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对精神障碍治疗的感知需求:一项综述与批判性评价

Perceived need for treatment for mental disorders: A review and critical evaluation.

作者信息

Kazdin Alan E

机构信息

Department of Psychology, Yale University, Henry Koerner Center, 149 Elm Street, New Haven 06511, CT, USA.

出版信息

Clin Psychol Rev. 2025 Jul;119:102591. doi: 10.1016/j.cpr.2025.102591. Epub 2025 May 7.

Abstract

Mental disorders are highly prevalent worldwide. Unfortunately, most people with these disorders do not receive any treatment. This is due in part to a large set of barriers that impede treatment delivery. An initial barrier is the perception that one does not need treatment. Perceived need for treatment (PNFT) refers to whether an individual sees a need to obtain an intervention for their mental health problem. Among individuals with a mental disorder, lack of perceived need is the most common reason people give for not initiating treatment. This article describes PNFT, its characteristics, correlates, and predictors. A critical evaluation of the concept challenges key notions such as whether meeting criteria for a disorder means that someone needs treatment, whether PNFT actually is the initial obstacle limiting treatment seeking, how people may seek an intervention but do not elect mental health treatment, and that PNFT is neither a necessary nor a sufficient condition for entering treatment. Several research priorities are discussed including the importance of perceived need among parents and other caregivers, evaluating whether increasing the rates of PNFT would actually increase service use, the need to study the treatment needs of many neglected groups, and considering whether PNFT influences other facets of the treatment process (e.g., adherence to treatment, dropping out early) where perceiving there no longer is a mental health problem may occur.

摘要

精神障碍在全球范围内高度流行。不幸的是,大多数患有这些障碍的人没有接受任何治疗。这部分是由于一系列阻碍治疗提供的障碍。一个最初的障碍是认为自己不需要治疗。感知到的治疗需求(PNFT)是指个人是否认为有必要针对其心理健康问题获得干预。在患有精神障碍的个体中,缺乏感知到的需求是人们不开始治疗的最常见原因。本文描述了PNFT、其特征、相关因素和预测因素。对这一概念的批判性评估对一些关键概念提出了挑战,例如符合障碍标准是否意味着某人需要治疗、PNFT是否实际上是限制寻求治疗的最初障碍、人们如何可能寻求干预但不选择心理健康治疗,以及PNFT既不是进入治疗的必要条件也不是充分条件。讨论了几个研究重点,包括父母和其他照顾者中感知到的需求的重要性、评估提高PNFT率是否真的会增加服务使用、研究许多被忽视群体的治疗需求的必要性,以及考虑PNFT是否会影响治疗过程的其他方面(例如,坚持治疗、提前退出),在这些方面可能会出现认为不再存在心理健康问题的情况。

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