Wang P S, Berglund P, Kessler R C
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
J Gen Intern Med. 2000 May;15(5):284-92. doi: 10.1046/j.1525-1497.2000.9908044.x.
To relate the presence of recent mental disorders to use of mental health services.
Cross-sectional survey.
The study population was 3,032 respondents to the Midlife Development in the United States (MIDUS) survey, a nationally representative telephone-and-mail survey conducted in 1996. Twelve-month diagnoses according to the Diagnostic and Statistical Manual of Mental Disorders, Revised, Third Edition, of major depressive episode, panic disorder, generalized anxiety disorder, and serious mental illness were made using a structured assessment. Information was obtained on 12-month treatment for mental health problems in the general medical, mental health specialty, human services, and self-help sectors. Definitions of treatments consistent with evidence-based recommendations were developed using available practice guidelines.
Crude and adjusted likelihoods of receiving any mental health care and guideline-concordant care were measured. Although 53. 8% of respondents with at least one 12-month mental disorder received any mental health care in the previous year, only 14.3% received care that could be considered consistent with evidence-based treatment recommendations. Even among those with the most serious and impairing mental illness, only 25% received guideline-concordant treatment. Predictors of receiving guideline-concordant care included being white, female, severely ill, and having mental health insurance coverage.
An epidemic of untreated and poorly treated mental disorders exists in the United States, especially among vulnerable groups such as African Americans and the underinsured. Cost-effective interventions are needed to improve both access to and quality of treatment.
探讨近期精神障碍的存在与心理健康服务利用之间的关系。
横断面调查。
研究人群为3032名参与美国中年发展（MIDUS）调查的受访者，该调查于1996年通过电话和邮件方式进行，具有全国代表性。根据《精神障碍诊断与统计手册》修订版第三版，采用结构化评估对重度抑郁发作、惊恐障碍、广泛性焦虑障碍和严重精神疾病进行了为期12个月的诊断。收集了关于在普通医疗、心理健康专科、公共服务和自助部门接受心理健康问题12个月治疗的信息。利用现有的实践指南制定了与循证推荐一致的治疗定义。
测量了接受任何心理健康护理和符合指南护理的粗发生率和调整后发生率。尽管53.8%的至少患有一种为期12个月精神障碍的受访者在前一年接受了任何心理健康护理，但只有14.3%接受了可被认为与循证治疗推荐一致的护理。即使在患有最严重和致残性精神疾病的人群中，也只有25%接受了符合指南的治疗。接受符合指南护理的预测因素包括白人、女性、重病患者以及拥有心理健康保险。
在美国，存在未治疗和治疗不当的精神障碍流行情况，尤其是在非裔美国人及保险不足等弱势群体中。需要采取具有成本效益的干预措施，以改善治疗的可及性和质量。
