University of Detroit Mercy, Detroit, Michigan, USA.
Community Dent Oral Epidemiol. 2023 Jun;51(3):399-407. doi: 10.1111/cdoe.12762. Epub 2022 May 24.
This study evaluated which predisposing and enabling factors prospectively predicted dental utilization over 6 months among people with serious mental illness.
A sample of individuals with serious mental illness (86.3% African American; 97.4% with public health insurance) was recruited from community mental health centres in Detroit, Michigan, and responded to questionnaires at baseline and at least one follow-up visit at 3 or 6 months (N = 190). Baseline assessments included demographic and clinical information, established measures of health literacy, health insurance literacy, stigma related to mental illness, experiences of racial discrimination and medical mistrust. Insurance coverage for dental care and the availability of dental services at the participants' mental health centres was recorded. At follow-up visits, participants reported healthcare utilization, including dental and primary care, since baseline.
Three factors emerged as meaningful predictors of having a dental visit in bivariate and multivariate analyses: more medical comorbidities and dental care co-located with mental health care predicted increased likelihood of a dental visit, whereas having experienced racial discrimination in a medical setting predicted lower odds of having a dental visit in the follow-up period. Co-location of dental care with mental health care was the strongest predictor of having a dental visit.
Co-locating dental care with mental health care may increase dental utilization among people with serious mental illness, possibly by mitigating known barriers to dental care for this population. Among African Americans, the co-location of dental care with mental health care may also attenuate the negative effect of prior racial discrimination in a medical setting on dental utilization.
本研究旨在评估哪些倾向因素和促成因素能在 6 个月内预测患有严重精神疾病的人群的牙科就诊情况。
从密歇根州底特律市的社区心理健康中心招募了患有严重精神疾病的个体（86.3%为非裔美国人；97.4%有公共医疗保险），他们在基线和至少一次 3 或 6 个月的随访中回答了问卷（N=190）。基线评估包括人口统计学和临床信息、已建立的健康素养、健康保险素养、与精神疾病相关的耻辱感、经历过的种族歧视和医疗不信任。记录了参与者的牙科保健保险覆盖范围以及他们所在心理健康中心的牙科服务可用性。在随访访问中，参与者报告了自基线以来的医疗保健利用情况，包括牙科和初级保健。
在单变量和多变量分析中，有三个因素成为有牙科就诊的有意义预测因素：更多的医疗合并症和与精神卫生保健共置的牙科护理，预示着牙科就诊的可能性增加，而在医疗环境中经历过种族歧视则预示着在随访期间牙科就诊的可能性降低。牙科护理与精神卫生保健共置是预测牙科就诊的最强因素。
将牙科护理与精神卫生保健共置可能会增加患有严重精神疾病的人群的牙科就诊率，这可能是通过缓解该人群已知的牙科护理障碍。在非裔美国人中，将牙科护理与精神卫生保健共置可能也会减轻在医疗环境中先前经历过的种族歧视对牙科就诊率的负面影响。
