Outpatient visits and hospital discharges of depression and schizophrenia patients in mental health facilities, 2014 – 2019: a sampling survey across China
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摘要:
目的 了解中国2014 — 2019年精神卫生医疗机构抑郁症和精神分裂症患者就诊和出院情况，为我国精神卫生服务配置提供政策依据。 方法 于2020年11月 — 2021年2月采用分层抽样方法在中国内地31个省（自治区、直辖市）和新疆生产建设兵团共抽取46家省级和36家地市级精神卫生医疗机构调查2014年1月1日 — 2019年12月31日精神科门诊就诊患者和出院患者年度总人次数以及诊断中包含抑郁症/精神分裂症患者就诊人次数和出院人次数等。 结果 最终纳入分析的74家精神卫生医疗机构中，省级精神卫生医疗机构40家（54.05%），地市级精神卫生医疗机构34家（45.95%）；精神专科医院45家（60.81%），综合医院精神科29家（39.19%）。中国2014 — 2019年精神卫生医疗机构抑郁症就诊患者占精神科门诊就诊患者的比例总体呈升高趋势（χ2趋势 = 144209.17，P < 0.001），从2014年的4.28%升高至2019年的7.63%；精神分裂症就诊患者占精神科门诊就诊患者的比例总体呈下降趋势（χ2趋势 = 73411.23，P < 0.001），从2014年的13.34%下降至2019年的10.53%；抑郁症出院患者占精神科出院患者的比例总体呈升高趋势（χ2趋势 = 3754.42，P < 0.001），从2014年的4.92%升高至2019年的7.10%；精神分裂症出院患者占精神科出院患者的比例总体呈下降趋势（χ2趋势 = 1573.79，P < 0.001），从2014年的18.87%下降至2019年的16.82%。不同级别精神卫生医疗机构比较，2014、2015、2016、2017、2018、2019年省级精神卫生医疗机构抑郁症就诊患者占精神科门诊就诊患者的比例均高于地市级精神卫生医疗机构，精神分裂症就诊患者占精神科门诊就诊患者的比例均低于地市级精神卫生医疗机构，省级精神卫生医疗机构抑郁症和精神分裂症出院患者占精神科出院患者的比例均低于地市级精神卫生医疗机构（均P < 0.001）。不同类别精神卫生医疗机构比较，2014、2015、2016、2017、2018、2019年精神专科医院中抑郁症、精神分裂症就诊患者和出院患者占精神科门诊就诊患者和出院患者的比例均高于综合医院精神科（均P < 0.001）。 结论 中国2014 — 2019年精神卫生医疗机构抑郁症患者就诊和出院人次数占比均呈升高趋势，而精神分裂症患者就诊和出院人次数占比均呈下降趋势，应加强对抑郁症等常见精神障碍服务利用的资源配置。 Abstract:Objective To examine person-times and proportion of outpatient visits and hospital discharges for depression and schizophrenia patients in mental health facilities across China during 2014 – 2019 for providing evidence to improve the allocation of mental health services in China. Methods Using stratified sampling, we conducted a survey among 46 provincial-and 36 prefecture-level mental health facilities in 31 provincial-level administrative divisions across China from November 2020 to February 2021. A self-designed questionnaire was used to collect the facilities′ data on outpatient visits and hospital discharges for all patients and those diagnosed with depression and schizophrenia (with the International Statistical Classification of Diseases and Related Health Problems, 10th Revision [ICD-10] codes of F32 and F33) during the period from 2014 through 2019. Results Eligible responses were collected from 74 mental health facilities, in which, 40 (54.05%) were at provincial-level and 34 at (45.95%) prefecture-level, including 45 psychiatric hospitals and 29 psychiatric departments in general hospitals. During the period from 2014 to 2019 for all the facilities surveyed, significant increase was observed in the proportion of outpatient visits (person-times) by depression patients against all other patients (4.28% to 7.63%, χ2trend = 144 209.17; P < 0.001) and in the proportion of hospital discharges (person-times) of depression patients against all other patients (4.92% to 7.10%, χ2trend = 3 754.42; P < 0.001); but there was significant decrease in the proportion of outpatient visits by schizophrenia patients (13.34% to 10.53%, χ2trend = 73 411.23; P < 0.001 ) and in the proportion of hospital discharges of schizophrenia patients (18.87% to 16.82%, χ2trend = 1 573.79; P < 0.001). Throughout the 6-year period compared to those for the facilities at prefecture-level, all the annual proportion of the outpatient visits by depression patients were significantly higher for the facilities at provincial-level but the annual proportion of the outpatient visits by schizophrenia patients were significantly lower (all P < 0.001); all the annual proportion of hospital discharges of both depression and schizophrenia patients were significantly lower for the facilities at provincial-level (all P < 0.001). When compared to those for the psychiatry departments of general hospitals, all the annual proportions of outpatient visits by depression and schizophrenia patients and all the annual proportions of hospital discharges of depression and schizophrenia patients were significantly higher for the psychiatric hospitals over the 6-year period (all P < 0.001). Conclusion During the period from 2014 to 2019 for the mental health facilities in China, the annual proportions of depression patients′ outpatient visits and hospital discharges showed an increasing trend but those of schizophrenia patients′ showed a decreasing trend. The study results should be concerned in allocation of health resources for mental healthcare. -
Key words:
- depression /
- schizophrenia /
- outpatient visits /
- discharges /
- mental health facilities
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表 1 中国2014 — 2019年精神卫生医疗机构抑郁症和精神分裂症患者就诊和出院情况
Table 1. Annual person-times and proportion of outpatient visits and hospital discharges of depression and schizophrenia patients at 74 mental health facilities, 2014 – 2019: a sampling survey across China
年份 总人次数 就诊患者 总人次数 出院患者 抑郁症 精神分裂症 抑郁症 精神分裂症 人次数 % 人次数 % 人次数 % 人次数 % 2014 9 690 070 414 710 4.28 1292276 13.34 527 923 25970 4.92 99615 18.87 2015 10 755 015 543 969 5.06 1468866 13.66 583 763 29368 5.03 111713 19.14 2016 11 609 390 650 955 5.61 1503100 12.95 630 965 33220 5.26 115628 18.33 2017 12 465 063 741 835 5.95 1520066 12.19 685 060 38343 5.60 122044 17.82 2018 13 712 391 891 248 6.50 1609814 11.74 734 356 44412 6.05 128707 17.53 2019 15 251 752 1163 628 7.63 1606278 10.53 782 523 55549 7.10 131642 16.82 
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表 2 中国2014 — 2019年不同级别精神卫生医疗机构抑郁症和精神分裂症患者就诊情况比较
Table 2. Annual person-times and proportion of outpatient visits of depression and schizophrenia patients at 40 provincial- and 34 prefecture-level mental health facilities, 2014 – 2019: a sampling survey across China
年份 总人次数 省级精神卫生医疗机构 总人次数 地市级精神卫生医疗机构 抑郁症 精神分裂症 抑郁症 精神分裂症 人次数 % 人次数 % 人次数 % 人次数 % 2014 6309661 331095 5.25 723302 11.46 3380409 83615 2.47 a 568974 16.83 b 2015 6939823 438487 6.32 830311 11.96 3815192 105482 2.76 a 638555 16.74 b 2016 7361064 514551 6.99 850299 11.55 4248326 136404 3.21 a 652801 15.37 b 2017 7870339 571028 7.26 830304 10.55 4594724 170807 3.72 a 689762 15.01 b 2018 8687585 677731 7.80 891786 10.27 5024806 213517 4.25 a 718028 14.29 b 2019 9720715 834894 8.59 873516 8.99 5531037 328734 5.94 a 732762 13.25 b 注：a 与省级精神卫生医疗机构抑郁症就诊患者比例比较，P < 0.001；b 与省级精神卫生医疗机构精神分裂症就诊患者比例比较，P < 0.001。
