在欧盟国家中，精神障碍的服务利用是否存在性别差异？来自欧盟-世界精神卫生调查的结果。

Are there gender differences in service use for mental disorders across countries in the European Union? Results from the EU-World Mental Health survey.

机构信息

Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057 Paris Descartes University, Paris, France.

Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057 Paris Descartes University, Paris, France Inserm UMR_S1136, Institut Pierre-Louis d'Epidemiologie et de Santé Publique, Paris, France.

出版信息

J Epidemiol Community Health. 2014 Jul;68(7):649-56. doi: 10.1136/jech-2013-202962. Epub 2014 Mar 10.

DOI:10.1136/jech-2013-202962

PMID:24616352

Abstract

BACKGROUND

Women are more likely than men to use mental healthcare (MHC) due to differences in the types of problems and help-seeking behaviours. The consistency of this relationship across European countries, whose MHC organisation differs substantially, is unknown.

METHODS

Lifetime MHC-use and the type of MHC provider were assessed in 37 289 participants from the EU-World Mental Health (EU-WMH) survey, including 10 European countries (Northern Ireland, The Netherlands, Belgium, Germany, France, Spain, Italy, Portugal, Bulgaria and Romania). Lifetime mood/anxiety disorders (DSM-IV) and severity were evaluated using the CIDI V.3.0.

RESULTS

MHC use was significantly higher for women than men in every country except for Romania (overall OR=1.80, 95% CI1.64 to 1.98), while remaining so after adjusting for socioeconomic characteristics (age, income level, employment status, education, marital status; adjusted OR=1.87, 95% CI 1.69 to 2.06) and country-level indicators (MHC provision, private household out-of-pocket expenditure, and Gender Gap Index; adjusted OR=1.89, 95% CI 1.71 to 2.08). Compared with men, women were also more likely to consult general practitioners (GP) versus specialised MHC (OR=1.32, 95% CI 1.12 to 1.56) with high between-country variability. In participants with mood disorder, the gender relationship in MHC use and type of MHC did not change. Conversely, in participants with anxiety disorder, no significant gender relationship in MHC use was observed (adjusted OR=1.21, 95% CI 0.99 to 1.47). Finally, men with severe mental health problems had a significantly higher odds of MHC use (OR=14.70) when compared with women with similar levels (OR=8.95, p for interaction=0.03) after adjusting for socioeconomic characteristics and country-level indicators.

CONCLUSIONS

Women use MHC and GPs more frequently than men, yet this depends on the type and severity of mental health problems.

摘要

背景

由于问题类型和寻求帮助行为的差异，女性比男性更有可能使用精神卫生保健（MHC）。在 MHC 组织差异很大的欧洲国家，这种关系是否一致尚不清楚。

方法

在欧盟-世界精神卫生调查（EU-WMH）中，对来自 10 个欧洲国家（北爱尔兰、荷兰、比利时、德国、法国、西班牙、意大利、葡萄牙、保加利亚和罗马尼亚）的 37289 名参与者评估了终生 MHC 使用情况和 MHC 提供者类型。使用 CIDI V.3.0 评估终生情绪/焦虑障碍（DSM-IV）和严重程度。

结果

除罗马尼亚外，每个国家的女性 MHC 使用均显著高于男性（总体 OR=1.80，95%CI1.64 至 1.98），而在调整了社会经济特征（年龄、收入水平、就业状况、教育程度、婚姻状况）和国家层面指标（MHC 提供、私人家庭自付支出和性别差距指数）后仍然如此（调整后的 OR=1.87，95%CI 1.69 至 2.06）（调整后的 OR=1.89，95%CI 1.71 至 2.08）。与男性相比，女性也更有可能咨询全科医生（GP）而不是专门的 MHC（OR=1.32，95%CI 1.12 至 1.56），且各国之间存在高度差异。在患有情绪障碍的参与者中，MHC 使用和 MHC 类型的性别关系没有改变。相反，在患有焦虑症的参与者中，MHC 使用的性别关系不显著（调整后的 OR=1.21，95%CI 0.99 至 1.47）。最后，与患有类似严重程度精神健康问题的女性相比，患有严重精神健康问题的男性使用 MHC 的几率显著更高（OR=14.70），调整社会经济特征和国家层面指标后（OR=8.95，交互检验 p 值=0.03）。