Lin E, Goering P N, Lesage A, Streiner D L
Health Systems Research Unit, Clarke Institute of Psychiatry, Toronto, Ontario, Canada.
Soc Psychiatry Psychiatr Epidemiol. 1997 Aug;32(6):355-62. doi: 10.1007/BF00805441.
The traditional purpose of psychiatric epidemiologic surveys has been the assessment of mental illness and, by implication, the need for care. Previous research has focused on unmet need, defined as those who meet "caseness" but do not receive care, but has rarely examined the converse. Since survey respondents receiving care but not meeting caseness have been found to represent up to one-half of mental health service users, this is a significant service delivery issue. The data are drawn from the Mental Health Supplement to the Ontario Health Survey (the Supplement), a household survey of 9,953 respondents, which used the University of Michigan's version of the Composite International Diagnostic Interview (UM-CIDI) as its diagnostic instrument. Community residents who used formal mental health services in the past year but who did not have a concurrent UM-CIDI/DSM-III-R (Diagnostic and Statistical Manual 3, revised) diagnosis were defined as "treated without CIDI disorder". Their need for care was evaluated by comparing them to "treated depressed" and "healthy" respondents, using indicators of functional impairment, vulnerability to developing disorder, and risk of relapse. The match between need and care levels was examined by comparing their type and intensity of use with those of the treated depressed. Results present strong evidence for conceptualizing need as continuous, rather than discrete. The results for the group defined as "treated without CIDI disorder" were consistently between those for the other two groups (with the "treated depressed" always showing the highest need) on all indicators as well as on a summary need index. However, their type and intensity of service use appeared to be unrelated to their level of need. Although some of the "treated without CIDI disorder" group may require preventive or follow-up treatment, the need for service for others is not as convincingly demonstrated. Outcome studies are needed to provide comparative data to describe more fully the problems experienced by this group and indicate whether treatment is helpful. In an age of fiscal restraint, when resource reallocation (rather than generation of new resources) is the likely scenario, such close examination of the fit between need and care is critical if services are to be targeted appropriately.
精神科流行病学调查的传统目的一直是评估精神疾病，进而推断护理需求。以往的研究聚焦于未满足的需求，即那些符合“病例标准”但未接受护理的人群，但很少研究相反的情况。由于发现接受护理但不符合病例标准的调查对象占心理健康服务使用者的比例高达一半，这是一个重大的服务提供问题。数据取自《安大略省健康调查心理健康补充问卷》（以下简称《补充问卷》），这是一项针对9953名受访者的家庭调查，采用密歇根大学版的综合国际诊断访谈（UM-CIDI）作为诊断工具。过去一年使用过正规心理健康服务但未同时符合UM-CIDI/《精神疾病诊断与统计手册》第三版修订版（DSM-III-R）诊断标准的社区居民被定义为“接受治疗但无CIDI障碍”。通过将他们与“接受治疗的抑郁症患者”和“健康”受访者进行比较，利用功能损害指标、患疾病的易感性以及复发风险来评估他们的护理需求。通过比较他们与接受治疗的抑郁症患者的使用类型和强度，来考察需求与护理水平之间的匹配情况。结果提供了有力证据，表明应将需求概念化为连续的，而非离散的。在所有指标以及综合需求指数方面，被定义为“接受治疗但无CIDI障碍”的群体的结果始终介于其他两组之间（“接受治疗的抑郁症患者”的需求始终最高）。然而，他们的服务使用类型和强度似乎与需求水平无关。虽然“接受治疗但无CIDI障碍”群体中的一些人可能需要预防性或后续治疗，但其他人的服务需求并未得到令人信服的证明。需要开展结果研究以提供比较数据，更全面地描述该群体所经历的问题，并表明治疗是否有帮助。在财政紧缩的时代，当可能的情况是资源重新分配（而非产生新资源）时，如果要合理地确定服务目标，如此仔细地考察需求与护理之间的契合度至关重要。
