Outcome Predictors in Patients with Mental Illness Receiving Community Care Services: A Cohort Study

精神疾病病人接受社區照護服務的預後預測因子

林敬恩(Ching-En Lin)；陳儷棻(Li-Fen Chen)；陳益乾(Yi-Chyan Chen)；吳家樑(Chia-Liang Wu)；陳奕呈(Yi-Cheng Chen)；葉啟生(Chi-Sheng Yeh)；魏慧如(Hui-Ju Wei)；羅乙棠(Yi-Tang Lo)

community care services ； mental illness ； risk predictors ； risk factors ； 社區照護 ； 精神疾病 ； 預後因子 ； 危險因子

台灣精神醫學

31卷1期（2017 / 03 / 01）

90 - 95+iv

英文

Objective: In this study, we intended to identify possible predictors of the clinical outcome in patients receiving community care services provided by Taipei Tzu-Chi Hospital. Methods: We recruited patients with mental illness who received community care services (CCS) between April 1, 2011 and September 30, 2015. We included 319 patients with mental illness in this study. In this cohort study, we compared CCC-participated patients with a favorable or an unfavorable outcomes. Results: The adjusted hazard ratios (AHR) with their 95% confidence intervals (CIs) of predictors such as having interpersonal conflicts (AHR = 2.59, 95% CI = 1.52 - 4.41, and p ＜ 0.01), active psychiatric symptoms (AHR = 1.99, 95% CI = 1.14 - 3.46, p ＜ 0.05), and illicit drugs use (AHR = 2.24, 95% CI = 1.18 - 4.28, p ＜ 0.05) were significantly higher than those of their control groups, meaning that those three clinical characteristics were predictors of a poor outcome in those CCS patients. Conclusion: Our findings highlight the need for psychiatric evaluation and intervention for patients with mental illness, comorbid with substance use disorder, or active psychiatric symptoms, and those who have ongoing interpersonal conflicts.

目的：研究精神疾病病人接受台北慈濟醫院提供的社區關懷服務後的預後因子。方法：從2011 年4 月1 日至2015 年9 月30 日收集接受社區關懷服務的精神疾病病人共319 案，做一個追蹤研究去分析個案預後因子。結果：病人合併人際衝突（修正後風險比 [AHR] =2.59, 95% CI = 1.52 - 4.41, p ＜ 0.01）、急性精神症狀 (AHR = 1.99, 95% CI = 1.14 - 3.46, p ＜O.05)、非法物質的使用 (AHR = 2.24, 95% CI = 1.18 - 4.28, p ＜ 0.05)，其不良的修正後風險比在統計上有顯著的區別意，表示為不佳預後的預測因子。結論：研究發現精神疾病病人在接受社區關懷照顧時，需要積極評估是否合併非法物質使用，是否有急性精神症狀，或合併人際衝突，以期有良好預後。

1. American Psychiatric Association(2013).Diagnostic Statistical Manual 5.Arlinton, Virginia, USA:American Psychiatric Association.
2. Appleby, L,Shaw, J,Amos, T(1999).Suicide within 12 months of contact with mental health services: national clinical survey.Bri Med J,318,1235-1239.
3. Bond, GR,Drake, RE,Mueser, KT(2001).Assertive community treatment for people with severe mental illness.Dis Manag Health Outcomes,9,141-159.
4. Hoff, RA,Rosenheck, RA(1999).The cost of treating substance abuse patients with and without comorbid psychiatric disorders.Psychiatr Ser,50,1309-1315.
5. Hunt, GE,Bergen, J,Bashir, M(2002).Medication compliance and comorbid substance abuse in schizophrenia: impact on community survival 4 years after a relapse.Schizophr Res,54,253-264.
6. Nelson, EA,Maruish, ME,Axler, JL(2014).Effects of discharge planning and compliance with outpatient appointments on readmission rates.Psychiat Serv,51,885-889.
7. Scott, H,Johnson, S,Menezes, P(1998).Substance misuse and risk of aggression and offending among the severely mentally ill.Bri J Psychiatry,172,345-350.
8. Stein, LI,Test, MA(1980).Alternative to mental hospital treatment: I. Conceptual model, treatment program, and clinical evaluation.Arch Gen Psychiatry,37,392-397.
9. Swartz, MS,Swanson, JW,Hiday, VA(1998).Violence and severe mental illness: the effects of substance abuse and nonadherence to medication.Am J Psychiatry,155,226-231.
10. Tessler, RC(1987).Continuity of care and client outcome.Psychosoc Rehabil J,11,39.
11. Weaver, T,Madden, P,Charles, V(2003).Comorbidity of substance misuse and mental illness in community mental health and substance misuse services.Bri J Psychiatry,183,304-313.

1. 游淑真(2017)。從旋轉門效應來看精神疾患者的社區照顧服務。社會工作實務與研究學刊，5，59-98。