Netherlands Institute for Health Services Research (NIVEL), 3500 BN Utrecht, the Netherlands.
Psychiatr Serv. 2010 Mar;61(3):250-7. doi: 10.1176/ps.2010.61.3.250.
This study focused on patients in the general population whose anxiety or depressive disorder is untreated. It explored reasons for not receiving treatment and compared four groups of patients-three that did not receive treatment for different reasons (no problem perceived, no perceived need for care, and unmet need for care) and one that received treatment-regarding their predisposing, enabling, and need factors.
Cross-sectional data were used for 743 primary care patients with current anxiety or depressive disorder from the Netherlands Study of Depression and Anxiety (NESDA). Diagnoses were confirmed with the Composite International Diagnostic Interview. Patients' perception of the presence of a mental problem, perceived need for care, service utilization, and reasons for not receiving treatment were assessed with the Perceived Need for Care Questionnaire.
Forty-three percent of the respondents with a six-month anxiety or depression diagnosis did not receive treatment. Twenty-one percent of all respondents with depression or anxiety expressed a need for care but did not receive any. Preferring to manage the problem themselves was the most common reason for respondents to avoid seeking treatment. There were no significant differences in clinical need factors between treated patients and untreated patients with a perceived need for care. Compared with patients in the other two untreated groups, untreated patients with a perceived need for care were more hindered in regard to symptom severity, functional disability, and psychosocial functioning.
General practitioners should pay considerable attention to patients whose need for care is unmet. Furthermore, findings support the implementation of patient empowerment in mental health care in order to contribute to easily accessible and patient-centered care.
本研究关注的是一般人群中未接受治疗的焦虑或抑郁障碍患者。它探讨了未接受治疗的原因，并比较了四组患者——三组因不同原因未接受治疗（无感知问题、无感知护理需求和未满足的护理需求）和一组接受治疗的患者——关于其倾向因素、促成因素和需求因素。
使用来自荷兰抑郁和焦虑研究（NESDA）的横断面数据，对 743 名有当前焦虑或抑郁障碍的初级保健患者进行研究。使用复合国际诊断访谈（Composite International Diagnostic Interview）对诊断进行确认。使用感知护理需求问卷（Perceived Need for Care Questionnaire）评估患者对存在心理问题的感知、感知护理需求、服务利用情况和未接受治疗的原因。
在有六个月焦虑或抑郁诊断的受访者中，有 43%的人未接受治疗。所有有抑郁或焦虑的受访者中，有 21%表示有护理需求，但未得到任何护理。受访者避免寻求治疗的最常见原因是他们更愿意自己管理问题。有感知护理需求但未接受治疗的患者与接受治疗的患者之间在临床需求因素方面没有显著差异。与其他两组未接受治疗且有感知护理需求的患者相比，有感知护理需求但未接受治疗的患者在症状严重程度、功能障碍和心理社会功能方面受到的阻碍更大。
全科医生应高度关注那些未得到护理需求满足的患者。此外，研究结果支持在精神卫生保健中实施患者赋权，以促进获得方便和以患者为中心的护理。
