| Objective:To explore the extent of utilization of mental health services and its influencing factors among patients with schizophrenia in rural communities, so as to provide evidence for government enacting rural mental health policy and taking effective intervention measures.Methods:Three xiang/towns (23 villages) were sampled from Liuyang City using stratified-cluster random sampling techniques. Clues of schizophrenia were identified among 61165 residents in 23 villages sampled.220 patients with schizophrenia diagnosis using the Structured Clinical Interview for DSM-â…£-TR Axis I Disorders-Patient Edition (SCID-I/P). The Global Assessment of Functioning (GAF) was used to assess the functioning of the patients with schizophrenia throughout the survey. Delay of help-seeking is defined to be delayed 60 days and more to doctor visiting after psychiatric symptoms was notified. Delay of diagnosis is defined to be delayed 30 days and more that patient did not obtain correct diagnosis after they had seen a doctor for the first time. Delay of treatment is defined to be delayed 90 days and more to receiving treatment after psychiatric symptoms was notified. Delay of rehabilitation is defined that patient did not recieve basic psychiatric rehabilitation services after condition was stabled (six months after specific treatment).Result:1.The consultation rate of patients with schizophrenia was 87.3% and the ratio of delay in help-seeking was 58.6% in rural communities of Liuyang. The ratio of delay in diagnosis was 12.5%. Treatment ratio was 86.4% and the ratio of delay in treatment was 58.6%. Rehabilitation ratio was 61.8% and the ratio of delay in rehabilitation was 64.2%. The median of delay in help-seeking among patients with schizophrenia who had visited doctors was 275 days (5 days-21.84 years) and who had never visited doctor was 12.30 years (1.46 years-44.80 years). The median of delay in diagnosis was 6.12 years (23 days-39.63 years). The median of delay in treatment among patients with schizophrenia who had visited doctor was 1.10 years (1 day-39.46 years) and who had never visited doctor was 12.47years (1.37 years-44.72 years). The median of delay in rehabilitation was 10.50 years(1 month-35.92 years). Average GAF score was (53.59-18.71).2. Logistic regression shows that to patients with schizophrenia, influential factors of coping measures at onset of schizophrenia were characteristic of psychiatric symptom, transnatural attribution to symptom (believe in daimon), and their OR are respectively 5.222,0.434. influential factors of help-seeking behaviors among patients with schizophrenia admitted to a medical institution were characteristic of psychiatric symptom and family income level, their OR are respectively 21.060,0.198. Sex was the influential factor of help-seeking behaviors among patients with schizophrenia admitted to a psychiatric hospital, and OR is 0.325. Influential factors of delay in help-seeking were education level and marital status, their OR are respectively 0.291,0.417. Influential factor of delay in diagnosis was category of medical institution, and OR is 0.053. Influential factors of treatment were characteristic of psychiatric symptom, transnatural attribution to symptom (believe in daimon) and distance to psychiatric hospital, and their OR are respectively 5.627,2.752,0.064; Influential factors of re-examination of pathogenetic condition were education level, course of disease, tallest education level of family member, insight and aid of psychotropic drug, and their OR are respectively 2.376,0.995,2.860,3.034,4.638; Education level and homestyle (nuclear family, trunk family or defect family structure) were the influential factors of delay in treatment, and their OR are respectively 0.303,1.316,4.627; Influential factors of rehabilitative treatment were age of onset and insight, and their OR are respectively 0.952,9.755; Insight was the influential factor of delay in rehabilitation, and OR is 0.326.Conclusion:1. Delay in help-seeking, delay in diagnosis, delay in treatment and delay in rehabilitation of patients with schizophrenia are serious mental health problems in rural areas.2. Utilization of mental health services among patients with schizophrenia in rural communities are influenced by sex, age of onset, education level, tallest education level of family member, marital status, homestyle, family income level, characteristic psychiatric symptom, transnatural attribution to symptom (believe in daimon), category of medical institution, distance to psychiatric hospital, course of disease, insight, and aid of psychotropic drug. This study implies that targeted health education and scanning for schizophrenia are urgently needed to promote patients with schizophrenia seeking help from medical institutions, identify ratio, treatment ratio and rehabilitation ratio. Objective:To explore the state of utilization of mental health services and influencing factors among patients with schizophrenia in rural communities, further propose explanation models of mental disorder and utilization models of mental health services, so as to provide decision-making basis for establishing strategies by related departments for rural mental disorders control.Methods:Using purpose sampling, in-depth-interview were undertaken with 10 patients,18 family members of patients with schizophrenia,2 mental health staff,6 primary health care personnel and 10 village doctors. Methods of analysis:all interview records were transcribed and analyzed by thematic framework.Result:Information of 24 patients with schizophrenia about their utilization of mental health services were collected. One had never visit a doctor. Five patients firstly admitted to non-psychiatric hospital and eighteen patients to psychiatric hospital after they suffered from schizophrenia. Two patients had never accepted psychotropic drug treatment. Fifteen patients still maintenance treatment with psychotropic drug, and 12 was by the aid of psychotropic drug among them. Patients with schizophrenia and their family members regard mental disorders as extraneous illness, such as supernaturalism, body toxication. During the course of mental health service utilization, they often experienced five stages:ignore of symptom, attribution of symptom, magic or religion and medical cure together, numbness of help-seeking behaviors and accepting the truth of suffering from mental illness. Their help-seeking behaviors showed characteristic about segmentation and rotation of place. Now rural mental disorders prevention and cure net has not been truly unfolded in Liuyang City and accessibility of rural community mental health services is still lower. The obstacles of mental health skill delivery between mental hospital and primary health care personnel, the obstacles of mental health services between primary health care personnel and patients with schizophrenia and also their family members have result in knowledge obstacle of mental health and utilization obstacle of mental health services among patients with schizophrenia in rural communities.Conclunsion:There are lack of systemic specific treatment and mental health services utilization among patients with schizophrenia in rural communities. There are two main causes, one is that patients with schizophrenia and their relatives lack knowledge about mental health and illness, another is that it is lack of full time or part-time psychiatrist in rural community. This study suggests that it is urgent for the government to take effective measures including setting up a full time psychiatrist in a rural town and carrying out mental health education, so as to improve identify capability of mental disorders, help seeking capability among country dwellers.
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