Schnyder Nina, Sawyer Michael G, Lawrence David, Panczak Radoslaw, Burgess Philip, Harris Meredith G
School of Public Health, The University of Queensland, Brisbane, QLD, Australia.
Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Brisbane, QLD, Australia.
Aust N Z J Psychiatry. 2020 Oct;54(10):1007-1019. doi: 10.1177/0004867420919158. Epub 2020 May 8.
To assess changes in barriers to mental health care for children and adolescents over 16 years.
We used data from two nationally representative surveys of Australian children and adolescents (4-17 years old), conducted in 1998 ( = 4509) and 2013-2014 ( = 6310). Barriers to care were assessed among parents who had reported a perceived partially met or unmet need for their child in the past 6 months in 1998, and the past 12 months in 2013-2014; barriers were similarly assessed among adolescents in relation to themselves. We addressed measurement inconsistencies between surveys by harmonising barriers to accommodate differences in wording and performing sensitivity analyses among those with a 1-month disorder to equalise the timeframes in which barriers were assessed. To assess change, we examined whether the rank order of the three most commonly endorsed barriers changed and whether the 95% confidence intervals (CI) around their estimates overlapped.
Similar proportions of parents reported a partially met or unmet need in 1998 (12.9%, 95% CI = [11.7, 14.0]) as in 2013-2014 (14.3%, 95% CI = [13.2, 15.3]), but the ratio of unmet to partially met need decreased from 3:1 in 1998 to 1:1 in 2013-2014. Top three parent-endorsed barriers ('self-reliance', 'unsure where to get help', and 'cost') were the same at both time points; 'self-reliance' decreased from 65.9% (95% CI = [61.1%, 70.7%]) to 34.9% (95% CI = [31.5%, 38.3%]). Top two adolescent-endorsed barriers ('self-reliance' and 'concerned what others might think') were the same at both time points, the third differed, but none of them decreased.
Perceived unmet need for mental health care for children and adolescents may have decreased between 1998 and 2013-2014, but the gap in receiving sufficient care may have increased. Despite investments in community awareness and treatment during this period, key barriers seemed largely unchanged. For parents, the decrease in self-reliance may reflect a positive shift in beliefs about the potential benefits of treatment.
评估16年来儿童和青少年获得心理健康护理的障碍变化情况。
我们使用了1998年（n = 4509）和2013 - 2014年（n = 6310）对澳大利亚4至17岁儿童和青少年进行的两项全国代表性调查的数据。在1998年过去6个月以及2013 - 2014年过去12个月中，向报告认为孩子的需求部分得到满足或未得到满足的家长评估护理障碍；同样也针对青少年自身评估障碍。我们通过统一障碍表述以适应措辞差异并对患有1个月疾病的人群进行敏感性分析来平衡障碍评估的时间范围，从而解决调查之间的测量不一致问题。为评估变化情况，我们检查了最常被认可的三种障碍的排名顺序是否改变以及其估计值的95%置信区间（CI）是否重叠。
1998年（12.9%，95% CI = [11.7, 14.0]）和2013 - 2014年（14.3%，95% CI = [13.2, 15.3]）报告需求部分得到满足或未得到满足的家长比例相似，但未满足需求与部分满足需求的比例从1998年的3:1降至2013 - 2014年的1:1。家长认可的前三大障碍（“自力更生”、“不确定何处获取帮助”和“费用”）在两个时间点相同；“自力更生”从65.9%（95% CI = [61.1%, 70.7%]）降至34.9%（95% CI = [31.5%, 38.3%]）。青少年认可的前两大障碍（“自力更生”和“担心他人看法”）在两个时间点相同，第三个不同，但均未减少。
1998年至2013 - 2014年期间，儿童和青少年未得到满足的心理健康护理需求可能有所下降，但获得充分护理的差距可能有所增加。尽管在此期间对社区意识和治疗进行了投入，但关键障碍似乎基本未变。对于家长而言，自力更生观念的下降可能反映出对治疗潜在益处看法的积极转变。
