Treatment Patterns and Barriers in Comorbid Mental and Substance Disorders

说明（由申请人提供）：社区中有很大一部分酗酒和滥用非法药物和依赖毒品的人也有精神障碍，反之亦然，很大一部分有各种精神障碍的人也有物质障碍。然而，这些人中的大多数并不寻求治疗。即使在接受治疗的患者中，共病性精神障碍的治疗结果往往比非共病性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满足的治疗需求知之甚少。我们也不知道他们在获得服务方面是否面临与非共病精神或物质障碍患者相同的障碍。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，我们计划使用两个数据来源，这些数据来自最近对美国普通人群进行的具有全国代表性的大型调查，以获得这一急需的信息。我们将使用来自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年全国药物使用和健康年度横断面调查（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组（如少数种族）的服务使用和护理障碍，而以前的研究由于样本量小而无法充分检查。在这项研究的目的1中，我们检查了服务使用模式，并比较了这些调查中患有共病和非共病疾病的参与者，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对未满足的护理需求的感知。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具体原因的类型和流行程度，并比较了不使用精神健康与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比其他原因更持久，以及一些原因是否比其他原因更强烈地与未来不使用服务相关。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些服务组合是否与更大程度地减少药物使用、戒断或更好的社会功能有关。我们还将在这些分析中考察种族和性别的影响。除了它们的科学价值之外，这项研究的结果将有助于设计更能满足精神和物质障碍共病患者需求的服务。这些数据还将有助于设计旨在通过减少耻辱感和其他态度和结构障碍来改善获得服务的公共运动。

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.