Purpose To describe the mortality rate and cause of death among Han Chinese schizophrenia patients and to explore the risk factors affecting survival. Methods We performed a retrospective analysis of death among patients with schizophrenia from Jan 1, 2012, to Dec 31, 2019, using the Severe Mental Disorders Information System of Shandong Province (henceforth referred to as the SMDI system) in Shandong, China. The cohort included 72,102 patients, and 11,766 patients died during follow-up. The data in this cohort study were derived from the SMDI system. We calculated the crude mortality rate and standardized mortality rate (SMR, standardized according to the sex and age composition of the population in Shandong Province) for patients with schizophrenia. Cox regression analysis was used to analyze the risk factors affecting patient survival, and the statistical index was the hazard ratio (HR). Results The mean age of the cohort patients was 47.21±14.05 years; 51.79% were males, and 48.21% were females. Among them, 68.98% (49,735) had only a primary education level, 85.36% (61,549) were farmers, 64.37% (46,413) were married, and 94.01% (67,775) received community management. A total of 16.32% of the cohort died. The SMR in patients with schizophrenia was 4.9, and it was higher for males than females (4.99 versus 4.82). Among the 6 registered causes of death, physical illness had the highest SMR (5.15), followed by other causes of death (4.86), mental illness-related complications (4.57), homicide (4.31), accidents (4.13), and suicide (3.87). Higher levels of education, employment (in-service status), marriage, and urban residence were protective factors for survival among patients with schizophrenia. Conclusion In China, the SMR of schizophrenia is relatively high, and physical diseases are the main cause of death. We suggest that a variety of measures should be taken early to treat somatic diseases and reduce SMR in patients with schizophrenia.

BACKGROUND:Depression is characterized by debilitating symptoms and high recurrence rates, and there are relatively few large-scale epidemiological surveys of depressive disorders conducted in Shandong since 2005. Data from the largest Epidemiological Survey of Mental Disorders conducted in 2015 in Shandong were collected to investigate the prevalence of depressive disorders and associated demographic characteristics in general adult population.METHODS:A multi-stage stratified cluster sampling method was adopted to select residents and a two-stage screening and assessment process was used to define the prevalence and characteristics of depressive disorders. Respondents were initially screened using the General Health Questionnaire followed by a structured clinical interview using the DSM-IV criteria.RESULTS:Among 27,489 respondents who completed the survey, 1277 respondents met the diagnostic criteria for depressive disorders. The adjusted prevalence in the last month was 4.86%, among which the prevalence of major depressive disorder, dysthymia, and unspecified depressive disorder were 2.32%, 1.78%, and 0.75%, respectively. 40.35% of depression patients had moderate or severe functional impairment and only 10.65% of patients had visited a psychiatric service. Univariate and multivariate analyses revealed that age, gender, occupation, education, marital status, and urban/rural living were associated with the prevalence.LIMITATIONS:The key limitation is that this is a cross-sectional survey therefore cannot draw any causal relationship between risk factors and disease progression.CONCLUSIONS:Findings from this largest epidemiological study reveal current prevalence of depressive disorders and associated demographic factors and offers opportunities for policy makers and health-care professionals to improve mental health provision in Shandong.

目的:了解山东省精神障碍患者的生命质量状况,分析其相关因素.方法:2015年,采用多阶段分层整群随机抽样在山东省开展第四次精神障碍流行病学调查.筛选符合精神障碍诊断与统计手册第4版诊断标准的精神障碍患者作为研究对象.采用一般情况调查表、匹兹堡睡眠质量指数量表、简易应对方式问卷、功能大体评定量表、生命质量量表进行调查.结果:农村居民(β=-0.96,P＜0.01)、女性(β=-1.92,P＜0.001)、未婚(β=-2.72,P＜0.01)、农民/渔民(β=-0.94,P＜0.05)、无业或失业(0=-1.93,P＜0.01)患者生命质量得分更低,躯体健康状况(β=-5.59,P＜0.001)和心理健康状况(β=-4.19,P＜0.001)越差、匹兹堡睡眠质量指数(β=-0.49,P＜0.001)越高,患者生命质量得分越低;积极应对(β=1.65,P＜0.001)和功能大体评定量表(β=0.12,P＜0.001)得分越高,患者生命质量得分越高.结论:精神障碍患者生命质量较差,应重点关注农村居民、女性、未婚、农民或渔民、无业或失业、躯体或心理健康状况差、睡眠质量差、功能受损重,较少采取积极应对方式的患者,提高其生命质量.

