赌博障碍的心理行为特征与健康相关服务体系

doi:10.3969/j.issn.1006-9771.2024.10.007

摘要/Abstract

摘要：

目的探讨赌博障碍的心理行为特征，以构建相关的健康服务体系。

方法基于《国际疾病分类第十一次修订本》(ICD-11)和《国际功能、残疾和健康分类》(ICF)分析赌博障碍的心理行为特征和功能影响。系统分析世界卫生组织心理健康政策文件与赌博障碍的健康相关服务内容，包括《2013-2030精神卫生综合行动计划》《mhGAP干预指南2.0版》《联合国精神健康与人权行动计划》《可持续发展目标(SDGs)》，基于《健康服务体系中的康复》构建赌博障碍的健康服务体系。

结果赌博障碍的主要特征包括控制受损、逐渐加大赌注(耐受性增加)、多次失败的戒赌尝试、利用赌博逃避现实压力，以及赌博行为对个人生活、家庭和社交功能的持续负面影响；功能上表现为注意力、决策力和情绪功能下降，导致工作效率和社交关系恶化。环境是影响行为的重要因素：家庭和社会支持系统可以促进赌博障碍的康复，而赌博场所和经济社会压力等则会加剧成瘾行为。针对赌博障碍的主要健康相关服务包括预防、干预、康复与健康促进，健康服务体系覆盖领导与治理、资金保障、心理健康工作者培养、服务提供、医疗产品与技术应用、卫生信息系统支持6个领域。

结论赌博障碍主要表现为注意力、决策力和情绪功能障碍，工作效率低下和社交关系障碍，环境因素发挥着重要的作用。针对赌博障碍的健康相关服务涉及预防、干预、康复与健康促进4个环节。健康服务体系覆盖领导力与治理、资金保障、心理健康工作者培养、服务提供、医疗产品与技术应用、卫生信息系统支持6个领域。

关键词: 赌博障碍, 心理行为特征, 健康相关服务

Abstract:

Objective To investigate the psychological and behavioral manifestations of gambling disorder and its implications for health services.

Methods International Classification of Diseases, 11th Revision (ICD-11) and International Classification of Functioning, Disability and Health (ICF) were employed to analyze the psychological, behavioral and functional impacts of gambling disorder. World Health Organization (WHO) mental health policy documents and gambling disorder-related health services were systematically reviewed, encompassing Comprehensive Mental Health Action Plan 2013-2030, mhGAP Intervention Guide 2.0, UN Mental Health and Human Rights Action Plan and Sustainable Development Goals (SDGs). A health service system tailored for gambling disorder was constructed, drawing upon the WHO Rehabilitation in Health Systems framework.

Results Gambling disorders primarily characterized with impaired control, escalating bets (tolerance), repeated unsuccessful attempts to quit, gambling as an escape mechanism, and the persistent detrimental effects of gambling on personal, familial and social functioning. Individuals with gambling disorder impaired in attention, decision-making and emotional regulation, leading to poor work performance and social relationship. Environmental factors were very important that family and social support systems fostered recovery, while gambling environments, socioeconomic pressures and other adverse factors exacerbated addiction. The WHO health service for gambling disorder included prevention, intervention, treatment, rehabilitation and health promotion. The health service system included six building blocks: leadership and governance, financing, mental health workforce development, service delivery, medical products and technologies, and health information systems.

Conclusion Gambling disorder may impair attention, decision-making and emotional function, and diminish work productivity and social relationship. Environmental factors play a pivotal role. Health-related services for gambling disorder should encompass prevention, treatment, rehabilitation and health promotion, necessitating a comprehensive health service system addressing leadership and governance, financing, workforce, service delivery, medical products and technologies, and health information systems.

Key words: gambling disorder, psychological behavior characteristics, health-related services

中图分类号:

R197.1

干政, 刘炼. 赌博障碍的心理行为特征与健康相关服务体系[J]. 《中国康复理论与实践》, 2024, 30(10): 1172-1178.

GAN Zheng, LIU Lian. Psychological and behavioral characteristics of gambling disorder and related health service system[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(10): 1172-1178.

图/表 1

表1

基于WHO架构构建赌博障碍的健康服务体系"

