Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, LVR-Klinikum Düsseldorf, Bergische Landstr 2, 40629 Düsseldorf, Germany.
Eur Arch Psychiatry Clin Neurosci. 2012 Nov;262 Suppl 2:S51-5. doi: 10.1007/s00406-012-0363-2. Epub 2012 Sep 2.
The analysis of the utilization of mental healthcare services using routine data provided by statutory health insurance companies and pension funds is a way to assess the frequency of service use, the distribution of the service use among various healthcare settings (inpatients vs. outpatients, rehabilitation according mainly to the German Social Code Book IX vs. curative treatment according to the German Social Code Book V [note that some elements of rehabilitation are financed according to Social Code Book V as well]) and medical disciplines (psychiatry and psychosomatic medicine vs. somatic disciplines and general medicine). In addition, these data can provide information on the social consequences of mental disorders, as assessed by the number of cases and the duration of sick leave or case numbers of early retirement due to mental disorders. In this study, healthcare utilization data from 10 million Germans were analysed. Within a 3 year observation period (2005-2007), about one-third (approx. 3.3 million) persons had a contact with a healthcare service due to a diagnosis of the ICD-10 groups F0-F5. Given the large number of persons with depression in Germany, the initial results of an analysis of mental healthcare utilization due to depression are presented here. Among the study group of 3.3 million Germans with mental healthcare utilization within the observation period, 1.4 million had at least one contact to healthcare system due to the diagnosis of depression. In most cases, depression was diagnosed without specification of severity. It was found that non-psychiatric disciplines like general practitioners were the most frequently used providers in outpatient mental health care, whereas inpatient treatment predominantly occurred in psychiatric departments. For those persons with depression for which a severity-indicating ICD-10 code was used, it was found that utilization of psychiatric and psychosomatic disciplines increased in both in- and outpatient treatment compared to use of general medical facilities with more severe depression. Specialists for psychosomatic medicine and psychological psychotherapists predominantly treated cases of mild and moderate depression, whereas severe cases were mostly cared for by psychiatrists or psychiatric departments.
利用法定健康保险公司和养老金提供的常规数据来分析精神保健服务的利用情况，是评估服务利用频率、服务在各种保健环境（住院与门诊、主要依据《德国社会法典第九卷》进行康复治疗与依据《德国社会法典第五卷》进行的治疗性治疗）和医疗学科（精神病学和身心医学与躯体学科和普通医学）之间分布的一种方法。此外，这些数据还可以提供有关精神障碍的社会后果的信息，其评估指标是病例数量和病假时间或因精神障碍提前退休的病例数量。在这项研究中，分析了 1000 万德国人的保健利用数据。在 3 年的观察期（2005-2007 年）内，约有三分之一（约 330 万人）因 ICD-10 组 F0-F5 的诊断而与保健服务有过接触。鉴于德国抑郁症患者人数众多，因此此处介绍了由于抑郁症而对精神保健利用情况进行分析的初步结果。在观察期内有精神保健利用的 330 万德国人的研究组中，有 140 万人因抑郁症的诊断而至少与医疗系统有过一次接触。在大多数情况下，抑郁症的诊断没有具体说明严重程度。结果发现，在门诊精神保健中，非精神病学学科（如全科医生）是最常使用的提供者，而住院治疗主要发生在精神科。对于那些因抑郁症而使用了指明严重程度的 ICD-10 代码的患者，发现与使用更严重的抑郁症的普通医疗设施相比，精神病学和身心医学学科在门诊和住院治疗中的利用都有所增加。身心医学专家和心理心理治疗师主要治疗轻度和中度抑郁症病例，而严重病例则主要由精神病医生或精神科部门照顾。
