【作者】 罗鸣春；

【导师】 黄希庭；

【作者基本信息】 西南大学 ， 基础心理学， 2010， 博士

【摘要】 心理健康服务需求是个体当前的心理健康水平和想要达到的心理健康水平之间的不平衡引起的缺乏状态。心理健康服务需求评定是个体对当前的心理健康状态与其想要达到的心理健康状态之间差距的觉察和确认,及对消除这个差距的评估。这一界定是建立在觉察到的需求之上的。心理健康服务需求包括觉察到的主观需求和未觉察到的客观需求。它是个体生存发展过程中维护和促进心理健康发展的普遍需要,它普遍存在于一般人群中之中。因而研究者可以通过理论和实证的方法对其进行界定。对目标群体的心理健康服务需求评定是心理健康服务工作的起点和基础。它着眼于目标群体心理健康水平的提升和发展,为将要达到的心理健康目标进行评定和规划,因而是一种发展性需求评价。西方发达国家对该问题的研究已持续多年,且仍在进一步深化；国内还缺乏基于中国人的心理健康服务需求的系统化的理论和实证研究。本研究立足于构建适合中国人的心理健康服务体系的现实需要,力求理论构建与实证研究相结合,立足中国实际与借鉴西方经验相结合,采用多学科、多方法研究中国青少年心理健康服务需求现状和特点问题。研究采用本土化思路：首先,按照心理测量学要求,编制信效度良好、适合我国国情的心理健康服务需求评价工具,用于测量目标群体觉察到的心理健康服务需求；接着用开发的工具调查中国青少年的心理健康服务需求现状和特点；然后探讨客观健康、健康相关生活方式以及生活质量对觉察到的心理健康服务需求的影响；最后讨论中国文化传统对心理健康服务需求的影响；在此基础上提炼出能有效满足中国青少年心理健康服务需求的对策建议。研究由5个部分、9个系列研究组成。研究1通过已有研究的文献综述和开放式问卷调查与访谈,系统探讨中国青少年心理健康服务需求的内容和特征,开发适合中国大学生和中学生的心理健康服务需求的评价工具。研究2检验世界卫生组织的生活质量简表的信度和效度。研究3编制健康相关生活方式简表。研究4对中国大中学生的心理健康服务需求现状进行全国性断面抽样调查。研究5探讨客观健康对目标群体心理健康服务需求的影响。研究6考察健康相关生活方式对目标群体心理健康服务需求的影响。研究7探讨生活质量与心理健康服务需求的关系。研究8探讨服务可得性对主观和客观心理健康服务需求的作用。研究9讨论传统文化对心理健康服务需求的影响。通过上述系列研究,得到以下主要结论：1.中国青少年心理健康服务需求的结构特点(1)编制的大学生的心理健康服务需求问卷包括专业服务、服务项目、态度与方式、非专业服务、公共服务、民间服务6个因素,是测量大学生心理健康服务需求的标准化工具。(2)青少年心理健康服务需求问卷包括专业服务、方式途径、非专业服务、服务项目、服务态度、民间服务6个因素,是评定中学生心理健康服务需求的标准化工具。2.中国青少年心理健康服务需求的现状和特点(1)大学生心理健康服务需求强度排列的前3位是服务项目(2.99)、非专业服务(2.73)、态度与方式(2.71)。调查样本中84.3%的大学生希望有固定的机构提供心理健康服务；83.2%的大学生认为有必要了解心理健康知识。(2)当代大学生最关注的心理健康服务项目是人际关系(91.8%)、择业和职业发展(90.4%)、学业问题(89.9%)。(3)科普宣传(80.0%)、健康教育(77.2%)、同学朋友咨询(74.7%)是当代大学生首选的获得心理健康服务的方式和途径。学校心理中心(71.2%)、社区心理中心(56.3%)、单位心理服务中心(55.0%)是大学生首选的心理健康服务机构；同学朋友(79.6%)、学校心理专家(72.4%)、父母家人(66.5%)是大学生首选的心理健康服务人员。(4)女大学生在服务项目、非专业服务两方面的心理健康服务需求显著(P<0.001)高于男生。非独生子大学生表达的心理健康服务需求显著(P(0.05)高于独生子女。经济困难大学生的心理健康服务需求显著(P<0.05)高于经济状况一般和经济富裕学生。一二年级大学生心理健康服务需求显著(P<0.05)高于三四年级。(5)中学生心理健康服务需求强度排列的前3位是服务内容(3.14)、服务态度(2.95)、非专业服务(2.78)。调查样本中85.1%的中学生希望有固定的机构提供心理健康服务；83.0%的中学生认为有必要了解心理健康知识。(6)当代中学生最关注的心理健康服务项目是人际关系(91.3%)、自己的身心管理(87.0%)、学业问题(87.0%)。(7)科普宣传(72.8%)、健康教育(72.5%)、同学朋友咨询(72.1%)是当今中学生首选的获得心理健康服务的方式和途径。学校心理中心(67.6%)、社区心理中心(60.0%)、单位心理服务中心(56.7%)是中学生首选的心理健康服务机构；同学朋友(75.1%)、父母家人(69.9%)、学校心理专家(67.8%)是中学生首选的心理健康服务人员。(8)男生在专业服务、民间服务方面的心理健康服务需求显著(P<0.05)高于女生；女生在服务内容、非专业服务方面的心理健康服务需求显著(P<0.05)高于男生；但男女生心理健康服务需求的总体强度差异不显著。(9)初二年级学生心理健康服务需求显著(P<0.05)高于初一、初三、高一、高二年级,是各种心理问题较为集中的时期。3.影响中国人心理健康服务需求的因素(1)大学生心理健康服务需求随身体不健康程度而增加。“过去1个月内是否生过病、过去1年中是否住院治疗、客观健康总分”3项指标可以负向预测大学生的心理健康服务需求；客观健康总分是大学生心理健康服务需求最好的预测变量。(2)大学生心理健康服务需求随生活方式的健康程度而增加。喝酒、吸烟、定期健康检查3项指标可以负向预测大学生的心理健康服务需求；生活方式总分、饮食作息规律、定期身体锻炼可以正向预测大学生心理健康服务需求；其中健康相关生活方式总分是最有影响力的大学生心理健康服务需求的预测变量。(3)生活质量总均分、生理质量、心理质量、社会关系质量、环境质量均可以正向预测大学生心理健康服务需求；大学生心理健康服务需求随生活质量提高而显著增长。(4)服务可得性在主观需求和客观需求之间起调节作用。当前大中学生的心理健康服务需求特点,反映出儒家文化对中国青少年的心理健康服务需求的作用和影响。本研究在理论和方法上有所创新。具体如下：1.理论创新：(1)将基础心理学的需要理论与中国青少年的心理健康服务需求联系起来,提出心理健康服务需求是个人在生存发展过程中维护和促进心理健康发展的基本需要的观点。(2)首次对中国青少年心理健康服务需求的内容和结构进行系统地理论研究,开发了评价中国青少年的心理健康服务需求的标准化工具。2.方法创新：(1)首次在全国范围内对大中学生的心理健康服务需求现状进行横断面抽样调查,获得了中国青少年心理健康服务需求现状与特点的系统资料。(2)初步探讨了客观健康、健康相关生活方式、生活质量、服务可得性对大学生心理健康服务需求的影响,筛选出客观健康、生活方式、生活质量、服务可得性4个影响青少年心理健康服务需求的变量。3.未来研究可以在以下领域进一步拓展：(1)将心理健康服务需求调查与国家或地区人口普查相结合,在更广泛的大样本调查中修订和完善心理健康服务需求的研究工具和研究方法。(2)进一步研究影响中国人心理健康服务需求的主要因素,揭示其内在的作用机制。(3)研究心理健康服务需求与心理健康的关系,以便在满足目标群体的心理健康服务需求时,改善和提高目标人群的心理健康水平。(4)进一步细化不同目标群体的心理健康服务需求的评价体系,有利于更好地满足不同群体的心理健康服务需求。(5)采用纵向追踪研究中国人心理健康服务需求发展变化的规律性。(6)采用跨文化研究方法研究影响中国人心理健康服务需求的文化机制。(7)采用认知神经科学范式研究心理健康服务需求的脑机制。(8)采用质的研究方法研究特殊群体和个案的心理健康服务需求。更多还原

