Goodwin Renee, Andersen Ronald M
Department of Epidemiology, Columbia University, Unit 43, 1051 Riverside Drive, New York, NY 10032, USA.
Soc Psychiatry Psychiatr Epidemiol. 2002 May;37(5):212-9. doi: 10.1007/s00127-002-0543-x.
The aim of this study was to identify predisposing, enabling, and need factors associated with health service use for panic attacks among adults in the United States using the Behavioral Model of Health Care Use.
Data were drawn from the National Comorbidity Survey (n = 8098), a community-based household sample representative of the United States adult (age 15-54) population. Stepwise logistic regression models were used to compute odds ratios (with 95 % confidence intervals) measuring the association between predisposing, enabling, and need factors and the self-reported health service use for treatment of panic attacks.
In addition to perceived (perception of poor mental health) and evaluated need (severity of panic attacks, psychiatric morbidity), predisposing (being older, married, more educated, white) factors were independently associated with use of treatment for panic attacks. Distinct correlates for use of primary care, specialized mental health treatment, and use of psychotropic medication were found. In addition to need factors, predisposing factors are independently associated with the use of services for panic attacks in the community.
These results suggest that factors other than severity of panic and degree of psychiatric morbidity may influence use of services for panic. Future studies that examine whether these factors reflect barriers to care for those in need of mental health treatment may help to inform programs aimed at targeting those with unmet need in the community.
本研究旨在运用医疗服务利用行为模型,确定美国成年人惊恐发作的易患因素、促成因素和需求因素。
数据取自全国共病调查(n = 8098),这是一个以社区为基础的家庭样本,代表了美国15 - 54岁的成年人口。采用逐步逻辑回归模型计算优势比(及其95%置信区间),以衡量易患因素、促成因素和需求因素与自我报告的用于治疗惊恐发作的医疗服务利用之间的关联。
除了感知需求(对心理健康不佳的感知)和评估需求(惊恐发作的严重程度、精神疾病发病率)外,易患因素(年龄较大、已婚、受教育程度较高、白人)与惊恐发作治疗的利用独立相关。还发现了初级保健利用、专门心理健康治疗利用和精神药物使用的不同相关因素。除了需求因素外,易患因素与社区中惊恐发作服务的利用独立相关。
这些结果表明,除了惊恐严重程度和精神疾病发病率外,其他因素可能会影响惊恐发作服务的利用。未来研究这些因素是否反映了有心理健康治疗需求者的护理障碍,可能有助于为旨在针对社区中有未满足需求者的项目提供信息。