[Abstract] Objective To understand the treatment rate of schizophrenia patients in Yichun city. Methods The survey method developed by the National Collaborative Group for Epidemiological Survey of Mental Disorders in 12 regions in 1982 was used to sample urban and rural populations in Yichun City, and a total of 17812 people were surveyed by door-to-door and telephone survey methods. Results.
①Schizophrenia patients 121 cases.
②The treatment rate of schizophrenia was 76.9%, the specialist outpatient treatment rate was 66.9%, the specialist inpatient treatment rate was 32.2%, the treatment compliance rate was 14.9%, the abandonment treatment rate was 65.9%, the traditional medicine treatment rate was 3.3%, and the superstition rate was 55.4%.
③The differences between urban and rural treatment rates, urban and rural specialist outpatient treatment rates, urban and rural abandonment rates, and urban and rural superstition rates for schizophrenia were all significant; the differences between the sexes for each type of treatment rate were not significant. Conclusion The low treatment rate of schizophrenia, especially the treatment compliance rate is even lower, suggesting that attention should be given to mental health work planning in the future.
1. Subjects and methods
1.1 Survey subjects
The survey sampling method and survey sample were basically the same as those of the 1999 survey [1], but because there were a few changes in the sample households over the past 6 years, the following provisions were made.
① The original sampling households are not visited, or 2 households combined into 1 household (calculated by 1 household), in the original sampling point according to the original sampling order to 50 households.
② original sampling households such as 1 household divided into 2 households (calculated by 2 households) so that the number of sampled households exceeds 50 households are deleted in the order of the extra households to 50 households. A total of 22,056 people were surveyed, of which 17,812 were ≥15 years old.
1.2 Methodology
1.2.1 The survey was based on the Chinese Classification and Diagnostic Criteria for Mental Disorders, Third Edition (CCMD-3) as the diagnostic basis. Assessment and screening tools: the Composite International Diagnostic Interview CIDI (CIDI), mental status checklist, self-administered socio-demographic questionnaire and schizophrenia treatment history form.
1.2.2 Survey methods: The investigators were uniformly trained and field tested, and the screening tools and diagnostic criteria were tested for consistency, with Kappa values ranging from 0.78 to 1.0 (P<0.05< font="">). A combination of door-to-door person-to-person survey (100% door-to-door rate and 77.2% meeting rate) and telephone survey (18.3% survey rate) was used to confirm the diagnosis of those who met the CCMD-3 diagnostic criteria for schizophrenia after examination by two deputy chief physicians. All cases were reviewed, and no false-positive cases were found. The survey was strictly quality controlled from the beginning, middle and end of the whole process, including the diagnostic criteria, the evaluation scale and questionnaire, the unification of the survey method and the detailed investigation of suspicious cases.
1.2.3 Survey indicators.
① Treatment rate: refers to the number of cases treated at least once in the hospital after the onset of the patient to the point of investigation / total number of cases × 100%;
②Specialty outpatient treatment rate: the number of patients who went to the psychiatric outpatient clinic for treatment at least once after the onset of illness to the point of investigation/total cases×100％;
③Specialized inpatient treatment rate: refers to the number of patients who went to psychiatric inpatient treatment at least once after the onset of illness to the point of investigation/total number of cases × 100%;
(iv) Treatment compliance rate: the number of cases in which patients missed ≤ 20% of medication according to medical advice after the onset of illness until the point of investigation/total cases × 100%;
⑤ Abandonment of treatment rate: the number of cases where the patients never sought medical treatment or missed ≥80% of medication according to medical advice after the onset of illness until the point of investigation/total cases × 100%;
⑥Treatment rate of traditional medicine: the number of cases of patients taking herbal medicine and other treatments after the onset of illness until the point of investigation/total cases×100%;
(7) Superstition rate: the number of cases of patients who had believed in various superstitions from the onset of disease to the point of investigation/total cases×100％.
1.2.4 Data statistics and analysis: SPSS 10.0 software was applied to perform general statistical analysis and χ2 test on all data.
2, Results
2.1 Number of schizophrenia cases: 121 patients with schizophrenia were diagnosed in this investigation, including 53 males and 68 females; 70 cases in urban areas and 51 cases in rural areas.
2.2 Treatment rate and distribution of schizophrenia.
2.2.1 The treatment rate of schizophrenia was 76.9% (93/121). The treatment rates of men and women were 75.5% (40/53) and 77.9% (53/68), respectively, with no significant difference in treatment rates by gender (χ2=0.10, P>0.05); the treatment rates of urban and rural areas were 84.3% (59/70) and 66.7% (34/51), respectively, with significant differences in treatment rates between urban and rural areas (χ2=5.15, P<0.05< font= "">).
