Department of Psychology, University of Pennsylvania, Philadelphia (Last, Schriger);Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Becker-Haimes, Beidas);Hall Mercer Community Mental Health, University of Pennsylvania Health System, Philadelphia (Becker-Haimes); Community Behavioral Health, Philadelphia (Fernandez-Marcote, Dallard, Jones); Penn Implementation Science Center, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Beidas).
Psychiatr Serv. 2022 Jul;73(7):774-786. doi: 10.1176/appi.ps.202100276. Epub 2021 Nov 29.
Efforts to improve mental health treatment delivery come at a time of rising inequality and cuts or insufficient increases to mental health funding. Public mental health clinicians face increased demands, experience economic stress, and treat underresourced patients disproportionately burdened by trauma. The authors sought to understand clinicians' current economic and psychological conditions and the relationship of these conditions to the delivery of an evidence-based intervention (EBI) designed to treat posttraumatic stress disorder among youths.
In July 2020, 49 public mental health clinicians from 16 Philadelphia clinics who were trained in an EBI, trauma-focused cognitive-behavioral therapy (TF-CBT), were surveyed by e-mail. Respondents reported on their economic precarity, financial strain, burnout, secondary traumatic stress (i.e., the stress response associated with caring for people exposed to trauma), and TF-CBT use. Associations between clinicians' job-related stressors and their use of TF-CBT were examined with mixed models. Content coding was used to organize clinicians' open-ended responses to questions regarding financial strain related to the COVID-19 pandemic.
Clinicians' economic precarity, financial strain, and job-related stress were high; 37% of clinicians were independent contractors, 44% of whom wanted a salaried position. Of 37 clinicians with education debt, 38% reported owing ≥$100,000. In the past year, 29% of clinicians reported lack of personal mental health care because of cost, and 22% met the cutoff for experiencing secondary traumatic stress symptoms. Education debt was negatively associated with use of TF-CBT (p<0.001).
The stress of providing care in underresourced clinical settings may interfere with efforts to integrate scientific evidence into mental health care.
在不平等加剧以及精神健康资金削减或增加不足的情况下，改善精神健康治疗服务的努力正在进行中。公共精神健康临床医生面临着更高的需求，经历着经济压力，并为资源不足的患者提供治疗，这些患者因创伤而承受着不成比例的负担。作者试图了解临床医生目前的经济和心理状况，以及这些状况与提供旨在治疗青少年创伤后应激障碍的循证干预措施（EBI）之间的关系。
2020 年 7 月，对 16 家费城诊所中接受过创伤焦点认知行为疗法（TF-CBT）培训的 49 名公共精神健康临床医生进行了电子邮件调查。受访者报告了他们的经济不稳定、经济压力、倦怠、二次创伤性压力（即与照顾创伤暴露者相关的应激反应）和 TF-CBT 的使用情况。使用混合模型检查临床医生与工作相关的压力源与他们使用 TF-CBT 之间的关联。使用内容编码对与 COVID-19 大流行相关的经济压力的开放性问题的回答进行了组织。
临床医生的经济不稳定、经济压力和工作相关压力很高；37%的临床医生是独立承包商，其中 44%的人希望有薪职位。在有教育债务的 37 名临床医生中，38%的人报告欠了≥100000 美元。在过去的一年中，由于费用问题，29%的临床医生报告缺乏个人心理健康护理，22%的人达到了经历二次创伤性应激症状的标准。教育债务与 TF-CBT 的使用呈负相关（p<0.001）。
在资源不足的临床环境中提供护理的压力可能会干扰将科学证据纳入精神卫生保健的努力。
