'First, do no harm': are disability assessments associated with adverse trends in mental health? A longitudinal ecological study.
'First, do no harm': are disability assessments associated with adverse trends in mental health? A longitudinal ecological study.
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DOI：
10.1136/jech-2015-206209
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发表时间：
2016-04
影响因子：
6.3
通讯作者：
Whitehead M
中科院分区：
文献类型：
--
作者：
Barr B;Taylor-Robinson D;Stuckler D;Loopstra R;Reeves A;Whitehead M
在英格兰，2010年至2013年期间，只有100多万主要失业残疾福利的领取者使用新的功能检查表-工作能力评估重新评估了他们的资格。医生和残疾人权利组织担心这对索赔人的心理健康产生了不利影响，但没有人口水平的研究探讨这一政策或类似政策对健康的影响。我们使用多变量回归来调查英格兰149个地方当局的重新评估趋势的变化是否与自杀，自我报告的心理健康问题和抗抑郁药处方率的地方趋势差异相关，同时调整基线条件和已知影响精神疾病的其他因素的趋势。每个地区每增加10000人进行再评估，就增加6例自杀（95%CI 2至9），2700例报告的精神健康问题（95%CI 548至4840），以及额外7020种抗抑郁药（95%CI 3930至10100）。重新评估过程与该国最贫困地区这些不良心理健康结果的最大增加有关，扩大了健康不平等。使用工作能力评估重新评估残疾人福利的计划与自杀，自我报告的心理健康问题和抗抑郁药处方的增加独立相关。这项政策可能对英格兰的心理健康产生了严重的不利后果，这可能超过将人们从残疾福利中转移出来所带来的任何好处。
In England between 2010 and 2013, just over one million recipients of the main out-of-work disability benefit had their eligibility reassessed using a new functional checklist—the Work Capability Assessment. Doctors and disability rights organisations have raised concerns that this has had an adverse effect on the mental health of claimants, but there are no population level studies exploring the health effects of this or similar policies. We used multivariable regression to investigate whether variation in the trend in reassessments in each of 149 local authorities in England was associated with differences in local trends in suicides, self-reported mental health problems and antidepressant prescribing rates, while adjusting for baseline conditions and trends in other factors known to influence mental ill-health. Each additional 10 000 people reassessed in each area was associated with an additional 6 suicides (95% CI 2 to 9), 2700 cases of reported mental health problems (95% CI 548 to 4840), and the prescribing of an additional 7020 antidepressant items (95% CI 3930 to 10100). The reassessment process was associated with the greatest increases in these adverse mental health outcomes in the most deprived areas of the country, widening health inequalities. The programme of reassessing people on disability benefits using the Work Capability Assessment was independently associated with an increase in suicides, self-reported mental health problems and antidepressant prescribing. This policy may have had serious adverse consequences for mental health in England, which could outweigh any benefits that arise from moving people off disability benefits.