Department of Public Health & Primary Care, Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK.
Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK.
Int J Equity Health. 2019 Aug 5;18(1):122. doi: 10.1186/s12939-019-1026-y.
Unmet need for mental health services remains high in the United States and is disproportionately concentrated in some groups. The scale and nature of these disparities have not been fully elucidated and bear further scrutiny. As such, in this study, we examine the demographic, socioeconomic, and health correlates of unmet need for mental health treatment as well as the reasons for unmet need.
We draw upon the National Survey for Drug Use and Health (NSDUH) from 2002 to 16 for adults aged 18 and over in the United States (n = 579,017). Using multivariable logistic regression, we simultaneously model the demographic, socioeconomic, and health correlates of unmet need for mental health treatment from 2002 to 16. We also analyse the reasons for unmet need expressed by these populations, reasons which include cost, perceived stigma, minimisation of symptoms, low perceived effectiveness of treatment, and structural barriers.
Major characteristics associated with increased odds of unmet need include past year substance abuse or dependence (other than hallucinogens and sedatives), fair, poor, or very poor health, being female, and an educational attainment of college or higher. With respect to reasons for unmet need, cost was most often cited, followed by perceived stigma, structural barriers, and minimisation. Characteristics associated with increased odds of indicating cost as a reason for unmet need include: being uninsured or aged 26-35. Minimisation and low perceived effectiveness are mentioned by high-income persons as reasons for unmet need. College-educated persons and women had higher odds of citing structural barriers as a reason for unmet need.
The correlates and causes of unmet need highlight the intersectionality of individual health needs with implications on addressing inequities in mental health policy and practice.
在美国，心理健康服务的需求未得到满足的情况仍然很高，而且在某些群体中尤为集中。这些差距的规模和性质尚未得到充分阐明，需要进一步审查。因此，在这项研究中，我们研究了未满足的心理健康治疗需求的人口统计学、社会经济和健康相关因素，以及未满足需求的原因。
我们借鉴了美国国家药物使用和健康调查（NSDUH）从 2002 年到 2016 年的数据，调查了年龄在 18 岁及以上的成年人（n=579017）。我们使用多变量逻辑回归，同时对 2002 年至 2016 年期间未满足心理健康治疗需求的人口统计学、社会经济和健康相关因素进行建模。我们还分析了这些人群表达的未满足需求的原因，包括费用、感知污名、症状最小化、治疗效果低和结构障碍。
与未满足需求的几率增加相关的主要特征包括过去一年的物质滥用或依赖（除致幻剂和镇静剂外）、一般、差或极差的健康状况、女性和大学或以上的教育程度。就未满足需求的原因而言，费用是最常被提及的原因，其次是感知污名、结构障碍和症状最小化。与将费用作为未满足需求的原因的几率增加相关的特征包括：没有保险或年龄在 26-35 岁之间。高收入人群将最小化和低治疗效果作为未满足需求的原因。大学教育程度的人和女性更有可能将结构障碍作为未满足需求的原因。
未满足需求的相关因素和原因突出了个人健康需求与解决心理健康政策和实践中的不平等问题的交叉性。
