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调查发现中国和印度急需心理健康服务

更新时间:2016-5-19 19:04:54 来源:纽约时报中文网 作者:佚名

China and India Burdened by Untreated Mental Disorders
调查发现中国和印度急需心理健康服务

The growing burden of untreated mental disorders in the world’s two most populous countries, India and China, cannot be adequately addressed without changes to their health care systems and by training folk healers to become collaborators, a new report has found.

一项新报告发现,世界上人口最多的两个国家,印度和中国,面临越来越严重的精神疾患得不到治疗的问题。如果两国不改进医疗卫生体系,不培训民间治疗师协助治疗,那么这个问题将无法得到充分解决。

The analysis, published as a part of a series in the journals The Lancet and The Lancet Psychiatry, draws on years of medical surveys in those countries. It represents the latest effort by an international coalition of researchers to put mental health care at the center of the global health agenda; last month, the World Bank and the World Health Organization convened hundreds of public officials, doctors and other specialists in a landmark meeting in Washington to focus attention on global mental health.

这项分析基于对这两国的多年医学调查,是发表在《柳叶刀》(The Lancet)和《柳叶刀精神病学》(The Lancet Psychiatry)上的一系列论文的一部分。它代表着一个国际研究者联合行动的最新努力,想把心理卫生推向全球医疗服务日程的核心位置。上个月,世界银行(World Bank)和世界卫生组织(World Health Organization)召集数百名官员、医生和其他专家在华盛顿举行了一次具有重要意义的会议,集中讨论全球精神健康问题。

The new research, presented in three papers, found that less than 10 percent of people in India and China with a mental disorder received effective treatment, and that the resulting burden of disability from those two countries was higher than in all Western countries combined.

这项最新调查以三篇论文呈现,它发现印度和中国的精神疾病患者中只有不到10%接受过有效治疗,导致这两国的残障负担高于所有西方国家的总和。

“India and China together represent more than a third of world’s population, and both countries are at a remarkable stage of epidemiologic and demographic transition,” said a co-author of one of the papers, Dr. Vikram Patel, a professor of international mental health and co-founder of a community-based mental health center, Sangath, in Goa State in India, in a recorded interview accompanying the articles.

“印度和中国的人口总和超过世界人口的三分之一,而且这两个国家都处于流行病学和人口结构的重要转型期,”其中一篇论文的联合作者维克拉姆·帕特尔博士(Vikram Patel)在与这些论文同时发布的采访录音中说。他是一名国际精神健康教授,也是印度果阿邦社区精神健康中心Sangath的联合创办人。

One lesson, experts not involved in the research said, is that investment is still lagging well behind spending on other medical conditions. Both countries spend less than 1 percent of their total medical budget on mental health.

没有参与这项调查的专家们说,其中一个原因是在这方面的投资仍远远落后于针对其他疾患的投资。这两个国家在精神健康方面的花费只占医疗总预算的不到1%。

“I think politicians and service planners will find this research valuable,” said Dr. Alex Cohen, the course director of the global mental health program at the London School of Hygiene & Tropical Medicine. “But if you don’t have the resources to treat more than 2 percent of the people who need it,” then the overall burden can seem overwhelming.

伦敦卫生与热带医学学院(London School of Hygiene & Tropical Medicine)的全球精神健康科目课程主管亚历克斯·科恩博士(Alex Cohen)说,“我认为,政治家和公共服务规划者会发现这项调查很有价值。但是,如果不调动足够的资源去治疗超过2%的需要治疗的人”,那么总体负担就可能显得难以应付。

In the past decade, both India and China have taken steps to expand access to mental health care. In China, a government program started in 2004 reportedly has trained 10,000 psychiatrists and built hundreds of community mental health centers, in what some consider a historic investment in better psychiatric care. An Indian government program to increase care in communities has effectively reduced hospital costs, in some areas, though implementation has been spotty at best, experts said.

