Developmental Psychology,Department of Psychology,Rijksuniversiteit Groningen,Groningen,the Netherlands.
Department of Psychiatry,University Medical Center Groningen,Groningen,The Netherlands.
Epidemiol Psychiatr Sci. 2018 Dec;27(6):552-567. doi: 10.1017/S2045796017000774. Epub 2017 Dec 28.
A substantial proportion of persons with mental disorders seek treatment from complementary and alternative medicine (CAM) professionals. However, data on how CAM contacts vary across countries, mental disorders and their severity, and health care settings is largely lacking. The aim was therefore to investigate the prevalence of contacts with CAM providers in a large cross-national sample of persons with 12-month mental disorders.
In the World Mental Health Surveys, the Composite International Diagnostic Interview was administered to determine the presence of past 12 month mental disorders in 138 801 participants aged 18-100 derived from representative general population samples. Participants were recruited between 2001 and 2012. Rates of self-reported CAM contacts for each of the 28 surveys across 25 countries and 12 mental disorder groups were calculated for all persons with past 12-month mental disorders. Mental disorders were grouped into mood disorders, anxiety disorders or behavioural disorders, and further divided by severity levels. Satisfaction with conventional care was also compared with CAM contact satisfaction.
An estimated 3.6% (standard error 0.2%) of persons with a past 12-month mental disorder reported a CAM contact, which was two times higher in high-income countries (4.6%; standard error 0.3%) than in low- and middle-income countries (2.3%; standard error 0.2%). CAM contacts were largely comparable for different disorder types, but particularly high in persons receiving conventional care (8.6-17.8%). CAM contacts increased with increasing mental disorder severity. Among persons receiving specialist mental health care, CAM contacts were reported by 14.0% for severe mood disorders, 16.2% for severe anxiety disorders and 22.5% for severe behavioural disorders. Satisfaction with care was comparable with respect to CAM contacts (78.3%) and conventional care (75.6%) in persons that received both.
CAM contacts are common in persons with severe mental disorders, in high-income countries, and in persons receiving conventional care. Our findings support the notion of CAM as largely complementary but are in contrast to suggestions that this concerns person with only mild, transient complaints. There was no indication that persons were less satisfied by CAM visits than by receiving conventional care. We encourage health care professionals in conventional settings to openly discuss the care patients are receiving, whether conventional or not, and their reasons for doing so.
相当一部分患有精神障碍的人会寻求补充和替代医学（CAM）专业人士的治疗。然而，关于 CAM 接触在不同国家、不同精神障碍及其严重程度以及医疗保健环境中的差异的数据在很大程度上仍然缺乏。因此，本研究旨在调查在一个有 12 个月精神障碍的大型跨国样本中，CAM 提供者接触的流行率。
在世界心理健康调查中，采用复合国际诊断访谈来确定来自代表性的一般人群样本的 138801 名 18-100 岁参与者在过去 12 个月内是否存在精神障碍。参与者于 2001 年至 2012 年期间招募。为所有过去 12 个月有精神障碍的人计算了来自 25 个国家的 28 项调查中的每一项调查中自我报告的 CAM 接触率，以及 12 个精神障碍组。将精神障碍分为情绪障碍、焦虑障碍或行为障碍，并按严重程度进一步划分。还比较了对常规护理的满意度与对 CAM 接触的满意度。
估计有 3.6%（标准误差 0.2%）的过去 12 个月有精神障碍的人报告了 CAM 接触，而在高收入国家（4.6%；标准误差 0.3%）的这一比例是低收入和中等收入国家（2.3%；标准误差 0.2%）的两倍。不同类型的障碍 CAM 接触基本相似，但在接受常规护理的人群中尤其高（8.6-17.8%）。CAM 接触随着精神障碍严重程度的增加而增加。在接受专业心理健康护理的人群中，严重情绪障碍者报告 CAM 接触的比例为 14.0%，严重焦虑障碍者为 16.2%，严重行为障碍者为 22.5%。在同时接受 CAM 接触和常规护理的人群中，对护理的满意度与 CAM 接触（78.3%）和常规护理（75.6%）相当。
CAM 接触在严重精神障碍患者、高收入国家以及接受常规护理的患者中很常见。我们的发现支持 CAM 主要是补充性的观点，但与暗示 CAM 仅针对轻度、短暂投诉的观点相反。没有迹象表明 CAM 访问的患者满意度低于常规护理。我们鼓励常规环境中的医疗保健专业人员公开讨论患者正在接受的护理，无论是常规护理还是非常规护理，以及他们这样做的原因。
