【作者】 刘琴；

【导师】 汪洋；

【作者基本信息】 重庆医科大学 ， 临床检验诊断学， 2009， 博士

【摘要】 研究背景三峡百万移民问题是当前政府及社会各界普遍关注的焦点,以往的研究大都关注移民搬迁安置政策,移民的社会适应性、经济发展等层面,而对百万移民的社会心理健康问题缺乏关注。对于搬迁带来的一系列变故,移民能否积极应对和调整,心态如何,这关系到移民工作能否顺利进行,也关系到移民在安置地的长期稳定和发展。因此,针对三峡移民社会心理健康问题开展系统研究,对于预防和改善移民身心健康问题,促进移民稳定具有重要意义。研究目的掌握三峡水库移民的社会心理健康现状及存在问题;分析引起移民社会心理健康问题的相关危险因素;结合国际上非自愿移民心理健康的干预措施,为有针对性地制定适合于三峡移民心理健康的干预对策及改善其社会心理健康提供科学依据。研究方法1.采用定量研究与定性研究相结合的方法,对三峡移民及移居地当地居民心理健康问题及其相关因素进行现况调查。(1)定量研究:采用整群随机抽样的方法,应用自编的基本情况调查问卷、症状自评量表、团体用心理社会应激调查表及社会支持评定量表,对1303名三峡移民和1433名当地居民进行问卷调查,调查结果双录入EPIDATA数据库,并用SPSS11.0软件进行统计分析。(2)定性研究:有目的地抽取41名三峡移民和15名主管移民工作的干部,运用半结构式访谈提纲,分别进行移民个人深入访谈和关键人物访谈,利用MAXqda2软件管理定性资料,并用主题框架分析法进行资料分析。2.系统评价国内外针对非自愿移民心理健康的干预研究。检索了10个电子数据库和3个灰色文献数据库截止2008年11月发表的文献,并检索了相关机构的网站和Google搜索引擎以弥补数据库的遗漏。纳入描述和评价已实施的防治非自愿移民心理健康问题的干预研究。两名研究人员分别独立进行文献筛选、质量评价及资料提取,并交叉核对,讨论达成一致意见。采用定性方法系统归纳纳入文献的信息和结论,由于评价干预效果的各试验中干预类型、干预措施、研究设计及结局指标的异质性,故没有采用Meta分析。主要结果1.现况调查结果:(1)三峡移民心理健康状况及问题总体上三峡移民的心理健康状况较当地居民差,表现在SCL-90总分及躯体化、强迫、人际敏感、抑郁、焦虑、敌对、恐怖、偏执、精神病性等九个症状因子得分均显著高于当地居民,且出现阳性症状的比例高于当地居民。移民普遍存在着高期望值、心理不平衡、抱怨、焦虑和急躁情绪,具有惧怕心理、依赖心理、特殊公民心理和抱团心理等。不同搬迁方式下,移民的心理健康状况有差异,表现出不同程度的心理健康问题,其中,市内外迁组心理健康状况最差。对于移民已经出现的这些身心健康问题,很多移民干部还没有引起足够的重视和注意。(2)三峡移民心理健康影响因素影响三峡移民心理健康的因素主要包括四个方面:①社会因素:如生活事件和心理社会应激、社会支持、社会文化适应、职业与经济因素、生活质量、安全感、移民政策等;②自然环境因素:如所拥有的土地资源;③个体因素:性别和年龄、应对方式等;④其它因素:搬迁安置方式和地区、安置地居住时间等。其中,心理社会应激、社会支持、职业和经济状况等社会因素是影响移民心理健康的重要因素。2.系统评价结果:纳入分析的35篇文献中,16篇描述干预措施,19篇评价干预效果。干预对象主要是战争、暴力及其它酷刑引起的难民和寻求庇护者,水库移民仅一篇。所有心理干预分为预防和治疗干预两类,主要干预措施有:心理综合干预、团体疗法、认知行为疗法、证言疗法、叙事暴露疗法、支持性咨询服务、家庭支持及疗法等等,其中,综合干预是最常用的干预方法。评价心理干预效果的研究大部分为观察性研究,仅6项研究为对照试验,且存在很多方法学上的局限性。绝大多数研究均肯定了已开展的心理干预对非自愿移民心理健康有积极的促进作用。研究结论三峡移民的心理健康状况总体上较当地居民差,且不同搬迁方式下移民的心理问题各有其特点,移民的心理健康受到社会因素、自然环境因素、个体因素及其它因素的综合影响,因此采用综合性的心理干预措施有助于达到更好的干预效果。结合三峡移民心理健康问题的总体特点及现有的关于非自愿移民心理干预的证据,提出一套针对三峡移民心理问题的综合干预模式,即采取综合性的以预防为主的干预措施,从政府、社区及移民个体三个层面,重点针对影响移民心理健康的主要因素,通过多种干预方式减少移民的社会心理应激、改善其社会支持、提高移民就业及经济水平等,从而改善移民心理健康水平。此外,不同安置地区还应结合本地区移民心理问题的特殊性,开展一些有针对性的心理干预。更多还原

