Bär Deucher A, Hengartner M P, Kawohl W, Konrad J, Puschner B, Clarke E, Slade M, Del Vecchio V, Sampogna G, Égerházi A, Süveges Á, Krogsgaard Bording M, Munk-Jørgensen P, Rössler W
Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, PO Box 1930, 8021 Zurich, Switzerland.
Department of Applied Psychology, Zurich University of Applied Sciences (ZHAW), Pfingstweidstrasse 96, PO Box 707, 8037 Zurich, Switzerland.
Eur Psychiatry. 2016 May;35:39-46. doi: 10.1016/j.eurpsy.2016.02.001. Epub 2016 Apr 7.
The purpose of this paper was to examine national differences in the desire to participate in decision-making of people with severe mental illness in six European countries.
The data was taken from a European longitudinal observational study (CEDAR; ISRCTN75841675). A sample of 514 patients with severe mental illness from the study centers in Ulm, Germany, London, England, Naples, Italy, Debrecen, Hungary, Aalborg, Denmark and Zurich, Switzerland were assessed as to desire to participate in medical decision-making. Associations between desire for participation in decision-making and center location were analyzed with generalized estimating equations.
We found large cross-national differences in patients' desire to participate in decision-making, with the center explaining 47.2% of total variance in the desire for participation (P<0.001). Averaged over time and independent of patient characteristics, London (mean=2.27), Ulm (mean=2.13) and Zurich (mean=2.14) showed significantly higher scores in desire for participation, followed by Aalborg (mean=1.97), where scores were in turn significantly higher than in Debrecen (mean=1.56). The lowest scores were reported in Naples (mean=1.14). Over time, the desire for participation in decision-making increased significantly in Zurich (b=0.23) and decreased in Naples (b=-0.14). In all other centers, values remained stable.
This study demonstrates that patients' desire for participation in decision-making varies by location. We suggest that more research attention be focused on identifying specific cultural and social factors in each country to further explain observed differences across Europe.
本文旨在研究六个欧洲国家中重症精神疾病患者参与决策意愿的国家差异。
数据取自一项欧洲纵向观察性研究（CEDAR；ISRCTN75841675）。对来自德国乌尔姆、英国伦敦、意大利那不勒斯、匈牙利德布勒森、丹麦奥尔堡和瑞士苏黎世研究中心的514例重症精神疾病患者参与医疗决策的意愿进行了评估。采用广义估计方程分析参与决策意愿与中心所在地之间的关联。
我们发现患者参与决策的意愿存在很大的跨国差异，中心因素解释了参与意愿总方差的47.2%（P<0.001）。平均来看，且不考虑患者特征，伦敦（均值=2.27）、乌尔姆（均值=2.13）和苏黎世（均值=2.14）的参与意愿得分显著更高，其次是奥尔堡（均值=1.97），其得分又显著高于德布勒森（均值=1.56）。那不勒斯的得分最低（均值=1.14）。随着时间推移，苏黎世参与决策的意愿显著增加（b=0.23），而那不勒斯则下降（b=-0.14）。在所有其他中心，数值保持稳定。
本研究表明患者参与决策的意愿因地点而异。我们建议更多的研究关注识别每个国家的特定文化和社会因素，以进一步解释在欧洲观察到的差异。
