Blais Rebecca K, Tsai Jack, Southwick Steven M, Pietrzak Robert H
Dr. Blais is with the Department of Psychology, Utah State University, Logan (e-mail:
Psychiatr Serv. 2015 May 1;66(5):500-6. doi: 10.1176/appi.ps.201300469. Epub 2015 Feb 2.
Psychiatric disorders are more prevalent among older veterans compared with their civilian counterparts, but many veterans with symptoms of psychiatric disorders do not utilize mental health services. This study examined barriers and facilitators related to current mental health care utilization in a nationally representative sample of veterans ages 60 and older (N=2,025).
Using data from the National Health and Resilience in Veterans Study, the authors evaluated how predisposing, enabling, and need characteristics as well as perceived barriers to care were related to utilization of mental health care among older veterans.
A minority of veterans (N=130; weighted prevalence, 6%) reported current mental health care utilization. Among veterans (N=144) who screened positive for a current psychiatric disorder, 42 (weighted prevalence, 25%) were currently utilizing services. In the full sample, current utilization was associated with lifetime posttraumatic stress disorder or depression (odds ratio [OR]=5.88, 95% confidence interval [CI]=3.51-9.84), lifetime drug use disorder (OR=2.87, CI=1.59-5.17), severity of current psychiatric symptoms (OR=1.40, CI=1.19-1.65), general medical difficulties (OR=1.28, CI=1.10-1.50), and lower perceptions of stigma (OR=.80, CI=.68-.93). Non-Hispanic veterans were less likely to utilize care (OR=.42, CI=.25-.69). Among psychiatrically distressed veterans, current utilization was associated with younger age (OR=.89, CI=.81-.97), current suicidal ideation (OR=5.60, CI=1.98-15.84), and fewer negative beliefs about mental health care (OR=.23, CI=.09-.56).
Efforts to identify psychiatrically distressed veterans and to reduce stigma and negative beliefs about mental health care may help increase mental health service utilization among older U.S. veterans.
与普通民众相比，精神疾病在老年退伍军人中更为普遍，但许多有精神疾病症状的退伍军人并未使用心理健康服务。本研究在一个具有全国代表性的60岁及以上退伍军人样本（N = 2025）中，考察了与当前心理健康服务利用相关的障碍和促进因素。
利用退伍军人健康与复原力全国研究的数据，作者评估了 predisposing、 enabling 和需求特征以及感知到的护理障碍与老年退伍军人心理健康服务利用之间的关系。
少数退伍军人（N = 130；加权患病率为6%）报告目前正在使用心理健康服务。在目前筛查出患有精神疾病呈阳性的退伍军人（N = 144）中，有42人（加权患病率为25%）目前正在使用服务。在整个样本中，目前的服务利用与终生创伤后应激障碍或抑郁症（优势比[OR]=5.88，95%置信区间[CI]=3.51 - 9.84）、终生药物使用障碍（OR = 2.87，CI = 1.59 - 5.17）、当前精神症状的严重程度（OR = 1.40，CI = 1.19 - 1.65）、一般医疗困难（OR = 1.28，CI = 1.10 - 1.50）以及较低的耻辱感认知（OR = 0.80，CI = 0.68 - 0.93）相关。非西班牙裔退伍军人使用服务的可能性较小（OR = 0.42，CI = 0.25 - 0.69）。在有精神困扰的退伍军人中，目前的服务利用与较年轻年龄（OR = 0.89，CI = 0.81 - 0.97）、当前的自杀意念（OR = 5.60，CI = 1.98 - 15.84）以及对心理健康服务较少的负面信念（OR = 0.23，CI = 0.09 - 0.56）相关。
识别有精神困扰的退伍军人并减少对心理健康服务的耻辱感和负面信念的努力，可能有助于提高美国老年退伍军人的心理健康服务利用率。
