Xiong Glen L, Iosif Ana-Maria, Bermudes Richard A, McCarron Robert M, Hales Robert E
Department of Internal Medicine, University of California, Davis School of Medicine, Sacramento, CA, USA.
Prim Care Companion J Clin Psychiatry. 2010;12(5). doi: 10.4088/PCC.09m00927gre.
This study examines predictors of reduced preventive health service use in patients with severe mental illness by examining psychiatric diagnoses and demographic factors.
Of 387 patients approached in 4 community mental health clinics regarding their preventive health services use from January 2005 to May 2007, 234 (60.5%) were interviewed. Of those participants interviewed, 221 had a DSM-IV-TR diagnosis of (1) primary psychotic disorder (schizophrenia or schizoaffective disorder), (2) bipolar disorder, or (3) recurrent major depressive disorder. Psychiatric disorders and demographic factors that predicted high service utilization were analyzed using analysis of variance and χ² tests.
In the linear predictive model, use of preventive services was not statistically different among the 3 diagnostic groups. Participants with primary psychotic disorder used a similar number of preventive services compared to those with bipolar disorder and major depression. Women used more services than men (P < .01), and individuals with health insurance used more than uninsured participants (P < .001).
Male gender and not having medical insurance were predictive of lower preventive health service use in this sample of patients with severe mental illness. Further research is needed to replicate these findings and to improve use of preventive health services in people with severe mental illness.
本研究通过检查精神科诊断和人口统计学因素，探讨严重精神疾病患者预防性健康服务使用减少的预测因素。
2005年1月至2007年5月期间，在4家社区精神卫生诊所对387名患者进行了关于其预防性健康服务使用情况的询问，其中234名（60.5%）接受了访谈。在接受访谈的参与者中，221人符合《精神疾病诊断与统计手册》第四版修订版（DSM-IV-TR）的诊断标准，患有以下疾病之一：（1）原发性精神障碍（精神分裂症或分裂情感性障碍）、（2）双相情感障碍或（3）复发性重度抑郁症。使用方差分析和χ²检验分析预测高服务利用率的精神障碍和人口统计学因素。
在线性预测模型中，三个诊断组之间预防性服务的使用在统计学上没有差异。原发性精神障碍患者使用的预防性服务数量与双相情感障碍和重度抑郁症患者相似。女性使用的服务比男性多（P <.01），有医疗保险的个体比没有医疗保险的参与者使用的服务多（P <.001）。
在这个严重精神疾病患者样本中，男性和没有医疗保险是预防性健康服务使用较低的预测因素。需要进一步研究来重复这些发现，并改善严重精神疾病患者预防性健康服务的使用情况。
