Jacobi F, Klose M, Wittchen H-U
Institut für Klinische Psychologie und Psychotherapie, AG, Technische Universität Dresden, Dresden.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2004 Aug;47(8):736-44. doi: 10.1007/s00103-004-0885-5.
Mental disorders are considered to be costly in terms of elevated rates of healthcare utilization and increased disability days. For the general German population there has been a lack of data on healthcare utilization and disability rates. The available administrative data are incomplete and problematic because they are based on routine clinical diagnoses that lack reliability. Using the German Health Interview and Examination Survey 1998/99 and its Mental Health Supplement (GHS-MHS) data, this paper examines healthcare utilization and disability associated with mental disorders in a representative sample of the general adult population (18-65 years, n=4181). After reviewing the size and treatment status of mental disorders in Germany, data about primary care or specialist consultations, inpatient treatment, and disability days in the last year are presented for the following groups: (1) subjects who never met the criteria of the diagnosis of a mental disorder, (2) subjects who had one or more mental disorders in the past but none in the past year ("remitted") and (3) subjects who currently (within the last year) met the criteria of one or more mental disorders. We found increased healthcare utilization as well as more disability days in those individuals with a current diagnosis. Remitted persons, however, showed results similar to those who never had a diagnosis of a mental disorder during their lifetimes. The results are consistent with the episodic course of many mental disorders and furthermore might indicate that treatment of mental disorders might contribute to a substantial reduction of direct and indirect illness costs.
精神障碍在医疗保健利用率上升和残疾天数增加方面被认为成本高昂。对于德国普通人群，缺乏关于医疗保健利用率和残疾率的数据。现有的行政数据不完整且存在问题，因为它们基于缺乏可靠性的常规临床诊断。本文利用1998/99年德国健康访谈与检查调查及其心理健康补充调查（GHS-MHS）的数据，在一般成年人群（18 - 65岁，n = 4181）的代表性样本中研究与精神障碍相关的医疗保健利用率和残疾情况。在回顾德国精神障碍的规模和治疗状况后，给出了以下几组人群去年的初级保健或专科会诊、住院治疗以及残疾天数的数据：（1）从未符合精神障碍诊断标准的受试者；（2）过去有过一种或多种精神障碍但过去一年没有的受试者（“缓解期”）；（3）目前（过去一年）符合一种或多种精神障碍标准的受试者。我们发现目前被诊断出患有精神障碍的个体医疗保健利用率增加，残疾天数也更多。然而，缓解期的人显示出与一生中从未被诊断出患有精神障碍的人相似的结果。这些结果与许多精神障碍的发作过程一致，此外可能表明精神障碍的治疗可能有助于大幅降低直接和间接疾病成本。