【Abstract】 BackgroundThe issue of millions of Three Gorges migrants has currently been a focus of attention to the government and the public. Most of the previous studies concerned a lot the migrant issues in the aspects of relocation and resettlement strategies, social adaptiveness, and economic development and so on. However, little attention was paid to the psychosocial problems of the migrants. Whether the migrants could actively response to and adapt themselves to the various life events caused by relocation, as well as their mentality, would influence the progress of migration work as well as the long-term stability and development of migrants in the new resettlement areas. Therefore, to systematically study on the mental health problems of the Three Georges migrants is of great importance to preventing and improving mental health problems of migrants and their stability.ObjectivesTo understand the mental health status and problems in the Three Gorges migrants; to analyze the relevant risk factors inducing their mental health problems; to systematically review the international interventions on mental health of involuntary migrants, in order to explore intervention strategies targeting the Three Gorges migrants and provide scientific evidence for promoting their mental health.Methods1. Quantitative and qualitative study methods are both used in this cross-sectional survey to identify the mental health problems and relevant factors of the Three Gorges migrants and the local residents.(1) Quantitative studyA total of 1303 migrants and 1433 local residents were selected under a cluster sampling design, and completed a self-designed questionnaire for general status and three mental scales including Symptom Checklist 90 (SCL-90), Psychosocial Stress Survey for Groups (PSSG), Social Support Rating Scale (SSRS). The data were double entered using EPIDATA 3.02. After validation, the data were converted into SPSS format and analyzed using SPSS 11.0.(2) Qualitative studyAccording to semi-structured topic guides, we conducted 41 in-depth interviews with the migrants and 15 key informant interviews with government officials responsible for migration at different levels. Framework approach was applied to analyze narrative data from these interviews, using the software of MAXqda2 to manage, code and retrieve data.2. Systematic review of international intervention studies on mental health of involuntary migrants.We searched 10 international electronic databases and 3 grey literature databases to November 2008. Websites of relevant organizations and Google were searched for any missing information. Research papers that reported describing or evaluating any interventions on preventing and treating mental health problems of involuntary migrants were included. Two reviewers independently screened, appraised and extracted the data, disagreements were resolved by discussion. Implemented interventions were summarized and analyzed by qualitative synthesis method. As there was heterogeneity in the type of interventions, study design, and outcomes, the study results were not pooled statistically in Meta analysis.Results1. Results from cross-sectional survey(1) Mental health status and problems of Three Gorges migrantsGenerally speaking, the Three Gorges migrants had poorer mental health than their local counterparts. The SCL-90 results showed that the total scores and the nine factor scores of all the positive symptoms including somatization, obsessive, interpersonal sensitivity, depression, anxiety, hostility, photic anxiety, paranoid ideation and psychoticism in the migrants were significantly higher than that of their local counterparts. Mental health problems were more prevalent in the migrants in comparison with local residents. It is common that high-expectation, psychological imbalance, complain, anxiety and impatience existing in the migrants. They have psychological characteristics of fear, anaclisis, special residents, and clustering etc. Under different relocation schemes, the mental health status and problems of migrants are different. The group migrated to other counties within the municipality has the poorest mental health status. However, many government officials responsible for migration have not paid enough attention to the existing mental health problems of migrants.(2) Factors influencing mental health of the Three Gorges migrantsFactors influencing mental health of the Three Gorges migrants:①social factors, including life events and psychosocial stress, social support, social culture adaption, occupation and economic factors, quality of life, feeling of security, and migration policy, etc.②natural environment factors: such as land resource possessed;③personal factors: gender, age and coping styles, etc.④other factors: relocation schemes and areas, period staying in the resettlement area, etc. Of which, social factors, such as psychosocial stress, social support, occupation and economic factors were most important factors influencing mental health of migrants. 2. Results from systematic reviewOf the 35 studies included in the analysis, 16 studies aimed to describe intervention strategies, while 19 studies were to evaluate effectiveness of interventions. The targeted population were mainly refugees and asylum seekers caused by the war, violence and other tortures, while only one study targeted at reservoir migrants. All the psychological interventions were divided into prevention intervention and treatment intervention. The main interventions include: integrated psychological intervention, group treatment, cognitive behavior therapy, testimony, narrative exposure therapy, supportive counseling service, family support and therapy, etc. Of which, integrated psychological interventions are the most common intervention. Most of the studies evaluating effectiveness are observational studies, while only six are controlled trials. The results of most evaluation studies show that the implemented psychological interventions have positive impact on mental health of involuntary migrants.ConclusionsAs a whole, the Three Georges migrants had poorer mental health than their local counterparts, and migrants under different relocation schemes had specific characteristics in their mental health problems. Social factors, natural environmental factors, personal factors and other factors combined to produce a complex impact on the mental health of migrants. Therefore, an integrated psychological intervention strategy would be helpful to achieve better effects. Based on the general characteristics of mental health problems of the Three Georges migrants, as well as currently available evidence related to psychological interventions on mental health of involuntary migrants, a comprehensive intervention strategy is proposed for the Three Gorges migrants. The strategy adopts comprehensive interventions with prevention as its priority. It focuses on the major factors influencing the mental health of migrants, using various intervention measures at three system levels, including government, community and individual levels, in order to relieve the psychosocial stress of migrants, improve their social support, increase their job chances and economic levels, and thus to improve their mental health level. Besides, different resettlement places should carry out target-oriented psychological interventions, considering the particularity of mental health problems among migrants in a certain resettlement.更多还原