Status And Influencing Factors Of Public Health Services Utilization Among Rural Patients With Severe Mental Illness In Yunnan Province

Objective:This study takes the heavy mental patients in rural areas of Yunnan Province as the object of empirical research to understand the current status of the use of public health services in rural residents with severe mental illness in Yunnan Province,and analyzes the factors influencing the use of public health services in rural residents with severe mental illness in Yunnan Province.The difficulties and deficiencies in the implementation of public health services for severe mental illness in the rural areas of the province were encountered.To provide mental health service policies for the government and related departments,to rationally allocate mental health resources,and to provide a scientific basis for improving the utilization rate of public health services for heavy mental patients in rural areas.Methods:Used the literature review method and combined with research experience and results domestic of foreign experts and scholars in rural severe mental patients with public health services utilization,influence factors and intervention measures,then made questionnaire and interview outline and adopt the method of combining with qualitative research.Used stratified cluster sampling method to select Yunnan rural 284 cases of the major caregivers of severe mental disorders and evaluated caregivers burden scores through CBI scale for Chinese version to;Used chi-square or t test to compare different types caregivers' burden scores and multiple linear regression to analyze the main caregiver burden influence factors in rural main patients with severe mental illness;Used chi-square test to compare the difference in public health service utilization in different categories patients and caregivers and Multiariable logistic regression method to analyze the influence factors in the public health service utilization.Results:(1)A total of 284 cases of rural patients with severe mental illness were investigated,including 144 males(50.7%)and 140 females(49.3%).The rate of medical file filing,follow up rate of village doctor,participation rate of free physical examination and health education acceptance rate among patients with severe mental illness were 89.8%,84.9%,73.2%and 56.7%respectively(P<0.05).Female patients had higher participation rate of free physical examination than male patients,and patients have work and patients with controlled disease condition and their caregivers had higher rates of health education acceptance rate than their counterparts(P<0.05).(2)Among caregivers,108(38.0%)of which belonged to patients' parents,79(27.8%)of which were patients' spouse,and 97(34.2%)were patients' relatives.The overall mean score CBI was 54.52 ± 15.62,and domain of emotional limitation had the highest score(14.93 ±4.09).The results of multiple regression analysis indicated that caregivers belonged to patients' parents and number of caregivers was main regression analysis,influencing factors of the burden of CBI.Caregivers belonged to patients' parents were more likely to have higher score of CBI,and the more number of caregivers,the less score of CBI.(3)Interview study found that there is a serious shortage of mental health knowledge in rural areas of Yunnan Province;the main caregiver of severe mental patients has a heavy mental burden,and religious superstitions affect the patient's medical practice;free drug recipients determine whether the adherence of a fixed-point medical institution to drug treatment can be sustained;There are few health care workers,low academic qualifications,multiple self-employed people,and inadequate technical skills;the lack of coordination among patients or their caregivers affects the use of public health services for severe mental patients in rural Yunnan.Conclusion:Severe mental illness of rural public health services in Yunnan province to carry out the project more comprehensive,but the public health service utilization was low,so the existing resources and conditions to take measures to improve the mental health of public health service efficiency is very important.The burden of primary caregivers of patients with severe mental illness was substantial in rural Yunnan Province.Future measures to improve caregiver's mental and physical health should more focus on caregivers belonged to patients' parents.The lack of knowledge of mental health in rural areas of Yunnan Province affects the patient's seeking medical behavior and the use of public health services.It is recommended that certain intervention measures be taken to carry out mental health knowledge education activities in various forms.