with the environmental limitations of psychiatric wards, the patients' perception of coercion was more due to the restriction of right to make choice and decision by themselves;( 2) For patients who had not been asked for their opinions at admission, the total score of MPCS [4.00(2.00,5.00) vs. 1.00( 0,2.00),Z=8.592,P<0.01], total score of CES[ 52.00(39.00,81.00) vs. 44.00 (34.00,56.00),Z=3.236,P<0.01] and dimension score[ limitation of rights 13.00(9.00,27.00) vs. 9.00(9.00, 15.00),Z=3.746,P < 0.01] were significantly higher than those in the solicitation group at admission;The passive score was 14.00( 10.00,24.00) vs. 12.00( 9.00,18.00),Z=2.861,P<0.01; The negative environment score was 9.00( 6.00,13.00) vs. 8.00( 6.00,10.00),Z=2.000,P<0.05; The score of negative reaction was 4.00 (2.00,6.00) vs. 3.00(2.00,5.00),Z=2.706,P< 0.01), which were all higher than those in the solicitation group. (3) Lack of consent before admission, public security agency delivery, and higher education level were positive influencing factors of MPCS total score( F=25.076,P<0.01). Experienced restraint protection, severe BPRS thinking disorder and high coercion experience at admission were positive influencing factors of CES total score (F=5.135,P < 0.01). Conclusions Coercion experience is common in patients with mental disorders during admission and hospitalization. This subjective negative experience is related to various factors. More attention should be paid to this experience in clinical practice, and targeted measures should be taken to reduce patients' perception of coercion.

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袁丽娜 詹清和 李东菊 邵阳.精神障碍非自愿住院患者胁迫体验 及其影响因素[J].神经疾病与精神卫生,2020,20(9):
DOI :10.3969/j. issn.1009-6574.2020.09.002.

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  • 在线发布日期: 2020-12-21