Garety P, Toms R M
Institute of Psychiatry, London.
Br J Psychiatry. 1990 Aug;157:269-72. doi: 10.1192/bjp.157.2.269.
"OBJECTIVE--To assess the severity of psychiatric symptoms among residents of hostels for homeless people. DESIGN--Survey of residents in two hostels in Oxford, comprising three weeks of background fieldwork, a demographic questionnaire, and rating behaviour over two weeks with a behavioural rating scale (REHAB) and mental state with the brief psychiatric rating scale. SETTING--Two hostels for homeless people in Oxford. SUBJECTS--146 Medium to long term residents, of whom 48 were selected by hostel workers by the following criteria; continuous residence for at least two months, signs of persistent severe mental disability, and difficulty in coping independently in the community. Two subjects died during the study; three (previously long term psychiatric inpatients) declined to be assessed on the psychiatric scale. MAIN OUTCOME MEASURE--Behavioural disturbance and mental state. RESULTS--Only a third of the total sample had been born in Oxfordshire. Subjects had been accepted into the hostel either by arrangement with the local psychiatric service (22) or straight off the streets (26); 43 had had a previous (non-drug related) psychiatric admission. Subjects were significantly more likely than other residents to have spent longer (greater than 80 weeks) in a hostel in the past three years (p less than 0.02). With reference to norms for deviant behaviour, the 46 subjects assessed showed considerable deviant behaviour (average weekly scores: 0 (11 subjects), 1 (14), 2-3 (16), and greater than or equal to 4 (5)) not significantly different from that expected in moderately to severely handicapped psychiatric inpatients (chi 2 = 1.3, df = 3, p greater than 0.7); 22 had scores equivalent to those in most severely handicapped inpatients. Of the 43 subjects assessed with the psychiatric rating scale, 16 had symptoms of neurosis, 29 of florid psychosis, and 32 of a deficit state. Symptoms of deficit state were positively correlated with ratings of low social activity on the behavioural scale (Spearman's rank correlation coefficient 0.30, p = 0.03). CONCLUSIONS--Hostels are having to care for long term severely affected psychiatric patients discharged into the community. The suitability of the services offered to such subjects should be assessed."
目的——评估无家可归者收容所居民的精神症状严重程度。
设计——对牛津两所收容所的居民进行调查，包括为期三周的背景实地调查、一份人口统计学问卷，以及使用行为评定量表（REHAB）对两周内的行为进行评定，并使用简易精神评定量表对精神状态进行评定。
地点——牛津的两所无家可归者收容所。
研究对象——146名中长期居民，其中48名由收容所工作人员根据以下标准挑选；连续居住至少两个月、有持续严重精神残疾的迹象，以及在社区中难以独立应对。两名研究对象在研究期间死亡；三名（以前是长期精神病住院患者）拒绝接受精神病量表评估。
主要观察指标——行为障碍和精神状态。
结果——总样本中只有三分之一出生在牛津郡。研究对象通过与当地精神科服务机构安排（22人）或直接从街上接收（26人）进入收容所；43人曾有过（与药物无关的）精神病住院史。与其他居民相比，研究对象在过去三年中在收容所度过的时间更长（超过80周）的可能性显著更高（p<0.02）。参照异常行为规范，接受评估的46名研究对象表现出相当多的异常行为（平均每周得分：0（11名研究对象）、1（14名）、2 - 3（16名）和大于或等于4（5名）），与中度至重度残疾精神病住院患者预期的行为差异不显著（χ² = 1.3，自由度 = 3，p>0.7）；22人的得分与最严重残疾住院患者相当。在接受精神病评定量表评估的43名研究对象中，16人有神经症症状，29人有明显的精神病症状，32人有缺陷状态症状。缺陷状态症状与行为量表上低社交活动评分呈正相关（斯皮尔曼等级相关系数0.30，p = 0.03）。
结论——收容所不得不照顾被释放到社区的长期受严重影响的精神病患者。应评估为此类研究对象提供的服务的适宜性。
