Kouzis A C, Eaton W W
Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland 21205, USA.
Psychol Med. 1998 Nov;28(6):1301-10. doi: 10.1017/s0033291798007454.
This study examines the effects of distress and three types of social relationships (family, friends, and confidantes) on the use of out-patient health services in an adult sample from a community survey of 3481 persons in Baltimore, Maryland.
Independent effects of predisposing (age, education, marital status, race and sex), enabling (employment, income and insurance) and need (physical health) factors are adjusted for in estimating the odds of using health care services.
Illness, being female, and having insurance were positively related to use of services, while being aged was inversely related. After adjustment for the above factors, social support interacted with psychological distress to effect the use of medical care: the combination of high distress and low social support by a confidante results in a fourfold increase of medical utilization.
Our findings support the inclusion of psychological distress and social network variables in addition to physical health status in models attempting to explain the use of health services. Despite an inability to analyse change over time, our data suggest an understanding of the interrelationship between psychosocial factors, distress and health care use would benefit health providers and their patients.
本研究通过对马里兰州巴尔的摩市3481人的社区调查中的成年样本，考察了心理困扰以及三种社会关系类型（家人、朋友和知己）对门诊医疗服务使用情况的影响。
在估计使用医疗服务的几率时，对易患因素（年龄、教育程度、婚姻状况、种族和性别）、促成因素（就业、收入和保险）和需求因素（身体健康）的独立影响进行了调整。
疾病、女性身份和拥有保险与服务使用呈正相关，而年龄增长则呈负相关。在对上述因素进行调整后，社会支持与心理困扰相互作用，影响医疗护理的使用：知己给予的高困扰和低社会支持相结合，会使医疗利用率增加四倍。
我们的研究结果支持在试图解释医疗服务使用情况的模型中，除了身体健康状况外，还应纳入心理困扰和社会网络变量。尽管无法分析随时间的变化，但我们的数据表明，理解心理社会因素、困扰与医疗服务使用之间的相互关系将使医疗服务提供者及其患者受益。
