Failure and delay in initial treatment contact after first onset of mental disorders in the national comorbidity survey replication
Failure and delay in initial treatment contact after first onset of mental disorders in the national comorbidity survey replication
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DOI：
10.1001/archpsyc.62.6.603
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发表时间：
2005-06-01
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：
Wang, PS;Berglund, P;Kessler, RC
内容：在寻求帮助的过程中，一个未充分研究的关键步骤是在精神障碍首次发作后迅速与治疗提供者进行初步接触。目的：从最近完成的全国科摩罗调查复制中，提供美国精神障碍首次发作后进行初步治疗接触失败和延迟的模式和预测因素的数据。设计和设置：在2001年2月至2003年4月期间进行的具有全国代表性的面对面家庭调查。参与者：共有9282名年龄在18岁及以上的受访者。主要结果测量：终身DSM-IV疾病评估与世界精神卫生（WMH）调查倡议版本的世界卫生组织复合国际诊断访谈（WMH-CIDI），一个完全结构化的面试，旨在由训练有素的外行面试官管理。收集调查中评估的每种终生DSM-IV/WMH-CIDI疾病的首次专业治疗联系人的年龄信息，并与疾病发作时的年龄进行比较，以研究延迟的典型持续时间。累积的终生概率曲线显示，绝大多数终身疾病患者最终都会进行治疗，尽管情绪障碍（88.1%-94.2%）比焦虑障碍（27.3%-95.3%）、冲动控制障碍（33.9%-51.8%）或物质障碍（52.7%-76.9%）更常见。在那些最终进行治疗联系的人中，情绪障碍的延迟时间为6至8年，焦虑症的延迟时间为9至23年。未能作出初步治疗接触和延迟在那些谁最终作出治疗接触都与发病年龄早，是在一个较老的队列，和一些社会人口特征（男性，已婚，教育程度低，种族/少数民族）。结论：未能作出及时的初步治疗接触是一个普遍的方面，未满足的精神卫生保健的需要在美国。加快初步治疗接触的干预措施可能会减少未经治疗的精神障碍的负担和危害。
Context: An understudied crucial step in the help-seeking process is making prompt initial contact with a treatment provider after first onset of a mental disorder.Objective: To provide data on patterns and predictors of failure and delay in making initial treatment contact after first onset of a mental disorder in the United States from the recently completed National Comorbidity Survey Replication.Design and Setting: Nationally representative face-to-face household survey carried out between February 2001 and April 2003.Participants: A total of 9282 respondents aged 18 years and older.Main Outcome Measures: Lifetime DSM-IV disorders were assessed with the World Mental Health (WMH) Survey Initiative version of the World Health Organization Composite International Diagnostic interview (WMH-CIDI), a fully structured interview designed to be administered by trained lay interviewers. Information about age of first professional treatment contact for each lifetime DSM-IV/WMH-CIDI disorder assessed in the survey was collected and compared with age at onset of the disorder to study typical duration of delay.Results: Cumulative lifetime probability curves show that the Vast majority of people with lifetime disorders eventually make treatment contact, although more so for mood (88.1%-94.2%) disorders than for anxiety,(27.3%-95.3%), impulse control (33.9%-51.8%), or substance (52.7%-76.9%) disorders. Delay among those who eventually make treatment contact ranges from 6 to 8 years for mood disorders and 9 to 23 years for anxiety disorders. Failure to make initial treatment contact and delay among those who eventually make treatment contact are both associated with early age of onset, being in an older cohort, and a number of socio-demographic characteristics (male, married, poorly educated, racial/ethnic minority).Conclusions: Failure to make prompt initial treatment contact is a pervasive aspect of unmet need for mental health care in the United States. Interventions to speed initial treatment contact are likely to reduce the burdens and hazards of untreated mental disorder.