Craske Michelle G, Edlund Mark J, Sullivan Greer, Roy-Byrne Peter, Sherbourne Cathy, Bystritsky Alexander, Stein Murray B
University of California, Los Angeles, CA 90024-1563, USA.
Psychiatr Serv. 2005 Aug;56(8):988-94. doi: 10.1176/appi.ps.56.8.988.
This study estimated the extent of perceived unmet need for mental health treatment among individuals with panic disorder in primary care settings, investigated the determinants of unmet need, and assessed barriers to care.
Data were from baseline interviews in a clinical trial that investigated primary care treatment of panic disorder. Participants were asked whether there was any time in the past three months when they did not get as much care for emotional or personal problems as they needed or whether they had delays in getting care. Patients who endorsed unmet need were asked about specific perceived barriers. Logistic regression was used to investigate the determinants of unmet need.
Of the 231 patients eligible for the study, 88 (38 percent) endorsed unmet need for emotional or mental health problems. Individuals with worse mental health, those who were more worried about panic, and those without sick pay were significantly more likely to report unmet need. Commonly reported barriers included being unable to find out where to go for help (43 percent), worry about cost (40 percent), lack of coverage by health plan (35 percent), and being unable to get an appointment soon enough (35 percent).
The relatively low level of patient-reported unmet need for mental health treatment among primary care patients with panic disorder suggests that efforts to improve treatment of panic disorder should include patient education about mental illness and the effective treatments available. Although discussion of barriers to care has traditionally centered on stigma and economic factors, the results of this study suggest that simple logistic factors, such as not knowing whom to call for help, are also important barriers.
本研究估计了基层医疗环境中惊恐障碍患者感知到的未满足的心理健康治疗需求程度，调查了未满足需求的决定因素，并评估了护理障碍。
数据来自一项关于惊恐障碍基层医疗治疗的临床试验的基线访谈。参与者被问及在过去三个月中是否有任何时候他们没有得到所需的情感或个人问题护理，或者他们在获得护理方面是否有延迟。认可未满足需求的患者被问及具体的感知障碍。采用逻辑回归分析来研究未满足需求的决定因素。
在231名符合研究条件的患者中，88名（38%）认可存在情感或心理健康问题的未满足需求。心理健康状况较差的个体、更担心惊恐发作的个体以及没有病假工资的个体报告未满足需求的可能性显著更高。常见的障碍包括不知道去哪里寻求帮助（43%）、担心费用（40%）、健康计划覆盖不足（35%）以及无法尽快预约（35%）。
基层医疗中惊恐障碍患者报告的未满足心理健康治疗需求水平相对较低，这表明改善惊恐障碍治疗的努力应包括对患者进行精神疾病及可用有效治疗方法的教育。尽管传统上对护理障碍的讨论集中在耻辱感和经济因素上，但本研究结果表明，诸如不知道该向谁求助等简单的后勤因素也是重要的障碍。
