Hardy Cindy L, Kelly Karen D, Voaklander Don
Psychology Department, University of Northern British Columbia, Prince George, British Columbia, Canada.
Rural Remote Health. 2011;11(4):1766. Epub 2011 Oct 28.
Rural residence may reduce access to specialized mental health services. The objective of this study was to examine the role of rural residence in relation to service utilization. Using Canadian data collected in 2002, service use was examined as a function of the presence of anxiety or mood disorders and rural/urban residence. Use of four different types of professional mental health services was examined in relation to rural residence and additional demographic, social, and health status factors known to predict use of services.
Data were obtained from Statistics Canada's Canadian Mental Health Survey Cycle 1.2. Rural residence was defined as living in a rural community with a population of 1000 or less. For all participants, associations between the presence of anxiety or mood disorders, rural/urban residence, and any service use or use of specialized mental health services (psychiatry and psychology) were examined. For participants who had used professional services, associations were examined between 17 predictor variables, including location of residence, and the use of four types of service providers (family doctor or GP; nurse, social worker, counsellor, or psychotherapist; psychiatrist; or psychologist). Predictors included demographic, social, and health status variables. Cross-tabulated counts and adjusted odds ratios with 99% confidence intervals based on bootstrapped variance estimates were used to evaluate predictors.
Among the total sample (n = 35 140), 7.9% had used professional mental health services in the previous year. Among people who were likely to have had anxiety or mood disorders, rural or urban residence was not differentially related to past-year use of any professional services or specialized mental health services. Multivariate logistic regression was used to model factors predicting past year use of four different types of professional services. Location of residence was not a significant predictor of service utilization. Age, sex, race, level of education, degree of psychological distress, chronicity of distress, and the presence of anxiety or mood disorders predicted type of service used.
The notion that rural residence limits access to mental health services was not supported. Other demographic and health status indicators such as age, sex, race, education, distress, and type of illness were more important predictors of service utilization. However, null findings related to geographic residence must be interpreted cautiously due to the small sample of rural residents who sought mental health services. The mental health system in Canada must provide a variety of professional services in order to meet the preferences of diverse groups, and mental health specialists must find ways to adequately support general practice physicians and counsellors who provide mental health services.
居住在农村可能会减少获得专业心理健康服务的机会。本研究的目的是探讨农村居住情况与服务利用之间的关系。利用2002年收集的加拿大数据，将服务利用情况作为焦虑或情绪障碍的存在以及农村/城市居住情况的函数进行研究。考察了四种不同类型的专业心理健康服务的使用情况与农村居住情况以及已知可预测服务使用情况的其他人口统计学、社会和健康状况因素之间的关系。
数据取自加拿大统计局的加拿大心理健康调查第1.2轮。农村居住定义为居住在人口为1000或更少的农村社区。对于所有参与者，考察了焦虑或情绪障碍的存在、农村/城市居住情况与任何服务使用或专业心理健康服务（精神病学和心理学）使用之间的关联。对于使用过专业服务的参与者，考察了包括居住地点在内的17个预测变量与四种类型服务提供者（家庭医生或全科医生；护士、社会工作者、顾问或心理治疗师；精神科医生；或心理学家）的使用之间的关联。预测因素包括人口统计学、社会和健康状况变量。基于自抽样方差估计的交叉列表计数和调整后的优势比以及99%置信区间用于评估预测因素。
在总样本（n = 35140）中，7.9%的人在前一年使用过专业心理健康服务。在可能患有焦虑或情绪障碍的人群中，农村或城市居住情况与过去一年任何专业服务或专业心理健康服务的使用没有差异关系。多变量逻辑回归用于对预测过去一年使用四种不同类型专业服务的因素进行建模。居住地点不是服务利用的显著预测因素。年龄、性别、种族、教育程度、心理困扰程度、困扰的慢性程度以及焦虑或情绪障碍的存在可预测所使用的服务类型。
农村居住限制获得心理健康服务的这一观点未得到支持。其他人口统计学和健康状况指标，如年龄、性别、种族、教育程度、困扰和疾病类型，是服务利用更重要的预测因素。然而，由于寻求心理健康服务的农村居民样本较小，与地理居住相关的零结果必须谨慎解释。加拿大的心理健康系统必须提供各种专业服务，以满足不同群体的偏好，心理健康专家必须找到方法，充分支持提供心理健康服务的全科医生和顾问。