2.2.2 The treatment rate of schizophrenia specialist outpatient clinic was 66.9% (81/121). The treatment rates of male and female specialist outpatient clinics were 69.8% (37/53) and 64.7% (44/68), respectively; there was no significant difference in the treatment rates of gender specialist outpatient clinics (χ2=0.35, P>0.05); the treatment rates of urban and rural specialist outpatient clinics were 75.7% (53/70) and 54.9% (28/51), respectively; there was a significant difference in the treatment rates of urban and rural specialist outpatient clinics (χ2= 5.77, P<0.05< font="">).
2.2.3 The rate of specialist inpatient treatment for schizophrenia was 32.2% (39/121). The inpatient treatment rates were 34.0% (18/53) and 30.9% (21/68) for men and women, respectively, and 38.6% (27/70) and 23.5% (12/51) for urban and rural areas, respectively, with no significant differences between gender and urban and rural areas (χ2=0.13, P>0.05; χ2=3.06, P>0.05).
2.2.4 The treatment adherence rate for schizophrenia was 14.9% (18/121). The adherence rates were 13.2% (7/53) and 16.2% (11/68) for men and women, respectively; 17.1% (12/70) and 11.8% (6/51) for urban and rural areas, respectively, with no significant differences between gender and urban and rural areas (χ2=0.21, P>0.05; χ2=0.67, P>0.05).
2.2.5 The abandonment rate of treatment for schizophrenia was 65.3% (79/121). The abandonment rates of men and women were 71.7% (38/53) and 60.3% (41/68), respectively, and the difference between the abandonment rates of gender was not significant (χ2=1.71, P>0.05); the abandonment rates of urban and rural areas were 57.1% (40/70) and 76.5% (39/51), respectively, and the difference between the abandonment rates of urban and rural areas was significant (χ2=4.86, P< 0.05< font="">).
2.2.6 The rate of traditional medical treatment for schizophrenia was 3.3% (4/121).
2.2.7 The rate of schizophrenia superstition was 55.4% (67/121). The male and female superstition rates were 52.8% (28/53) and 57.4% (39/68), respectively; the difference in gender superstition rate was not significant (χ2=0.25, P>0.05); the urban and rural superstition rates were 44.3% (31/70) and 70.6% (36/51), respectively; the difference in urban and rural superstition rates was significant (χ2=8.26, P<0.01< font= "">).
3, Discussion
According to the sample size calculation formula:N(sample size)=(t2/r2)×Q/P, when the confidence level is 95%, t(μ0.05, r=∞)=1.96≈2, r(sampling error)=20%, P(prevalence)=0.7%[1], Q(impossible prevalence)=1-P=99.3%. n=22/0.22×99.3/0.7=14186 , the minimum sample size that should be surveyed in the city is 14186 people. The survey adopted the sampling method developed by the National Collaborative Group for Epidemiological Survey of Mental Disorders in 12 regions, and a total of 17,812 people were selected for the epidemiological survey of schizophrenia treatment rate, using a combination of household-by-household and telephone consultation survey methods, with a 100% household rate, a 77.2% meeting rate, and an 18.3% telephone survey rate, indicating that the survey sample is representative and can more truly reflect The current situation of schizophrenia treatment.
The survey results showed that the treatment rate of schizophrenia in Yichun was 76.9% (93/121), which was much higher than the WHO estimate of the treatment rate of schizophrenia in China in 1998 (about 30%) [2], with the treatment rate of schizophrenia in rural areas (66.7%) also higher than the treatment rate of schizophrenia in rural areas of Sichuan Province in the mid-1990s (less than 50%) [2]. The reason for this may be, firstly, the different understanding of the concept and definition of treatment rate and, secondly, the different time of the survey.
The survey showed that the urban treatment rate was higher than the rural treatment rate, and the urban specialist outpatient treatment rate was also higher than the rural specialist outpatient treatment rate, but the urban abandonment rate was lower than the rural abandonment rate, which may be mainly due to, firstly, the higher economic level in urban than in rural areas; secondly, the lower cultural quality of rural residents compared to urban residents, who do not understand schizophrenia, do not consider it as a disease, and often seek gods and worship Buddhism. The rate of superstition in rural areas (70.6%) was higher than the rate of superstition in urban areas (44.3%), and the difference was significant (p<0.01< span="">), which fully illustrates this point. Again, there is a lack of professional institutions and doctors in rural areas.
The survey results showed that the adherence rate of schizophrenia treatment was only 14.9% (18/121), with no significant difference between gender and rural and urban areas (p>0.05), which may be related to the fact that schizophrenia is difficult to be cured, patients are not self-aware and uncooperative in treatment, and their families are overwhelmed by the accumulated medical costs. The survey also found that the rate of traditional medical treatment for schizophrenia was only 3.3% (4/121), which may be related to the uncertainty of the efficacy of herbal medicine and acupuncture, the tedious treatment process, and the difficulty of patient cooperation. The survey showed no significant gender differences in treatment rates for all types of schizophrenia, which is consistent with the findings of Zhu et al [3].