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表 3 中国2014 — 2019年不同级别精神卫生医疗机构抑郁症和精神分裂症患者出院情况比较
Table 3. Annual person-times and proportion of hospital discharges of depression and schizophrenia patients at 40 provincial- and 34 prefecture-level mental health facilities, 2014 – 2019: a sampling survey across China
年份 总人次数 省级精神卫生医疗机构 总人次数 地市级精神卫生医疗机构 抑郁症 精神分裂症 抑郁症 精神分裂症 人次数 % 人次数 % 人次数 % 人次数 % 2014 378161 16600 4.39 57385 15.17 149762 9370 6.26 a 42230 28.20 b 2015 422869 18165 4.30 61909 14.64 160894 11203 6.96 a 49804 30.95 b 2016 455400 20672 4.54 61208 13.44 175565 12548 7.15 a 54420 31.00 b 2017 490833 25104 5.11 64432 13.13 194227 13239 6.82 a 57612 29.66 b 2018 522531 27876 5.33 65070 12.45 211825 16536 7.81 a 63637 30.04 b 2019 554903 33803 6.09 66108 11.91 227620 21746 9.55 a 65534 28.79 b 注：a 与省级精神卫生医疗机构抑郁症出院患者比例比较，P < 0.001；b 与省级精神卫生医疗机构精神分裂症出院患者比例比较，P < 0.001。
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表 4 中国2014 — 2019年不同类别精神卫生医疗机构抑郁症和精神分裂症患者就诊情况比较
Table 4. Annual person-times and ratio of outpatient visits of depression and schizophrenia patients at 45 psychiatric hospitals and 29 psychiatry departments of general hospitals, 2014 – 2019: a sampling survey across China
年份 总人次数 精神专科医院 总人次数 综合医院精神科 抑郁症 精神分裂症 抑郁症 精神分裂症 人次数 % 人次数 % 人次数 % 人次数 % 2014 4601907 306917 6.67 1161839 25.25 5088163 107793 2.12 a 130437 2.56 b 2015 5262788 402927 7.66 1296094 24.63 5492227 141042 2.57 a 172772 3.15 b 2016 5714000 494513 8.65 1303124 22.81 5895390 156442 2.65 a 199976 3.39 b 2017 6155056 566169 9.20 1324539 21.52 6310007 175666 2.78 a 195527 3.10 b 2018 6852021 720924 10.52 1421239 20.74 6860370 170324 2.48 a 188575 2.75 b 2019 7559783 977969 12.94 1384852 18.32 7691969 185659 2.41 a 221426 2.88 b 注：a 与精神专科医院抑郁症就诊患者比例比较，P < 0.001；b 与精神专科医院精神分裂症就诊患者比例比较，P < 0.001。
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表 5 中国2014 — 2019年不同类别精神卫生医疗机构抑郁症和精神分裂症患者出院情况比较
Table 5. Annual person-times and proportion of hospital discharges of depression and schizophrenia patients at 45 psychiatric hospitals and 29 psychiatry departments of general hospitals, 2014 – 2019: a sampling survey across China
年份 总人次数 精神专科医院 总人次数 综合医院精神科 抑郁症 精神分裂症 抑郁症 精神分裂症 人次数 % 人次数 % 人次数 % 人次数 % 2014 220188 17481 7.94 89135 40.48 307735 8489 2.76 a 10480 3.41 b 2015 240384 21058 8.76 100223 41.69 343379 8310 2.42 a 11490 3.35 b 2016 266497 23642 8.87 103654 38.89 364468 9578 2.63 a 11974 3.29 b 2017 293396 27066 9.23 109918 37.46 391664 11277 2.88 a 12126 3.10 b 2018 316532 31465 9.94 116626 36.84 417824 12947 3.10 a 12081 2.89 b 2019 343093 40646 11.85 119479 34.82 439430 14903 3.39 a 12163 2.77 b 注：a 与精神专科医院抑郁症出院患者比例比较，P < 0.001；b 与精神专科医院精神分裂症出院患者比例比较，P < 0.001。
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