Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, USA.
Psychiatr Serv. 2013 Apr 1;64(4):366-72. doi: 10.1176/appi.ps.201200272.
This study examined patterns, determinants, and costs of seeking care for mild to moderate psychiatric distress in order to determine optimal approaches for expanding mental health care in rural Haiti.
A cross-sectional, zone-stratified household survey of 408 adults was conducted in Haiti's Central Plateau. Multivariable logistic regression models were built to assess determinants of first-choice and lifetime health service use by provider type.
Thirty-two percent of respondents endorsed God as their first choice for care if suffering from mental distress, and 29% of respondents endorsed clinics and hospitals as their first choice. Forty-seven percent of respondents chose potential providers on the basis of anticipated efficacy. Suicidal individuals were 7.6 times (95% confidence interval [CI]=1.4-42.0) as likely to prefer community-based providers (herbal healer, church priest or pastor, or Vodou priest) over hospitals or clinics. Depression severity was associated with increased odds (adjusted odds ratio [AOR]=1.8, CI=1.5-2.3) of ever having been to an herbal healer. Having a household member with mental health problems was associated with increased odds of ever having been to church pastors or priests (AOR=5.8, CI=2.8-12.0) and decreased odds of ever having been to hospitals or clinics (AOR=.3, CI=.1-.8). Median actual service costs were US $1 for hospitals or clinics, $6 for herbal healers, and $120 for Vodou priests.
Three out of four rural Haitians said they would seek community resources over clinical care if suffering from mental distress. Therefore, isolated clinical interventions may have limited impact because of less frequent use. Efforts to expand mental health care should consider differential provider costs when selecting community resources for task shifting.
本研究旨在探讨轻度至中度精神困扰患者寻求医疗服务的模式、决定因素和费用，以确定在海地农村地区扩大精神卫生保健的最佳方法。
在海地中央高原进行了一项横断面、分区分层的家庭调查，调查了 408 名成年人。采用多变量逻辑回归模型，评估了按提供者类型选择首选和终生卫生服务的决定因素。
32%的受访者表示，如果精神困扰，他们会首先选择上帝作为治疗者，29%的受访者会选择诊所和医院作为首选。47%的受访者根据预期疗效选择潜在的提供者。有自杀念头的人更倾向于选择社区为基础的提供者（草药治疗师、教堂牧师或牧师或伏都教牧师）而不是医院或诊所，其可能性是 7.6 倍（95%置信区间[CI]=1.4-42.0）。抑郁严重程度与曾接受草药治疗师治疗的几率增加相关（调整后的优势比[AOR]=1.8，CI=1.5-2.3）。家中有精神健康问题的人更有可能曾去教堂牧师或牧师（AOR=5.8，CI=2.8-12.0），而不太可能曾去医院或诊所（AOR=0.3，CI=0.1-0.8）。实际服务费用中位数为：医院或诊所为 1 美元，草药治疗师为 6 美元，伏都教牧师为 120 美元。
如果患有精神困扰，四分之三的海地农村居民表示他们会选择社区资源而不是临床护理。因此，由于使用频率较低，孤立的临床干预可能影响有限。在选择社区资源进行任务转移以扩大精神卫生保健时，应考虑不同提供者的成本。
