Gaps in service utilization by Mexican Americans with mental health problems
Gaps in service utilization by Mexican Americans with mental health problems
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DOI：
10.1176/ajp.156.6.928
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发表时间：
1999-06-01
影响因子：
17.7
通讯作者：
Catalano, R
中科院分区：
文献类型：
--
作者：
Vega, WA;Kolody, B;Catalano, R
目的：本研究的目的是确定城市和农村墨西哥裔美国成年人的心理健康问题的服务利用不足的程度。方法：概率样本（N= 3，012）用于代表加州弗雷斯诺县的墨西哥裔美国人，并使用复合国际诊断访谈进行面对面访谈。采用双变量和多变量分析方法对诊断和服务利用数据进行分析。结果如下：在DSM-III-R定义的疾病的受访者中，只有大约四分之一的人在过去12个月内使用过单一服务或服务组合，墨西哥移民的使用率只有在美国出生的墨西哥裔美国人的五分之二。被诊断为精神障碍的人使用精神卫生保健提供者的总体比例为8.8%，使用普通医疗部门提供者的比例为18.4%，使用其他专业人员的比例为12.7%，使用非正式提供者的比例仅为3.1%。Logistic回归分析显示，影响精神卫生服务利用的因素包括女性、文化程度、失业、共病史。结论：移民不太可能使用心理健康服务，即使他们最近有一个障碍，但可能会使用全科医生，这就提出了关于适当性，可及性和成本效益的心理保健，这一人群的问题。关于服务利用率低的原因，有几个相互竞争的假设需要在今后的研究中加以审查。
Objective: The purpose of this study was to ascertain the degree of underutilization of services for mental health problems among urban and rural Mexican American adults. Method: A probability sample (N=3,012) was used to represent the Mexican American population of Fresno County, California, and face-to-face interviews were conducted with the use of the Composite International Diagnostic Interview. Bivariate and multivariate analyses were used to analyze the data on diagnosis and service utilization. Results: Among the respondents with DSM-lll-R-defined disorders, only about one-fourth had used a single service or a combination of services in the past 12 months, and Mexican immigrants had a utilization rate which was only two-fifths of that of Mexican Americans born in the United States. Overall use of mental health care providers by persons with diagnosed mental disorders was 8.8%, use of providers in the general medical sector was 18.4%, use of other professionals was 12.7%, and use of informal providers was only 3.1%. According to logistic regression analyses, factors associated with utilization of mental health services included female sex, higher educational attainment, unemployment, and comorbidity. Conclusions: Immigrants are unlikely to use mental health services, even when they have a recent disorder, but may use general practitioners, which raises questions about the appropriateness, accessibility, and cost-effectiveness of mental health care for this population. Several competing hypotheses about the reasons for low utilization of services need to be examined in future research.