【作者】 陈晓莉；

【导师】 闫永平； 王波；

【作者基本信息】 第四军医大学 ， 流行病与卫生统计学， 2012， 博士

【摘要】 研究背景精神障碍严重危害人民身心健康，损害了患者家庭功能和社会功能，同时也带来沉重的社会和经济负担。国内不少省市、自治区采用国际上通用的精神障碍的诊断标准和分类系统、标准化精神状况检查工具相继开展了精神障碍大规模抽样调查，但是对社区人群精神卫生服务需求和利用的研究较少。西安市作为陕西省省会以及西北地区的政治经济文化中心，社区人群精神障碍流行病学基础资料仍是空白。为了了解西安市社区居民各类精神障碍患病率及精神卫生服务需求，有必要进行系统的西安市社区居民精神卫生流行病学调查，为政府制定西安市精神卫生总体规划和进一步开展社区精神卫生工作提供可靠资料和科学依据。目的研究各类精神障碍在西安市城乡居民中的患病率、分布特点和共病情况；了解西安市社区居民和精神障碍患者对现有精神卫生服务的利用和求助行为的特点，探讨影响居民和患者利用精神卫生服务和求助行为的因素。方法采用分层两阶段容量比例概率随机抽样方法，于2010年5月～8月对西安市辖区9区4县的社区居委会及村委会有户籍登记16岁以上的居民进行入户调查。以北京大学精神卫生研究所提供的复合性国际诊断交谈表(CIDI-3.0)电子化中文版为调查工具，以与之配套的、国际通用的美国精神障碍诊断与统计手册-第4版(DSM-Ⅳ）为诊断标准，进行社区人群社会人口学、各类精神障碍和卫生服务利用的调查和诊断。使用SPSS11.5软件包进行资料整理和统计分析。描述各类精神障碍的30天、12月和终生患病率及比较在不同人群分布的差异；描述并分析社区人群及患者卫生服务利用率、求助途径及影响因素。取检验水准(α)为0.05，P<0.05为有统计学差异。结果1.各类精神障碍患病率、人口分布特点及共病本次调查共抽样3578人，完成访谈2500人，应答率为69.87%，合格问卷2447份，合格率为97.88%，有效应答率为68.39%。年龄范围16～75岁，平均年龄46.7士13.2岁，男性950人(38.82%)，女性1497人(61.18%)。按照DSM-Ⅳ的精神障碍相关单元诊断标准进行诊断，西安市社区居民终生罹患各种精神障碍人数为514人，精神障碍总的终生患病率为21.01%，12个月患病率为7.19%，30天患病率为3.51%。在特定障碍的终生患病率中，排在前三位的为烟草依赖(8.29%)、惊恐发作（6.21%）和重性抑郁障碍（3.88%）。总精神障碍终生患病率中，男性明显高于女性(29.68%VS15.50%,χ~2=70.492，P=0.000))；离婚分居丧偶人群患病率(36.00%)明显高于已婚者（20.43%）和未婚者（19.81%）。其它因素如年龄、文化程度、城乡、工作状况等终生患病率差异均不具有统计学意义。各类特定精神障碍中，间歇性爆发性障碍在不同年龄段之间差异有统计学意义（χ~2=14.397，P=0.013），其中26～35岁年龄段患病率最高（3.86%）。女性酒精滥用(0.20%VS5.89%)、烟草依赖(0.53%VS20.53%)、间歇性暴发性障碍(1.67%VS2.95%)终生患病率低于男性。而特殊恐怖症(2.54%VS0.95%)、惊恐发作(7.08%VS4.84%)终生患病率均高于男性。离婚分居丧偶人群重性抑郁障碍（16.00%）、社交恐怖症（3.00%）、特殊恐怖症（8.00%）、惊恐发作（12.00%）患病率均显著高于已婚和未婚人群，差异有统计学意义（P <0.05）。烟草依赖在不同文化程度人群之间差异有统计学意义（χ~2=8.854，P=0.012），其中初中高中组患病率（9.49%）明显高于文盲小学组（6.46%）和大专及以上文化（5.35%）。惊恐发作在不同工作状况人群之间差异有统计学意义（χ~2=10.050，P=0.007），其中无工作者患病率最高（7.69%）；烟草依赖在不同工作状况人群之间差异有统计学意义（χ~2=15.681，P=0.000），其中有工作者患病率最高（10.77%）；特殊恐怖症在不同工作状况人群之间差异有统计学意义（χ~2=8.994，P=0.011），其中有工作者患病率最低（1.08%）。农村地区特殊恐怖（2.68%）、惊恐发作（7.13%）患病率明显高于城市地区；城市地区酒精滥用患病率（3.41%）和烟草依赖（10.24%）明显高于农村地区。差异有统计学意义（P <0.05）。共患情感障碍、焦虑障碍、物质使用障碍中的任两种或三种精神障碍的共病率为3.11%，男性易患精神障碍共病。2.精神卫生服务利用及求助行为西安市城乡居民全人群精神卫生服务终生总利用率为2.45%,1年总利用率为1.27%；专业精神卫生服务终生总利用率为1.35%。各类精神障碍患者终生总利用率为4.67%，1年总利用率为2.33%，专业精神卫生服务终生总利用率为3.31%。其中，西安市社区居民最常见的精神障碍利用率较低，如情感障碍年利用率为1.50%，焦虑障碍年利用率为3.96%，物质使用障碍年利用率为2.97%。已婚者对精神卫生服务终生利用率（3.11%）高于离婚分居丧偶（0.58%）和未婚者（0.97%），差异有统计学意义（χ~2=7.004，P=0.030）。求助患者中，71.43%求助于非精神专业人员，主要以求助普通医生或其它医务人员为主（61.90%）；只有28.57%的患者求助于专业精神卫生服务人员，主要以精神科医生为主（23.81%）。52.38%的患者延迟求助，延迟求助时间最短为1周，最长25个月。延迟求助的主要原因包括缺乏对障碍的认识（54.55%）、对治疗或服务不满意（27.27%）和对经济方面担心（18.18%）。结论西安市社区居民精神障碍患病率在全国居于较高水平。精神障碍总的终生患病率为21.01%，12个月患病率为7.19%，30天患病率为3.51%。共患情感障碍、焦虑障碍、物质使用障碍中的任两种或三种精神障碍的共病率为3.11%。终生患病率排在前三位的特定精神障碍为烟草依赖(8.29%)、惊恐发作（6.21%）和重性抑郁障碍（3.88%）。男性、离婚分居丧偶人群是各类精神障碍患病的高发人群。西安市城乡居民精神卫生服务利用处于较低水平。全人群精神卫生服务终生总利用率只有2.45%，专业精神卫生服务终生总利用率为1.35%；各类精神障碍患者终生总利用率为4.67%，专业精神卫生服务终生总利用率为3.31%。精神障碍患者患病后多数求助于非精神科医生，而且常常延迟求助。更多还原

【Abstract】 BackgroundMental disorders bring serious harm to human physical and mental health,which not only damage the patient’s family and social function, but also bringabout heavy economic burden to patients and society. In China, many provincesand autonomous regions carried out large-scale surveies employing theinternational diagnostic criteria and standardized mental health examinationquestionare, however, in which there was few studies on the mental healthservice utilization. As the capital of Shaanxi Province and political economiccenter of Northwesten China, Xi’an city is lack of the basic epidemiologyinformation of mental disorder about the community population. In order toexplore the prevalence of mental disorders and mental health service utilizationamong general population, it is necessary to systematicly carry