【Abstract】 The mental health service needs (MHSN) refers to the individual’s current mental health and his desired mental health states casued by an imbalance between the lacks of status. MHSN assessment is the individual on the current state of their mental health status of their desired gap between the perceived and recognition, and the elimination of this gap assessment. This definition is based upon perceived needs; no perceived objective needs, such as body health and quality of life (QOL). The MHSN includes the perceived needs and no perceived needs. The MHSN is individual survival and development is the process of safeguarding and promotion the development of general MHSN, it is widespread among the general population. So researchers can approach its theoretical and empirical define. Assessment on the target group of MHSN is the infrastructure and starting point of mental health services. The Western developed countries have been going on MHSN for years, and still further deepened. But lack research of national MHSN of based on Chinese demand for services, systematic, theoretical and empirical study.This research based on the building for the reality of mental health services system needs, theoretical and empirical studies seek to build the combination of actual and reference base in China combine Western experience, multi-method, multi-disiplines study MHSN of Chinese youth and teenage status and characteristics. The study process as follows:First, in accordance with the psychometric requirements of reliability and validity of the preparation of a good fit for Chinese needs mental health services, evaluation tools for measuring the target groups perceived MHSN. Then using the development of tools investigates of Chinese youth and teenage mental health status and characteristics of MHSN. The next exploring the objective health, health-related lifestyle and QOL impact on MHSN of college students. Finally, the author discusses the Chinese cultural tradition on the impact of mental health service needs; on this basis, to extract an effective mental health services to meet the needs of young people in China’s countermeasures.This PhD program consists of five parts, composed of 9 series of studies. Study 1 through the existing research literature review and open-ended questionnaires and interviews, exploring content and features of MHSN of Chinese youth and teenage, developed assessement tools for MHNS. Study 2 revised World Health Organization Quality of Life-brief (WHOQOL-BREF). Study 3 development Health-related lifestyle brief scales (HRLSBS). Study 4 surveys of the Chinese college students and teenage MHSN of a national cross-section sample of the current situation. Study 5 tests objective health influence of Chinese college students MHSN. Study 6 conducted health-related lifestyle impact of Chinese college students MHSN. Study 7 conducted the QOL and the relationship between Chinese college students MHSN. Study 8 conducted the role of accessible services between on subjective and objective MHSN. Study 9 discusses of traditional culture on the Chinese college students and teenage MHSN.Through this series of studies, draws the following main conclusions:1. Chinese younth and teenage MHSN of the structural characteristics(1) The College Students Mental Health Services Needs Questionnaire (CMHSNQ) include 6 dimensions:professional services, service content, services of attitude and way, non-professional services, public services, civil services; it is a measure of MHSN of the standardized tool.