Weissman Judith D, Russell David, Beasley Jeannette, Jay Melanie, Malaspina Dolores
New York University School of Medicine, Department of General Internal Medicine and Clinical Innovation, United States.
Center for Home Care Policy & Research, Visiting Nurse Service of New York, United States.
J Psychosom Res. 2016 Dec;91:75-81. doi: 10.1016/j.jpsychores.2016.10.010. Epub 2016 Nov 1.
Adults with serious psychological distress have a high likelihood of mental health problems severe enough to cause serious impairment in social and occupational functioning requiring treatment. These adults visit doctors frequently yet have poor health compared to adults without serious psychological distress. This study examined associations between emotional states of serious psychological distress in relationship to healthcare utilization indicators. A guiding hypothesis was that somatization underlying emotional states contributes to excessive healthcare seeking among adults with serious psychological distress.
Using 2006-2014 National Health Interview Survey, in adults with serious psychological distress (n=9271), the six states: unable to make efforts, nervousness, hopelessness, sadness, worthlessness and restlessness were assessed in multivariate models in relation to four healthcare utilization indicators: change in the usual place of healthcare, change due to insurance, having seen a healthcare provider in the last 6months and having 10 or more doctor visits in the last 12months. Models were adjusted for sociodemographic variables, having seen a mental health provider, and health conditions.
Adults feeling unable to make efforts were more likely to seek healthcare in the last 6months and at least ten times in the last twelve months. Adults feeling hopeless were less likely to be heavy healthcare utilizers.
Predisposing medical conditions do not fully explain healthcare utilization in adults with serious psychological distress. Educating healthcare providers about the emotional states motivating healthcare seeking, and integrating mental healthcare into primary care, may improve the health of adults with serious psychological distress.
患有严重心理困扰的成年人极有可能存在严重到足以导致社会和职业功能严重受损且需要治疗的心理健康问题。与没有严重心理困扰的成年人相比，这些成年人经常就医，但健康状况却较差。本研究调查了严重心理困扰的情绪状态与医疗保健利用指标之间的关联。一个指导性假设是，情绪状态背后的躯体化现象导致患有严重心理困扰的成年人过度寻求医疗保健。
利用2006 - 2014年国家健康访谈调查，在患有严重心理困扰的成年人（n = 9271）中，在多变量模型中评估了六种状态：无力努力、紧张、绝望、悲伤、无价值感和坐立不安，这些状态与四个医疗保健利用指标相关：医疗保健常规地点的变化、因保险原因导致的变化、在过去6个月内看过医疗保健提供者以及在过去12个月内有10次或更多次就诊。模型针对社会人口统计学变量、看过心理健康提供者以及健康状况进行了调整。
感到无力努力的成年人在过去6个月内更有可能寻求医疗保健，并且在过去12个月内至少就诊十次。感到绝望的成年人不太可能是频繁的医疗保健使用者。
易患疾病并不能完全解释患有严重心理困扰的成年人的医疗保健利用情况。让医疗保健提供者了解促使寻求医疗保健的情绪状态，并将心理保健纳入初级保健，可能会改善患有严重心理困扰的成年人的健康状况。
