D.N.S. Candidate, Faculty of Nursing, Mahidol University, Bangkok, Thailand.
Department of Mental Health and Psychiatric Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand.
BMC Health Serv Res. 2022 Jul 11;22(1):899. doi: 10.1186/s12913-022-08250-5.
Prevalence of depression in older persons was a leading cause of disability. This group has the lowest access to service and retention in care compared to other age groups. This study aimed to explore continuing mental health service use and examined the predictive power of the mental health service delivery system and individual factors on mental health service use among older persons diagnosed with depressive disorders.
We employed an analytic cross-sectional study design of individual and organizational variables in 12 general hospitals selected using multi-stratified sampling. There were 3 clusters comprising community hospitals, advanced and standard hospitals, and university hospitals. Participants in each group were 150 persons selected by purposive sampling. We included older persons with a first or recurring diagnosis of a depressive disorder in the last 6 to 12 months of the data collection date. Data at the individual level included socio-demographic characteristics, Charlson Comorbidity Index, Attitude toward Depression and its treatment, and perceived social support. Data at the organizational level had hospital level, nurse competency, nurse-patient ratio, and appointment reminders. Descriptive statistics, Pearson chi-square test, latent class analysis (LCA), and marginal logistic regression model using generalized estimating equation (GEE) were used to analyze the data.
The continuing mental health service use among older persons diagnosed with depressive disorders was 54%. The latent class analysis of four variables in the mental health services delivery organization yielded distinct and interpretable findings in two groups: high and low resource organization. The marginal logistic multivariable regression model using GEE found that organizational group and attitude toward depression and its treatment were significantly associated with mental health service use (p-value = 0.046; p-value = 0.003).
The findings suggest that improving continuing mental health services use in older persons diagnosed with depressive disorders should emphasize specialty resources of the mental health services delivery system and attitude toward depression and its treatment.
老年人的抑郁患病率是导致残疾的主要原因。与其他年龄组相比，该人群获得服务的机会最低，在护理中的保留率也最低。本研究旨在探讨继续使用心理健康服务的情况，并研究心理健康服务提供系统和个体因素对被诊断患有抑郁症的老年人使用心理健康服务的预测能力。
我们采用个体和组织变量的分析性横断面研究设计，在使用多分层抽样选择的 12 家综合医院中进行。有 3 个聚类，包括社区医院、高级和标准医院以及大学医院。在每组中，通过目的抽样选择 150 名参与者。我们纳入了在数据收集日期的过去 6 至 12 个月内首次或再次被诊断患有抑郁症的老年人。个体水平的数据包括社会人口统计学特征、Charlson 合并症指数、对抑郁及其治疗的态度以及感知社会支持。组织水平的数据包括医院级别、护士能力、护士与患者的比例和预约提醒。使用描述性统计、Pearson χ²检验、潜在类别分析（LCA）和使用广义估计方程（GEE）的边际逻辑回归模型对数据进行分析。
被诊断患有抑郁症的老年人继续使用心理健康服务的比例为 54%。心理健康服务提供组织中的四个变量的潜在类别分析产生了两个具有明显和可解释发现的群体：资源丰富的组织和资源不足的组织。使用 GEE 的边际逻辑多变量回归模型发现，组织群体和对抑郁及其治疗的态度与心理健康服务的使用显著相关（p 值=0.046；p 值=0.003）。
研究结果表明，要提高被诊断患有抑郁症的老年人对继续使用心理健康服务的重视，应强调心理健康服务提供系统的专业资源以及对抑郁及其治疗的态度。
