| Objective Regular use of antipsychotic medication is closely related to the rehabilitation of community-dwelling individuals with schizophrenia.However,there are few reports on the use of antipsychotic medications by individuals with schizophrenia who live in low-resourced regions with limited health services.The current study involved a questionnaire survey with the guardians of community-dwelling individuals with schizophrenia in Ningxia that focused on the factors that influence patients’ use and compliance with antipsychotic medications.The results provide important insights about how to improve the accessibility and eqitability of mental health services for community members with severe mental illnesses in Ningxia.Methods Participates selected by judgement sampling method and consider the proportion of Minority population and economic development level,four counties(districts)in Xingqing District,Litong District,Xiji County and Pengyang County were selected as research sites and all schizophrenia patients in the community health institution managed were included.The questionnaire developed for the study was based on the National Health and Family Planning Commission’s "Norms for the Management and Treatment of Severe Mental Illness(2012 edition)".It included general demographic information and detailed information about the current condition and treatment of the target patient.Investigators who received standardized training administered the questionnaire to patients’ guardians by telephone or – if it was not possible to make telephone contact – by household surveys.Logistic regression and decision tree analyzes were employed to identify factors associated with the use of antipsychotic medications in the prior three months by individuals withschizophrenia,schizoaffective disorder or paranoid disorder.Results 1.2014 qualified respondents were included,this left 1817 patients for whom the survey were completed: their mean age was 47.36 years(range 17-86 years,standard deviation was 12.87 years),46.23% were male,34.73% were of non-Han(minority)ethnicity,32.36% were illiterate or semi-literate,and 70.45% were living in rural areas.The mean duration of their illness was 18.22 years(range 0-61 years,standard deviation was 10.69 years),the mean age of onset was 28.66 years(range 14-79 years,standard deviation was 11.39 years).2.Among the 1817 patients,1480(81.45%)had received antipsychotic medication,337(18.55%)had not received antipsychotic medication,and 1328(73.09%)had received antipsychotic medication in the past five years.Logistic regression indicated that among persons with server mental illness after adjusting for all variables in the model current or prior receipt of antipsychotic medication was significantly more likely in women(OR=1.89,95% CI(1.29~2.77),P=0.001),Han ethnicity(OR=2.18,95% CI(1.52~3.12),P <0.001),higher education level(OR=1.42,95% CI(1.17~1.72),P <0.001),with family history of mental disorders(OR=2.08,95% CI(1.23~3.52),P=0.006).Compared with patients who had never visited a psychiatrist,patients who had visited a psychiatrist in the past year were more likely to have received medication(OR=39.38,95% CI(24.42~63.51),P<0.001).The relative importance of these significant factors(from most to least important)was prior assessment by a psychiatrist,ethnicity,gender,education,and family history.Decision tree analysis identified potential interaction effects: a)between prior assessment by a psychiatrist and ethnicity and level of education b)between ethnicity and gender,and c)between family history of a mental illness,and level of education and ethnicity.3.Of the 1480 patients who had taken antipsychotics,350(23.65%)patients was noncompliance,162(10.95%)patients was partial compliance,and 968(65.41%)patientswas complete compliance.Ordinal logistic regression analysis adjusting for all factors in the model found that the following factors were significantly associated with the level of compliance: living with family members(OR=1.60,95%CI(1.13~2.28),P=0.009),living in urban communities(OR=2.44,95% CI(1.73~3.43),P<0.001),possessing a disability certificate(OR=2.21,95% CI(1.67~2.92),P<0.001).Compared with patients who had never visited a psychiatrist,patients who had visited a psychiatrist in the past year were more likely to compliance medication(OR=13.29,95% CI(8.83~20.00),P<0.001).The relative importance of these significant factors(from most to least important)were time of last visit with a psychiatrist,urban residence,possession of a disability certificate,and living with family members.Decision tree analysis identified potential interactions between urban residence and time of last psychiatric visit and possession of a disability certificate.Conclusion 1.The proportion of use antipsychotic medication among individuals with schizophreniain-studied area was lower than national average level.Factors associated with the use of antipsychotic medication in these individuals include prior psychiatrists visiting,ethnicity,gender,education level,and family history of mental illness.Therefore,it is urgent to strengthen the management of patients who had never visited psychiatrists,increase the quality and quantity of mental health human resources,and improve the proportion of patients receiving antipsychotic drugs.2.Noncompliance with antipsychotic medications is a common problem in community-dwelling patients with schizophrenia.The factors affecting compliance include the frequency of visits with psychiatrists,urban(v.rural residence),ethnicity,and education level.Improving the accessibility and eqitability of mental health services for community-dwelling persons with severe mental illnesses requires focusing on resource-poor rural areas where mental health human resources are very limited or non-existent. |
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