过去10年,印度和中国都采取措施普及精神健康服务。据报道,中国政府2004年启动了一个项目,培训了1万名精神科医生,建立了上千个社区精神健康中心,有些人认为这是改善精神病治疗方面的一项历史性投资。印度政府的一个旨在增加社区医疗服务的项目在一些地区有效降低了去医院的成本,尽管专家们说项目执行水平最多只能说是参差不齐。

But particularly in rural areas, the majority of people in both countries still have little means or access to psychiatrists or therapists.

但是,两国的多数人口依然几乎没有接受精神病医生或心理治疗师服务的能力或途径,尤其是农村地区。

“Very few Chinese with common mental illnesses such as depression and anxiety ever seek treatment,” Dr. Michael Phillips, of Shanghai Jiao Tong University and Emory University, said in a statement. “ And the country as a whole is ill prepared for the coming epidemic of dementia as the population ages rapidly.”

“患有抑郁症或焦虑症等常见精神疾病的中国人极少寻求治疗,”上海交通大学和埃默里大学(Emory University)的迈克尔·菲利普斯博士(Michael Phillips)在一项声明中说,“随着人口快速老化,这个国家总体来说没有准备好迎接即将到来的认知障碍症大面积发作问题。”

One group of practitioners that is very accessible — and one the researchers said policy makers should consider potential allies — include traditional healers, herbalists and spiritual guides. In China, many doctors get some training in traditional healing arts, like herbal treatments, acupuncture and qigong. In India, likewise, many doctors incorporate yoga, and Ayurveda medicine.

有一群行医者是普通人很容易接触到的,包括传统治疗师、草药医生和性灵导师。研究者称,政策制定者应该考虑与这群人合作。在中国,很多医生接受过一些传统治疗方法的培训,比如草药治疗、针灸和气功。印度也是这样,很多医生把瑜伽和阿育吠陀医学融入治疗。

A collaboration makes good sense for another reason, the researchers wrote: “In view of the popularity of traditional, complementary and alternative medicine, it is likely that even if sufficient biomedical mental health services were available, people would continue to access other therapeutic systems.”

研究者们写道,需要协作的另一个原因是:“考虑到传统的、补充性的、替代性的医学的受欢迎程度,即便提供足够的生物医学精神健康服务,人们依然很可能会继续从其他治疗体系中寻求帮助。”

Yet the evidence that medical doctors and folk healers can work together to provide effective mental health care is scarce, experts said. A recent review of the role of traditional healing for mental disorders, led by Dr. Oye Gureje of the University of Ibadan in Nigeria, found that healers “have more readily adopted conventional psychiatric diagnoses such as depression or anxiety” than disorders like schizophrenia or bipolar disorder, which are thought to be spiritual in nature by the healers. And in some developing countries, traditional healers routinely use shackles, isolation and fasting — methods that “might fail to meet widespread understandings of human rights and humane care,” the paper concluded.

但是专家们说,西方医师和民间治疗师携手合作有效治疗精神疾病的案例很少。前不久,尼日利亚伊巴丹大学(University of Ibadan)的奥耶·居雷耶博士(Oye Gureje)领导了一项研究,评估传统疗法对精神疾病治疗的作用。研究发现,治疗师们“更容易接受抑郁症或焦虑症之类的传统的精神病诊断”,而不容易接受精神分裂症或躁郁症,他们认为这些疾病从本质上讲是有关性灵的。论文还指出,在有些发展中国家,传统治疗师经常使用手铐脚镣、隔离和禁食等方法,这些方法“可能违背人们对人权和人道关怀的普遍理解”。

The growing burden detailed in the new papers was due largely to aging and population growth. Some diagnoses, like attention deficit disorder in China, declined between 1990 and 2013; others, like dementia and abuse of drugs and alcohol have risen. For reasons no one understands, suicide rates have fallen sharply in China in that time, and risen steadily in India.

新论文中详细描述的不断增大的负担主要是由于人口老化和人口增长。从1990年到2013年,一些病症的诊断(比如注意力缺失症)在中国减少;也有些症状增多了,比如认知障碍症以及滥用药物和酗酒。这一时期,中国的自杀率大幅降低,而在印度却稳步上升,原因不得而知。

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