Flisher A J, Kramer R A, Grosser R C, Alegria M, Bird H R, Bourdon K H, Goodman S H, Greenwald S, Horwitz S M, Moore R E, Narrow W E, Hoven C W
Division of Child and Adolescent Psychiatry, Columbia University, New York State Psychiatric Institute, New York, USA.
Psychol Med. 1997 Sep;27(5):1145-54. doi: 10.1017/s0033291797005412.
Little is known about the extent and correlates of unmet need for mental health services in community samples of children and adolescents.
Data were obtained from the 1285 parent/youth pairs interviewed at four sites in the USA and Puerto Rico in the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. Unmet need was defined to exist if psychopathology and associated functional impairment were present but no mental health services had been received in the previous 6 months.
Of the total sample, 17.1% had unmet need. Adjusting for demographic variables, logistic regression analyses revealed that unmet need was significantly associated with: indicators of economic disadvantage, such as being on public assistance and not being covered by health insurance; opinions of the parents and children or adolescents that the latter had poor mental health; parental psychopathology; poor school grades; and parent-reported access barriers such as concern that the child would want to solve the problem unassisted, would refuse to attend mental health services, or would be hospitalized or taken away against the parent's will. No youth-reported access barriers were significantly associated with unmet need.
The economic correlates of unmet need may attain increased importance in the light of current reform in health care financing in the USA. Access may be facilitated by increasing parental knowledge of mental health services and enabling children and adolescents to initiate contact with services independently of their families.
关于儿童和青少年社区样本中未满足的心理健康服务需求的程度及其相关因素，人们了解甚少。
数据来自在美国和波多黎各四个地点对1285对父母/青少年进行访谈的儿童和青少年精神障碍流行病学方法（MECA）研究。如果存在精神病理学及相关功能损害，但在过去6个月内未接受任何心理健康服务，则定义为存在未满足的需求。
在总样本中，17.1%存在未满足的需求。在对人口统计学变量进行调整后，逻辑回归分析显示，未满足的需求与以下因素显著相关：经济劣势指标，如接受公共援助和未参加医疗保险；父母、儿童或青少年认为后者心理健康状况不佳；父母的精神病理学；学业成绩差；以及父母报告的获取障碍，如担心孩子想独自解决问题、会拒绝接受心理健康服务，或会违背父母意愿住院或被带走。青少年报告的获取障碍与未满足的需求均无显著关联。
鉴于美国当前医疗保健融资改革，未满足的需求与经济因素之间的关联可能变得更加重要。通过增加父母对心理健康服务的了解，并使儿童和青少年能够独立于家庭主动联系服务机构，可能会促进服务的获取。
