Dunbar Michael S, Breslau Joshua, Collins Rebecca, Beckman Robin, Engel Charles C
RAND Corporation, 4750 Fifth Avenue, Suite 600, Pittsburgh, PA, 15213-2665, USA.
RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA.
Adm Policy Ment Health. 2023 Aug 18. doi: 10.1007/s10488-023-01289-4.
The goal of the current study is to examine heterogeneity in mental health treatment utilization, perceived unmet treatment need, and barriers to accessing care among U.S. military members with probable need for treatment. Using data from the 2018 Department of Defense Health Related Behavior Survey, we examined a subsample of 2,336 respondents with serious psychological distress (SPD; past-year K6 score ≥ 13) and defined four mutually exclusive groups based on past-year mental health treatment (treated, untreated) and self-perceived unmet treatment need (recognized, unrecognized). We used chi-square tests and adjusted regression models to compare groups on sociodemographic factors, impairment (K6 score; lost work days), and endorsement of treatment barriers. Approximately 43% of respondents with SPD reported past-year treatment and no unmet need (Needs Met). The remainder (57%) met criteria for unmet need: 18% endorsed treatment and recognized unmet need (Treated/Additional Need); 7% reported no treatment and recognized unmet need (Untreated/Recognized Need); and 32% reported no treatment and no unmet need (Untreated/Unrecognized Need). Compared to other groups, those with Untreated/Unrecognized Need tended to be younger (ages 18-24; p = 0.0002) and never married (p = 0.003). The Treated/Additional Need and Untreated/Recognized Need groups showed similar patterns of treatment barrier endorsement, whereas the Untreated/Unrecognized Need group endorsed nearly all barriers at lower rates. Different strategies may be needed to increase appropriate mental health service use among different subgroups of service members with unmet treatment need, particularly those who may not self-perceive need for treatment.
本研究的目的是调查美国可能需要治疗的军人在心理健康治疗利用、感知到的未满足治疗需求以及获得护理的障碍方面的异质性。利用2018年国防部健康相关行为调查的数据，我们对2336名有严重心理困扰（SPD；过去一年K6评分≥13）的受访者进行了抽样，并根据过去一年的心理健康治疗情况（接受治疗、未接受治疗）和自我感知的未满足治疗需求（已认识到、未认识到）定义了四个相互排斥的组。我们使用卡方检验和调整后的回归模型，比较各组在社会人口学因素、功能损害（K6评分；误工天数）以及治疗障碍认可方面的差异。约43%有SPD的受访者报告过去一年接受了治疗且没有未满足的需求（需求得到满足）。其余（57%）符合未满足需求的标准：18%接受了治疗并认识到未满足的需求（接受治疗/额外需求）；7%报告未接受治疗但认识到未满足的需求（未接受治疗/已认识到需求）；32%报告未接受治疗且没有未满足的需求（未接受治疗/未认识到需求）。与其他组相比，未接受治疗/未认识到需求的人往往更年轻（18 - 24岁；p = 0.0002）且从未结婚（p = 0.003）。接受治疗/额外需求组和未接受治疗/已认识到需求组表现出相似的治疗障碍认可模式，而未接受治疗/未认识到需求组对几乎所有障碍的认可率较低。可能需要采取不同策略来增加有未满足治疗需求的不同军人亚组对适当心理健康服务的使用，特别是那些可能未自我感知到治疗需求的人。
