Sareen Jitender, Wang Yunqiao, Mota Natalie, Henriksen Christine A, Bolton James, Lix Lisa M, Mojtabai Ramin, Bienvenu O Joseph, Crum Rosa M, Afifi Tracie O
Dr. Sareen and Dr. Bolton are with the Department of Psychiatry, Ms. Wang and Ms. Henriksen are with the Department of Psychology, Dr. Mota is with the Department of Clinical Health Psychology, and Dr. Lix and Dr. Afifi are with the Department of Community Health Sciences, all at the University of Manitoba, Winnipeg, Manitoba, Canada. Dr. Mojtabai is with the Department of Mental Health, Johns Hopkins School of Public Health, Dr. Bienvenu is with the Department of Psychiatry and Behavioral Sciences, and Dr. Crum is with the Department of Epidemiology, Johns Hopkins University, Baltimore. Send correspondence to Dr. Sareen (e-mail:
Psychiatr Serv. 2016 Jan;67(1):62-70. doi: 10.1176/appi.ps.201400317. Epub 2015 Nov 16.
Because of pervasive poor general medical and mental health status among patients receiving Medicaid, there has been substantial debate about whether Medicaid, as currently financed and delivered, is better than no insurance. The study aimed to address whether insurance status is associated with the subsequent incidence and persistence of common mental disorders.
Data came from a nationally representative U.S. population-based longitudinal survey that assessed mental disorders at two time points three years apart. Propensity score methods were used to adjust for potential confounding and to assess the association between three mutually exclusive insurance status groups (no insurance, private insurance only, and Medicaid only) and the subsequent incidence and persistence of mood, anxiety, and substance use disorders for persons ages 18-65 (N=26,410).
Compared with private insurance, lack of insurance was associated with higher odds of both the incidence and persistence of substance use disorders and with higher odds of persistence of any mood or anxiety disorder. Compared with having private insurance, having Medicaid insurance was associated with increased odds of persistent mood and anxiety disorders during follow-up. Overall, findings did not significantly differ between the uninsured and Medicaid groups.
The findings do not support prior reports that U.S. adults with Medicaid have worse mental health outcomes than uninsured adults. Lacking insurance may put individuals at higher risk of developing substance use disorders, and uninsured individuals with preexisting mental conditions were more likely to have mood, anxiety, and substance use problems that persist over time.
由于接受医疗补助计划的患者普遍存在较差的总体医疗和心理健康状况，对于现行筹资和实施方式下的医疗补助计划是否优于无保险，一直存在大量争论。该研究旨在探讨保险状况是否与常见精神障碍的后续发病率及持续存在情况相关。
数据来自一项具有全国代表性的基于美国人群的纵向调查，该调查在相隔三年的两个时间点评估精神障碍情况。倾向得分法用于调整潜在的混杂因素，并评估三个相互排斥的保险状况组（无保险、仅私人保险、仅医疗补助计划）与18至65岁人群（N = 26,410）情绪、焦虑和物质使用障碍的后续发病率及持续存在情况之间的关联。
与私人保险相比，无保险与物质使用障碍的发病率及持续存在几率较高相关，也与任何情绪或焦虑障碍持续存在的几率较高相关。与拥有私人保险相比，拥有医疗补助计划保险与随访期间持续性情绪和焦虑障碍的几率增加相关。总体而言，未参保组和医疗补助计划组的结果无显著差异。
研究结果不支持先前的报告，即参加医疗补助计划的美国成年人心理健康结果比未参保成年人更差。缺乏保险可能使个体患物质使用障碍的风险更高，并且已有精神疾病的未参保个体更有可能长期存在情绪、焦虑和物质使用问题。
