Parikh S V, Lin E, Lesage A D
Bipolar Clinic, Clarke Institute of Psychiatry, Toronto, Ontario.
Can J Psychiatry. 1997 Nov;42(9):929-34. doi: 10.1177/070674379704200903.
Epidemiologic research has demonstrated that the majority of mental illness in the community is not treated. Primary care physicians and the specialty mental health sector each have an important role in the provision of mental health services. Our goal is to clarify the extent of undertreatment of selected mental illnesses in Ontario and to examine how treatment is divided between the primary care and specialty sectors. In particular, we are interested in both the relative numbers and the types--based on sociodemographic and severity indicators--of patients found in each sector, as well as in confirming the key role of primary care in the provision of mental health services.
Data were taken from the Mental Health Supplement to the Ontario Health Survey, a community survey of 9953 individuals. All subjects who met DSM-III-R criteria for a past year diagnosis of mood, anxiety, substance abuse, bulimic, or antisocial personality disorders were categorized by their use of mental health services in the preceding year--into nonusers, primary care only patients, specialty only patients, and both sector patients. The 3 groups utilizing services were then compared by demographic, clinical, and disability characteristics.
Only 20.8% of subjects with a psychiatric diagnosis reported use of mental health services, but 82.9% of these same individuals used primary care physicians for general health problems. Among those who used mental health services, 38.2% used family physicians only for psychiatric treatment, compared with 35.8% who used only specialty mental health providers, and 26.0% who used both sectors. The 3 groups of users showed only modest differences on sociodemographic characteristics. Patients in the specialty only sector reported significantly higher rates of sexual and physical abuse. On specific disability measures, all 3 groups were similar.
The vast majority of individuals with an untreated psychiatric disorder are using the primary care sector for general health treatment, allowing an opportunity for identification and intervention. Primary care physicians also treat the majority of those seeking mental health services, and individuals seen only by these primary care physicians are probably as ill as those seen exclusively in the specialty mental health sector. From a public health perspective, future policy interventions should aim to improve collaboration between the 2 sectors and enhance the ability of primary care physicians to deliver psychiatric services.
流行病学研究表明，社区中大多数精神疾病患者未得到治疗。初级保健医生和专业心理健康部门在提供心理健康服务方面都发挥着重要作用。我们的目标是明确安大略省特定精神疾病治疗不足的程度，并研究治疗在初级保健和专业部门之间是如何分配的。特别是，我们对每个部门中根据社会人口统计学和严重程度指标划分的患者相对数量和类型感兴趣，同时也想确认初级保健在提供心理健康服务方面的关键作用。
数据取自安大略省健康调查的心理健康补充调查，这是一项对9953人进行的社区调查。所有在过去一年中符合《精神疾病诊断与统计手册》第三版修订版（DSM - III - R）中情绪、焦虑、药物滥用、暴食症或反社会人格障碍诊断标准的受试者，根据他们上一年使用心理健康服务的情况进行分类——分为未使用者、仅使用初级保健的患者、仅使用专业服务的患者以及同时使用两个部门服务的患者。然后，对使用服务的这三组人群在人口统计学、临床和残疾特征方面进行比较。
只有20.8%被诊断患有精神疾病的受试者报告使用了心理健康服务，但这些人中82.9%因一般健康问题看了初级保健医生。在使用心理健康服务的人群中，38.2%仅让家庭医生进行精神疾病治疗，相比之下，仅使用专业心理健康服务提供者的占35.8%，同时使用两个部门服务的占26.0%。这三组使用者在社会人口统计学特征上只有适度差异。仅使用专业服务部门的患者报告的性虐待和身体虐待发生率显著更高。在特定的残疾测量指标上，三组情况相似。
绝大多数未治疗的精神疾病患者因一般健康问题在初级保健部门就诊，这为识别和干预提供了机会。初级保健医生也治疗了大多数寻求心理健康服务的患者，仅由这些初级保健医生诊治的患者可能与仅在专业心理健康部门就诊的患者病情相当。从公共卫生角度看，未来的政策干预应旨在改善两个部门之间的合作，并提高初级保健医生提供精神科服务的能力。
