精神分裂癥或雙相情感障礙患者尋求醫(yī)療信息外文文獻

Contents lists available at ScienceDirect Psychiatry Research journal homepage Frequency and pattern of Internet use in patients with schizophrenia or bipolar disorders seeking medical information Hugo Baupa H l ne Verdouxa b a Univ Bordeaux U1219 F 33000 Bordeaux France b Inserm U1219 Bordeaux Population Health Research Center Pharmacoepidemiology research team F 33000 Bordeaux France A R T I C L E I N F O Keywords e patient Internet medical information Schizophrenia Bipolar disorder A B S T R A C T The aim was to explore how patients with bipolar N 59 or psychotic disorder N 41 seek medical information on Internet e patient Two thirds 64 of inpatients interviewed using a standardized semi structured questionnaire were e patients Compared to non e patients they were younger and had a higher educational level The proportion of e patients was comparable among persons with schizophrenia 61 and with bipolar disorder 66 Very few patients were familiar with quality codes for Internet medical information Patients should be informed about how to recognize reliable information on the Internet and web sites should cater for their cognitive defi cits 1 Introduction The proportion of e patients i e people seeking online medical information has dramatically increased in recent years Diaz et al 2002 Millard et al 2002 Mental health issues are the most commonly searched topics with depression bipolar disorder and anxiety problems accounting for nearly half 42 of all Internet searches Powell and Clarke 2002 The few studies that have investigated Internet use in patients with severe mental illness SMI have shown a proportion of e patients among this population ranging from 36 Borzekowski et al 2009 to 80 Treffl ich et al 2015 The aims of the study were to examine the frequency and the pattern of Internet use of patients with SMI seeking medical informa tion and to investigate whether use is diff erent between patients with bipolar disorder or schizophrenia 2 Methods 2 1 Sample Between November 2014 and March 2015 patients were recruited in three acute wards of the University Department of Adult Psychiatry in Bordeaux serving an urban catchment area of 170 000 inhabitants Inclusion criteria were i informed consent to participate in the study ii aged from 18 to 65 years iii clinical diagnosis of bipolar disorder schizophreniaor schizoaff ectivedisorderaccordingtothe International Classifi cation of Diseases Tenth Revision ICD 10 criteria iv French speaking 2 2 Questionnaire A standardized 37 item semi structured questionnaire was used to collect information from the patients and from medical records on demographic characteristics psychiatric history and Internet use Patients were interviewed by HB on Internet access and ownership of devices to go online smartphone home computer digital tablets Internet users were interviewed about their use of Internet to search for medical information e patient E patients were invited to recall their lifetime medical Internet researches regarding all medical health topics psychiatric or not For each medical topic searched information was collected using open questions on the web sites keywords and type of information sought e g symptoms indications for medication side eff ects etc The criteria used by the subjects to evaluate the quality of the information they found were explored 2 3 Statistical analyses Data were analyzed with STATA 11 software We used the Student t test and the chi square test to compare the following i the characteristics of e patients versus non e patients ii Internet use in the search for medical information between patients suff ering from bipolar disorder and those suff ering from schizophrenia and schizoaf fective disorders http dx doi org 10 1016 j psychres 2016 11 028 Received 4 July 2016 Received in revised form 14 November 2016 Accepted 22 November 2016 Correspondence to H pital Charles Perrens 121 rue de la B chade 33076 Bordeaux Cedex France E mail address helene verdoux u bordeaux fr H Verdoux Psychiatry Research 247 2017 152 154 Available online 23 November 2016 0165 1781 2016 Elsevier Ireland Ltd All rights reserved MARK 3 Results 3 1 Sample Characteristics Of the 108 patients fulfi lling the inclusion criteria 100 92 6 agreed to participate in the study refusal rate 7 4 Their mean age was 40 3 years SD 12 4 and half 52 were females Most patients were single 53 one third 33 had an educational level 12 years and 21 were currently employed Bipolar disorder was the most represented diagnosis 59 followed by schizoaff ective disorder 22 and schizophrenia 19 3 2 Characteristics of e patients and non e patients More than three quarters of the participants had Internet access 78 Devices used to go online were mostly home computers 91 and smartphones 67 Almost two thirds of the participants 64 were e patients Compared to non e patients e patients were younger had a higher educational level and more frequently had a home computer Table 1 The most frequent reasons given by non e patients