Centre for Youth Mental Health (Gao, Menssink, Filia, Rice, McGorry, Cotton) and Melbourne School of Population and Global Health (McDonald, Simons), University of Melbourne, Parkville, Victoria, Australia; Orygen, Parkville, Victoria, Australia (Gao, Hamilton, Menssink, Filia, Rice, McGorry, Cotton); headspace National Youth Mental Health Foundation, Melbourne (Rickwood); Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia (Rickwood); Brain and Mind, University of Sydney, Camperdown, New South Wales, Australia (Hickie).
Psychiatr Serv. 2023 Jun 1;74(6):581-588. doi: 10.1176/appi.ps.20220345. Epub 2022 Nov 29.
The authors aimed to evaluate changes in use of government-subsidized primary mental health services, through the Medicare Benefits Schedule (MBS), by young people during the first year of the COVID-19 pandemic in Australia and whether changes were associated with age, sex, socioeconomic status, and residence in particular geographical areas.
Interrupted time-series analyses were conducted by using quarterly mental health MBS service data (all young people ages 12-25 years, 2015-2020) for individual Statistical Area Level 3 areas across Australia. The data captured >22.4 million service records. Meta-analysis and meta-regression models estimated the pandemic interruption effect at the national level and delineated factors influencing these estimates.
Compared with expected prepandemic trends, a 6.2% (95% CI=5.3%-7.2%) increase was noted for all young people in use of MBS mental health services in 2020. Substantial differences were found between age and sex subgroups, with a higher increase among females and young people ages 18-25. A decreasing trend was observed for males ages 18-25 (3.5% reduction, 95% CI=2.5%-4.5%). The interruption effect was strongly associated with socioeconomic status. Service uptake increased in areas of high socioeconomic status, with smaller or limited uptake in areas of low socioeconomic status.
During 2020, young people's use of primary mental health services increased overall. However, increases were inequitably distributed and relatively low, compared with increases in population-level mental health burden. Policy makers should address barriers to primary care access for young people, particularly for young males and those from socioeconomically disadvantaged backgrounds.
本研究旨在评估澳大利亚 COVID-19 大流行期间，年轻人通过医疗保险福利计划（MBS）使用政府补贴的初级心理健康服务的变化情况，以及这些变化是否与年龄、性别、社会经济地位和居住在特定地理区域有关。
采用澳大利亚全国各统计区域 3 级地区的 MBS 季度心理健康服务数据（所有年龄在 12-25 岁的年轻人，2015-2020 年）进行中断时间序列分析。这些数据共记录了超过 2240 万条服务记录。荟萃分析和荟萃回归模型在国家层面上评估了大流行的中断效应，并确定了影响这些估计值的因素。
与大流行前的预期趋势相比，2020 年所有年轻人使用 MBS 心理健康服务的比例增加了 6.2%（95%CI=5.3%-7.2%）。在年龄和性别亚组之间发现了显著差异，女性和 18-25 岁的年轻人增幅较高。18-25 岁男性的趋势呈下降趋势（减少 3.5%，95%CI=2.5%-4.5%）。中断效应与社会经济地位密切相关。在社会经济地位较高的地区，服务利用率增加，而在社会经济地位较低的地区，服务利用率则较低或有限。
2020 年，年轻人对初级心理健康服务的使用总体上有所增加。然而，与人群心理健康负担的增加相比，增加的幅度不均等，相对较低。政策制定者应解决年轻人，特别是年轻男性和社会经济劣势背景的年轻人获取初级保健的障碍。
