Evans-Lacko S, Clement S, Corker E, Brohan E, Dockery L, Farrelly S, Hamilton S, Pinfold V, Rose D, Henderson C, Thornicroft G, McCrone P
Health Service and Population Research Department,Institute of Psychiatry,King's College London,De Crespigny Park,London E5 8AF,UK.
Epidemiol Psychiatr Sci. 2015 Oct;24(5):423-34. doi: 10.1017/S2045796014000377. Epub 2014 Jun 6.
This study builds on existing research on the prevalence and consequences of mental illness discrimination by investigating and quantifying the relationships between experienced discrimination and costs of healthcare and leisure activities/social participation among secondary mental health service users in England.
We use data from the Mental Illness-Related Investigations on Discrimination (MIRIAD) study (n = 202) and a subsample of the Viewpoint study (n = 190). We examine experiences of discrimination due to mental illness in the domains of personal relationships, community activities, and health care, and how such experienced discrimination relates to patterns of service use and engagement in leisure activities.
Our findings show that the cost of health services used for individuals who reported previous experiences of discrimination in a healthcare setting was almost twice as high as for those who did not report any discrimination during the last 12 months (Relative Risk: 1.73; 95% Confidence Interval (CI): 1.39, 2.17) and this was maintained after controlling for symptoms and functioning. Experienced discrimination in healthcare (Relative Risk: 0.83; 95% CI: 0.81, 0.84) or in relationships (Relative Risk: 0.89; 95% CI: 0.87, 0.91), however, was associated with lower participation in, and hence lower costs of, leisure activities. Individuals who reported any discrimination in a healthcare setting had, on average, £434 higher costs associated with health service use while reported discrimination in the community was associated with increased leisure costs of £32.
These findings make an important initial step towards understanding the magnitude of the costs of mental health-related discrimination.
本研究基于现有的关于精神疾病歧视的患病率及后果的研究,通过调查和量化英格兰二级心理健康服务使用者所经历的歧视与医疗保健及休闲活动/社会参与成本之间的关系来展开。
我们使用了来自精神疾病相关歧视调查(MIRIAD)研究(n = 202)和观点研究的一个子样本(n = 190)的数据。我们考察在人际关系、社区活动和医疗保健领域因精神疾病而遭受歧视的经历,以及这种经历的歧视如何与服务使用模式和休闲活动参与情况相关。
我们的研究结果表明,在医疗保健环境中报告有过歧视经历的个人所使用的医疗服务成本,几乎是在过去12个月中未报告任何歧视的个人的两倍(相对风险:1.73;95%置信区间(CI):1.39,2.17),并且在控制了症状和功能后这一情况依然存在。然而,在医疗保健(相对风险:0.83;95% CI:0.81,0.84)或人际关系(相对风险:0.89;95% CI:0.87,0.91)方面经历的歧视,与较低的休闲活动参与度相关,进而与较低的休闲活动成本相关。在医疗保健环境中报告有任何歧视的个人,与医疗服务使用相关的成本平均高出434英镑,而在社区中报告的歧视与休闲成本增加32英镑相关。
这些发现朝着理解与心理健康相关的歧视成本规模迈出了重要的第一步。