加拿大精神病医院去机构化对社区心理困扰的影响。

Sealy Patricia, Whitehead Paul C

Department of Nursing, University of Western Ontario, London, Ontario, Canada.

J Health Soc Policy. 2006;21(4):73-94. doi: 10.1300/J045v21n04_04.

OBJECTIVE

There has been a plethora of studies that evaluate the impact of deinstitutionalization of psychiatric services, but they have not examined whether this policy has had an impact on the broader community. The present study addresses this gap by evaluating the impact of the deinstitutionalization of psychiatric hospitals on the mental health of the general population in Canada.

METHOD

This research builds on an empirical analysis of 40 years of the process of deinstitutionalization of psychiatric services in Canada (Sealy and Whitehead 2004). An experimental design is simulated through the use of a derived construct, earlier vs. later deinstitutionalization, in order to test whether the policy of deinstitutionalization has achieved the goal of decreasing levels of psychological distress for people in the community. This study attempts to rectify some of the methodological limitations of past evaluations by standardizing the rates of deinstitutionalization among the provinces and taking into consideration the impact of the interaction among levels of perceived social support and the various social correlates of psychological distress. Cross sectional data from the 1994/95 (n = 16,989) and the 1998/99 waves of the National Population Health Survey (n = 14,682) are used to measure levels of psychological distress.

RESULTS

Provinces that implemented this policy earlier have levels of psychological distress that are significantly lower than the provinces that implemented deinstitutionalization later. All high risk groups (people with lower levels of income and education, younger people, people living in urban areas) have significantly lower levels of psychological distress in 1998/99 (as compared to 1994/95) with the exception of single parents in the provinces that implemented deinstitutionalization earlier.

CONCLUSION

Based on the NPHS, the earlier implementation of deinstitutionalization is associated with lower levels of psychological distress of the community as compared to the provinces that implemented deinstitutionalization later.

目的

已有大量研究评估了精神科服务去机构化的影响，但这些研究并未考察该政策是否对更广泛的社区产生了影响。本研究通过评估精神病院去机构化对加拿大普通人群心理健康的影响来填补这一空白。

方法

本研究基于对加拿大精神科服务去机构化40年过程的实证分析（西利和怀特黑德，2004年）。通过使用一个派生结构，即早期去机构化与后期去机构化，模拟实验设计，以检验去机构化政策是否实现了降低社区人群心理困扰水平的目标。本研究试图通过标准化各省的去机构化率，并考虑感知社会支持水平与心理困扰的各种社会相关因素之间相互作用的影响，来纠正以往评估中的一些方法学局限性。使用1994/95年（n = 16,989）和1998/99年全国人口健康调查（n = 14,682）的横断面数据来衡量心理困扰水平。