(2) The Adolescent Mental Health Services Needs Questionnaire(AMHSNQ) include 6 dimensions:professional services, approach and channel, non-professional services, services content, services attitude, civil services; it was the assessment MHSN young students a standardized tool.2. Chinese youth and teenage MHSN of the situation and characteristics(1)Intensity of MHSN is arranged in the top 3:services content (2.99), non-professional services (2.73), attitude and way of services (2.71).84.3% of the college students hope to have fixed the agency to provide mental health services; 83.2% of the college students need to understand the mental health knowledge.(2) The college students are most concerned about mental health services is the relationship (91.8%), choice career and career development (90.4%), academic problems (89.9%).(3) Science outreach (80.0%), health education (77.2%), peer group support mutual aid (74.7%) were college students preferred access to mental health services ways and means. School psychological center (71.2%), community mental center (56.3%),units psychological services center (55.0%) were college students preferred mental health services. Classmates and friends (79.6%), school psychologists (72.4%), parents and family members (66.5%) of students preferred the mental health servicers.(4) Female college student services content, non-professional services needs of mental health services were significantly (p<0.001) than boys. Students of non-only child mental health service needs expressed by a significant (p<0.05) higher than the an-only child. Poor-economic of college students’MHSN were significantly (p<0.05) higher than the general economic conditions and well-off students.1-2 grades college students MHSN were significantly (p<0.05) higher than 3-4 grades.(5) Middle school students’MHSN intensity is arranged in the top 3:services contents (3.14), attitude (2.95), and non-professional services (2.78).85.1% of the students hope to have fixed agency to provide mental health services; 83.0% of the students considered it necessary to understand the mental health knowledge.(6) The middle school students are most concerned about mental health services is the relationship (91.3%), their physical and mental management (87.7%), academic problems (87.7%).(7) Science outreach (72.8%), health education (72.5%), classmates and friends consulting (72.1%) is currently young students preferred receive mental health services ways and means. The middle students preferred mental health services agency:school psychological center (67.6%), community mental centers (60.0%), units of psychological services center (56.7%). Classmates and friends (75.1%), parents and family members (69.9%), school psychologists (67.8%) are the preferred young students of mental health servicers.(8) The male students in professional services, civil services MHSN were significantly (p<0.05) higher than females; and the female students in services contents, non-professional services were significantly (p<0.05) than males; However, MHSN of males and females overall strength of the difference was not significant.