Verhaak Peter F M, Hoeymans Nancy, Garssen Anna A, Westert Gert P
Netherlands Institute of Health Services Research (NIVEL), Utrecht, the Netherlands.
Br J Gen Pract. 2005 Oct;55(519):770-5.
In the last 15 years, both the demand for and supply of specialised mental health care increased considerably in the Netherlands. Increased demand may reflect a change in psychological morbidity, but may also be a consequence of increased supply. Specialised health care in the Netherlands is accessible only through referral by a GP, and so it is important to consider the role of primary care in the diagnosis of mental health problems.
The aim of this study is to achieve a better understanding of the development of mental health status in the Dutch population and the consequent help-seeking behaviour in primary care.
Using two comparable morbidity studies carried out in the Dutch population and in primary care, we compared data from 1987 and 2001 to assess the following: possible differences in mental health between 1987 and 2001; possible differences in prevalence of mental disorder as diagnosed by GPs in 1987 and 2001; possible differences in the sociodemographic determinants of mental health and mental disorder in primary care between 1987 and 2001.
Our results show an increase in mental and social problems in the population between 1987 and 2001. However, GPs diagnosed fewer patients as having a mental disorder in 2001 than they did in 1987. The risk of mental disorders or social problems in several sociodemographic groups remained largely the same, as did the chance of receiving a psychological or social diagnosis.
We conclude that, while mental disorder in the population is increasing, the role of primary care has changed. Although GPs diagnose a lower percentage of mental problems as such, they refer an increasingly larger proportion of these to secondary care.
在过去15年里，荷兰对专业心理健康护理的需求和供给均大幅增加。需求增加可能反映了心理发病率的变化，但也可能是供给增加的结果。在荷兰，只有通过全科医生转诊才能获得专业医疗服务，因此，考虑初级保健在心理健康问题诊断中的作用非常重要。
本研究旨在更好地了解荷兰人群心理健康状况的发展以及随之而来的在初级保健中的求助行为。
我们利用在荷兰人群和初级保健机构中进行的两项可比发病率研究，比较了1987年和2001年的数据，以评估以下内容：1987年至2001年期间心理健康方面可能存在的差异；1987年和2001年全科医生诊断的精神障碍患病率可能存在的差异；1987年至2001年期间初级保健中影响心理健康和精神障碍的社会人口学决定因素可能存在的差异。
我们的研究结果显示，1987年至2001年期间，人群中的心理和社会问题有所增加。然而，2001年全科医生诊断患有精神障碍的患者比1987年更少。几个社会人口学群体中患精神障碍或出现社会问题的风险基本保持不变，接受心理或社会诊断的可能性也是如此。
我们得出结论，虽然人群中的精神障碍在增加，但初级保健的作用已经发生了变化。尽管全科医生诊断出的精神问题比例较低，但他们将这些问题转诊至二级保健机构的比例却越来越大。
