Cross-sectional Study On Social Welfare Of Patients With Severe Mental Illness Among Four Counties In Ningxia

Objective As a disadvantaged group concerned by the whole society,the patients with severe mental illness is in a difficult stratum in terms of both economic and social equity.The social welfare status of this group was under reported.The purpose of this study is to describe the proportion and distribution characteristics of social welfare among patients with severe mental illness in Ningxia,and to provide reference for relevant departments to improve the social welfare policy and improve the living conditions of this disadvantaged groups.Method Depend on the economic level and the population characteristics,four counties(districts)were selected from totally 22 counties(districts)in Ningxia by judgement sampling method;Stractural questionnaire developed for the study based on the National Health and Family Planning Commission’s “Norms for the Management and Treatment of Severe Mental Illness(2012 edition)”,included disease situation,treatment and social welfare of the target participants with severe mental illness managed in community health care settings.Investigators who received standardized training administered the questionnaire to patents’ guardians by telephone or – if it was not possible to make telephone contact – by household surveys.Excel database was used to input information,descriptive statistical method was used to analyze patients’ illness and social welfare access,and multi-factor unconditional logistic regression model was used to explore the possible influencing factors on patients’ social welfare access.Results: 1.3295 qualified respondents were included,this left 2959 patients for whom the survey was completed,of them,50.2% were males,42.3% were minorities and 73.3%were rural residents.The mean age of the subjects was(43.66±14.03)years.Schizophrenia was the predominant diagnosis,accounting for 65.4%.The mean course of disease was(19.79±12.40)years.61.4% of the patients once received antipsychotic drugs and 15.2% of the patients reported with family history of mental illness.Patient guardianship of human type was mainly direct relatives,accounting for 80.7%,2.5% of patients without guardians,and80.0% of the total sample was reported in poverty level.2.Among the 2959 patients,61.4% of the patients had the minimum living security;74.7% of the patients had disability certificates;59.8% of the patients reported received regular follow-up by grass-roots medical staff,only 51.3% of the 1817 patients received pay free antipsychotic drugs.The main sources of pay free drugs were civil affairs department(1.8%),disability federation(9.1%)and health department(23.9%),multiple sources(16.5),at patients’ own expense(48.7%).3.Logistic regression indicated that whether patients had the minimum living security was associated with age(OR=0.99,95%CI: 0.98-0.99,P=0.006),gender(OR=0.81,95%CI:0.66-0.95,P=0.011),economic status(OR=0.58,95%CI: 0.45-0.74,P<0.001),education level in junior middle school(OR=0.72,95%CI: 0.56-0.93,P=0.010),education level in high school and above(OR=0.56,95%CI: 0.41～0.76,P<0.001),received hospitalization therapy(OR=0.80,95%CI: 0.65～0.99,P=0.044),urban/rural(OR=1.98,95%CI: 1.61～2.45,P<0.001),family mental illness history(OR=1.30,95%CI: 1.03～1.63,P=0.025),disability certificate(OR=2.57,95%CI: 2.12～3.11,P<0.001).Whether the patients have disability certificates was significantly correlated with urban/rural(OR=0.31,95%CI: 0.24～0.42,P<0.001),married(OR=0.57,95%CI: 0.44～0.74,P<0.001),diagnosis was bipolar affective disorder(OR=0.48,95%CI: 0.32～0.72,P=0.001),diagnosis was mental retardation(OR=1.57,95%CI: 1.12～2.20,P=0.009),course of disease(OR=1.02,95%CI: 1.01～1.03,P<0.001),past hospitalization(OR=1.57,95%CI: 1.23～1.99,P<0.001),the minimum living security(OR=2.62,95%CI:2.16～3.17,P<0.001),combined with or without other conditions(OR=2.39,95%CI:1.86～3.07,P<0.001).Whether patients were regularly followed up was significantly correlated withcourse of disease(OR=0.99,95%CI: 0.98～0.99,P=0.001),urban/rural(OR=0.73,95%CI: 0.59～0.91,P=0.005),economic status(OR=1.34,95%CI: 1.05～1.71,P=0.020),once use antipsychotic drugs(OR=1.97,95%CI: 1.55～2.50,P<0.001),family mental disorder history(OR=1.30,95%CI: 1.04～1.62,P=0.021),combined with or without other conditions(OR=1.37,95%CI: 1.11～1.69,P=0.003).There was a significant correlation between whether to receive free antipsychotic drugs and age(OR=0.98,95%CI: 0.97～0.99,P=0.004),economic status(OR=0.54,95%CI: 0.39～0.76,P<0.001),urban/rural(OR=0.53,95%CI: 0.40～0.69,P<0.001),education(R=0.72,95%CI: 0.54～0.98,P=0.036),diagnosed as epilepsy(OR=0.42,95%CI: 0.25～0.7,P=0.001),diagnosed as mental retardation with mental disorders(OR=0.26,95%CI: 0.15～0.45,P<0.001),injury behavior(OR=0.52,95%CI:0.28～0.95,P=0.034),hospitalized patients(OR=1.33,95%CI: 1.05～1.69,P=0.019),the minimum living security(OR=1.30,95%CI: 1.04～1.62,P=0.022),disability certificate(OR=3.39,95%CI: 2.62～4.39,P<0.001),regular follow-up(OR=1.81,95%CI: 1.46～2.25,P<0.001).Conclusion: 1.The poverty rate of severe mental illness patients in the community is high and most part of patients with certain degree of functional disability.However,compared with their disability and poverty level,the proportion of receive pay free antipsychotic treatment in a low level.It is necessary to further optimize the work flow through multi-sectoral coordination to improve the accessibility and coverage of the main social welfare of these patients.2.There are many factors that may affect the main social welfare of patients with severe mental illness in the community.Regular follow-up and health education program should be strengthened for young patients and those who have never received psychiatric service.More precise measures should be taken to increase the proportion of patients receiving social assistance and pay free antipsychotic treatment.