Treatment Patterns and Barriers in Comorbid Mental and Substance Disorders

描述(申请人提供)：在社区中，有很大比例的酗酒和非法药物滥用和依赖的个人也有精神障碍，反之亦然，很大比例的各种精神障碍的个人也有物质障碍。然而，这些人中的大多数人没有寻求治疗。即使在那些接受治疗的人中，共病障碍的治疗结果往往比非共病精神或物质障碍的治疗结果更差。然而，我们对这些人使用的服务类型或他们未得到满足的治疗需求知之甚少。我们也不知道他们是否面临着与患有非共病精神或物质障碍的人一样的获得服务的障碍。如果我们要改善这些人获得适当的精神健康和物质障碍服务的机会，我们就必须更多地了解他们的服务使用模式、他们未得到满足的需求以及他们在获得服务方面面临的障碍。在拟议的项目中，我们计划使用两个来源的数据，这些数据来自对美国总体人口的大型和最近的全国代表性调查，以获得这些亟需的信息。我们将使用全国酒精及相关疾病纵向流行病学调查(NESARC)第1波和第2波的数据，以及2004-2008年年度全国药物使用与健康横向调查(NSDUH)的数据。这些数据提供了一个前所未有的机会来检查人口亚群(如少数族裔)的服务使用情况和护理障碍，以前的研究由于样本量小而无法对这些群体进行充分的检查。在研究的目标1中，我们检查了服务使用的模式，并比较了这些调查中的参与者与共病和非共病的障碍，以确定他们是否使用相同类型、组合或数量的精神健康或物质障碍服务。我们还比较了这些群体在感知到的未得到满足的护理需求方面的差异。在目标2中，我们比较了共病组和非共病组不使用所需服务的特定原因的类型和流行率，并比较了不使用精神健康服务和物质障碍服务的原因。我们利用NESARC数据的纵向设计来评估一些原因是否在一段时间内比其他原因更持久，以及一些原因是否与未来不使用服务的原因比其他原因更密切相关。在目标3中，我们还使用NESARC的纵向数据来评估在基线时使用某些服务或某种服务组合是否与更大程度地减少药物使用、戒除或在后续行动中更好地发挥社会功能有关。我们还将在这些分析中审查种族、族裔和性别的影响。除了科学价值之外，这项研究的结果将有助于设计更符合精神和物质障碍患者需求的服务。这些数据还将有助于设计公共活动，旨在通过减少耻辱和其他态度和结构性障碍来改善获得服务的机会。 公共卫生相关性：大多数患有精神和物质障碍的人不寻求治疗，而在那些确实寻求治疗的人中，治疗结果往往比非共病障碍的结果更糟糕。为了帮助改善对这一群体的服务和护理结果，这项研究将使用来自美国两项大型流行病学调查的数据来回答三个问题：(1)共病障碍患者是否与非共病障碍患者使用相同的服务类型、数量和组合，以及他们是否经历了相同程度的未得到满足的需求；(2)共病障碍患者在心理健康和物质障碍服务方面是否面临与非共病障碍患者相同的障碍，哪些障碍更持久，造成更大的障碍；以及(3)某种类型或服务组合是否与共病障碍患者的临床和社会结果更好相关。

DESCRIPTION (provided by applicant): A large proportion of individuals with alcohol and illicit drug abuse and dependence in the community also have mental disorders and, vice versa, a large proportion of individuals with various mental disorders also have substance disorders. Nevertheless, the majority of these individuals do not seek treatment. Even among those who receive treatment the outcomes of treatment for comorbid disorders are often worse than for non-comorbid mental or substance disorders. However, we know very little about the types of services that these individuals use or their unmet need for treatment. We also do not know whether they face the same barriers to accessing services as individuals with non-comorbid mental or substance disorders. If we are to improve these individuals' access to appropriate mental health and substance disorder services we have to learn more about their service use patterns, their unmet needs and the barriers they face in accessing services. In the proposed project we plan to use two sources of data from large and recent nationally representative surveys of the US general population to obtain this much needed information. We will use data from the longitudinal National Epidemiological Survey of Alcohol and Related Conditions (NESARC) waves 1 and 2, and the annual cross-sectional National Survey of Drug Use and Health (NSDUH) for years 2004-2008. These data provide an unprecedented opportunity to examine service use and barriers to care in population subgroups (e.g., racial minorities) that could not be adequately examined in previous studies due to small sample sizes. In Aim 1 of the study we examine patterns of service use and compare participants in these surveys with comorbid and non-comorbid disorders to determine whether they use the same types, mix or amount of mental health or substance disorder services. We also compare these groups regarding perceived unmet need for care. In Aim 2 we compare the comorbid and non- comorbid groups regarding the types and prevalence of specific reasons given for not using needed services and compare the reasons for not using mental health vs. substance disorder services. We capitalize on the longitudinal design of the NESARC data to assess whether some reasons are more persistent than others over time and whether some reasons are more strongly associated with not using services at a future time than other reasons. In Aim 3 also we use the longitudinal NESARC data to assess whether use of certain services or a certain mix of services at baseline is associated with a greater reduction in use of substances, abstinence or better social functioning at follow-up. We will also examine the effects of race-ethnicity and gender in these analyses. Beyond their scientific merits, the results from this study will be helpful in designing services that are more responsive to the needs of patients with comorbid mental and substance disorders. The data will also help in designing public campaigns that aim to improve access to services by reducing the stigma and other attitudinal and structural barriers to care. PUBLIC HEALTH RELEVANCE: The majority of individuals with comorbid mental and substance disorders do not seek treatment and among those who do seek treatment, the outcomes of treatment are often worse than for non-comorbid disorders. To help improve access to services and outcome of care for this group of individuals this study will use data from two large US epidemiological surveys to answer three questions: (1) whether individuals with comorbid disorders use the same types, amount and mix of services as those with non- comorbid disorders and whether they experience the same degree of unmet need; (2) whether individuals with comorbid disorders face the same barriers to mental health and substance disorder services as those with non-comorbid disorders and which barriers are more persistent and cause greater hindrance; and (3) whether a certain type or mix of services is associated with better clinical and social outcomes in individuals with comorbid disorders.