Mental health care utilisation among internally displaced persons in Ukraine: results from a nation-wide survey
Mental health care utilisation among internally displaced persons in Ukraine: results from a nation-wide survey
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DOI：
10.1017/s2045796017000385
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发表时间：
2019-02-01
影响因子：
8.1
通讯作者：
Richardson, E.
中科院分区：
文献类型：
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作者：
Roberts, B.;Makhashvili, N.;Richardson, E.
目标。由于乌克兰东部的武装冲突，估计有150万境内流离失所者。本文的目的是探讨利用模式的心理健康和心理社会支持（MHPSS）照顾国内流离失所者在乌克兰。采用横断面调查设计。数据收集自2016年3月至5月期间乌克兰各地的2203名成年境内流离失所者。收集了关于精神卫生保健利用的数据，沿着的结果包括创伤后应激障碍（PTSD）、抑郁和焦虑。采用描述性和多元回归分析。PTSD患病率为32%，抑郁患病率为22%，焦虑患病率为17%。在那些可能需要照顾的人中，（筛查阳性的三种疾病之一，也自我报告的问题）有一个很大的治疗差距，与74%的受访者谁可能需要MHPSS护理在过去的12个月内没有收到它。对于26%（N = 180），已寻求护理，最常见的服务/支持来源是药店，家庭或地区医生/护理人员、综合诊所的神经科医生、综合医院的内科医生/神经科医生、访问社区的心理学家以及非政府组织/志愿精神卫生/心理社会中心。在180名确实寻求护理的受访者中，163人可以回忆起他们是否必须支付护理费用。在这163名受访者中，有72人（44%）回忆说，尽管乌克兰政府的医疗服务是免费的，但他们还是支付了医疗费用。在过去的12个月里，他们为护理支付的平均费用为107美元。所有180名受访者都表示必须支付药品费用，过去12个月的平均药品费用为109美元。在74%的人中，尽管可能需要护理，但他们没有寻求护理;不寻求护理的主要原因是：认为使用自己的药物会变得更好，无法支付医疗服务或药物，不知道在哪里接受帮助，医疗保健提供者的理解不足，服务质量差，以及耻辱/尴尬。多元回归分析的结果显示，贫困家庭的经济状况对无法获得医疗服务有显着影响。该研究强调了乌克兰境内流离失所者中精神障碍的高负担和MHPSS治疗的巨大差距。调查结果支持需要扩大规模，全面和创伤知情的反应提供MHPSS照顾国内流离失所者在乌克兰的同时更广泛的卫生系统加强。
Aims. There are an estimated 1.5 million internally displaced persons (IDPs) in Ukraine because of the armed conflict in the east of the country. The aim of this paper is to examine utilisation patterns of mental health and psychosocial support (MHPSS) care among IDPs in Ukraine.Methods. A cross-sectional survey design was used. Data were collected from 2203 adult IDPs throughout Ukraine between March and May 2016. Data on mental health care utilisation were collected, along with outcomes including post-traumatic stress disorder (PTSD), depression and anxiety. Descriptive and multivariate regression analyses were used.Results. PTSD prevalence was 32%, depression prevalence was 22%, and anxiety prevalence was 17%. Among those that likely required care (screened positive with one of the three disorders, and also self-reporting a problem) there was a large treatment gap, with 74% of respondents who likely required MHPSS care over the past 12 months not receiving it. For the 26% (N = 180) that had sought care, the most common sources of services/support were pharmacies, family or district doctor/paramedic (feldsher), neurologist at a polyclinic, internist/neurologist at a general hospital, psychologists visiting communities, and non-governmental organisations/volunteer mental health/psychosocial centres. Of the 180 respondents who did seek care, 163 could recall whether they had to pay for their care. Of these 163 respondents, 72 (44%) recalled paying for the care they received despite government care officially being free in Ukraine. The average costs they paid for care was US$107 over the previous 12 months. All 180 respondents reported having to pay for medicines and the average costs for medicines was US$109 over the previous 12 months. Among the 74% had not sought care despite likely needing it; the principal reasons for not seeking care were: thought that they would get better by using their own medications, could not afford to pay for health services or medications, no awareness of where to receive help, poor understanding by health care providers, poor quality of services, and stigma/embarrassment. The findings from multivariate regression analysis show the significant influence of a poor household economic situation on not accessing care.Conclusions. The study highlights a high burden of mental disorders and large MHPSS treatment gap among IDPs in Ukraine. The findings support the need for a scaled-up, comprehensive and trauma-informed response to provision of MHPSS care of IDPs in Ukraine alongside broader health system strengthening.