印度农村地区抑郁症状的卫生保健利用和治疗寻求：探索性横断面分析。
Health care use and treatment-seeking for depression symptoms in rural India: an exploratory cross-sectional analysis.
机构信息
Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
Department of Research, Pravara Institute of Medical Sciences, Loni, Maharashtra, India.
出版信息
BMC Health Serv Res. 2020 Apr 6;20(1):287. doi: 10.1186/s12913-020-05162-0.
BACKGROUND
There is a large "treatment gap" for depression worldwide. This study aimed to better understand the treatment gap in rural India by describing health care use and treatment-seeking for depression.
METHODS
Data were analysed from a two round cross-sectional community survey conducted in rural Madhya Pradesh between May 2013 and December 2016. We examined the proportion of individuals who screened positive for depression (≥10) on the Patient Health Questionnaire (PHQ-9) who sought treatment in different sectors, for depression symptoms and for any reason, and compared the latter with health service use by screen-negative individuals. We analysed the frequency with which barriers to healthcare utilisation were reported by screen-positive adults. We also analysed the association between seeking treatment for depression and various predisposing, enabling and need factors using univariable regression.
RESULTS
86% of screen-positive adults reported seeking no depression treatment. However, 66% had used health services for any reason in the past 3 months, compared to 46% of screen-negative individuals (p < 0.0001). Private providers were most frequently consulted by screen-positive adults (32%), while only 19% consulted traditional providers. Structural barriers to healthcare use such as cost and distance to services were frequently reported (54 and 52%, respectively) but were not associated with treatment-seeking for depression. The following factors were found to be positively associated with treatment-seeking for depression: higher symptom severity; lack of energy, lack of interest/pleasure, low self-esteem, or slow movements/restlessness on more than 7 days in the past 2 weeks; being married; having discussed depression symptoms; and reporting problems with medication availability and supply as a barrier to healthcare. No evidence was found for an association between treatment-seeking for depression and most socio-economic, demographic or attitudinal factors.
CONCLUSIONS
These findings suggest that the majority of adults who screen positive for depression seek healthcare, although not primarily for depression symptoms, indicating the need to improve detection of depression during consultations about other complaints. Private providers may need to be considered in programmes to improve depression treatment in this setting. Further research should test the hypotheses generated in this descriptive study, such as the potential role of marriage in facilitating treatment-seeking.
背景
全球范围内，抑郁症存在着巨大的“治疗缺口”。本研究旨在通过描述印度农村地区抑郁症的治疗情况，更好地了解该地区的治疗缺口。
方法
本研究数据来自于 2013 年 5 月至 2016 年 12 月在印度中央邦农村地区进行的两轮横断面社区调查。我们分析了在患者健康问卷（PHQ-9）上筛查出抑郁症（≥10 分）的个体中，寻求不同部门治疗的比例，以及为抑郁症症状和任何其他原因寻求治疗的比例，并将后者与筛查阴性个体的卫生服务使用情况进行了比较。我们分析了筛查阳性成年人报告的医疗服务利用障碍的频率。我们还使用单变量回归分析了寻求抑郁症治疗与各种倾向因素、促成因素和需求因素之间的关联。
结果
86%的筛查阳性成年人表示未寻求任何抑郁症治疗。然而，在过去 3 个月内，66%的人因任何原因使用过卫生服务，而筛查阴性个体为 46%（p<0.0001）。筛查阳性成年人最常咨询的是私人提供者（32%），而只有 19%的人咨询传统提供者。医疗服务利用的结构性障碍，如费用和服务距离，经常被报告（分别为 54%和 52%），但与寻求抑郁症治疗无关。以下因素与寻求抑郁症治疗呈正相关：症状严重程度较高；在过去两周内，有超过 7 天出现乏力、缺乏兴趣/愉悦感、自卑或动作缓慢/烦躁不安；已婚；曾讨论过抑郁症症状；以及报告药物可得性和供应方面存在问题是医疗服务利用的障碍。没有证据表明寻求抑郁症治疗与大多数社会经济、人口统计学或态度因素有关。
结论
这些发现表明，大多数筛查出抑郁症的成年人会寻求医疗服务，尽管不是主要为了治疗抑郁症症状，这表明需要在治疗其他疾病的咨询中提高对抑郁症的检出率。在这种情况下，可能需要考虑私人提供者来改善抑郁症的治疗。应进一步研究以验证本描述性研究中提出的假设，例如婚姻在促进治疗寻求方面的潜在作用。
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