Posttraumatic stress disorder and the use of health services
Posttraumatic stress disorder and the use of health services
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DOI：
10.1097/00006842-200109000-00018
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发表时间：
2001-09-01
影响因子：
3.3
通讯作者：
Creamer, K
中科院分区：
文献类型：
--
作者：
Deykin, EY;Keane, TM;Creamer, K
目的：先前的研究表明，越来越多的人使用医疗服务的焦虑和抑郁症。这项调查研究了创伤后应激障碍（PTSD）与使用非精神卫生服务的可能联系。方法：一项病例对照设计招募了102名健康服务的高使用者和54名低使用者，他们被评估了PTSD诊断和PTSD症状的严重程度。受试者是在18个月期间接受VA波士顿医疗保健系统初级保健诊所服务的男性退伍军人。通过访谈收集数据，使用标准化工具，包括临床医生管理的创伤后应激障碍量表DSM-IV，生活事件清单，贝克抑郁量表。数据分析采用比值比，线性和逻辑回归，路径分析，结果：高用户的医疗保健几乎是两倍，低用户（27.5%对14.8%），以满足当前PTSD的诊断标准。两组在症状频率和强度上均存在显著差异。路径分析显示，PTSD和卫生服务使用之间存在间接的正相关关系，医生诊断的健康状况作为中介变量。辅助分析表明，PTSD和抑郁症状的综合心理健康负担也与健康状况的数量呈正相关。结论：研究结果表明，创伤后应激障碍，单独和与抑郁症相结合，与身体健康有直接的负面关系，反过来，与更频繁地使用初级卫生保健服务有关。这些结果并不表明PTSD导致不适当的（例如，痛苦动机）使用服务。
Objective: Prior research has demonstrated increased use of medical services among persons with anxiety and depression. This investigation examined the possible association of posttraumatic stress disorder (PTSD) with the use of nonmental health services. Method: A case-comparison design enrolled 102 high users of health services and 54 low users who were assessed for PTSD diagnosis and severity of PTSD symptoms. Subjects were male veterans receiving services from the primary care clinics of the VA Boston Healthcare System during an 18-month period. Data were collected by interview by use of standardized instruments including the Clinician Administered PTSD Scale for DSM-IV, the Life Events Checklist, and the Beck Depression Inventory. Data analysis employed odds ratios, linear and logistic regression, and path analyses, Results: High users of health care were almost twice as likely as low users (27.5% vs. 14.8%) to meet diagnostic criteria for current PTSD. The two groups differed significantly on both symptom frequency and intensity. Path analyses showed an indirect positive association between PTSD and health services use, with physician-diagnosed health conditions as a mediating variable. Auxiliary analysis demonstrated that the combined mental health burden of PTSD and depression symptoms also is positively associated with number of health conditions. Conclusions: The findings indicate that PTSD, alone and in combination with depression, has a direct negative relationship with physical health that, in turn, is associated with more frequent use of primary health care services. These results do not suggest that PTSD leads to inappropriate (eg, distress-motivated) use of services.