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目的:探讨汶川地震14个月后极重灾区县基层医务人员心理健康状态及相关因素。方法:采用方便取样,选取参加卫生部-联合国人口基金会“汶川震后社会心理支持项目”培训与心理干预的6个极重灾区县基层医务人员307人。先用一般状况调查表、心理健康自评问卷(SRQ20)及创伤后应激障碍筛查表(PTSD7)进行调查。然后,对SRQ20≥10分或PTSD7≥4分者均进行国际神经精神科简式访谈问卷(MINI)的抑郁发作和PTSD诊断评估以及自杀倾向评定。结果:SRQ20≥10或PTSD7≥4者81人。在完成MINI抑郁发作诊断评估的51人中,符合目前抑郁发作7人;在完成PTSD诊断评估的61人中,符合PTSD发作7人;两者共病3人。在完成自杀倾向诊断评估的62人中,存在自杀倾向10人。不同性别和年龄组之间的抑郁发作、PTSD和自杀倾向检出率差异均无统计学意义;不同安置点之间的PTSD检出率差异有统计学意义,北川的检出率(40.0%)最高。搬迁次数是灾区基层医务人员精神痛苦的危险因素(OR=1.24)。结论:震后14个月后,极重灾区县基层医务人员仍存在明显的精神痛苦,少数人存在抑郁发作、创伤后应激障碍及自杀倾向。震后多次搬迁可能促使精神痛苦的发生及症状加重。
Objective: To investigate the mental health status and related factors of grassroots medical workers in the severely affected areas after 14 months of Wenchuan earthquake. Methods: Convenient sampling was used to select 307 grassroots medical personnel in 6 extremely severely affected counties participating in the Ministry of Health - UNFPA “Post-Wenchuan Social Psychological Support Project ” training and psychological intervention. The first survey was conducted using the General Status Questionnaire, the Self-Assessment Mental Health Scale (SRQ20) and the Post-Traumatic Stress Disorder Screening List (PTSD7). Then, depression and PTSD diagnostic assessment of the International Neuropsychiatric Short Form Questionnaire (MINI) and assessment of suicide tendencies were performed on subjects with an SRQ20 ≥10 or PTSD7 ≥4. Results: 81 people with SRQ20≥10 or PTSD7≥4. Of the 51 people who completed the diagnostic assessment of depression in the MINI group, 7 were present with depressive episodes and 7 of the 61 persons who completed the PTSD diagnostic assessment met the PTSD episode; three were co-morbid. Among the 62 people who completed the diagnosis of suicide tendency, 10 were suicides. There were no significant differences in the detection rates of depression, PTSD and suicide among different genders and age groups. The detection rate of PTSD was significantly different among different settlements. The detection rate of Beichuan was 40.0% highest. The number of relocations was a risk factor for mental pain among grassroots medical staff in disaster areas (OR = 1.24). Conclusion: At 14 months after the earthquake, there was still significant mental suffering among grassroots medical workers in the severely affected areas. Some people had depressive episodes, post-traumatic stress disorder and suicidal tendencies. After the earthquake many relocations may lead to the occurrence of mental pain and symptoms worse.