ABSTRACT
BACKGROUND: Severe acute respiratory syndrome (SARS) is a kind of very strong infective respiratory system diseases. Due to rapid development of disease course, severe symptoms, forced isolation, being away the supports from relatives and friends, many patients with SARS presented extremely anxiety and panic, even depression and despair, and they are in the crisis state and need mental support and help.OBJECTIVE: To evaluate the therapeutic effect of mental crisis intervention in patients with SARS.DESIGN: Controlled observation.SETTING: Xiaotangshan Hospital of Chinese PLA.PARTICIPANTS: Totally 680 patients with SARS who received the mental intervention in the Psychological Counseling Center, Xiaotangshan Hospital of Chinese PLA in May 2003. The patients, 379 male (55.74%)and 301 female (44.26%), were aged (35±7) years. Degree of education:34.5% of patients received education below junior high school, 31.5% senior high school and 34.0% college. 100% of the patients had family member or colleague-infected life events, and 14.4% of the patients lost their family members. Degree of disease: 6.9% of patients were in the severe period, 67.5% in the stable period and 25.6% in the rehabilitation period.METHODS: ① Totally 489 patients who received telephone counseling,and attended telephone mutual-help group, group debugging, individual counseling and group counseling were chosen, serving as intervention group, and the other 191 patients served as control group. ②The mental health state of patients in the 2 groups was evaluated at admission with symptom checklist 90 (SCL-90), which consisted of somatization, obsessive compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation and psychoticism 9 factors. The grading scoring was used. The higher grades, the more severe symptoms. ③ The patients of intervention group were given comprehensive mental intervention, which included handing out materials(self-debugging propagandist manual), care from staff, mental counseling by telephone, group debugging, individual counseling, guidance by mental doctor, etc. Patients in the control group only received handed materials (self-debugging propagandist manual) and the care from staff. SCL-90 was used to re-evaluate the patients of intervention group and control group before discharge. ④Intervention therapeutic effect of patients in 2 groups were evaluated with comprehensive mental intervention questionnaires, which were mainly about self and social cognition, feeling and emotion, life behavior styles, physiological and body symptoms 4 dimensions. Grading scoring was used. The higher points, the better intervention effect. Self-rating and rating by others were used in each question. If the results in self-rating are the same as those in rating by others, questionnaire is valid, otherwise, it is invalid). ⑤ The scoring of all the patients at admission was compared with that of Beijing norm by using SCL-90.The mental health of patients of 2 groups after intervention was measured, evaluated and compared with SCL-90.MAIN OUTCOME MEASURES: Difference in scoring of SCL-90 between all the patients and Beijing norm; Changes in the scoring of SCL-90 between intervention group and control group at admission and after intervention.RESULTS: Totally 680 comprehensive mental intervention questionnaires were handed out, and 669 of them were retrieved, among which 483 from intervention group and 186 from control group. Altogether 669 patients participated in the result analysis. ① Points of each factor in SCL-90 of patients at admission were significantly higher than norm, especially in anxiety and phobic anxiety. 45.5% and 50.1% of the investigated patients had more than 3 points in anxiety and phobic anxiety respectively. 86.5% of the investigated patients had mental problems to different degrees. ②There was no significant difference in the points of various factors in SCL-90 at admission between intervention group and control group (P＞0.05).In the various factors of SCL-90, no significant difference in the points of various factors in SCL-90 at admission between intervention group and control group (P＞0.05).In the various factors of SCL-90,no significant difference exists in phobic anxiety and paranoid ideation and psychoticism between two groups (P＞0.05),but the points of the other factors of intervention group were significantly lower than those of control group (P＜0.05-0.01).CONCLUSION: Mental crisis intervention can remarkably lighten the somatization, obsessive-compulsive, anxiety and depression, lower interpersonal sensitivity and improve hostility.