Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Center for Rural Health, Oklahoma State University, Tulsa, OK, USA.
Community Ment Health J. 2021 Aug;57(6):1017-1022. doi: 10.1007/s10597-020-00719-z. Epub 2020 Oct 8.
Co-occurring mental health (MH) problems are common among those with opioid use disorders (OUDs). However, most opioid treatment programs (OTPs) do not provide MH services. We measured the association between state level characteristics (Medicaid expansion status and rurality) and MH/OUD services integration. We used a generalized linear model to estimate how the association between integration and Medicaid expansions varied across levels of rurality (National Survey on Substance Abuse Treatment Services; 2018; n = 1507 OTPs). The predicted probability of OTPs offering MH services decreased as rurality increased, and the strength of the negative association was greater in non-expansion states ([Formula: see text]=-0.038, SE = 0.005, p < 0.0001) than in expansion states ([Formula: see text]=-0.020, SE = 0.003, p < 0.0001). Access to integrated MH services was lowest in rural non-Medicaid expansion states, despite the high risk of opioid misuse and a high need for MAT and MH services in this population.
共同出现的心理健康（MH）问题在患有阿片类药物使用障碍（OUD）的人群中很常见。然而，大多数阿片类药物治疗计划（OTP）并不提供 MH 服务。我们测量了州级特征（医疗补助扩展状态和农村地区）与 MH/OUD 服务整合之间的关联。我们使用广义线性模型来估计整合与医疗补助扩展之间的关联在农村地区（国家药物滥用治疗服务调查；2018 年；n=1507 个 OTP）的不同水平上的变化情况。提供 MH 服务的 OTP 的预测概率随着农村化程度的增加而降低，并且在非扩展州中，这种负相关的强度更大（[Formula: see text]=-0.038，SE=0.005，p<0.0001），而不是在扩展州中（[Formula: see text]=-0.020，SE=0.003，p<0.0001）。尽管该人群中阿片类药物滥用的风险很高，并且对 MAT 和 MH 服务的需求很高，但在农村非医疗补助扩展州中，获得综合 MH 服务的机会最低。
