National Trends in the Mental Health Care of Children, Adolescents, and Adults by Office-Based Physicians
National Trends in the Mental Health Care of Children, Adolescents, and Adults by Office-Based Physicians
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DOI：
10.1001/jamapsychiatry.2013.3074
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发表时间：
2014-01-01
期刊：
影响因子：
25.8
通讯作者：
Correll, Christoph U.
中科院分区：
文献类型：
--
作者：
Olfson, Mark;Blanco, Carlos;Correll, Christoph U.
尽管有证据表明精神药物的使用越来越多，但对儿童、青少年和成人门诊精神卫生治疗的广泛变化知之甚少。目的评估全国办公室医疗实践中儿童、青少年和成人精神卫生保健的趋势和模式。设计、环境和参与者：1995-2010年全国门诊医疗调查（N = 446 542）中门诊医生的门诊就诊情况。首先比较了青少年（21岁）和儿童（0-13岁）和青少年（14-20岁）的心理保健指标就诊趋势（1995-2010年）。背景和临床特征的最近访问（2007-2010）导致精神障碍的诊断在儿童，青少年和成人之间也进行了比较。主要结果和测量：就诊导致精神障碍诊断、精神药物处方、提供心理治疗或精神科护理。结果1995-1998年和2007-2010年期间，青少年每百人精神障碍诊断次数（从7.78次增加到15.30次）明显快于成人（从23.23次增加到28.48次）（交互作用：P < 0.001）。青少年看精神病医生的次数（从2.86次增加到5.71次）明显快于成年人（从10.22次增加到10.87次）（交互作用：P < .001）。青少年（从8.35次增加到17.12次）和成人（从30.76次增加到65.90次）的精神药物就诊次数增加的比率相当（相互作用：P = 0.13）。青少年的心理治疗就诊次数从每100人2.25次增加到3.17次，而成年人的心理治疗就诊次数从8.37次减少到6.36次（相互作用：P < 0.001）。2007-2010年，27.4%的儿童就诊、47.9%的青少年就诊和36.6%的成人就诊是在精神科医生那里诊断出精神障碍的。结论及相关性与成人相比，青少年的精神卫生保健增加更快，且与精神药物使用增加相一致。在以办公室为基础的医疗实践中，绝大多数儿童、青少年和成人的精神卫生保健都是由非精神病医生提供的，这要求各专业之间增加咨询和沟通。
IMPORTANCE Despite evidence of the increasing use of psychotropic medications, little is known about the broader changes in the delivery of outpatient mental health treatment to children, adolescents, and adults.OBJECTIVE To assess national trends and patterns in the mental health care of children, adolescents, and adults in office-based medical practice.DESIGN, SETTING, AND PARTICIPANTS Outpatient visits to physicians in office-based practice from the 1995-2010 National Ambulatory Medical Care Surveys (N = 446 542). Trends (1995-2010) in visits with mental health care indicators are first compared between youths (= 21 years) and then between children (0-13 years) and adolescents (14-20 years). Background and clinical characteristics of recent visits (2007-2010) resulting in a mental disorder diagnosis are also compared among children, adolescents, and adults.MAIN OUTCOMES AND MEASURES Visits resulting in mental disorder diagnoses, prescription of psychotropic medications, provision of psychotherapy, or psychiatrist care.RESULTS Between 1995-1998 and 2007-2010, visits resulting in mental disorder diagnoses per 100 population increased significantly faster for youths (from 7.78 to 15.30 visits) than for adults (from 23.23 to 28.48 visits) (interaction: P < .001). Psychiatrist visits also increased significantly faster for youths (from 2.86 to 5.71 visits) than for adults (from 10.22 to 10.87 visits) (interaction: P < .001). Psychotropic medication visits increased at comparable rates for youths (from 8.35 to 17.12 visits) and adults (from 30.76 to 65.90 visits) (interaction: P = .13). While psychotherapy visits increased from 2.25 to 3.17 per 100 population for youths, they decreased from 8.37 to 6.36 for adults (interaction: P < .001). In 2007-2010, 27.4% of child visits, 47.9% of adolescent visits, and 36.6% of adult visits resulting in a mental disorder diagnosis were to a psychiatrist.CONCLUSIONS AND RELEVANCE Compared with adult mental health care, the mental health care of young people has increased more rapidly and has coincided with increased psychotropic medication use. A great majority of mental health care in office-based medical practice to children, adolescents, and adults is provided by nonpsychiatrist physicians calling for increased consultation and communication between specialties.