Das Abhery, Singh Parvati, Bruckner Tim
Program in Public Health, University of California, Irvine, CA 92617, USA.
J Psychiatr Brain Sci. 2020;5(2). doi: 10.20900/jpbs.20200006. Epub 2020 Apr 13.
Less than half of African American youth with severe mental disorders receive psychiatric care. When they do receive care, African American youth use the Emergency Department at higher rates than whites. We examine whether rapid expansion of primary mental health care at Community Health Centers reduces Emergency Department visits for psychiatric care especially among African American youth. Through four studies, we examine (1) the impact of mental health service capacity on the disparity of psychiatric care among African American youth; (2) how Community Health Center mental health visits vary with repeat psychiatric emergency visits; (3) the county-level drivers of the expansion of Community Health Centers; and (4) how Community Health Center expansion affects overall psychiatric emergency care. Results indicate that increased continuity of mental health care at Community Health Centers corresponds with a reduction in racial disparities in youth psychiatric ED visits. In addition, an increase in Community Health Center capacity varies inversely with repeated psychiatric Emergency Department visits and inversely with psychiatric Emergency Department visits overall. And finally, results show an increase in Community Health Center mental health services among counties with greater poverty, lower physician availability, and higher percentage of uninsured. Our studies indicate that expansion of federally-funded primary mental health services affects the overall system of emergency psychiatric care. However, this expansion does not appear to dramatically reduce racial/ethnic disparities in psychiatric emergency department visits.
患有严重精神障碍的非裔美国青年中，接受精神科护理的比例不到一半。当他们确实接受护理时，非裔美国青年使用急诊科的比例高于白人。我们研究社区卫生中心初级精神卫生保健的快速扩张是否会减少因精神科护理而前往急诊科就诊的情况，尤其是在非裔美国青年中。通过四项研究，我们考察了：（1）精神卫生服务能力对非裔美国青年精神科护理差异的影响；（2）社区卫生中心的精神卫生就诊情况与精神科急诊复诊情况如何变化；（3）社区卫生中心扩张的县级驱动因素；（4）社区卫生中心的扩张如何影响整体精神科急诊护理。结果表明，社区卫生中心精神卫生护理连续性的提高与青年精神科急诊科就诊的种族差异减少相对应。此外，社区卫生中心服务能力的提高与精神科急诊复诊次数以及总体精神科急诊就诊次数呈负相关。最后，结果显示，在贫困程度更高、医生可及性更低、未参保比例更高的县，社区卫生中心的精神卫生服务有所增加。我们的研究表明，联邦资助的初级精神卫生服务的扩张影响了急诊精神科护理的整体系统。然而，这种扩张似乎并没有显著减少精神科急诊科就诊中的种族/民族差异。
