Gureje Oye, Lasebikan Victor O
Dept. of Psychiatry, University College Hospital, P.M.B. 5116, Ibadan, Nigeria.
Soc Psychiatry Psychiatr Epidemiol. 2006 Jan;41(1):44-9. doi: 10.1007/s00127-005-0001-7. Epub 2006 Jan 1.
Evidence from developed industrialized countries suggests poor uptake of mental health services. No data exist in developing resource-constrained countries about met and unmet need for mental health service in the community.
A four-stage stratified probability sample of households was studied in the Yoruba-speaking part of Nigeria (population, approximately 25 million people or 22% of the Nigerian national population). Face-to-face interviews were conducted with persons 18 years old and above (n=4,984) using the World Mental Health version of the Composite International Diagnostic Interview. We determined the proportions of respondents with 12-month Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) anxiety, mood, or substance use disorder who had received any mental health treatment and the correlates of treatment receipt.
Only 9.0% of those with any 12-month DSM-IV disorder had received treatment. While 11% of those with a mood disorder had received some treatment, none of those with substance use disorders had used a mental health service. Most treatments were received from general medical settings, with only about 1% of those with DSM-IV disorders receiving specialist mental health service. Surprisingly, complementary or alternative health providers were also consulted by only about 4% of those with mental disorders, although a much higher proportion of 57% of those with no DSM-IV disorders but who nevertheless received mental health treatment did so from such providers. Irrespective of the disorders or the sector where treatment was received, virtually no treatment was adjudged minimally adequate.
There is a striking level of unmet need for mental health service in the community in this developing country setting. While inadequacy of the formal public health sector may be partly responsible for this observation, there is the likelihood that receipt of treatment for mental health problems may also be hampered by the public's poor knowledge of the nature of the disorders and by stigma.
来自发达工业化国家的证据表明，心理健康服务的利用率较低。在资源有限的发展中国家，尚无关于社区心理健康服务需求满足情况和未满足情况的数据。
在尼日利亚讲约鲁巴语的地区（人口约2500万，占尼日利亚全国人口的22%），对家庭进行了四阶段分层概率抽样研究。使用世界心理健康版综合国际诊断访谈，对18岁及以上的人群（n = 4984）进行面对面访谈。我们确定了患有《精神疾病诊断与统计手册》第四版（DSM-IV）中12个月焦虑、情绪或物质使用障碍且接受过任何心理健康治疗的受访者比例，以及治疗接受情况的相关因素。
在患有任何12个月DSM-IV障碍的人群中，只有9.0%接受过治疗。虽然11%的情绪障碍患者接受过某种治疗，但物质使用障碍患者中无人使用过心理健康服务。大多数治疗是在普通医疗环境中接受的，患有DSM-IV障碍的人群中只有约1%接受过专科心理健康服务。令人惊讶的是，患有精神障碍的人群中只有约4%咨询过补充或替代健康服务提供者，尽管在没有DSM-IV障碍但接受过心理健康治疗的人群中，有高达57%的人是从这类提供者那里接受治疗的。无论患有何种障碍或在哪个部门接受治疗，几乎没有治疗被判定为基本足够。
在这个发展中国家的社区环境中，心理健康服务的未满足需求程度惊人。虽然正规公共卫生部门的不足可能部分导致了这一现象，但公众对这些障碍性质的了解不足以及耻辱感也可能阻碍心理健康问题的治疗接受情况。
