Department of Psychology, Jackson State University, College of Liberal Arts, 2nd Floor, 1400 John R. Lynch St., Jackson, MS 39217, USA.
Psychiatr Serv. 2010 Jul;61(7):669-74. doi: 10.1176/ps.2010.61.7.669.
Persons with severe mental illness do not receive adequate general medical health care, and African Americans are at greater risk of poor-quality care than their European-American counterparts. Services for patients with mental illness should include an assessment of health status. Self-report is the most efficient means of obtaining health information but may be susceptible to bias. The purpose of the study was to determine the effects of psychiatric symptoms, psychological factors, and demographic variables on the global self-reported health of African-American psychiatric patients.
Study participants were a sample of 151 African-American psychiatric patients who received an orally administered screening interview of self-report scales, including measures of paranoia, lack of trust, need for approval, and self-esteem. Structural equation modeling (SEM) was used to estimate the effects of demographic characteristics (gender, age, and education), psychological factors (distrust, need for approval, cultural mistrust, and self-esteem), and psychiatric symptoms (subjective and objective measures of psychosis) on global self-reported health.
The best-fitting SEM model excluded demographic variables and indicated that the latent construct for psychological factors (beta=.63) had a much stronger influence than psychiatric symptoms (beta=.37) on the self-reported health status of these patients.
Physicians' assessments of medical complaints by patients with severe mental illness should consider the effects of nonclinical psychological factors on patients' reporting. Psychological factors associated with attitudes in the larger African-American community toward health care providers are also present in the segment with severe mental illness.
严重精神疾病患者得不到充分的一般医疗保健，非裔美国人获得低质量医疗保健的风险比欧洲裔美国人更高。为精神疾病患者提供的服务应包括对健康状况的评估。自我报告是获取健康信息最有效的手段，但可能容易受到偏差的影响。本研究的目的是确定精神症状、心理因素和人口统计学变量对非裔美国精神科患者整体自我报告健康状况的影响。
研究参与者是 151 名接受口头管理的自我报告量表筛查访谈的非裔美国精神科患者样本，包括偏执、缺乏信任、对认可的需求和自尊的测量。结构方程模型（SEM）用于估计人口统计学特征（性别、年龄和教育程度）、心理因素（不信任、对认可的需求、文化不信任和自尊）以及精神症状（主观和客观的精神病测量）对整体自我报告健康的影响。
最佳拟合 SEM 模型排除了人口统计学变量，并表明心理因素的潜在结构（β=.63）对这些患者自我报告健康状况的影响远大于精神症状（β=.37）。
医生对严重精神疾病患者医疗投诉的评估应考虑非临床心理因素对患者报告的影响。与非裔美国人社区整体健康护理提供者态度相关的心理因素也存在于严重精神疾病患者中。
