Katz S J, Kessler R C, Lin E, Wells K B
Department of Internal Medicine, University of Michigan, Ann Arbor 48109-0376, USA.
J Gen Intern Med. 1998 Feb;13(2):77-85. doi: 10.1046/j.1525-1497.1998.00022.x.
To compare rates of contact for mental problems and receipt of appropriate antidepressant medication management for persons in the general population with major depression in the United States and Ontario, Canada.
Survey using the U.S. National Comorbidity Survey and the Mental Health Supplement of the Ontario Health Survey.
All persons with major depression as described in DSM-III-R in the previous 12 months, from a multistage random sample of persons aged 21 to 54 years living in households in the United States (n = 574) and Ontario (n = 250) in 1990.
Self-reported contact with general medical or mental health specialty providers for mental problems and appropriate medication management, defined as a combination of antidepressant medication use and four or more visits to any provider within the previous 12 months, were the main outcome measures. The proportion of depressed persons receiving appropriate management was lower in the United States than in Ontario (7.3% vs 14.9% in Ontario, adjusted odds ratio [AOR] 95% CI 0.4; 95% confidence interval [CI] 0.2, 0.8). This difference was largely the result of fewer Americans than Canadians having any mental health care from general medical physicians (9.6% in the United States vs 25.8% in Ontario; AOR 0.3; 95% CI 0.1, 0.5) rather than from specialty providers (20.8% in the United States vs 28.9% in Ontario; AOR 0.7; 95% CI 0.4, 1.1). These between-country differences were much greater for the poor than for those with higher incomes. The Ontario-United States AOR of making contact with either type of clinical provider was 7.5 (95% CI 2.7, 20.7) for lowest-income persons but 2.1 (95% CI 0.3, 5.6) for highest-income persons. The proportions of depressed recipients of any mental health care who received appropriate management were similar between countries (23.9% in the United States vs 27.7% in Ontario; AOR 0.8; 95% CI 0.3, 1.7).
Most persons with depression in the United States and Ontario do not receive appropriate medication management. The rate of appropriate medication management in the United States relative to Ontario is lower largely because there is less contact with general medical physicians for mental problems, especially for the poor. Economic barriers, rather than knowledge and attitudinal factors, appear to explain this difference.
比较美国和加拿大安大略省普通人群中重度抑郁症患者出现心理问题后寻求接触的比例，以及接受适当抗抑郁药物治疗管理的比例。
采用美国国家共病调查和安大略省健康调查心理健康补充调查进行的调查。
来自1990年居住在美国（n = 574）和安大略省（n = 250）家庭的21至54岁人群的多阶段随机样本中，过去12个月内符合《精神疾病诊断与统计手册第三版修订本》（DSM-III-R）中重度抑郁症描述的所有人员。
自我报告因心理问题与普通医疗或心理健康专科提供者的接触情况，以及适当的药物治疗管理情况，适当的药物治疗管理定义为在过去12个月内使用抗抑郁药物并就诊于任何提供者4次或更多次，这是主要的结果指标。在美国，接受适当管理的抑郁症患者比例低于安大略省（美国为7.3%，安大略省为14.9%，调整优势比[AOR] 95%置信区间[CI] 0.4；95%置信区间[CI] 0.2，0.8）。这种差异主要是因为接受普通内科医生心理健康护理的美国人比加拿大人少（美国为9.6%，安大略省为25.8%；AOR 0.3；95%置信区间[CI] 0.1，0.5），而非接受专科提供者护理的情况（美国为20.8%，安大略省为28.9%；AOR 0.7；95%置信区间[CI] 0.4，1.1）。国家间的这种差异在穷人中比在高收入者中更大。最低收入人群与任何一类临床提供者接触的安大略省与美国的AOR为7.5（95%置信区间[CI] 2.7，20.7），而最高收入人群为2.1（95%置信区间[CI] 0.3，5.6）。各国接受任何心理健康护理的抑郁症患者中接受适当管理的比例相似（美国为23.9%，安大略省为27.7%；AOR 0.8；95%置信区间[CI] 0.3，1.7）。
美国和安大略省的大多数抑郁症患者未接受适当的药物治疗管理。相对于安大略省，美国适当药物治疗管理的比例较低，主要是因为因心理问题与普通内科医生的接触较少，尤其是穷人。经济障碍而非知识和态度因素似乎可以解释这种差异。
