Income differences in persons seeking outpatient treatment for mental disorders - A comparison of the United States with Ontario and the Netherlands
Income differences in persons seeking outpatient treatment for mental disorders - A comparison of the United States with Ontario and the Netherlands
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DOI：
10.1001/archpsyc.57.4.383
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发表时间：
2000-04-01
影响因子：
--
通讯作者：
Kessler, RC
中科院分区：
文献类型：
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作者：
Alegria, M;Bijl, RV;Kessler, RC
背景：通过比较在精神卫生服务的组织和筹资方面存在差异的3个国家的数据，研究了收入、使用精神卫生服务和护理部门之间关系的差异。方法：数据来自1990-1992年全国合并症调查（n=5384）、安大略省健康调查1990-1991年精神健康补充（n= 6321）和1996年荷兰精神健康调查和发病率研究（n= 6031）。对年龄在18岁至54岁之间的人群进行了收入与使用精神卫生服务之间的关系分析。调查了三个部门对心理健康治疗的差别使用情况：一般医疗部门、专业部门和人文服务部门。结果：在这三个国家中，没有观察到任何精神障碍患者的收入与任何精神健康治疗之间的显著关联。然而，各国在收入与心理保健治疗部门之间的关系方面存在显著差异。在美国，收入与专业部门接受的治疗呈正相关，与人类服务部门接受的治疗负相关。在荷兰，中等收入阶层的患者不太可能接受专科护理，而高收入阶层的患者则不太可能出现在人力服务部门。在安大略省，收入与病人护理部门无关。结论：未来的研究应该检查美国低收入人群进入专业部门的机会差异是否与较差的心理健康结果有关。
Background: Variations in the relationships among income, use of mental health services, and sector of care are examined by comparing data front 3 countries that differ in the organization and financing of mental health services.Methods: Data come from the 1990-1992 National Comorbidity Survey (n=5384), the 1990-1991 Mental Health Supplement to the Ontario Health Survey (n = 6321), and the 1996 Netherlands Mental Health Survey and Incidence Study (n = 6031). Analysis of the association between income and use of mental health services was carried out for the population that was between ages 18 and 54 years. Differential use of mental health treatment was examined in 3 sectors: the general medical sector, the specialty sector, and the human services sector.Results: No significant association between income and probability of any mental health treatment was observed for persons with psychiatric disorders in any of the 3 countries. However, there were significant differences among countries in the association between income and sector of mental health care treatment. In the United States, income is positively related to treatment being received in the specialty sector and negatively related to treatment being received in the human services sector. In the Netherlands, patients in the middle income bracket Lire less likely to receive specialty care, while those in the high-income bracket are less likely to be seen in the human service sector. Income is unrelated to the sector of care for patients in Ontario.Conclusions: Future research should examine whether differential access to the specialty sector for low-income people in the United States is associated with worse mental health outcomes.