O'Brien Aileen, Fahmy Rana, Singh Swaran P
Division of Mental Health, St. George's University of London, Cranmer Terrace, London, SW17 0RE, UK.
Soc Psychiatry Psychiatr Epidemiol. 2009 Jul;44(7):558-68. doi: 10.1007/s00127-008-0476-0. Epub 2008 Nov 26.
This paper reviews the literature on disengagement from mental health services examining how the terms engagement and disengagement are defined, what proportion of patients disengage from services, and what sociodemographic variables predict disengagement. Both engagement and disengagement appear to be poorly conceptualised, with a lack of consensus on accepted and agreed definitions. Rates of disengagement from mental health services vary from 4 to 46%, depending on the study setting, service type and definition of engagement used. Sociodemographic and clinical predictors of disengagement also vary, with only a few consistent findings, suggesting that such associations are complex and multifaceted. Most commonly reported associations of disengagement appear to be with sociodemographic variables including young age, ethnicity and deprivation; clinical variables such as lack of insight, substance misuse and forensic history; and service level variables such as availability of assertive outreach provision. Given the importance of continuity of care in serious mental disorders, there is a need for a consensual, validated and reliable measure of engagement which can be used to explore associations between patient, illness and service related variables and can inform service provision for difficult to reach patients.
本文回顾了关于脱离心理健康服务的文献，研究了参与和脱离的定义方式、脱离服务的患者比例，以及哪些社会人口统计学变量可预测脱离。参与和脱离这两个概念似乎都缺乏清晰的界定，对于公认的和一致的定义尚未达成共识。根据研究背景、服务类型以及所采用的参与定义，脱离心理健康服务的比例在4%至46%之间不等。脱离的社会人口统计学和临床预测因素也各不相同，仅有少数一致的研究结果，这表明此类关联是复杂且多方面的。最常报告的与脱离相关的因素似乎包括社会人口统计学变量，如年龄小、种族和贫困；临床变量，如缺乏洞察力、药物滥用和犯罪史；以及服务层面的变量，如是否有积极外展服务。鉴于持续护理在严重精神障碍中的重要性，需要一种达成共识、经过验证且可靠的参与度衡量方法，可用于探究患者、疾病和服务相关变量之间的关联，并为难以接触到的患者提供服务提供参考。