目的 探讨山东省抑郁障碍患者应对方式的特点及影响因素.方法 研究组为2015年山东省精神障碍流行病学调查中诊断出的且量表完整的1174例抑郁障碍患者,对照组为按照与研究组同性别、同年龄组、同村居1:1配对原则,自调查对象中抽取的筛查阴性者.研究工具包括自制的一般资料调查表、一般健康问卷(GHQ-12)及增加的风险评估问题、DSM-Ⅳ轴Ⅰ障碍用临床定式检查(SCID-I/P)、功能大体评定量表(GAF)及简易应对方式问卷(SCSQ).结果 研究组SCSQ积极应对评分低于对照组,消极应对评分高于对照组(P<0.01).未特定抑郁障碍的积极应对评分高于其他两个亚型(P<0.01).研究组中不同职业、医疗来源、年龄、受教育程度、GAF评分的积极应对评分比较差异有统计学意义(P<0.05),研究组中仅不同居住方式的消极应对评分比较差异存在统计学意义(P<0.01).相关性分析结果显示,受教育程度、GAF评分与积极应对评分均呈正相关(P<0.01),年龄与积极应对评分呈负相关(P<0.01).回归分析结果显示,医保/商业保险、受教育程度、GAF评分能预测积极应对评分的4.8％.结论 抑郁障碍患者较一般人群多采取消极应对方式,较少采取积极应对方式;恶劣心境障碍患者采取积极应对方式的能力更差;无医疗来源、较低的受教育程度、严重的社会功能受损是抑郁障碍患者积极应对能力的危险因素.

Objective:This study aims to investigate the prevalence and distribution characteristics of mental disorders among people aged 18 and above in Shandong Province.Methods:In 2015, an epidemiological survey was carried out to investigate the patterns of mental disorders in 49 counties of Shandong Province. A total of 28 000 individuals aged 18 years or older were selected using the multistage stratified cluster sampling method. All these participants were classified as at a high or low risk of mental disorders according to the assessment results of the revised version of the General Health Questionnaire (GHQ). The diagnosis of mental disorders was confirmed using the Structured Clinical Interview for Diagnostic and Statistical Manual, Forth edition (DSM-Ⅳ) axis I or MMSE. All participants at high risk of mental disorders were evaluated using DSM-Ⅳ or MMSE to confirm the psychiatric diagnoses, while 10% of participants at low risk of mental disorders were randomly selected to be evaluated. The prevalence and its 95% confidence interval of mental disorders were adjusted according to study design and sociodemographic characteristics of the sample. The between-group differences of prevalence were compared using chi-square tests or Fisher′s exact tests as appropriately.Results:A total of 27 489 individuals completed survey. The adjusted prevalence of any mental disorder was 17.46% (95 %CI 17.02%-17.89%). The five most prevalent mental disorder spectrums were substance use disorders (5.29%), mood disorders (4.47%), anxiety disorders (4.46%), intellectual and mental disorders due to physical or substance (1.91%), and psychotic disorders (1.12%). The most common mental disorders were alcohol use disorder (5.27%) and major depressive disorder (2.14%). The prevalence of mental disorders in men was higher than that in women (23.37% vs. 13.89%; χ 2=408.91, P<0.01). There was no significant difference in the prevalence of mental disorders between rural residents and urban residents (17.69% vs. 17.20%; χ2=1.05, P=0.305). Of participants with mental disorders, 26.12% (1 047/4 008) had moderate to severe functional impairment and 10.98% (428/3 898) have sought professional help. Conclusion:The prevalence of mental disorders among people aged 18 and above in Shandong Province is basically consistent with the results of similar domestic studies. The prevalence of mental disorder was higher in men than in women and was not differ in participants living in urban and rural areas. Alcohol use disorder, major depressive disorder, non-specific anxiety disorder and non-specific depressive disorder are most common mental disorders.

目的 调查山东省社会心理咨询机构服务资源的现状,并在此基础上为确定社会心理健康服务体系结构,制定与山东省经济和社会发展水平相适应的政策措施提供参考依据.方法 统一编制社会心理咨询机构调查问卷,问卷调查采取普查的方式进行.各市、县(市、区)精防部门分别负责组织本系统有关单位按照要求填写调查表.调查问卷由各部门审核汇总后交由各市精防部门上报进行审核并统一分析.结果 山东省社会心理咨询机构共385所,专职服务人员仅占22.8％,低于全国平均水平(34.8％).36.8％的服务人员为本科以下学历,业务水平良莠不齐.服务场所面积小,每所咨询机构平均用房面积仅为102.6 m2,低于全国水平(137.95 m2).机构设施不足,部分心理咨询机构还没有专用的沙盘资料室.社会心理咨询机构收入主要来源是个人心理咨询服务.结论 山东省相关部门和组织很有必要对目前社会心理咨询机构现状进行探讨,制定出切实有效的与山东省经济和社会发展水平相适应的政策措施,提升对心 理咨询机构服务资源的配置,提高现有服务人员的业务水平.

