PATHWAYS TO SPECIALITY MENTAL HEALTH CARE

基本卫生服务系统面临的一个关键挑战是 将治疗扩大到那些最需要治疗的人。这个项目的目标是 就是找出并检查阻碍或拖延 为患有以下疾病的个人提供专门的心理健康护理 焦虑、情感或药物使用障碍。将绘制数据 来自国家共病调查(NCS)的大型(N=8,098) 年进行了具有全国代表性的流行病学调查 1990-92年。NCS提供了一个独特的先学习的机会 基于人群的突发心理健康寻求行为研究 透视。对于每一种类型的障碍，心理健康护理 将开发出显示患者流入 由心理健康专家、初级保健医生和 其他健康专业人士。将使用Logistic回归分析 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，这些特征在哪里 发挥他们最大的作用。生存分析将被用于 检查临床和社会人口学特征的影响 论疾病起病与初治的间隔时间 联系。我们将研究，在每一组中， 障碍，社会弱势个人(黑人，西班牙裔， 低收入或高中以下教育程度的人) 比起有优势的同行接受治疗的可能性更小 那些接受治疗的人经历了更长的延误，并且 不太可能直接或直接去看心理健康专家 在另一位专业人士的治疗下。类似的假说也会 接受有关疾病严重程度的测试。我们还将研究 假设，在接受治疗的人中，女性是 比男性更有可能去看初级保健医生，而不太可能 去看心理健康专家。这项研究的发现将 大大增加了我们对求医行为的了解 用于治疗情感障碍、焦虑症和药物使用障碍。

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.