Olfson M, Kessler R C, Berglund P A, Lin E
Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
Am J Psychiatry. 1998 Oct;155(10):1415-22. doi: 10.1176/ajp.155.10.1415.
The authors describe the timing of the first treatment contact following new-onset DSM-III-R mood, anxiety, and addictive disorders in community samples from the United States and Ontario, Canada, before and after passage of the Ontario Health Insurance Plan.
The authors drew data from the National Comorbidity Survey (NCS) (N=8,098) and the mental health supplement to the Ontario Health Survey (OHS) (N= 9,953). They assessed psychiatric disorders with a modified version of the Composite International Diagnostic Interview; they also assessed retrospectively age at disorder onset and first treatment contact. They used the Kaplan-Meier method to generate time-to-treatment curves and survival analysis to compare time-to-treatment intervals across the two surveys.
The overall time-to-treatment curves revealed substantial differences between disorders that were consistent across the two surveys. In both surveys, panic disorder had the highest probability of first-year treatment (NCS, 65.6%; OHS supplement, 52.6%), while phobia (NCS, 12.0%; OHS supplement: 6.5%) and addictive disorders (NCS, 6.4%; OHS supplement, 4.2%) had the lowest in both surveys. Retrospective subgroup analysis suggests that before the passage of the Ontario public insurance plan, the likelihood of receiving treatment in the year of disorder onset was greater in Ontario than in the United States but that this relationship reversed following passage of the Ontario plan. During this period, the authors observed no significant between-country differences in the probability of prompt treatment of adults with 12 or fewer years of education.
These results challenge the assumption that the universal health insurance plan in Ontario promotes greater access to mental health services than is available in the United States for vulnerable groups. Marked differences between disorders in the speed to first treatment suggest that in both countries, clinical factors play an important role in the timing of the initial decision to seek treatment.
作者描述了在美国和加拿大安大略省的社区样本中，安大略省医疗保险计划通过前后，新发性DSM-III-R情绪、焦虑和成瘾性障碍首次治疗接触的时间。
作者从全国共病调查（NCS）（N = 8,098）和安大略省健康调查（OHS）心理健康补充调查（N = 9,953）中提取数据。他们使用综合国际诊断访谈的修改版评估精神障碍；还回顾性评估了障碍发作年龄和首次治疗接触年龄。他们使用Kaplan-Meier方法生成治疗时间曲线，并使用生存分析比较两项调查的治疗时间间隔。
总体治疗时间曲线显示，两项调查中不同障碍之间存在显著差异且一致。在两项调查中，惊恐障碍在第一年接受治疗的概率最高（NCS为65.6%；OHS补充调查为52.6%），而恐惧症（NCS为12.0%；OHS补充调查为6.5%）和成瘾性障碍（NCS为6.4%；OHS补充调查为4.2%）在两项调查中概率最低。回顾性亚组分析表明，在安大略省公共保险计划通过之前，安大略省在障碍发作当年接受治疗的可能性高于美国，但在安大略省计划通过后这种关系发生了逆转。在此期间，作者观察到受教育年限为12年或更少的成年人在及时治疗概率方面没有显著的国家间差异。
这些结果挑战了一种假设，即安大略省的全民健康保险计划比美国为弱势群体提供了更多获得心理健康服务的机会。不同障碍在首次治疗速度上的显著差异表明，在这两个国家，临床因素在寻求治疗的初始决定时间方面都起着重要作用。
