School of Public Health, University of Minnesota, Minneapolis, Minnesota.
Health Science Department, California State University-Long Beach, Long Beach, California.
J Womens Health (Larchmt). 2019 Sep;28(9):1286-1294. doi: 10.1089/jwh.2018.7551. Epub 2019 Jun 7.
Reproductive-age women have a high rate of contact with the health care system for reproductive health care. Yet, beyond pregnancy, little is known about psychological distress and unmet health care needs among these women. We examined reasons for delayed medical care and types of foregone care by level of psychological distress. We used a nationally representative sample of U.S. women aged 18-49, from the 2015-2016 National Health Interview Survey. Using the K6 screening tool for nonspecific psychological distress, we examined differences in reasons for delayed care and types of care foregone due to cost by level of psychological distress (none, moderate psychological distress [MPD], and severe psychological distress [SPD]). Overall, 20% of U.S. women aged 18-49 had MPD (16%) or SPD (4%), equating to nearly 13 million women of reproductive age living with psychological distress. Women with SPD or MPD are more likely to have delayed and foregone care. Notably, women with SPD have higher odds of needing but not receiving mental health care (adjusted odds ratios [AOR] = 12.4, 95% confidence interval [CI] 8.4-18.4), specialist care (AOR = 3.6, 95% CI 2.6-5.1), and follow-up care (AOR = 3.5, 95% CI 2.4-5.1) due to cost than women with no psychological distress. Cost is the greatest barrier to timely medical care for women with MPD and SPD. Women of reproductive age with psychological distress face considerable structural and cost-related barriers to accessing health care, which may be exacerbated by their psychological state. Despite recent policy advances such as the Affordable Care Act, additional efforts by policymakers and providers are crucial to address the needs of this population.
育龄妇女在生殖健康护理方面与医疗保健系统的接触率很高。然而，除了怀孕之外，对于这些女性的心理困扰和未满足的医疗保健需求知之甚少。我们研究了心理困扰程度不同的女性延迟医疗护理的原因和放弃护理的类型。我们使用了来自 2015-2016 年全国健康访谈调查的美国 18-49 岁女性的全国代表性样本。使用 K6 筛选工具评估非特异性心理困扰，我们研究了心理困扰程度（无、中度心理困扰 [MPD] 和重度心理困扰 [SPD]）不同的女性延迟护理的原因和因费用而放弃的护理类型。总的来说，20%的美国 18-49 岁女性有 MPD（16%）或 SPD（4%），这相当于近 1300 万育龄妇女患有心理困扰。有 SPD 或 MPD 的女性更有可能延迟和放弃护理。值得注意的是，与没有心理困扰的女性相比，患有 SPD 的女性更有可能需要但未获得心理健康护理（调整后的优势比 [AOR] = 12.4，95%置信区间 [CI] 8.4-18.4）、专科护理（AOR = 3.6，95%CI 2.6-5.1）和随访护理（AOR = 3.5，95%CI 2.4-5.1），原因是费用。对于 MPD 和 SPD 女性来说，费用是及时获得医疗护理的最大障碍。有心理困扰的育龄妇女在获得医疗保健方面面临相当大的结构性和与费用相关的障碍，而她们的心理状态可能会使这些障碍恶化。尽管最近的政策取得了进展，例如《平价医疗法案》，但政策制定者和提供者仍需做出更多努力，以满足这一人群的需求。
