School of Public Health,The University of Queensland,Herston,Queensland 4006,Australia.
Centre for Mental Health,Melbourne School of Population and Global Health,The University of Melbourne,Melbourne,Victoria 3010,Australia.
Epidemiol Psychiatr Sci. 2016 Dec;25(6):548-561. doi: 10.1017/S2045796015000876. Epub 2015 Oct 2.
To examine: (1) gender-specific determinants of help-seeking for mental health, including health professional consultation and the use of non-clinical support services and self-management strategies (SS/SM) and; (2) gender differences among individuals with unmet perceived need for care.
Analyses focused on 689 males and 1075 females aged 16-85 years who met ICD-10 criteria for a past-year affective, anxiety or substance use disorder in an Australian community-representative survey. Two classifications of help-seeking for mental health in the previous year were created: (1) no health professional consultation or SS/SM, or health professional consultation, or SS/SM only, and; (2) no general practitioner (GP) or mental health professional consultation, or GP only consultation, or mental health professional consultation. Between- and within-gender help-seeking patterns were explored using multinomial logistic regression models. Characteristics of males and females with unmet perceived need for care were compared using chi-square tests.
Males with mental or substance use disorders had relatively lower odds than females of any health professional consultation (adjusted odds ratio [AOR] = 0.46), use of SS/SM only (AOR = 0.59), and GP only consultation (AOR = 0.29). Notably, males with severe disorders had substantially lower odds than females of any health professional consultation (AOR = 0.29) and GP only consultation (AOR = 0.14). Most correlates of help-seeking were need-related. Many applied to both genders (e.g., severity, disability, psychiatric comorbidity), although some were male-specific (e.g., past-year reaction to a traumatic event) or female-specific (e.g., past-year affective disorder). Certain enabling and predisposing factors increased the probability of health professional consultation for both genders (age 30+ years) or for males (unmarried, single parenthood, reliance on government pension). Males with unmet perceived need for care were more likely to have experienced a substance use disorder and to want medicine or tablets or social intervention, whereas their females peers were more likely to have experienced an anxiety disorder and to want counselling or talking therapy. For both genders, attitudinal/knowledge barriers to receiving the types of help wanted (e.g., not knowing where to get help) were more commonly reported than structural barriers (e.g., cost).
Findings suggest a need to address barriers to help-seeking in males with severe disorders, and promote GP consultation. Exploring gender-specific attitudinal/knowledge barriers to receiving help, and the types of help wanted, may assist in designing interventions to increase consultation. Mental health promotion/education efforts could incorporate information about the content and benefits of evidence-based treatments and encourage males to participate in other potentially beneficial actions (e.g., physical activity).
研究(1)心理健康求助的性别决定因素,包括健康专业咨询以及使用非临床支持服务和自我管理策略(SS/SM);(2)未满足的护理需求个体之间的性别差异。
分析集中在澳大利亚社区代表性调查中患有过去一年情感、焦虑或物质使用障碍的 689 名男性和 1075 名 16-85 岁的女性。在过去一年中创建了两种心理健康求助分类:(1)没有健康专业咨询或 SS/SM,或只有健康专业咨询或 SS/SM,或;(2)没有全科医生(GP)或心理健康专业咨询,或只有 GP 咨询,或心理健康专业咨询。使用多项逻辑回归模型探讨了性别内和性别间的求助模式。使用卡方检验比较了有和没有未满足的护理需求的男性和女性的特征。
患有精神或物质使用障碍的男性与女性相比,接受任何健康专业咨询(调整后的优势比 [AOR] = 0.46)、仅使用 SS/SM(AOR = 0.59)或仅接受 GP 咨询(AOR = 0.29)的可能性相对较低。值得注意的是,严重障碍的男性与女性相比,接受任何健康专业咨询(AOR = 0.29)和仅接受 GP 咨询(AOR = 0.14)的可能性都低得多。求助的大多数相关性与需求有关。大多数相关性适用于两性(例如,严重程度、残疾、精神共病),尽管有些是男性特有的(例如,过去一年对创伤事件的反应)或女性特有的(例如,过去一年的情感障碍)。某些赋权和促成因素增加了两性(30 岁以上)或男性(未婚、单亲父母、依赖政府养老金)接受健康专业咨询的可能性。有未满足的护理需求的男性更有可能患有物质使用障碍,并希望接受药物或片剂或社会干预,而他们的女性同龄人更有可能患有焦虑症,并希望接受咨询或谈话治疗。对于两性来说,接受所需帮助类型的态度/知识障碍(例如,不知道在哪里可以获得帮助)比结构障碍(例如,成本)更常见。
研究结果表明,需要解决严重障碍男性寻求帮助的障碍,并促进 GP 咨询。探索接受帮助的性别特定态度/知识障碍以及所需的帮助类型,可能有助于设计增加咨询的干预措施。心理健康促进/教育工作可以纳入有关循证治疗内容和益处的信息,并鼓励男性参与其他可能有益的行动(例如,体育活动)。