(9) Grade two high school students’MHSN were significantly (p<0.05) higher than other grade; There is a period of variety of psychological problems concentrated.3. Impact of Chinese youth MHSN factors(1) The total objective health is MHSN the best predictive variables; the college students’demand for MHSN was increased with the degree of ill health; there are 3-index:over the past one month is been ill, over the past one year if hospitalized, total objective health, can predict negative college students’MHSN.(2) The college students with MHSN are to increase the health of lifestyle; 3-indicators:drinking, smoking, regular health check can predict negative college students’MHSN; the other 3-indicators: total lifestyle, diet rest rules, regular physical exercise can positive predict college students’MHSN. Among total health-related lifestyle are the most influential college students’MHSN of the predictor variables.(3) The college students with MHSN to improve the quality of life significantly increased. Total average QOL, physical quality, psychological quality, quality of social relations, environmental quality can positive predict college students’MHSN.(4) Current college and youth MHSN features reflects the Confcian culture on the Chinese people’s MHSN of the role and influence.The innovation of this research as follows:1.Theory innovation:(1) This reseach links the needs of theory of basic psychology to Chinese young people’s MHSN, put forwards the view that MHSN of individuals in the course of the survival and development to maintain and promotion the development of the basic needs. (2) For the first time the Chinese MHSN content and structure of a systematic are studied and initiative development to assess Chinese MHSN standardized tools.2. Method of innovation:(1) First time on the college and middle students across the country MHSN of the current situation of the nationwide sample survey, collects the status of Chinese younth and teenage MHSN and characteristics of the system information. (2) Exploring the objective health, health-related lifestyle, quality of life, traditional culture impact of Chinese youth and teenage MHSN, and selected impact of Chinese MHSN three important variables.3. Future research could further expand in the following areas:(1) Mental health services of the census and national or regional combines, in a broader survey of large sample revise and improve the MHSN of the research tools and methods. (2) Further conducted the impact of the MHSN of Chinese major factors, revealing its inner mechanism. (3) Study the relations of MHSN and mental health status, in order to meet the target groups’demand for mental health services, and improve and enhance the level of the target population’s mental health. (4) To further refine the mental health services needs assessment system of different target groups, is conducive to better meet the needs of different groups of mental health services needs. (5) To use longitudinal study of Chinese with mental health services to the regularity of development and changes in demand. (6) To use method of cross-cultural to study the impact of MHSN of Chinese cultural mechanism. (7) To use paradigm of cognitive neuroscience research by Chinese MHSN of brain mechanisms. (8) To use qualitative studies methods and case studies researches special groups of MHSN.更多还原