Han Beth, Olfson Mark, Mojtabai Ramin
Substance Abuse and Mental Health Services Administration, Rockville, MD, USA.
Department of Psychiatry, College of Physicians and Surgeon, Columbia University, New York, NY, USA.
Depress Anxiety. 2017 Mar;34(3):291-300. doi: 10.1002/da.22592. Epub 2017 Feb 2.
We compared the prevalence of receiving depression care between adults with past-year major depressive episodes (depressed) and substance use disorders (SUD) in the United States and their depressed counterparts without SUD.
Data were from 25,500 adults who participated in the 2008-2014 National Surveys on Drug Use and Health. Descriptive analyses and logistic regression models were applied.
During 2008-2014, approximately 55.4% of depressed U.S. adults with SUD received past-year depression care, while 60.1% of depressed adults without SUD received such care. Overall, co-occurring SUD was associated with an 8% decreased likelihood of receiving past-year depression care (risk ratio (RR) = 0.92, 95% CI = 0.89-0.96). For depressed adults with severe functional impairment, co-occurring SUD was associated with a 9% decreased likelihood of receiving past-year depression care (RR = 0.91, 95% CI = 0.87-0.95). For depressed men, co-occurring SUD was associated with a 13% decreased likelihood of receiving past-year depression care (RR = 0.87, 95% CI = 0.81-0.94). The following depressed adults were at increased risk of not receiving depression care: those without functional impairment, without suicidal ideation, and without physical comorbidities, aged 18-29, male, racial/ethnic minorities, having less than high school education, uninsured, and never married.
Among depressed adults in the United States, comorbid SUD modestly but significantly decreases the likelihood of receiving past-year depression care. Depressed young adults, men, racial/ethnic minorities, less educated individuals, uninsured adults, and never married adults are also at increased risk for not receiving depression care. Outreach efforts are needed to broaden access to depression care for these underserved adults.
我们比较了美国过去一年有重度抑郁发作（抑郁）的成年人与有物质使用障碍（SUD）的成年人以及无SUD的抑郁成年人接受抑郁症护理的患病率。
数据来自25500名参与2008 - 2014年全国药物使用和健康调查的成年人。应用描述性分析和逻辑回归模型。
在2008 - 2014年期间，约55.4%有SUD的美国抑郁成年人接受了过去一年的抑郁症护理，而无SUD的抑郁成年人中这一比例为60.1%。总体而言，共病SUD与过去一年接受抑郁症护理的可能性降低8%相关（风险比（RR）=0.92，95%置信区间（CI）=0.89 - 0.96）。对于有严重功能障碍的抑郁成年人，共病SUD与过去一年接受抑郁症护理的可能性降低9%相关（RR = 0.91，95% CI = 0.87 - 0.95）。对于抑郁男性，共病SUD与过去一年接受抑郁症护理的可能性降低13%相关（RR = 0.87，95% CI = 0.81 - 0.94）。以下抑郁成年人未接受抑郁症护理的风险增加：无功能障碍、无自杀意念、无躯体合并症、年龄在18 - 29岁、男性、少数种族/族裔、高中以下学历、未参保以及从未结婚者。
在美国抑郁成年人中，共病SUD适度但显著降低了过去一年接受抑郁症护理的可能性。抑郁的年轻人、男性、少数种族/族裔、受教育程度较低者、未参保成年人以及从未结婚的成年人未接受抑郁症护理的风险也增加。需要开展外展工作，以扩大这些未得到充分服务成年人获得抑郁症护理的机会。
