Deb Shreyasi, Miller Nancy A
Health Policy, American Academy of Orthopaedic Surgeons.
School of Public Policy, University of Maryland, Baltimore County.
Psychiatr Rehabil J. 2017 Jun;40(2):233-243. doi: 10.1037/prj0000230. Epub 2017 Mar 2.
Many working-age individuals with a serious mental health disability go without primary care. Gender and racial/ethnic disparities have been found in primary care utilization. This article examines whether the interaction of gender and race/ethnicity with serious mental health disability is associated with primary care use among working-age individuals.
We pooled data from the Medical Expenditure Panel Survey-Household Component (MEPS-HC) panels for the years 2001 to 2007 creating a sample of 34,199 individuals, 1,605 of whom had serious mental health disability. MEPS-HC is a nationally representative survey of the civilian noninstitutionalized population of the United States. We defined serious mental health disability as having scored less than 30 on the Mental Health Composite Score of the Short Form 12. Primary care visits were defined as nonspecialty, nonemergency visits to a physician's office or clinic. Zero-inflated Poisson regression models and bootstrapped predictive margins of visits were estimated using weights to account for survey design.
Relative to women, men with serious mental health disability had significantly more primary care visits and lower log odds of "zero" visits-the opposite pattern was found for people without serious mental health disability. We did not find a significant interaction between race/ethnicity and serious mental health disability.
Serious mental health disability appears to have differing impacts on men and women's use of primary care. There is a continued need to understand what differentiates users from nonusers among adults with serious mental health disability and the relative contribution of patient, provider, and system factors. (PsycINFO Database Record
许多患有严重精神疾病的劳动年龄个体未接受初级保健。在初级保健利用方面已发现性别和种族/族裔差异。本文探讨性别和种族/族裔与严重精神疾病之间的相互作用是否与劳动年龄个体的初级保健利用相关。
我们汇总了2001年至2007年医疗支出面板调查 - 家庭成分（MEPS - HC）各小组的数据，创建了一个由34,199人组成的样本，其中1,605人患有严重精神疾病。MEPS - HC是对美国非机构化平民人口具有全国代表性的调查。我们将严重精神疾病定义为在简短形式12的心理健康综合评分中得分低于30分。初级保健就诊定义为到医生办公室或诊所的非专科、非急诊就诊。使用权重估计零膨胀泊松回归模型和就诊的自举预测边际，以考虑调查设计。
与女性相比，患有严重精神疾病的男性有更多的初级保健就诊次数，且“零”就诊的对数几率更低——在没有严重精神疾病的人群中发现了相反的模式。我们没有发现种族/族裔与严重精神疾病之间存在显著的相互作用。
严重精神疾病似乎对男性和女性的初级保健利用有不同的影响。持续需要了解患有严重精神疾病的成年人中使用者与非使用者的差异所在，以及患者、提供者和系统因素的相对贡献。（PsycINFO数据库记录
