Mental Health Services Use: Baltimore Epidemiologic Catchment Area Follow-Up
Mental Health Services Use: Baltimore Epidemiologic Catchment Area Follow-Up
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DOI：
10.1097/jgp.0b013e3181aad5c5
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发表时间：
2009-08-01
影响因子：
7.2
通讯作者：
Unuetzer, Juergen
中科院分区：
文献类型：
--
作者：
Bogner, Hillary R.;de Vries, Heather F.;Unuetzer, Juergen
目的：在巴尔的摩流行病学集水区随访中，研究老年人以前和现在使用精神卫生服务的模式。检查最近的一组老年人是重要的，因为利用模式可能已经改变，由于治疗的进步，精神卫生保健服务的变化，以及更大的心理健康意识。设计：以人群为基础的纵向调查。背景：1981年居住在东巴尔的摩的社区居住成年人研究的持续参与者。参与者：共有1，067名成年人，他们的完整数据可用。测量：在进行心理健康评估之前，分别询问参与者使用卫生服务的情况。认知状态和身体健康状况使用标准化工具进行评估。使用诊断访谈计划评估精神障碍。结果如下：与2004年40-59岁的成年人相比，60岁及以上的成年人报告专业精神卫生服务的可能性低于没有精神卫生组成部分的一般医疗保健（调整后的比值比= 0.28，95%置信区间[0.14-0.56]）。多变量模型控制了潜在的影响特征，包括重性抑郁症或与近期丧亲相关的抑郁症，焦虑症和过去使用精神卫生服务。结论：60岁及60岁以上的成年人与40-59岁的成年人相比，约有三分之一的人可能咨询心理健康专家，即使考虑到与差别使用服务有关的其他因素。我们的研究加强了初级保健对老年精神疾病治疗仍然重要的证据。(Am J Geriatr Psychiatry 2009; 17：706-715）
Objective: To examine the patterns of previous and current mental health services use among older adults in the Baltimore Epidemiologic Catchment Area Follow-up. Examination of a recent cohort of older adults is important because patterns of utilization may have changed due to treatment advances, changes in mental health-care services, and greater mental health awareness. Design: A population-based longitudinal survey. Setting: Continuing participants in a study of community-dwelling adults who were living in East Baltimore in 1981. Participants: In all, 1,067 adults for whom complete data were available. Measurements: Separately, and before the mental health assessments were made, participants were asked about use of health services. Cognitive status and physical health were assessed using standardized instruments. Mental disorders were assessed using the Diagnostic Interview Schedule. Results: Compared with adults aged 40-59 years in 2004, adults aged 60 years and older were less likely to report specialty mental health services versus general medical care without a mental health component (adjusted odds ratio = 0.28, 95% confidence interval [0.14-0.56]). Multivariate models controlled for potentially influential characteristics including major depression or depression associated with recent bereavement, anxiety disorders, and past use of mental health services. Conclusion: Adults aged 60 years and older are approximately one third as likely to consult a specialist in mental health compared with adults aged 40-59 years even accounting for other factors associated with differential use of services. Our study strengthens evidence that the primary care remains important for the treatment of psychiatric disorders in the elderly. (Am J Geriatr Psychiatry 2009; 17: 706-715)