Veterans Affairs (VA) Desert Pacific Mental Illness Research, Education and Clinical Center (MIRECC), 11301 Wilshire Blvd. (210A), Los Angeles, CA 90073, USA.
Psychiatr Serv. 2013 Mar 1;64(3):257-63. doi: 10.1176/appi.ps.201200176.
Despite robust evidence of efficacy, family services for individuals diagnosed as having serious mental illness are of limited availability and drastically underutilized. This underutilization may be due to a mismatch between consumer and family preferences and the services offered. This study is the first systematic report on preferences expressed by consumers with serious mental illness for family involvement.
The study enrolled 232 mental health consumers with serious mental illness who had contact with family but did not have any family regularly involved in their mental health care. Consumers were recruited from outpatient mental health clinics at three large medical centers in two Veterans Integrated Service Networks. Interviews elicited demographic characteristics, treatment preferences regarding family involvement, and perceived benefits and barriers to involvement. Chart diagnoses and measures of symptom severity, family functioning, and contact were collected.
Seventy-eight percent (171 of 219) of the consumers wanted family members to be involved in their care, and many desired involvement through several methods. Consumers were concerned with the impact of involvement on both themselves and their family member. The consumer's degree of perceived benefit of family involvement significantly predicted the degree of desire for family involvement after analyses controlled for service need (family conflict, family-related quality of life, and symptom severity), enabling factors (family contact and family capacity), demographic variables (age, gender, race, living with family, and marital status), and barriers perceived by the consumer.
The extent of overall support for family involvement in care coupled with the heterogeneity of preferred modes and concerns and anticipated benefits underscore the imperative to offer diverse family services and to elicit consumers' preferences regarding whether and how to involve their families.
尽管有大量疗效确凿的证据，但针对被诊断患有严重精神疾病的个体的家庭服务的可及性有限，且利用率极低。这种低利用率可能是由于消费者和家庭的偏好与所提供的服务之间不匹配所致。本研究首次系统报告了患有严重精神疾病的消费者对家庭参与的偏好。
该研究纳入了 232 名曾与家人接触但没有任何家人定期参与其精神卫生保健的患有严重精神疾病的精神卫生消费者。消费者是从两个退伍军人综合服务网络中的三个大型医疗中心的门诊精神科诊所招募的。访谈引出了人口统计学特征、对家庭参与的治疗偏好，以及对参与的感知益处和障碍。还收集了图表诊断和症状严重程度、家庭功能和接触的衡量标准。
78%（219 名中的 171 名）的消费者希望家庭成员参与他们的护理，并且许多人希望通过几种方法来参与。消费者关注参与对自己和家庭成员的影响。在对服务需求（家庭冲突、与家庭相关的生活质量和症状严重程度）、促进因素（家庭接触和家庭能力）、人口统计学变量（年龄、性别、种族、与家人同住和婚姻状况）以及消费者感知到的障碍进行分析后，消费者对家庭参与的感知益处程度显著预测了对家庭参与的渴望程度。
对家庭参与护理的总体支持程度，加上对偏好模式和关注的异质性以及预期益处的认识，突显了提供多样化家庭服务以及了解消费者是否以及如何参与其家庭的必要性。
