Black B S, Rabins P V, German P, Roca R, McGuire M, Brant L J
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287-7279, USA.
Psychol Med. 1998 May;28(3):519-30. doi: 10.1017/s0033291798006631.
Elderly residents of public housing have high rates of psychiatric disorders, but most of those in need of care do not use any mental health service. This study examines the use of formal and alternative informal sources of mental health care in a sample of elderly African-American public-housing residents.
Data from an epidemiological survey of six Baltimore public-housing developments for the elderly (weighted N = 818) were analysed to examine the utilization of mental health services by older African-American residents. Logistic regression analyses were used to determine correlates of using formal and informal sources by those needing mental health care.
Thirty-five per cent of subjects needed mental health care. Less than half (47%) of those in need received any mental health care in the previous 6 months. Residents in need were more likely to use formal (38.5%) than informal sources (18.6%) for care. The strongest correlates of using formal providers were substance use disorder (OR = 15.62), Medicare insurance (OR = 10.31) and psychological distress (OR = 10.27). The strongest correlates of using informal sources were perceiving little or no support from religious/spiritual beliefs (OR = 21.65), cognitive disorder (OR = 19.71) and having a confidant (OR = 15.07).
Contrary to elderly African-Americans in general, those in public housing rely more on formal than informal sources for mental health problems. Nevertheless, both sources fail to fill the gap between need and met need. Interventions to increase identification, referral and treatment of elderly public-housing residents in need should target general medical providers and clergy and include assertive outreach by mental health specialists.
公共住房中的老年居民精神疾病患病率较高，但大多数需要护理的人并未使用任何心理健康服务。本研究调查了老年非裔美国公共住房居民样本中正规和非正规心理健康护理来源的使用情况。
分析了对巴尔的摩六个老年公共住房开发区进行的流行病学调查数据（加权N = 818），以研究老年非裔美国居民对心理健康服务的利用情况。采用逻辑回归分析来确定需要心理健康护理的人使用正规和非正规来源的相关因素。
35%的受试者需要心理健康护理。在过去6个月中，不到一半（47%）有需要的人接受了任何心理健康护理。有需要的居民更有可能使用正规来源（38.5%）而非非正规来源（18.6%）来获得护理。使用正规服务提供者的最强相关因素是物质使用障碍（OR = 15.62）、医疗保险（OR = 10.31）和心理困扰（OR = 10.27）。使用非正规来源的最强相关因素是感觉从宗教/精神信仰中获得很少或没有支持（OR = 21.65）、认知障碍（OR = 19.71）和有一个知己（OR = 15.07）。
与一般老年非裔美国人不同，公共住房中的居民在心理健康问题上更多地依赖正规而非非正规来源。然而，这两种来源都未能填补需求与满足需求之间的差距。针对有需要的老年公共住房居民加强识别、转诊和治疗的干预措施应针对普通医疗服务提供者和神职人员，并包括心理健康专家积极的外展服务。
