Department of Psychiatry, Harborview Medical Center, University of Washington School of Medicine, 325 9th Ave., Box 359911, Seattle, WA 98104-2499, USA.
Psychiatr Serv. 2009 Sep;60(9):1190-7. doi: 10.1176/ps.2009.60.9.1190.
This study sought to determine whether previously reported poor outcomes among patients of low socioeconomic status who have depression and anxiety could result from not receiving mental health treatment or from receiving minimally adequate treatment.
The study sample consisted of 1,772 participants in the National Comorbidity Survey Replication (NCS-R) who met criteria for a mood or anxiety disorder. Bivariate and multivariate logistic regression analyses were used to examine associations between education, income, and assets and receipt of treatment and quality of treatment (minimally adequate treatment) for mood and anxiety disorders in sectors with the capacity to deliver evidence-based treatments (the general medical and mental health specialty sectors). Multivariate analyses controlled for age, gender, race-ethnicity, marital status, health insurance, and urbanicity.
Age, gender, marital status, and race-ethnicity were strong and fairly consistent predictors of mental health services use, with some modest variations by sector. In contrast, in bivariate and multivariate analyses, education, income, and assets were minimally related to use of mental health care and to receipt of minimally adequate care in both general medical and mental health specialty sectors.
Socioeconomic status does not appear to play a major role in determining aspects of treatment for depression and anxiety disorders. Poor outcomes of depressed and anxious patients with low socioeconomic status may be due to differences in quality of care beyond the minimally adequate level assessed in this study or to factors unrelated to quality of care that could counteract effective treatments, such as the presence of ongoing chronic stress.
本研究旨在确定经济社会地位较低的抑郁和焦虑患者先前报告的不良结局是否是由于未接受心理健康治疗或仅接受最低限度充分治疗所致。
本研究样本包括符合心境或焦虑障碍标准的全国共病调查再测（NCS-R）1772 名参与者。使用双变量和多变量逻辑回归分析来检查教育、收入和资产与接受治疗以及心境和焦虑障碍治疗质量（最低限度充分治疗）之间的关联，治疗质量的评估依据为提供基于证据的治疗的能力（一般医疗和精神卫生专业部门）。多变量分析控制了年龄、性别、种族-民族、婚姻状况、医疗保险和城市性。
年龄、性别、婚姻状况和种族-民族是心理健康服务利用的强有力且相对一致的预测因素，但在不同部门存在一些适度的差异。相比之下，在双变量和多变量分析中，教育、收入和资产与一般医疗和精神卫生专业部门的心理健康护理的使用以及最低限度充分护理的获得几乎没有关系。
社会经济地位似乎并没有在确定抑郁和焦虑障碍治疗方面的各个方面中起主要作用。社会经济地位较低的抑郁和焦虑患者的不良结局可能是由于治疗质量的差异所致，而不仅仅是本研究评估的最低限度充分水平，或者是与治疗质量无关的因素，这些因素可能会抵消有效的治疗，例如持续存在的慢性压力。
