PATHWAYS TO SPECIALITY MENTAL HEALTH CARE

精神卫生服务体系面临的一个关键挑战是 将治疗扩大到最需要的人。 这个项目的目标 是确定和审查阻碍或拖延的因素， 为患有精神疾病的人提供专门的精神卫生保健 焦虑情感或物质使用障碍 数据将被提取 根据科摩罗国家调查（NCS），一个大型（N= 8，098） 进行的全国代表性流行病学调查， 1990-92. NCS提供了一个独特的机会，首先学习 心理健康寻求行为从人口为基础的 perspective. 对于每种类型的疾病， 将开发显示患者流入的路径 心理健康专家、初级保健医生的治疗， 其他卫生专业人员。 逻辑回归将用于 评估个人特征之间的关联（即， 精神症状、社会人口学特征，以及 心理社会因素）和心理健康治疗，并确定 在寻求心理健康的过程中， 发挥最大的作用。 生存分析将用于 检查临床和社会人口特征的影响 疾病发作与首次治疗的间隔时间 contact. 我们将研究假设，在每一组 障碍，社会弱势群体（黑人，西班牙裔， 低收入或高中以下学历的人）， 他们接受治疗的可能性比他们的同龄人要小 而那些接受治疗的人会经历更长的延迟， 不太可能直接去看心理健康专家， 被另一个专业人士拒绝了。 类似的假设将 以病为鉴，以病为鉴。 我们亦会研究 假设在接受治疗的人中，妇女 比男性更有可能去看初级保健医生， 去看心理健康专家 这项研究的结果将 大大增加了我们对寻求医疗保健行为的了解 用于治疗情感、焦虑和物质使用障碍。

A critical challenge facing themental health service system is to extend treatment to those in greast need. The goal of this project is to identify and examine factors which impede or delay the delivery of specialized mental health care to individuals with anxiety, affective, or substance use disorders. Data will be drawn from the National Comorbidity Survey (NCS), a large (N=8,098) nationally representative epidemiologic survey conducted in 1990-92. The NCS provides a unique opportunity to study first episode mental health seeking behavior from a population-based perspective. For each type of disorder, mental health care pathways will be developed which display the flow of patients into treatment by mental health specialists, primary care physicians, and other health professionals. Logistic regression will be used to evaluate associations between personal characteristics (i.e., psychiatric symptoms, sociodemographic characteristics, and psycosocial factors) and mental health treatment and to determine where in the mental health seeking process these characteristics exert their greatest effects. Survival analysis will be used to examine the effect of clinical and sociodemographic characteristics on the time period separating disorder onset from first treatment contact. We will examine the hyopthesis that, within each group of disorders, socially disadvantaged individuals (blacks, hispanics, persons with low income or less than a high school education) are less likely than their advantaged counterparts to receive treatment and those who receive treatment experience longer delays and are less likely to see a mental health specialist either directly or following treatent by another professional. Similar hypotheses will be tested concerning illness severity. We will also examine the hypothesis that, among those who receive treatment, women are more likely than men to see primary care physicians and less likely to see mental health specialists. The findings from this study will add substantially to our knowldge of health care seeking behavior for the treatment of affective, anxiety, and substance use disorders.