个案管理对社区精神分裂症患者直接照料者社会支持及家庭负担的影响

摘要

Objective To analyze the effects of case management on the social support and family burden of direct caregivers of patients with schizophrenia in the community. Methods A total of 40 direct caregivers of patients with schizophrenia who met the research criteria in Nanlang Town Zhongshan City where the case management service were provided were selected into case management group. According to the economic and demographic matching principle, another 40 direct caregivers of patients with schizophrenia in Minzhong Town Zhongshan City where basic management service were provided were randomly selected into control group. The patients and their families in the case management group received community case management, while the patients and their families in the control group was provided national standard basic management services. The two groups were followed up for one year. The Social Support Rating Scale (SSRS) and Family Burden Scale (FBS) were applied at the time of admission and the second year. The difference of the social support and disease burden of the two groups were compared. Results The added value of the case management group was better than that of the basic management group in objective support, subjective support, support utilization and SSRS total points (t=5.84,5.02,7.41,10.89,respectively; P<0.01). The subtraction score of the case management group was better than that of the basic management group in the family financial burden, household daily activities, family relationships, family members' mental health and FBS total points (t=-4.86,-2.73,-3.16,-3.80,-4.37, respectively; P<0.01). Conclusions Case management can better promote social support for family members of schizophrenic patients and reduce family burden relative to basic management.%目的 分析个案管理对社区精神分裂症患者直接照料者社会支持和家庭负担的效果.方法 从开展社区个案管理服务的中山南朗镇选取符合研究标准的精神分裂症患者的直接照料者40名作为个案管理组,根据经济和人口匹配原则,从开展社区基础管理的中山民众镇随机抽取40名精神分裂症患者的直接照料者作为对照组.个案管理组患者及家庭接受社区个案管理,对照组组患者及家庭接受国家要求提供的基础管理服务.对两组患者跟踪随访1年,采用社会支持量表(SSRS)及家庭负担会谈量表(FBS)在入组时及第2年进行评估,对两组的社会支持和疾病负担差值进行比较.结果 个案管理组的照料者在客观支持、主观支持、支持利用度及SSRS总分的增加值优于基础管理组(t分别为5.84、5.02、7.41、10.89;P<0.01);个案管理组的家庭经济负担、家庭日常活动、家庭关系、家庭成员心理健康和FBS总分减分值优于基础管理组(t分别为-4.86、-2.73、-3.16、-3.80、-4.37;P<0.01).结论 个案管理相对于基础管理可更好地提升对精神分裂症患者家属的社会支持,降低家庭负担.