General medical and specialty mental health service use for major depression
General medical and specialty mental health service use for major depression
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DOI：
10.2190/tlxj-yxlx-f4ya-6pha
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发表时间：
2000-01-01
影响因子：
2
通讯作者：
Schulberg, HC
中科院分区：
文献类型：
--
作者：
Burns, BJ;Wagner, HR;Schulberg, HC
目的：虽然重度抑郁症很常见，但许多抑郁症患者最多只能得到不充分的治疗。纠正重度抑郁症检测和治疗不足的第一步需要了解治疗的途径——从无人护理的情况到疾病识别，再到转诊和适当的治疗——以及识别与这几个阶段之间的变化相关的因素。方法：使用流行病学区域样本，我们确定了与普通医疗或心理健康专家部分的治疗相关的因素，或在当前患有重度抑郁症的个体的子样本中与不治疗相关的因素。结果：引人注目的是，四分之一的样本没有接受任何服务，超过一半的人接受普通医疗部门的护理，只有五分之一的人寻求心理健康专家的帮助。在接受任何健康服务（一般或精神）的人中，报告有自杀症状的男性和受访者面临得不到护理的风险，而感知到的健康状况不佳和一系列核心抑郁症状与使用服务（一般或精神）的几率增加相关。在接受一般医疗服务的受访者中，自认为健康状况不佳、核心抑郁症状、抑郁病史和共病精神疾病增加了在专业心理健康部门接受治疗的几率。结论：研究结果强调需要采取公共卫生举措：1）改善那些有可能得不到护理的人的发现和接受治疗； 2) 确保进入医疗保健系统后，初级保健治疗和专科转诊流程符合循证治疗指南。
Objective: While major depression is common, many depressed persons receive, at best, inadequate treatment. A first step in remedying inadequate detection and treatment of major depression requires understanding the pathways into treatment-from situations of no care, to disease recognition, to referral and appropriate treatment-as well as identifying factors associated with movement between these several stages. Methods: Using the Epidemiologic Catchment Area sample, we identified factors associated with treatment in the general medical or mental health specialist section, or no treatment in a subsample of individuals with current major depression. Results: Strikingly, one-fourth of the sample received no services, over half received care in the general medical sector, and only one-fifth accessed a mental health specialist. Among those receiving any health services (general or mental), men and respondents reporting suicidal symptoms were at risk of receiving no care, while perceived poor health and a cluster of core depressive symptoms were associated with increased odds of service use (general or mental). Among respondents receiving general medical services, perceived poor health, core depressive symptoms, a history of depression, and comorbid mental conditions increased the odds of treatment in the specialty mental health sector. Conclusions: The findings emphasize the need for public health initiatives to 1) improve detection and movement into treatment among those at risk of receiving no care; and 2) insure that, once within the health care system, the processes of primary care treatment and specialty referrals conform to evidence-based treatment guidelines.