目的 探索医学生的幸福取向与自杀风险的关联强度.方法 在山东济南两所大学医学生中按年级分层后整群抽取研究样本,对其自杀风险及幸福取向等因素进行问卷调查.自杀风险采用修订版自杀行为问卷(SBQ-R)获取,幸福取向采用幸福取向量表(OTH)测量.结果 分发2 197份问卷,有效问卷2 074份(94.40％).按SBQ-R得分7分及以上计,具有高自杀风险者达20.64％.幸福取向划分为高意义-高快乐(503人,24.25％)、高意义-低快乐(545人,26.28％)、低意义-高快乐(662人,31.92％)、低意义-低快乐(364人,17.55％)4组.4组SBQ-R评分差异有统计学意义(F=11.736,P＜0.001).在调整学习成绩、单亲家庭、睡眠状况、经济水平等变量后,多因素Logistic回归模型显示,以低意义-低快乐为参照组,高意义-高快乐、高意义-低快乐均与自杀风险呈负关联,OR(95％CI)分别为0.632(0.449～0.887)、0.604(0.430～ 0.848).结论 医学生的自杀风险处于相对较高水平,高意义感的幸福取向自杀风险低.

The prevalence of various mental disorders and their age and gender specific characteristics among suicide attempters remains unclear in rural China. This study using 1:1 paired case-control design included 409 suicide attempters and 409 paired controls matched on age, gender and place of residence. Mental disorders were assessed using the Structured Clinical Interview for DSM-IV-TR Axis I Disorders. The prevalence of mental disorders was 32.3% for suicide attempters and 4.9% for paired controls. Mental disorder constituted a significant risk factor for suicide attempt with an adjusted odds ratio of 7.16 (95%CI: 3.65–14.04). The prevalence of mental disorders was higher among male than female suicide attempters. Major depressive disorder was most common in female suicide attempters while alcohol use disorder was most common in the males. The prevalence of mental disorders seemed to increase with age. Suicide attempters of higher ages were more prone to have mood disorders, especially a major depression. Suicide attempters with mental disorders differed from those without mental disorders on a number of socio-economic characteristics and suicidal behavior features. These insights should be taken into account in strategies and efforts to improve mental health care and ultimately to reduce suicidal behavior among residents in rural China.

Objective:To assess the relationship of suicide knowledge and attitudes toward suicide to self-esteem among village physicians.Methods:A cross-sectional study was implemented in Zoucheng City of Shandong province.Non-probability sampling was conducted to select participants.A self-made questionnaire and the Self-esteem Scale (SES) were used.The knowledge of suicide and attitudes toward suicide were measured with the General Social Survey (GSS) for suicidal attitudes,the Suicide Attitude Questionnaire (QSA) for nature of suicidal behavior and the Scale of Public Attitudes about Suicide (SPAS) for suicide knowledge,prevention of suicide,social importance of suicide and positive attitude to suicide.Results:The scores of subscales for nature of suicidal behavior,social importance of suicide,preventability of suicide and positive attitudes toward suicide were 2.7,27,60,and 67.Mean score of the SES was 31.Regression analysis revealed the correlations between the scores of attitudes for the approvals of suicide,prevention of suicide subscale and social importance of suicide subscale and Self-esteem Scale.The village physicians with higher SES score were more likely to disapprove suicide and tended to believe that suicide was an important social problem and preventable.Conclusion:Self-esteem of village physicians could be related to the attitudes toward suicide for the approvals of suicide,and to its social importance and prevention of suicide.

目的 了解邹城市乡村医生的自杀意念发生率及其影响因素.方法 以非随机取样方法,对邹城市13个乡镇的乡村医生开展现况调查,以自制的人口学信息调查表、社会支持量表、抑郁量表、简易应对技能量表、自尊量表以及自杀意念、计划、姿态、企图量表为调查工具,对收集的信息进行多因素logistic回归模型分析,筛选自杀意念相关因素.结果 乡村医生中有4.9％有过自杀意念(n=30),在过去12个月中,自杀意念发生率为2.9％(n=18,占有自杀意念乡村医生的60.0％).回归分析显示,有躯体疾病、身体体质指数(BMI)大、社会支持量表得分低与村医自杀意念呈正关联.结论 乡村医生中自杀意念问题值得重视.BMI、躯体疾病及社会支持是自杀意念的影响因素.

BACKGROUND:Village doctors are primary care physicians at the grass root-level of rural medical and health institutions in China. Their depression can increase medical errors and affect quality of medical care services. This study aims to examine depressive symptoms and their correlates among Chinese village doctors.METHODS:A total of 616 village doctors were recruited from Zoucheng County of Shandong province. The Center for Epidemiologic Studies Depression Scale (CES-D), the Duke Social Support Index (DSSI) and the Simplified Coping Style Questionnaire (SCSQ) were used to measure depressive symptoms in the last week, social support and coping styles, respectively. Logistic regression model was conducted to identify the associated factors of depressive symptoms among village doctors.RESULTS:The prevalence rate of depressive symptoms was 27.4% (28.54% for males, 24.69% for females). Logistic regression analysis found that body mass index (BMI), poor physical health, low educational level, and negative coping styles were associated with increased risk of depressive symptoms. Positive coping styles were associated with decreased risk of depressive symptoms in village doctors.CONCLUSIONS:Depressive symptoms are prevalent among village doctors in China. They need to adopt more positive coping strategies to respond to negative emotions. More professional and medical trainings may be important to reduce risk of depressive symptoms and improve their quality of healthcare among village doctors in China.