Psychiatr Serv. 2014 Jan 1;65(1):59-67. doi: 10.1176/appi.ps.201200528.
The purpose of this study was to examine racial-ethnic differences in use of mental health treatment for a comprehensive range of specific disorders over time.
Data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey were used to examine adult outpatient mental health visits to U.S. physicians from 1993 to 2008 (N=754,497). Annual visit prevalence for three racial-ethnic groups was estimated as the number of visits divided by the group's U.S. population size. Visit prevalence ratios (VPRs) were calculated as the minority group's prevalence divided by the non-Hispanic white prevalence. Analyses were stratified by diagnosis, physician type, patient characteristics, and year.
VPRs for any disorder were .60 (95% confidence interval [CI]=.52-.68) for non-Hispanic blacks and .58 (CI=.50-.67) for Hispanics. Non-Hispanic blacks were treated markedly less frequently than whites for obsessive-compulsive, generalized anxiety, attention-deficit hyperactivity, personality, panic, and nicotine use disorders but more frequently for psychotic disorders. Hispanics were treated far less frequently than whites for bipolar I, impulse control, autism spectrum, personality, obsessive-compulsive, and nicotine use disorders but more frequently for drug use disorders. Racial-ethnic differences in visits to psychiatrists were generally greater than for visits to nonpsychiatrists. Differences declined with increasing patient age and appear to have widened over time.
Racial-ethnic differences in receipt of outpatient mental health treatment from U.S. physicians varied substantially by disorder, provider type, and patient age. Most differences were large and did not show improvement over time.
本研究旨在考察不同种族群体在一段时间内使用心理健康治疗特定疾病的情况。
本研究使用了 1993 年至 2008 年美国国家门诊医疗调查和国家医院门诊医疗调查的数据，调查了 754497 名成年患者到美国医生处进行的门诊心理健康治疗。通过将就诊人数除以群体的美国人口规模，计算出三个种族群体的年度就诊患病率。就诊流行率比（VPR）定义为少数民族群体的就诊率除以非西班牙裔白人的就诊率。分析根据诊断、医生类型、患者特征和年份进行分层。
任何疾病的 VPR 为非西班牙裔黑人 0.60（95%置信区间[CI]：0.52-0.68），西班牙裔为 0.58（CI：0.50-0.67）。与白人相比，非西班牙裔黑人治疗强迫症、广泛性焦虑症、注意缺陷多动障碍、人格障碍、惊恐障碍和尼古丁使用障碍的频率明显较低，但治疗精神病障碍的频率较高。与白人相比，西班牙裔治疗双相情感障碍 I 型、冲动控制障碍、自闭症谱系障碍、人格障碍、强迫症和尼古丁使用障碍的频率较低，但治疗药物使用障碍的频率较高。与非精神科医生相比，精神科医生就诊的种族差异通常更大。随着患者年龄的增长，差异逐渐缩小，而且似乎随着时间的推移而扩大。
美国医生提供的门诊心理健康治疗在不同种族群体之间存在显著差异，差异的程度取决于疾病、医生类型和患者年龄。大多数差异较大，且随着时间的推移没有改善。