要素	服务内容	服务实施策略
领导力与治理	提供全球和国家层面的治理框架，确保赌博障碍的预防、治疗和康复得到充分的政策支持和法律保障	制定并实施赌博障碍的国家政策和法律框架，明确服务提供方的责任加强跨部门合作，涉及卫生、司法、教育和社会福利部门鼓励跨国合作，特别是在线赌博的监管，通过共享数据和最佳实践减少全球范围的赌博障碍
资金保障	保障赌博障碍相关服务的资金支持，包括预防、治疗和康复服务	政府拨款支持赌博障碍预防项目，特别是在青少年群体中将赌博障碍治疗纳入公共和私人健康保险的报销范围向赌博行业征收特别税，用于资助赌博障碍的治疗和康复项目
心理健康人力资源	培训卫生工作者，尤其是心理健康和成瘾治疗领域的专业人员，确保他们具备足够的技能应对赌博障碍	提供定期的成瘾行为管理和心理治疗培训课程鼓励多学科团队协作，涵盖心理医生、社会工作者和社区健康工作者建立成瘾行为管理的专家网络，促进知识共享和能力建设
服务提供	鼓励将赌博障碍的预防、治疗和康复服务整合到常规卫生服务中，确保服务的普及性和可及性	将行为成瘾的治疗纳入基本心理健康服务提供标准化成瘾治疗服务，如CBT和药物治疗设立社区成瘾支持和康复服务，保证服务持续提供
医疗产品与技术	确保治疗赌博障碍的药物、技术和工具的可及性，尤其是用于治疗并发症的药物	提供抗抑郁药、抗焦虑药物等辅助治疗药物使用远程医疗技术，提供在线心理咨询和治疗服务开发移动应用程序，用于自我管理和监控赌博行为
卫生信息支持系统	建立赌博障碍的监测与评估机制，收集和分析有关成瘾行为的流行数据	开发并实施赌博障碍的全国监测系统，跟踪服务利用率和成效收集成瘾行为相关的流行病学数据，用于政策制定和资源分配实现电子健康记录系统广泛应用，确保赌博障碍患者信息的共享与管理

