Vasiliadis Helen-Maria, Tempier Raymond, Lesage Alain, Kates Nick
Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, Quebec.
Can J Psychiatry. 2009 Jul;54(7):468-76. doi: 10.1177/070674370905400708.
To examine the determinants that lead Canadian adults to consult family physicians, psychiatrists, psychologists, psychotherapists, and other health professionals for mental health reasons and to compare the determinants of service use across provider types.
Data from the Canadian Community Health Survey: Mental Health and Well-Being were used for people aged 18 years and older (n = 35,236). A multivariate logistic regression was used to model outpatient consultations with different providers as a function of predictive determinants.
Three types of variables were examined: need, enabling, and predisposing factors. Among need, the most common predictors of service use for mental health reasons were self-rated mental health, the presence of chronic conditions, depression and panic attacks, unmet mental health needs, psychological well-being, and the ability to handle daily demands. Among enabling factors, emotional and informational support and income were important predictors. Among predisposing factors, men were less likely to consult with a family physician and other resources but not with psychiatrists; and people with less education were less likely to consult psychologists and other health providers.
Need factors were the most important predictors of both psychiatrist and combined family physician and psychiatrist consultation in the previous year. However, sex barriers remain and promotion campaigns in seeking mental health care should be aimed toward men. Further, education and income barriers exist in the use of specialty providers of psychotherapy and policies should thus focus on rendering these services more accessible to disadvantaged people.
探讨促使加拿大成年人因心理健康问题咨询家庭医生、精神科医生、心理学家、心理治疗师及其他健康专业人员的决定因素，并比较不同类型医疗服务提供者的服务使用决定因素。
使用来自加拿大社区健康调查：心理健康与幸福的数据，样本为18岁及以上人群（n = 35,236）。采用多元逻辑回归模型，将与不同医疗服务提供者的门诊咨询作为预测决定因素的函数进行建模。
研究了三种类型的变量：需求、促成因素和 predisposing 因素。在需求方面，因心理健康问题使用服务的最常见预测因素是自评心理健康状况、慢性病的存在、抑郁和惊恐发作、未满足的心理健康需求、心理幸福感以及处理日常需求的能力。在促成因素中，情感和信息支持以及收入是重要的预测因素。在 predisposing 因素中，男性咨询家庭医生和其他资源的可能性较小，但咨询精神科医生的可能性不存在差异；受教育程度较低的人咨询心理学家和其他健康服务提供者的可能性较小。
需求因素是上一年精神科医生以及家庭医生和精神科医生联合咨询的最重要预测因素。然而，性别障碍仍然存在，寻求心理健康护理的宣传活动应针对男性。此外，在使用心理治疗专科服务提供者方面存在教育和收入障碍，因此政策应侧重于使弱势群体更容易获得这些服务。