for not seeking medical information with Internet were lack of Internet skills 30 discussing health only with doctors or pharmacists 25 not being interested 25 or not having Internet access 19 Half 53 of non e patients considered that they probably or certainly would become e patients in the future 3 3 Comparison of patients with bipolar disorder and psychotic disorders Higher educational level was more frequent in bipolar patients 49 2 than in schizophrenia patients 9 8 Chi2 17 df 1 p 0 001 while the two groups did not diff er regarding age and gender The two groups did not diff er regarding availability of computer at home bipolar patients 91 8 vs schizophrenia patients 89 7 Chi2 0 11 df 1 p 0 75 and Internet access bipolar patients 83 1 vs schizophreniapatients 70 7 Chi2 2 14 df 1 p 0 14 The proportion of e patients was comparable in bipolar patients 66 1 and schizophrenia patients 61 Chi2 0 28 df 1 p 0 6 3 4 Characteristics of Internet search for medical information E patients n 64 reported all together a total of 272 lifetime Internet medical information searches Websites visited were mainly doctissimo fr 18 wikipedia org 11 and forums 6 Nearly half of the participants reported searching for bipolar disorder 48 4 one out of fi ve for schizophrenia 21 9 and one out of ten for depression 9 4 They also reported searching for psychotropic drugs mood stabilizers 20 3 antipsychotics 17 2 anxiolytics 9 4 and antidepressants 4 7 Chatting online about health was reported by 17 of e patients Few had bought medications online 11 or had a personal blog about health 6 Positive points reported by e patients regarding Internet informa tion searching were speed of use 25 improving medical knowledge 22 and amount of information available 15 Negative points were poor quality 50 or over abundance of information 17 and induced anxiety 15 Only 3 knew HONcode Health On the Net Foundation the quality code for medical and health related informa tion available on Internet 4 Discussion Internet access 78 and the proportion of e patients in our study 64 are very close to those reported by Treffl ich et al 2015 in 337 patients with psychiatric disorders 79 5 and 66 5 respectively These proportions are also similar to those found in the US 59 Fox 2011 and the French general population 71 IPSOS 2010 A noteworthy fi nding was that the proportion of e patients was compar able among persons with schizophrenia and bipolar disorder even though the latter had a higher educational level As in the study by Khazaal et al 2008 only 3 of e patients were familiar with quality codes such as HONcode There is still a lack of web sites catering for the cognitive defi cits of patients with SMI Models of such sites exist such as the Flat Explicit Design Model proposed by Rotondi et al 2015 which includes 18 design variables like simple sentence structure familial vocabulary and more focused content The present fi ndings should be interpreted in the light of potential limitations A selection bias may have led to the overestimation of e patient prevalence since the patients were recruited in a university department serving an urban catchment area Conversely this fre quency might be underestimated as only inpatients i e more severely ill patients were included This might also have contributed to attenuating the diff erences between the two groups A memory bias cannot be excluded leading to underestimation of e patient frequency due to forgotten searches 5 Conclusion Considering the high frequency of e patients among persons with SMI they should be informed about how reliable scientifi c information can be recognized on the Internet Table 1 Characteristics of e patients and non e patients e patients n 64 Non e patients n 36 Statistical analyses M SD aor N Demographic and clinical characteristics Age37 6 12 1 45 1 11 7 t 3 df 98 p 0 003 Male35 54 7 17 47 2 Chi2 0 51 df 1 p 0 47 Education 12 years29 45 3 4 11 1 Chi2 12 19 df 1 p 0 001 Diagnosis Bipolar disorder39 60 9 20 55 6 Chi2 0 28 df 1 p 0 60 Psychotic disorderb25 39 1 16 44 4 Chi2 0 28 df 1 p 0 60 Internet access Smartphone41 69 5 11 57 9 Chi2 0 87 df 1 p 0 35 Home computer54 91 5 17 89 5 Chi2 0 07 df 1 p 0 79 Internet at home59 92 2 19 52 8 Chi2 20 85 df 1 p 0 001 a Mean Standard deviation b Schizophrenia and schizoaff ective disorder H Baup H VerdouxPsychiatry Research 247 2017 152 154 153 Confl ict of interest none Funding sources Internally funded by INSERM U1219 University Bordeaux Acknowledgement The authors thank Ray Cooke for copyediting the manuscript References Borzekowski D L G Leith J Medoff D R Potts W Dixon L B Balis T et al 2009 Use of the internet and other media for health information among clinic outpatients with serious mental illness Psychiatr Serv 60 1265 1268 Diaz J A Griffi th R A Ng J J Reinert S E Friedmann P D Moulton A W 2002 Patients use of the internet for medical information J Gen Intern Med 17 180 185 Fox S 2011 The Social Life of Health Information Pew Research Center http www pewinternet org 2011 05 12 the social life of