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参考文献 30

[1]	KOLANDAI-MATCHETT K, WENDEN ABBOTT M. Gaming-gambling convergence: trends, emerging risks, and legislative responses[J]. Int J Ment Health Add, 2022, 20(4): 2024-2056.
[2]	STEFANOVICS E A, POTENZA M N. Update on gambling disorder[J]. Psychiatr Clin North Am, 2022, 45(3): 483-502.
[3]	World Health Organization. Addictive behaviour[EB/OL]. (2023-06-27) [2024-05-26]. https://www.who.int/health-topics/addictive-behaviour#tab=tab_1.
[4]	ABBOTT M W. Gambling and gambling-related harm: recent World Health Organization initiatives[J]. Public Health, 2020, 184(7): 56-59.
[5]	邱卓英, 李伦, 陈迪, 等. 基于世界卫生组织国际健康分类家族康复指南研究:理论架构和方法体系[J]. 中国康复理论与实践, 2020, 26(2): 125-135. doi: 10.3969/j.issn.1006-9771.2020.02.001
	QIU Z Y, LI L, CHEN D, et al. Research on rehabilitation guidelines using World Health Organization Family International Classifications: framework and approaches[J]. Chin J Rehabil Theory Pract, 2020, 26(2): 125-135.
[6]	杨亚茹, 郝传萍. 基于ICF构建智力残疾儿童适应性体育课程体系[J]. 中国康复理论与实践, 2022, 28(6): 659-669. doi: 10.3969/j.issn.1006-9771.2022.06.006
	YANG Y R, HAO C P. Construction of adapted physical education curriculum for children with intellectual disabilities using ICF[J]. Chin J Rehabil Theory Pract, 2022, 28(6): 659-669.
[7]	姜静远, 邱卓英, 王国祥, 等. 世界卫生组织国际健康分类家族在康复中系统应用的方案与路线图[J]. 中国康复理论与实践, 2020, 26(11): 1241-1255. doi: 10.3969/j.issn.1006-9771.2020.11.001
	JIANG J Y, QIU Z Y, WANG G X, et al. Systematic implementation of World Health Organization Family International Classifications in rehabilitation: protocol and roadmap[J]. Chin J Rehabil Theory Pract, 2020, 26(11): 1241-1255.
[8]	世界卫生组织. 国际功能、残疾和健康分类(国际中文增补版)[M]. 邱卓英,译. 日内瓦: 世界卫生组织, 2015.
	World Health Organization. International Classification of Functioning,Disability and Health-International Chinese Supplement[M]. QIU Z Y, trans trans. Geneva: World Health Organization, 2015.
[9]	世界卫生组织. 6C50赌博障碍[EB/OL]. (2024-01-01) [2024-05-02]. https://icd.who.int/browse/2024-01/mms/zh.
[10]	邱卓英, 李安巧, 黄珂, 等. 基于ICF和联合国«残疾人权利公约»对国际组织有关残疾定义及其测量的内容研究[J]. 中国康复理论与实践, 2018, 24(10): 1117-1121. doi: 10.3969/j.issn.1006-9771.2018.10.001
	QIU Z Y, LI A Q, HUANG K, et al. Content analysis of definition and measurement of disability: based on ICF and UN Convention on the Rights of Persons with Disabilities[J]. Chin J Rehabil Theory Pract, 2018, 24(10): 1117-1121.
[11]	ŠKAŘUPOVÁ K, VLACH T, MRAVČÍK V. Early intervention and identification of gambling disorder: a systematic literature review of strategies implemented by gambling operators[J]. Cent Eur J Public Health, 2020, 28(1): 18-23.
[12]	MIDE M, MATTIASSON J, NORLIN D, et al. Internet-delivered therapist-assisted cognitive behavioral therapy for gambling disorder: a randomized controlled trial[J]. Front Psychiatry, 2023, 14(11): 1243826.
[13]	LUCAS I, GRANERO R, FERNÁNDEZ-ARANDA F, et al. Gambling disorder duration and cognitive behavioural therapy outcome considering gambling preference and sex[J]. J Psychiatr Res, 2023, 158(2): 341-349.
[14]	HÅKANSSON A, FRANKLIN K, DAHLSTRÖM M, et al. Responsible gambling through a motivational telephone intervention to high-risk gamblers: an evaluation of user satisfaction and subjective intervention effects[J]. Front Psychol, 2022, 13(30): 917216.
[15]	HAKANSSON A, FRANKLIN K, DAHLSTRÖM M, et al. Motivational telephone intervention to risk gamblers by a state-owned gambling operator in Sweden[J]. Front Psychiatry, 2024, 15(30): 1343733.
[16]	World Health Organization. The epidemiology and impact of gambling disorder and other gambling-related harm[EB/OL]. (2017-06-28) [2024-04-28]. https://www.who.int/publications/m/item/the-epidemiology-and-impact-ofgambling-disorder-and-othergambling-related-harm.
[17]	World Health Organization. mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings: mental health Gap Action Programme (mhGAP) version 2.0[M]. Geneva: World Health Organization, 2016.
[18]	World Health Organization. Comprehensive mental health action plan 2013-2030[M]. Geneva: World Health Organization, 2021.
[19]	World Health Organization. mhGAP training manuals for the mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings[M]. Geneva: World Health Organization, 2017.
[20]	World Health Organization, United Nations Office of the High Commissioner for Human Right. Mental health, human rights and legislation: guidance and practice[R]. Geneva: World Health Organization, 2023.
[21]	World Health Organization Regional Office for the Western Pacific. Sustainable development goals (SDGs) [posters][R]. Manila: WHO Regional Office for the Western Pacific, 2016.
[22]	世界卫生组织. 健康服务体系中的康复[J]. 邱卓英,郭键勋,李伦,译. 中国康复理论与实践, 2020, 26(1): 1-14.
	World Health Organization. Rehabilitation in Health System[J]. QIU Z Y, KWOK J K F, LI L,trans. Chin J Rehabil Theory Pract, 2020, 26(1): 1-14.
[23]	汤修齐, 邱服冰, 邱卓英, 等. 国际康复政策架构与核心内容研究:基于世界卫生组织康复政策文件的内容分析[J]. 中国康复理论与实践, 2021, 27(9): 996-1005. doi: 10.3969/j.issn.1006-9771.2021.09.002
	TANG X Q, QIU F B, QIU Z Y, et al. Theoretical framework and key elements of international rehabilitation policy: contents analysis of WHO rehabilitation policy documents[J]. Chin J Rehabil Theory Pract, 2021, 27(9): 996-1005.
[24]	邱卓英, 郭键勋, 杨剑, 等. 康复2030:促进实现«联合国2030年可持续发展议程»相关目标[J]. 中国康复理论与实践, 2017, 23(4): 373-378. doi: 10.3969/j.issn.1006-9771.2017.04.001
	QIU Z Y, KWOK J K F, YANG J, et al. Rehabilitation 2030: realization of United Nation Sustainable Development Goals 2030[J]. Chin J Rehabil Theory Pract, 2017, 23(4): 373-378.
[25]	ABBOTT M W. The changing epidemiology of gambling disorder and gambling-related harm: public health implications[J]. Public Health, 2020, 184(6): 41-45.
[26]	WARDLE H, REITH G, LANGHAM E, et al. Gambling and public health: We need policy action to prevent harm[J]. BMJ, 2019, 365(8): l1807.
[27]	DAVIES N, JOHN B, DRUMMOND L, et al. Development and validation of the IDENT-Pro: a brief tool for the early identification of gambling risk factors indicative of harm[J]. J Public Health, 2024. https://doi.org/10.1007/s10389-024-02290-3.
[28]	BLANK L, BAXTER S, WOODS H B, et al. Interventions to reduce the public health burden of gambling-related harms: a mapping review[J]. Lancet Public Health, 2021, 6(1): e50-e63.
[29]	FORWARD C, NORRIE C, BRAMLEY S, et al. Assessing potential brief screening questions for use within different social care-related contexts to identify individuals experiencing gambling-related harms: a scoping review[J]. Health Soc Care Commun, 2022, 30(6): e3519-e3533.
[30]	WARDLE H, REITH G, BEST D, et al. Measuring gambling-related harms. A framework for action[M]. Geneva: Gambling Commission, 2018.