Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario.
Can J Psychiatry. 2010 Jan;55(1):9-20. doi: 10.1177/070674371005500103.
Knowledge is lacking on the extent to which area-level characteristics contribute to variations observed in the use of mental health services. This study examined the influence of area- and individual-level characteristics on the use of mental health services.
Data from a nationally representative, population-based, cross-sectional survey, the Canadian Community Health Survey-Mental Health and Well-Being, consisting of adults aged 15 years or older (n = 36 984), were linked to Canadian 2001 Census profiles according to health region boundaries (n = 97). Multilevel multivariable logistic regression modelling was used to: estimate variation in 12-month self-reported use of health services for mental health reasons between health regions; and, estimate the effects of individual- and area-level need, health resources, and sociodemographic factors on self-reported 12-month use of medical services for mental health reasons.
There was a 2.1% and 3.5% regional variation for general practitioner-family physician (GP-FP) and psychiatric health service use during 12 months, respectively. Most of the regional variation observed was explained by number of physicians per health region and regional and individual need factors. Adults who were middle-aged, had a post-secondary education, low-income, were separated, widowed, or divorced, and Canadian-born were significantly more likely to use GP-FP and psychiatry services for mental health reasons at the individual level, even after adjusting for area- and individual-level need factors.
Most area-level variation was explained by the availability of health region resources and individual-level need factors. After accounting for need, numerous sociodemographic factors retained their association with use of mental health services. Additional efforts are needed at the area and individual level to reduce inequities through appropriate targeted care.
关于区域特征对精神卫生服务利用差异的影响程度，目前相关知识较为匮乏。本研究旨在调查区域和个体特征对精神卫生服务利用的影响。
本研究使用来自全国代表性的、基于人群的、横断面调查——加拿大社区健康调查-精神健康和幸福感的数据，该调查包括 15 岁及以上的成年人（n=36984），并根据健康区域边界与加拿大 2001 年人口普查资料进行链接（n=97）。采用多水平多变量逻辑回归模型来：估计健康区域之间因精神健康原因导致的 12 个月内自我报告的卫生服务使用情况的差异；并估计个体和区域层面的需求、卫生资源以及社会人口因素对 12 个月内因精神健康原因而使用医疗服务的自我报告的影响。
在 12 个月期间，全科医生-家庭医生（GP-FP）和精神卫生服务的区域使用率分别存在 2.1%和 3.5%的差异。观察到的大部分区域差异可由每个健康区域的医生数量以及区域和个体需求因素来解释。在个体层面上，中年、受过高等教育、低收入、离异、丧偶或离婚以及加拿大出生的成年人因精神健康原因使用 GP-FP 和精神病服务的可能性显著更高，即使在调整了区域和个体需求因素后也是如此。
大多数区域差异可由健康区域资源和个体需求因素的可获得性来解释。在考虑到需求后，许多社会人口因素仍然与精神卫生服务的使用相关。需要在区域和个体层面上做出更多努力，通过适当的针对性护理来减少不平等现象。
