严重精神障碍患者家庭角色缺失对其未成年子女健康的影响路径研究

Child health is a comprehensive indicator to measure social and economic development of a nation. People with severe mental disorders have ability shortage at family care and work, so that their minor offspring become special vulnerable children. Based on the child health production theory and family ecological systems theory, the study will be conducted on health of minor offspring of people with severe mental disorders both from theoretical and empirical perspectives, to reveal health disparities in physical health, mental health and social well-being between minor offspring of people with severe mental disorders and health people, identify the key family environment factors which significant influence health of minor offspring of people with severe mental disorders, explore the influence path of family roles absence on the health of minor offspring of people with severe mental disorders, and put forward some key measures to enhance health of these children. Prospective nested case-control study design will be conducted in the empirical study; twice field surveys (1 year interval) and once intervention between twice field surveys on key family characteristics will be conducted. Three provinces will be randomly selected respectively from eastern, central and western regions of China and two counties will be randomly selected in each sample province. Respondents include minor offspring of people with severe mental disorders and health people and primary caregivers of these children. The study is for the first time in China to comprehensively focus on influencing mechanism of non-biological factors on health of minor offspring of people with severe mental disorders, and will provide scientific evidence for health promotion policy making for these particular vulnerable children.

儿童健康是衡量社会经济发展的综合指标。严重精神障碍患者家庭照料和就业能力都较弱，使其未成年子女成为特殊的弱势儿童。本研究以儿童健康生产和家庭生态系统理论为基础，开展严重精神障碍患者未成年子女健康的理论和实证研究，从身体、心理和社会适应三维度揭示严重精神障碍患者未成年子女与健康人群子女的健康差异，识别影响此类弱势儿童健康的关键家庭环境因素，进而探索出严重精神障碍患者家庭角色缺失对其未成年子女健康的影响路径，并提出增进此类儿童健康的关键措施。实证研究采用前瞻性巢式病例对照研究设计，进行两轮现场调查（间隔1年）并在期间对关键家庭环境特征进行干预。现场调查将在东、中、西部各随机抽1个省，每省随机抽2个县开展。调查对象为严重精神障碍患者未成年子女、健康人群子女及其主要照顾者。本研究在国内首次深入研究非生物学因素影响严重精神障碍患者未成年子女健康的机制，并为此类儿童相关健康促进政策的制定提供科学依据。

儿童健康是衡量一国社会经济发展的综合指标。严重精神障碍患者的家庭照料和就业能力都较弱，使其未成年子女成为特殊的弱势儿童。本研究以儿童健康生产和家庭生态系统理论为基础，构建了严重精神障碍患者家庭环境影响其未成年子女健康的理论框架，并开展实证研究。按照全国各地市州经济发展水平的高、中、低，分别抽取了上海市、山东省枣庄市、四川省内江市作为现场调查样本地区，共调查了473户、604名9-15岁的儿童，其中有严重精神障碍患者家庭235户、儿童288名。实证研究采用前瞻性巢式病例对照研究设计，目前已完成第一轮调查、大部分干预对象的2次随访，干预1年后的第2轮调查尚未全部完成。本研究发现患者家庭儿童比非患者家庭儿童的健康状况差，表现为患者家庭儿童四周患病率显著高于非患者家庭儿童，且有更多的门诊和住院卫生服务需要；患者家庭儿童在自我意识发展水平（行为、幸福与满足两个分维度）比非患者家庭儿童差，孤独感和社交焦虑水平均高于非患者家庭儿童；患者家庭儿童的人际交往能力和综合社会适应能力也均显著差于非患者家庭儿童。本研究发现患者家庭与非患者家庭的部分社会经济学特征不同，这些特征的差异是导致两类儿童健康差异的关键原因，包括：儿童劳动负担、家庭经济收入、主要照顾者年龄、受教育程度、对孩子身体健康和心情的关注程度以及与孩子的关系是否亲密。与非患者家庭儿童相比，患者家庭儿童暴露于身体健康危险因素（儿童劳动负担重、主要照顾者对孩子身体健康的关注度低、主要照顾者与孩子不太亲密）、心理健康危险因素（家庭经济差、主要照顾者文化程度低、主要照顾者与孩子不太亲密）、社会适应能力危险因素（家庭经济差、主要照顾者文化程度低、主要照顾者与孩子不太亲密）的可能性均较高。提高患者家庭儿童的健康水平，应以降低儿童各维度健康危险因素的暴露水平为主要措施，包括在社区提供健康教育、家长儿童心理疏导、经济政策帮扶，在家庭加强亲子沟通、增加收入，在学校开展家长课堂和提供心理关怀等。