Pastore D R, Juszczak L, Fisher M M, Friedman S B
Division of Adolescent Medicine, Mount Sinai Medical Center, Mount Sinai School of Medicine, New York, NY 10128, USA.
Arch Pediatr Adolesc Med. 1998 Aug;152(8):763-7. doi: 10.1001/archpedi.152.8.763.
As school-based health centers (SBHCs) continue to grow, it remains important to study use of the centers. The extent to which mental health problems exist in the students with access to the centers, whether those students are using the available services, if they are satisfied with the services, and the reasons for nonuse by those students who do not enroll are all meaningful questions.
The above issues were studied in an urban high school with a 2-year-old SBHC by administering questions during physical education classes on health center use and mental health concerns. The 630 respondents were 45% male, 55% female, 61% black, 29% Hispanic, 54% in grades 9 or 10, 46% in grades 11 or 12.
Sixty percent of the students were registered in the SBHC; 40% were not registered. Seventy-five percent of registered students reported average use (< or =3 visits); females were more likely than males (P=.017) to be frequent (>3 visits) users of SBHC services. Mental health problems among all participants included depression in 31%, use of alcohol 1 time or more per month in 21%, use of alcohol daily in 5%, suicidal ideation in 16%, history of a suicide attempt in 10%, knowing someone who had been murdered in 50%, and being in at least 1 fight at school in 26%. Frequent users, average users, and nonusers did not differ by age, grade, race, or any of the measured mental health problems. Among the 472 students who completed the survey section on SBHC perceptions, 305 described health center use: 92% were satisfied with health center services, 79% were comfortable being seen in the SBHC, 74% believed visits were kept confidential, 61% told their parents about each visit, and 51% considered the SBHC their regular health care source. The health center was used for mental health services by 34% and sexuality-related care by 15%. The 167 students who described reasons for not using the SBHC most frequently reported that they already had a physician (60%), did not need it (50%), prefer continuing previous health care (45%), did not get around to it (30%), parents were opposed (20%), were not comfortable (19%), did not know about the service (19%), and did not want problems known (19%).
We conclude that, in this urban high school, (1) average users, frequent users, and nonusers did not differ in the mental health problems measured in this study; (2) those who used the SBHC indicated strong satisfaction with the care received; and (3) those who did not use the SBHC chose to stay away for a variety of reasons, most commonly the availability of other care or the perception of lack of need.
随着校内健康中心（SBHCs）不断增加，对这些中心的使用情况进行研究仍然很重要。有机会使用这些中心的学生中存在心理健康问题的程度、这些学生是否在使用现有的服务、他们对服务是否满意，以及未登记使用的学生不使用的原因，都是有意义的问题。
在一所拥有两年历史的校内健康中心的城市高中，通过在体育课上就健康中心的使用和心理健康问题进行提问，对上述问题进行了研究。630名受访者中，45%为男性，55%为女性，61%为黑人，29%为西班牙裔，54%为九年级或十年级学生，46%为十一年级或十二年级学生。
60%的学生在SBHC登记；40%未登记。75%登记的学生报告平均使用次数（≤3次就诊）；女性比男性更有可能（P = 0.017）频繁（>3次就诊）使用SBHC服务。所有参与者中的心理健康问题包括31%有抑郁症、21%每月饮酒1次或更多、5%每天饮酒、16%有自杀念头、10%有自杀未遂史、50%认识被谋杀的人、26%在学校至少参与过1次打斗。频繁使用者、平均使用者和非使用者在年龄、年级、种族或任何测量的心理健康问题方面没有差异。在完成关于SBHC认知调查部分的472名学生中，305名描述了健康中心的使用情况：92%对健康中心服务满意，79%在SBHC就诊感到自在，74%认为就诊记录保密，61%每次就诊都告知父母，51%将SBHC视为其常规医疗保健来源。健康中心用于心理健康服务的占34%，用于性健康相关护理的占15%。167名描述不使用SBHC原因的学生最常报告的是他们已经有医生（60%）、不需要（50%）、更喜欢继续之前的医疗保健（45%）、没时间去（30%）、父母反对（20%）、不自在（19%）、不知道有这项服务（19%）、不想让问题被人知道（19%）。
我们得出结论，在这所城市高中，（1）本研究测量的心理健康问题在平均使用者、频繁使用者和非使用者之间没有差异；（2）使用SBHC的人对所接受的护理表示高度满意；（3）不使用SBHC的人出于各种原因选择不使用，最常见的是有其他医疗保健途径或认为没有必要。
