Coleman Karen J, Stewart Christine, Waitzfelder Beth E, Zeber John E, Morales Leo S, Ahmed Ameena T, Ahmedani Brian K, Beck Arne, Copeland Laurel A, Cummings Janet R, Hunkeler Enid M, Lindberg Nangel M, Lynch Frances, Lu Christine Y, Owen-Smith Ashli A, Trinacty Connie Mah, Whitebird Robin R, Simon Gregory E
Dr. Coleman is with the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (e-mail:
Psychiatr Serv. 2016 Jul 1;67(7):749-57. doi: 10.1176/appi.ps.201500217. Epub 2016 Apr 15.
The objective of this study was to characterize racial-ethnic variation in diagnoses and treatment of mental disorders in large not-for-profit health care systems.
Participating systems were 11 private, not-for-profit health care organizations constituting the Mental Health Research Network, with a combined 7,523,956 patients age 18 or older who received care during 2011. Rates of diagnoses, prescription of psychotropic medications, and total formal psychotherapy sessions received were obtained from insurance claims and electronic medical record databases across all health care settings.
Of the 7.5 million patients in the study, 1.2 million (15.6%) received a psychiatric diagnosis in 2011. This varied significantly by race-ethnicity, with Native American/Alaskan Native patients having the highest rates of any diagnosis (20.6%) and Asians having the lowest rates (7.5%). Among patients with a psychiatric diagnosis, 73% (N=850,585) received a psychotropic medication. Non-Hispanic white patients were significantly more likely (77.8%) than other racial-ethnic groups (odds ratio [OR] range .48-.81) to receive medication. In contrast, only 34% of patients with a psychiatric diagnosis (N=548,837) received formal psychotherapy. Racial-ethnic differences were most pronounced for depression and schizophrenia; compared with whites, non-Hispanic blacks were more likely to receive formal psychotherapy for their depression (OR=1.20) or for their schizophrenia (OR=2.64).
There were significant racial-ethnic differences in diagnosis and treatment of psychiatric conditions across 11 U.S. health care systems. Further study is needed to understand underlying causes of these observed differences and whether processes and outcomes of care are equitable across these diverse patient populations.
本研究的目的是描述大型非营利性医疗保健系统中精神障碍诊断和治疗方面的种族差异。
参与研究的系统是11家构成心理健康研究网络的私立非营利性医疗保健组织，2011年期间共有7523956名18岁及以上的患者接受了治疗。从所有医疗保健机构的保险理赔和电子病历数据库中获取诊断率、精神药物处方率以及接受正式心理治疗的总疗程数。
在该研究的750万患者中，有120万（15.6%）在2011年接受了精神科诊断。这在种族方面存在显著差异，美国原住民/阿拉斯加原住民患者的任何诊断率最高（20.6%），而亚洲患者的诊断率最低（7.5%）。在有精神科诊断的患者中，73%（N = 850585）接受了精神药物治疗。非西班牙裔白人患者比其他种族群体更有可能（77.8%）接受药物治疗（优势比[OR]范围为0.48 - 0.81）。相比之下，只有34%有精神科诊断的患者（N = 548837）接受了正式心理治疗。种族差异在抑郁症和精神分裂症方面最为明显；与白人相比，非西班牙裔黑人因抑郁症（OR = 1.20）或精神分裂症（OR = 2.64）接受正式心理治疗的可能性更大。
在美国11个医疗保健系统中，精神疾病的诊断和治疗存在显著的种族差异。需要进一步研究以了解这些观察到的差异的潜在原因，以及在这些不同患者群体中护理过程和结果是否公平。
