Wang JianLi, Langille Donald B, Patten Scott B
Department of psychiatry of the faculty of medicine at the University of Calgary in Alberta, Canada.
Psychiatr Serv. 2003 Jun;54(6):878-83. doi: 10.1176/appi.ps.54.6.878.
This study estimated the rates of mental health service provision and of specialist referral in primary care in Canada and investigated factors associated with receiving mental health services and with referral to mental health specialists among persons who reported major depressive episodes.
S: Data from the 1998-1999 Canadian National Population Health Survey were used. The 608 respondents who reported having major depressive episodes in the 12 months preceding the survey and who reported contacting a general practitioner or family doctor during that time were included in the study. The rates of provision of mental health services by general practitioners and family doctors and of referral to mental health specialists were calculated. Demographic, socioeconomic, and clinical characteristics associated with receiving mental health services and with referral to specialists were investigated.
Among the 608 respondents who had contacted general practitioners or family doctors for any reason, 153 had contacted them for emotional or mental problems. Of this subgroup of 153, 64.5 percent received mental health services either from these practitioners or by referral to specialists, and 26 percent were referred to mental health specialists. Depressed respondents who reported having talked to a general practitioner or family doctor about mental health problems, who reported impairment, and whose depressive symptoms had lasted eight or more weeks were more likely to have received mental health services. Respondents aged 12 to 24 years were more likely to be referred to mental health specialists.
S: Impairment associated with depression and chronicity of depressive symptoms appear to be the primary determinants of the decisions made by general practitioners and family doctors about providing mental health services. Patients' willingness to consult with general practitioners or family doctors for mental health problems may also be a key factor, both for effective management of depression in primary care settings and for referral to mental health specialists.
本研究估算了加拿大初级保健中心理健康服务的提供率和专科转诊率，并调查了报告有重度抑郁发作的人群中接受心理健康服务以及被转诊至心理健康专科医生的相关因素。
使用了1998 - 1999年加拿大全国人口健康调查的数据。研究纳入了在调查前12个月内报告有重度抑郁发作且在此期间报告联系过全科医生或家庭医生的608名受访者。计算了全科医生和家庭医生提供心理健康服务的比率以及转诊至心理健康专科医生的比率。调查了与接受心理健康服务和转诊至专科医生相关的人口统计学、社会经济和临床特征。
在因任何原因联系过全科医生或家庭医生的608名受访者中，有153人因情绪或心理问题联系过他们。在这153人的亚组中，64.5%的人从这些医生处或通过转诊接受了心理健康服务，26%的人被转诊至心理健康专科医生。报告曾与全科医生或家庭医生谈论过心理健康问题、报告有功能损害且抑郁症状持续了8周或更长时间的抑郁受访者更有可能接受心理健康服务。12至24岁的受访者更有可能被转诊至心理健康专科医生。
与抑郁相关的功能损害和抑郁症状的慢性化似乎是全科医生和家庭医生决定提供心理健康服务的主要决定因素。患者就心理健康问题咨询全科医生或家庭医生的意愿，对于初级保健环境中抑郁症的有效管理以及转诊至心理健康专科医生而言，也可能是一个关键因素。
