Psychiatric Morbidity of Patients Treated at a Temporary Medical Aid Facility in Mongolia

蒙古義診病人之精神病理特徵

李明濱(Ming-Been Lee) ； 陳潤秋(Ran-Chou Chen) ； 謝志民(Chih-Min Hsieh) ； 李熹昌(His-Chang Lee) ； 陳映燁(Ying-Yeh Chen)

《北市醫學雜誌》 2卷7期 (2005/07) Pp. 648-658

https://doi.org/10.6200/TCMJ.2005.2.7.08

摘要

背景與目的：臺北市立聯合醫院醫療團隊於2004年4月到蒙古國烏蘭巴托市與蘇赫巴托市義診，共11天服務1061人次，年齡介於4-91歲。本研究報告為此次義診之第三篇報告，旨在探討接受義診患者之精神病理特徵，並探討簡式症狀量表(BSRS-5)作為精神疾病患篩選之適用性。方法：本研究報告之分析對象為求診個案中，完成醫師臨床檢查且填寫BSRS-5問卷量表者。BSRS-5為5題症狀評量表，包含失眠、焦慮、憂鬱、憤怒、人際敏感等五項目，每題就嚴重度評分由無至非常嚴重（0-4分），此量表可透過自填與訪談進行。結果：共計有1004人納入本研究之分析對象，男性327(32.6%)人，女性677(67.4%)人，平均年齡為45.6±16.0歲。主訴為疼痛者佔就診個案之98.8%。本研究中BSRS-5之Cronbach α值為0.88，以BSRS得分6分作為精神疾病診斷篩選之切割點，發現1004位求診個案中，有42.3%的個案符合精神科疾病的嚴重度，女性比率(47.0%)高於男性(32.7%)。篩選為精神科疾患個案者，若以症狀發生嚴重度觀之，症狀困擾在嚴重程度以上者，依序為憤怒(50.6%)、失眠(45.9%)、焦慮(36.0%)、憂鬱(27.8%)與人際敏感(5.6%)。就精神疾患比率與BSRS-5測量之總分及五項個別評分而言，女性均比男性嚴重；20歲以下之個案，罹患精神疾患之比率比其他年齡層高。臨床主訴中，頭痛與精神病理症狀嚴重度，包括BSRS-5總分、失眠、焦慮、憤怒密切相關。此外，失眠困擾之嚴重度與主訴心臟疼痛、血壓之收縮壓與舒張壓成正相關。結論：蒙古兩地區義診門診病人之精神疾患比率與其他地區之基層醫療門診病人相似，就心理困擾程度而言，女性比男性嚴重。BSRS-5為一簡便之自填量表，可適用於大型義診，作為精神疾患之篩選。本研究由問卷測量發現有高比率之輕型精神疾患，但臨床醫師的臨床診斷中並未涵蓋精神科診斷別，其原因值得進一步探討，然此一發現亦可作為未來相關義診活動規劃之重要參考。

關鍵字

精神疾病 ； 簡式症狀量表 ； 基層醫療 ； 蒙古國

並列摘要

Background and Purpose: Minor mental disorders are very prevalent in non-psychiatric primary care settings. The present study attempted to understand the psychiatric morbidity and its associated factors in patients treated at a temporary international medical aid facility in Mongolia. Methods: The Brief Symptom Rating Scale-5 (BSRS-5) was used for assessment of psychiatric morbidity. In total, 1004 subjects who visited the facility and completed both the Mongolian version of the BSRS-5 questionnaire and clinical examinations were recruited for analysis. They included 327 (32.6%) males and 677 (67.4%) females with a mean age of 45.6±16.0 years. Results: Using 5/6 measured by the BSRS-5 as the cutoff point for determination of psychiatric morbidity, the prevalence of psychiatric morbidity for all subjects was 42.3% with a significantly higher rate in females (47.0%) than in males (32.7%). Regarding the severity of general psychopathology of BSRS-5-defined cases, 16.0% were in the category of moderate or severe. With respect to the psychological distress with a severe or very severe degree in patients with psychiatric morbidity, hostility ranked highest (50.6%), followed by sleeping troubles (45.9%), anxiety (36.0%), depression (27.8%), and interpersonal sensitivity (5.6%). In summary, female patients presented more-severe psychological distress for all items of the BSRS-5. Patients aged over 20 years rated higher scores on the BSRS-5 and presented a significantly higher rate of psychiatric morbidity than did those younger than 20. Although a high rate of psychiatric morbidity was detected by the BSRS-5, no formal psychiatric diagnosis was made by the physicians. Conclusions: The prevalence of psychiatric morbidity of outpatients seen in these 2 regions of Mongolia is similar to data obtained at primary care settings in Taiwan. The BSRS-5 is a useful screening tool to help non-psychiatric physicians detect associated psychiatric morbidity of outpatients in different cultures.

並列關鍵字

psychiatric morbidity ； Brief Symptom Rating Scale ； primary care ； Mongolia