Page 100 - 中国全科医学2022-04

http://www.chinagp.net E-mail:zgqkyx@chinagp.net.cn ·481·

*
Corresponding author：WANG Ruoxi，Lecturer；E-mail：ruoxiwang@hust.edu.cn
【Abstract】 Background Understanding the characteristics of social support of family caregivers of persons with severe
mental illness，and identifying the associated factors are the preconditions of developing evidence-based intervention strategies to
improve social support for this vulnerable group. Among the limited studies concerned family caregivers of patients with severe mental
illness，the majority focused on their own individual factors，leaving patient- and family-level associated factors largely under-
investigated. Objective To explore the social support and associated factors among family caregivers of persons with severe mental
illness，providing a theoretical basis for the development of evidence-based strategies to enhance the level of social support in this
group. Methods A cross-sectional design was used. Multistage sampling was used to select three tertiary grade A mental health
organizations from three cities located in eastern，central，and western China，respectively（one was extracted from each city），
then from which，family caregivers of persons with severe mental illness who received outpatient services between August 2018 and
December 2019 were selected，and their family caregivers（n=1 001）were recruited as participants. A self-administered survey
was conducted in the family caregivers using a questionnaire〔consisting of two parts：demographics and the Social Support Rating
Scale（SSRS）〕compiled by our research team to collect their individual and family information and social support status，as well
as patients'（the care receivers'）information. Multiple linear regression was employed to identify associated factors for the total score
and domain scores of SSRS. Results The mean total score of SSRS for the family caregivers was（34.4±9.1）. And the mean score
for its three domains，subjective social support，objective social support，and social support utilization was （20.3±6.2），（7.5±2.8），
（6.6±2.3），respectively. The type of occupation of the caregivers，and the type of mental diseases and stability of symptoms
of patients cared by them，as well as mean household monthly income per person were associated with the total score of SSRS for
the family caregivers（P<0.05）. Furthermore，marital status and religious belief of caregivers，as well as their relationship with
the patients cared by them also affected the total score of SSRS of the family caregivers（P<0.05）. As for the scores of domains
of SSRS，they were found to be influenced by the type of occupation of the caregivers，the type of mental diseases and stability of
symptoms of patients cared by them，and mean household monthly income per person（P<0.05）. Besides that，gender，marital
status，living area（rural or urban），and religious belief of caregivers，their relationship with patients cared by them，and the
amount of family subsidies also affected the score of subjective social support of family caregivers（P<0.05）；the amount of family
subsidies also affected the objective social support score of family caregivers（P<0.05）；gender and living area（rural or urban）
of caregivers，and the amount of family subsidies also affected the score of social support utilization of family caregivers（P<0.05）.
Conclusion Family caregivers of patients with severe mental illness possessed a low level of social support，had limited access
to social support，perceived insufficient support，and used social support rather insufficiently. There were differences in factors
associated with their overall social support and domain-specific social support. More attention should be paid to family caregivers who
are single，unemployed，have low household monthly income per person，care for patients with schizophrenia or unstable mental
symptoms，and provide them with support in accordance with their needs，by which their care burden can be alleviated，and their
physical and mental health will be improved eventually.
【Key words】 Mental disorders，severe；Family caregivers；Social support；Root cause analysis

因长期照护社会功能严重受损且病情迁延的居家严 碍社区康复服务发展的意见》 ［5］ ，国家卫生健康委员
重精神障碍患者，家庭照护者常承受着巨大的照护负担， 会印发的《严重精神障碍管理治疗工作规范（2018 年
且面临着生理、心理、经济等多方面的压力 ［1］ 。与此 版）》 ［6］ 等文件中均明确要求构建社区支持网络，为
同时，在连带病耻感的影响下，严重精神障碍患者的家 有严重精神障碍患者的家庭提供工具性支持与情绪性支
庭照护者常羞于或不愿寻求社会支持，甚至处于社会隔 持。在此政策背景下，精准识别严重精神障碍患者家庭
离状态，这进一步加重了其照护负担 ［2］ 。沉重的照护 照护者这一弱势群体中亟须社会支持的重点人群，明确
负担不仅严重影响着照护者自身的健康与生活质量，还 其需求特征，并揭示影响其社会支持水平的因素，已成
使严重精神障碍患者预后不良的风险大幅增加 ［3］ 。研 为充分利用有限社区资源以提升这一弱势群体社会支持
究显示，通过为严重精神障碍患者家庭照护者提供充足 水平的现实要求。然而，相较于海量探索社会支持对个
的主观、客观社会支持，并提高其对社会支持的利用度， 体精神健康促进作用的研究而言，目前，有关精神障碍
有助于减轻其照护负担，促进严重精神障碍患者康复， 患者或其家庭照护者社会支持状况及影响因素的研究较
并提升弱势家庭的获得感 ［4］ 。鉴于社会支持对于严重 为匮乏，而有限的研究又多聚焦于精神障碍患者 ［7-8］ ，
精神患者及其家庭照护者的重要意义，民政部会同财政 对于其家庭照护者的关注较少。针对严重精神障碍患者
部、原卫生计生委、中国残联起草的《关于加快精神障 家庭照护者社会支持的实证研究更是不足。此外，现有