outepidemiological survey to provide reliable information and scientific data for thegovernment to develop mental health policy. ObjectiveTo assess the prevalence, distribution characteristics and comorbidity ofmental disorders in urban and rural residents of Xi’an, and to study the status ofhealth care utilization and help seeking behavior among community population,as well as its related factors that affect utilization and help seeking behavior.MethodsA representative sample of the Xi’an general population aged16years andolder was interviewed from May to August2010. Respondents were selectedfrom a stratified two-stage probabilities proportional to size (PPS) sample of thenon-institutionalized household population. The World Health OrganizationComposite Intemational Diagnostic Interview Version3.0(CIDI-3.0) was usedto assess mental disorders and health care utilization according to Diagnosticand Statistical Manual of Mental Disorders (DSM-IV) criteria. SPSS11.5software was used to data analysis. The30days,12month and lifetimeprevalence of mental disorders were described. The utilization of health services,help seeking behaviors and related factors among the community population andpsychiatric patients were analyzed. Statistical significance was based ontwo-tailed tests evaluated at the0.05level of significance.Results1. The prevalence, distribution and comorbidity of mental dosordersTotally3578Xi’an citizens were sampled and it completed2500subjects(69.87%). The final sample was composed of2447subjects after deleting someunqualified data. The respondent rate was68.39%. There were950males and1497females. The cohort ranges from16to75years old and mean age was46.7士13.2years.The30-day,12-month and lifetime prevalence of any DSM-IV disorders were3.51%,7.19%,21.01%, respectively. The top three of the lifetimeprevalence of specific disorders were tobacco dependence (8.29%), panicattacks (6.21%) and major depressive disorder (3.88%).Any mental disorders were more common in men than women (29.68%vs15.50%, χ2=70.492, P=0.000). Lifetime prevalence of any mental disordersamong group of divorced/separated/widowed (36.00%) was significantly higherthan that of married persons (20.43%) and unmarried (19.81%). Among otherdifferent groups such as age, education level, urban and rural areas, and workingconditions, there was no statistical significance of lifetime prevalence of anymental dosorders.Among specific mental disorders, the liftime prevalence of intermittentexplosive disorder was difference between different age groups (χ2=14.397, P=0.013) and the prevalence of26～35years was highest (3.86%).The lifetime prevalences of alcohol abuse (0.20%vs5.89%), tobaccodependence (0.53%vs20.53%), intermittent explosive disorder(1.67%vs2.95%)among female group were lower than that of male group. The lifetimeprevalences of specific phobia (2.54%vs0.95%), panic attacks (7.08%vs4.84%) of female were higher than male.Among group of divorced/separated/widowed group, the lifetimeprevalences of major depressive disorder (16.00%), social phobia (3.00%),specific phobia (8.00%), panic attacks (12.00%) were significantly higher thanthat of married and unmarried population (P <0.05).The liftime prevalence of tobacco dependence differed statisticallysignificant between different education level group (χ~2=8.854, P=0.012). Theprevalence of junior/high school group (9.49%) was significantly higher thanthat of illiterate/primary school group (6.46%) and college higher education level (5.35%).Among the different occupations, panic attacks differed statisticallysignificant (χ~2=10.050, P=0.007), the prevalence in the unemployed groupwasthe highest (7.69%). Tobacco dependence was also difference statistically (χ~2=15.681, P=0.000), the prevalence of the employed was the highest (10.77%).Specific phobia differed statistically significant (χ~2=8.994, P=0.011), theprevalence of the employed was the lowest (1.08%).The prevalences of specific phobia (2.68%), panic attacks (7.13%) of therural area were significantly higher than that of urban area (P<0.05). But theprevalence of alcohol abuse prevalence (3.41%) and tobacco dependence(10.24%) of the urban area were significantly higher than that of rural area (P<0.05).The prevalence of lifetime comorbid any of two or three common mentaldisorders was3.11%, which refer to affective disorders, anxiety disorders andsubstance use disorders. The male population is liability to mental disorderco-morbidity.2. Mental health service utilization and help-seeking behaviorIn the community population of Xi’an city, the total lifetime utilization rateof mental health service was2.45%, and the12-month utilization rate was1.27%. The lifetime utilization rate of professional mental health service was1.35%. In the population of suffered mental disorders of Xi’an city, the totallifetime utilization rate of mental health service was4.67%, and the12-monthutilization rate was2.33%. The lifetime utilization rate of professional mentalhealth service was3.31%. The utilization of mental health service in thecommon mental disorders was poor. The12-month utilization rates of affectivedisorders, anxiety disorders, substance use disorders were1.50%,3.96%,2.97% respectively.The lifetime utilization rate in married population (3.11%) washigher than that of the divorced/separated/widowed (0.58%) and the unmarried(0.97%). The difference was statistically significant (χ~2=7.004, P=0.030).Of71.43%patients with help-seeking contacted non mental healthprofessionals, especially general physician or other medical personnel (61.90%).Only28.57%of the patients visited professional mental health personnel,mainly psychiatrist (23.81%). Eleven cases (52.38%) delayed for help. Delayduration ranged from1week to25month. The main reasons for delayed seekinghelp were as follows: lack of perception and knowledge of the mental disorders(54.55%), not satisfied with the treatment or services (27.27%) and worry aboutthe economy issues(18.18%).ConclusionsThe30-day,12-month and lifetime prevalence of any DSM-IV disorderswere3.51%,7.19%,21.01%respectively among Xi’an community population.The prevalence of lifetime comorbid any of two or three common mentaldisorders was3.11%. The top three of the lifetime prevalence of specificdisorders were tobacco dependence (8.29%), panic attacks (6.21%) and majordepressive disorder（3.88%）. The male and the divorced/separated/widowedpersons were liability to mental disorder. The lifetime prevalence of mentaldisorders in Xi’an was in a higher level compared with some other cities inChina.The total lifetime utilization rate of mental health service was2.45%, theutilization rate of professional mental health service was1.35%. In thepopulation of suffered mental disorders, the total lifetime utilization rate ofmental health service was4.67%, the lifetime utilization rate of professionalmental health service was3.31%. Majority patients contacted non mental health professionals, especially general physician and often delay help-seeking. Mentalhealth service utilization in the community population of Xi’an city was in thelower level compared with some other cities in China.更多还原