Use of mental health services in a developing country - Results from the Nigerian survey of mental health and well-being
Use of mental health services in a developing country - Results from the Nigerian survey of mental health and well-being
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DOI：
10.1007/s00127-005-0001-7
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发表时间：
2006-01-01
影响因子：
4.4
通讯作者：
Lasebikan, VO
中科院分区：
文献类型：
--
作者：
Gureje, O;Lasebikan, VO
背景 来自发达工业化国家的证据表明，人们对心理健康服务的接受度很低。资源有限的发展中国家没有关于社区精神卫生服务满足和未满足需求的数据。方法 对尼日利亚约鲁巴语地区的家庭进行四阶段分层概率样本研究（人口约 2500 万人，占尼日利亚全国人口的 22%）。使用世界心理健康版本的综合国际诊断访谈对 18 岁及以上的人（n=4,984）进行了面对面访谈。我们确定了接受过任何心理健康治疗的 12 个月精神障碍诊断和统计手册第四版 (DSM-IV) 焦虑、情绪或药物滥用障碍受访者的比例以及接受治疗的相关性。结果 患有任何 12 个月 DSM-IV 疾病的患者中只有 9.0% 接受了治疗。虽然 11% 的情绪障碍患者接受过一些治疗，但药物滥用障碍患者中没有人使用过心理健康服务。大多数治疗是在一般医疗机构接受的，只有约 1% 的 DSM-IV 障碍患者接受了专业心理健康服务。令人惊讶的是，在接受过精神障碍治疗的患者中，只有约 4% 的人向补充或替代医疗服务提供者进行了咨询，而在没有 DSM-IV 障碍但接受过精神健康治疗的患者中，有 57% 的比例更高。无论是哪种疾病或接受治疗的部门如何，实际上没有任何治疗被认为是最低限度的充分。结论 在这个发展中国家，社区对精神卫生服务的需求未得到满足的程度惊人。虽然正规公共卫生部门的不足可能是造成这一现象的部分原因，但公众对精神健康问题的性质了解甚少以及耻辱感也可能阻碍接受精神健康问题的治疗。
Background Evidence from developed industrialized countries suggests poor uptake of mental health services. No data exist in developing resource-constrained countries about met and unmet need for mental health service in the community. Method A four-stage stratified probability sample of households was studied in the Yoruba-speaking part of Nigeria (population, approximately 25 million people or 22% of the Nigerian national population). Face-to-face interviews were conducted with persons 18 years old and above (n=4,984) using the World Mental Health version of the Composite International Diagnostic Interview. We determined the proportions of respondents with 12-month Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) anxiety, mood, or substance use disorder who had received any mental health treatment and the correlates of treatment receipt. Results Only 9.0% of those with any 12-month DSM-IV disorder had received treatment. While 11% of those with a mood disorder had received some treatment, none of those with substance use disorders had used a mental health service. Most treatments were received from general medical settings, with only about 1% of those with DSM-IV disorders who were treated receiving specialist mental health service. Surprisingly, complementary or alternative health providers were also consulted by only about 4% of those with treated mental disorders, although a much higher proportion of 57% of those with no DSM-IV disorders but who nevertheless received mental health treatment did so from such providers. Irrespective of the disorders or the sector where treatment was received, virtually no treatment was adjudged minimally adequate. Conclusion There is a striking level of unmet need for mental health service in the community in this developing country setting. While inadequacy of the formal public health sector may be partly responsible for this observation, there is the likelihood that receipt of treatment for mental health problems may also be hampered by the public's poor knowledge of the nature of the disorders and by stigma.