Joska John, Flisher Alan J
Dept. of Psychiatry and Mental Health, University of Cape Town, Valkenberg Hospital, Cape Town, South Africa.
Soc Psychiatry Psychiatr Epidemiol. 2005 Jul;40(7):529-39. doi: 10.1007/s00127-005-0920-3.
The field of psychiatric epidemiology has yielded several large and important studies of the prevalence of psychiatric disorders. These surveys have been enhanced by the inclusion of methodologies that reflect the needs for care of the population in question. Clinical studies of psychiatric disorders and unmet needs have focussed on identifying needs and correlating them with service evaluation and satisfaction measures. The association between prevalence, service use and unmet need requires review in order to establish whether there are trends and consistent findings.
Peer-reviewed studies involving the assessment of need up to the present were included. These were of two broad groups: population-based studies and clinical studies. Studies based on outcome measures, review articles, and child psychiatry, old age, and intellectual disability samples were excluded. We conducted a search of MEDLINE and PSYCHINFO using the key words, "mental health needs","assessment of need", and "needs assessment". In addition, we hand-searched key journals and sought personal communication with researchers in the field.
A total of 14 population studies and 19 clinical studies were retrieved. The percentage of the general population who reported at least one need for care ranged from 9.5% to 13.8%. The numbers of needs in psychiatric patients ranged from 3.3 to 8.6. Correlates of unmet need include: unemployment, single status, low quality of life and high disability scores, and the presence of certain psychiatric diagnoses, such as affective psychosis and personality disorders. Higher rates of met need and service satisfaction are correlated with a longer duration of service contact.
The assessment of need to date has been established either by service use data to make inferences about unmet need, by asking limited guided questions about needs, or by using established needs assessment instruments. The high prevalence of psychiatric disorders and the weak correlation between disorder and unmet need require a combined approach towards service development.
精神疾病流行病学领域已经开展了多项关于精神疾病患病率的大型重要研究。通过纳入反映相关人群护理需求的方法，这些调查得到了加强。精神疾病及未满足需求的临床研究主要集中在识别需求，并将其与服务评估及满意度指标相关联。为了确定是否存在趋势和一致的研究结果，需要对患病率、服务利用和未满足需求之间的关联进行综述。
纳入截至目前涉及需求评估的同行评审研究。这些研究主要分为两大类：基于人群的研究和临床研究。基于结果指标的研究、综述文章以及儿童精神病学、老年精神病学和智力残疾样本的研究被排除在外。我们使用关键词“心理健康需求”“需求评估”和“需求评定”在MEDLINE和PSYCHINFO数据库中进行了检索。此外，我们还手工检索了主要期刊，并与该领域的研究人员进行了个人交流。
共检索到14项人群研究和19项临床研究。报告至少有一项护理需求的普通人群比例在9.5%至13.8%之间。精神科患者的需求数量在3.3至8.6之间。未满足需求的相关因素包括：失业、单身状态、低生活质量和高残疾评分，以及某些精神科诊断的存在，如情感性精神病和人格障碍。更高的需求满足率和服务满意度与更长的服务接触时长相关。
迄今为止，需求评估要么通过服务利用数据来推断未满足的需求，要么通过询问有限的关于需求的指导性问题，要么通过使用既定的需求评估工具来进行。精神疾病的高患病率以及疾病与未满足需求之间的弱相关性要求在服务发展方面采取综合方法。
