Department of Health Services Research, Faculty of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.
Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
BMC Psychiatry. 2021 Feb 2;21(1):68. doi: 10.1186/s12888-021-03065-w.
Approximately one out of every three people in Germany who meets the diagnostic criteria for major depression has contact with mental health services. Therefore, according to treatment guidelines, two thirds of all individuals with depression are insufficiently treated. In the past, the subjective perspective of people who (do not) make use of mental health services has been neglected. Factors related to the use of health services are described in Andersen's Behavioral Model of Health Services Use (ABM). The aim of this study is to supplement operationalizations of subjectively perceived and evaluated individual characteristics in the ABM and to evaluate whether the supplemented model can better explain mental health services use in individuals with depression than established operationalizations.
A representative telephone study with two measurement points will be conducted. In an explanatory mixed-methods design, qualitative interviews will be added to further interpret the quantitative data. A nationwide sample scoring 5 or more on the Patient Health Questionnaire (PHQ-9) will be recruited and interviewed via telephone at T0 and 12 months later (T1). Data on established and subjective characteristics as well as mental health service use will be collected. At T1, conducting a diagnostic interview (Composite International Diagnostic Interview, DIA-X-12/M-CIDI) enables the recording of 12-month diagnoses according to DSM-IV-TR criteria. Ideally, n = 768 datasets will be available and analyzed descriptively by means of regression analysis. Up to n = 32 persons who use or do not use depression-specific health services incongruent with their objective or subjective needs will be interviewed (face-to-face) to better explain their behavior. In addition, theories of non-need-based mental health service use are developed within the framework of the grounded theory-based analysis of the qualitative interviews.
The study intends to contribute to the theoretical foundation of health services research and to specify the characteristics described in the ABM. Thus, after completion of the study, a further sophisticated and empirically tested model will be available to explain mental health services. The identified modifiable influencing factors are relevant for the development of strategies to increase mental health service use in line with the objective and subjective needs of individuals with depression.
在德国，每三个符合重度抑郁症诊断标准的人中，就有一个人会接触到精神卫生服务。因此，根据治疗指南，三分之二的抑郁症患者治疗不充分。过去，人们（不）利用精神卫生服务的主观视角被忽视了。与卫生服务利用相关的因素在安德生的卫生服务利用行为模式（ABM）中有所描述。本研究的目的是补充 ABM 中主观感知和评估的个体特征的操作性定义，并评估补充后的模型是否比现有的操作性定义能更好地解释抑郁症患者的精神卫生服务利用。
将进行一项具有两个测量点的代表性电话研究。在解释性混合方法设计中，将增加定性访谈以进一步解释定量数据。将招募全国范围内 PHQ-9 评分在 5 分或以上的患者，并通过电话在 T0 和 12 个月后（T1）进行访谈。将收集有关既定和主观特征以及精神卫生服务利用的数据。在 T1 时，进行诊断访谈（复合国际诊断访谈，DIA-X-12/M-CIDI），根据 DSM-IV-TR 标准记录 12 个月的诊断。理想情况下，将有 n=768 个数据集可用于描述性回归分析。最多 n=32 名使用或不使用与他们的客观或主观需求不一致的特定于抑郁症的卫生服务的人将接受（面对面）访谈，以更好地解释他们的行为。此外，在基于扎根理论的定性访谈分析框架内，发展了非基于需求的精神卫生服务利用理论。
该研究旨在为卫生服务研究的理论基础做出贡献，并具体说明 ABM 中描述的特征。因此，在研究完成后，将提供一个更复杂和经过实证检验的模型来解释精神卫生服务。确定的可改变的影响因素与制定战略以增加符合抑郁症患者客观和主观需求的精神卫生服务利用有关。
