Crawford Eric F, Elbogen Eric B, Wagner H Ryan, Kudler Harold, Calhoun Patrick S, Brancu Mira, Straits-Troster Kristy A
VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center, Durham, North Carolina, USA; Duke University Medical Center, Department of Psychiatry & Behavioral Sciences, Durham, North Carolina, USA.
J Trauma Stress. 2015 Apr;28(2):118-26. doi: 10.1002/jts.21993. Epub 2015 Mar 27.
This study examined health care barriers and preferences among a self-selected sample of returning U.S. veterans drawn from a representative, randomly selected frame surveyed about posttraumatic stress disorder (PTSD) symptomatology and mental health utilization in the prior year. Comparisons between treated (n = 160) and untreated (n = 119) veterans reporting PTSD symptoms were conducted for measures of barriers and preferences, along with logistic models regressing mental health utilization on clusters derived from these measures. Reported barriers corroborated prior research findings as negative beliefs about treatment and stigma were strongly endorsed, but only privacy concerns were associated with lower service utilization (B = -0.408, SE = 0.142; p = .004). The most endorsed preference (91.0%) was for assistance with benefits, trailed by help for physical problems, and particular PTSD symptoms. Help-seeking veterans reported stronger preferences for multiple interventions, and desire for services for families (B = 0.468, SE = 0.219; p = .033) and specific PTSD symptoms (B = 0.659, SE = 0.302; p = .029) were associated with increased utilization. Outcomes of the study suggested PTSD severity drove help-seeking in this cohort. Results also support the integration of medical and mental health services, as well as coordination of health and benefits services. Finally, the study suggested that outreach about privacy protections and treatment options could well improve engagement in treatment.
本研究调查了从一个具有代表性的、随机抽取的样本中自行选择的回国美国退伍军人的医疗保健障碍和偏好，该样本在前一年接受了关于创伤后应激障碍（PTSD）症状和心理健康利用情况的调查。对报告有PTSD症状的已治疗退伍军人（n = 160）和未治疗退伍军人（n = 119）进行了障碍和偏好测量的比较，并建立了逻辑模型，将心理健康利用情况回归到从这些测量中得出的类别上。报告的障碍证实了先前的研究结果，即对治疗的负面信念和耻辱感得到了强烈认可，但只有隐私担忧与较低的服务利用率相关（B = -0.408，SE = 0.142；p = .004）。最受认可的偏好（91.0%）是获得福利援助，其次是身体问题帮助和特定的PTSD症状帮助。寻求帮助的退伍军人对多种干预措施的偏好更强，对家庭服务的需求（B = 0.468，SE = 0.219；p = .033）和特定PTSD症状的需求（B = 0.659，SE = 0.302；p = .029）与利用率增加相关。研究结果表明，PTSD严重程度推动了该队列中的求助行为。结果还支持医疗和心理健康服务的整合，以及健康和福利服务的协调。最后，研究表明，关于隐私保护和治疗选择的宣传很可能会提高治疗参与度。
