Disentangling Disparities in Trauma and Mental Health Service Use

描述（由申请人提供）：创伤后应激障碍（PTSD）与一系列负面的长期后果有关，包括人际关系问题、不健康行为的高比例、身体问题和死亡率（Tanielian & Jaycox, 2008）。虽然每个人都有暴露于诱发PTSD的创伤性事件的风险，但新兴的文献表明，PTSD风险存在显著差异，特别是少数民族（例如，Pole等，2008）和女性（例如，Olff等，2007；Tolin和Foa， 2006）。例如，拉丁美洲人被认为是创伤和创伤后应激障碍的高风险人群（Eisenman et al., 2008）。女性患PTSD的总体患病率更高（10.4% vs. 5.0%），而且更有可能因受到身体攻击等特殊创伤而患上PTSD （Kessler et al., 1995）。创伤后应激障碍（PTSD）患者报告的护理障碍比正常人多（Amaya- Jackson et al., 1999），某些亚群可能比其他人遇到更多障碍（Boscarino et al., 2005; Jaycox et al., 2004）。尽管创伤后应激障碍有有效的治疗方法（Foa等人，2000；Ursano等人，2004;VA/DoD 2004； NICE, 2005），包括药物治疗、心理治疗、教育和支持服务，但许多人不寻求治疗，或者严重拖延寻求治疗。即使PTSD患者得到了治疗，也可能是不够的（Frueh et al., 2006; Wang, Lane et al., 2005）。然而，关于创伤和心理健康服务使用中的种族-民族和性别差异知之甚少。本研究旨在1)通过检查创伤暴露和PTSD发展方面的种族、民族和性别差异，确定哪里的需求最大；2)通过探究PTSD患者在获得精神卫生保健方面的认知障碍，考察种族和性别差异；3)描述不同种族和性别PTSD患者的心理健康服务利用模式。本研究以Ronald Andersen（1995）的《卫生服务使用行为模型》为指导，采用了协作精神病学调查的数据。这些数据包含了20013个诊断性访谈，其中1194个受访者在生活中的某个阶段符合创伤后应激障碍的标准。这是第一个有足够力量来调查文化对心理健康影响的国家数据（Colpe et al., 2004），目前还没有发表过关于PTSD综合数据的研究。消除健康差距是公共卫生研究的一个基本目标，也是2010年健康人的主要重点之一。本研究旨在探讨创伤暴露及后续创伤后应激障碍（PTSD）的差异、心理保健障碍和心理健康服务利用的差异，以缓解创伤后应激障碍（PTSD）的种族和性别差异。这项研究的结果将有助于通过识别负担较高的人群，更好地定位和改善预防和干预的结果，帮助提供者更好地照顾经历差异的人群，并为解决健康差异提供资金建议，从而减轻PTSD的差异。

DESCRIPTION (provided by the applicant): Post traumatic stress disorder (PTSD) is associated with a wide range of negative long-term consequences, including problems with interpersonal relationships, higher rates of unhealthy behaviors, physical problems, and mortality (Tanielian & Jaycox, 2008). Although everyone is at some risk of exposure to traumatic events that precipitate PTSD, a burgeoning literature suggests there are significant disparities in PTSD risk, especially for racial-ethnic minorities (e.g., Pole et al., 2008) and women (e.g., Olff et al., 2007; Tolin & Foa, 2006). For example, Latinos are thought to be at both high risk of trauma and PTSD (Eisenman et al., 2008). Women have both a higher overall prevalence of PTSD (10.4% vs. 5.0%) and are much more likely to develop PTSD in response to particular traumas like physical assault (Kessler et al., 1995). Individuals with PTSD report more barriers to care than those without the disorder (Amaya- Jackson et al., 1999), and certain subgroups may experience more barriers than others (Boscarino et al., 2005; Jaycox et al., 2004). Despite the availability of effective treatments for PTSD (Foa et al., 2000; Ursano et al., 2004; VA/DoD 2004; NICE, 2005), including pharmacological treatment, psychotherapeutic treatment, and education and support services, many do not seek treatment or they substantially delay treatment seeking. Even when those with PTSD do receive care, it may be inadequate (Frueh et al., 2006; Wang, Lane et al., 2005). Yet, little is known about racial-ethnic and gender variation in trauma and mental health service use. This study seeks to 1) identify where needs are greatest by examining racial-ethnic and gender disparities in exposure to trauma and development of PTSD; 2) examine racial-ethnic and gender disparities in access to mental health care by exploring perceived barriers to mental health care for those with PTSD; and 3) describe mental health service utilization patterns among racial-ethnic and gender groups with PTSD. The study is guided by Ronald Andersen's (1995) Behavioral Model of Health Services Use and employs the Collaborative Psychiatric Epidemiology Surveys data. These data contain 20,013 diagnostic interviews, and 1,194 of those interviewed met criteria for PTSD at some point in their lives. This is the first national data with enough power to investigate cultural influences on mental health (Colpe et al., 2004), and no studies have yet been published that focus on PTSD in the combined data. Eliminating health disparities is a fundamental goal of public health research and one of the main focuses of Healthy People 2010. This research aims to alleviate racial-ethnic and gender disparities in posttraumatic stress disorder (PTSD) by exploring variation in trauma exposure and subsequent PTSD, barriers to mental health care, and differences in utilization of mental health services. Findings from this research will help alleviate disparities in PTSD by identifying populations with higher burdens, better targeting and improving the outcomes of prevention and intervention, preparing providers to better care for populations experiencing disparities, and suggesting implications for funding that addresses health disparities.