Department of Sociology, College of Arts & Sciences and the Irsay Institute, Indiana University, IN, Bloomington, USA.
Department of Applied Health, School of Public Health and the Irsay Institute, Indiana University, IN, Bloomington, USA.
Soc Psychiatry Psychiatr Epidemiol. 2024 Mar;59(3):443-453. doi: 10.1007/s00127-023-02474-4. Epub 2023 Apr 17.
The persistent gap between population indicators of poor mental health and the uptake of services raises questions about similarities and differences between social and medical/psychiatric constructions. Rarely do studies have assessments from different perspectives to examine whether and how lay individuals and professionals diverge.
Data from the Person-to-Person Health Interview Study (P2P), a representative U.S. state sample (N ~ 2700) are used to examine the overlap and correlates of three diverse perspectives-self-reported mental health, a self/other problem recognition, and the CAT-MH™ a validated, computer adaptive test for psychopathology screening. Descriptive and multinominal logit analyses compare the presence of mental health problems across stakeholders and their association with respondents' sociodemographic characteristics.
Analyses reveal a set of socially constructed patterns. Two convergent patterns indicate whether there is (6.9%, The "Sick") or is not (64.6%, The "Well") a problem. The "Unmet Needers" (8.7%) indicates that neither respondents nor those around them recognize a problem identified by the screener. Two patterns indicate clinical need where either respondents (The "Self Deniers", 2.9%) or others (The "Network Deniers", 6.0%) do not. Patterns where the diagnostic indicator does not suggest a problem include The "Worried Well" (4.9%) where only the respondent does, The "Network Coerced" (4.6%) where only others do, and The "Prodromal" (1.4%) where both self and others do. Education, gender, race, and age are associated with social constructions of mental health problems.
The implications of these results hold the potential to improve our understanding of unmet need, mental health literacy, stigma, and treatment resistance.
人口中精神健康不良指标与服务利用率之间长期存在差距，这引发了人们对社会和医学/精神病学构建之间异同的质疑。很少有研究从不同角度进行评估，以考察普通个体和专业人员之间是否存在分歧，以及分歧的程度和方式。
本研究使用来自美国代表性州样本（N≈2700）的人际健康访谈研究（P2P）的数据，从自我报告的精神健康状况、自我/他人问题识别以及经过验证的计算机适应测试（CAT-MH）等三个不同角度来检查三种不同观点的重叠和相关性，CAT-MH 是一种用于精神病理学筛查的有效、计算机自适应测试。描述性和多项逻辑回归分析比较了不同利益相关者中存在精神健康问题的情况及其与受访者社会人口特征的关联。
分析揭示了一系列社会构建模式。两种趋同模式表明是否存在（6.9%，“患病者”）或不存在（64.6%，“健康者”）问题。“未满足需求者”（8.7%）表示，无论是受访者还是他们周围的人都没有认识到筛查器识别出的问题。两种模式表明存在临床需求，即受访者（“自我否认者”，2.9%）或他人（“网络否认者”，6.0%）否认问题。诊断指标不提示存在问题的模式包括：仅受访者表示存在问题的“担心的健康者”（4.9%）、仅他人表示存在问题的“网络强制者”（4.6%）以及受访者和他人均表示存在问题的“前驱期”（1.4%）。教育程度、性别、种族和年龄与精神健康问题的社会构建有关。
这些结果的意义有可能提高我们对未满足需求、精神健康素养、污名和治疗抵抗的理解。
