Treatment Patterns and Barriers in Comorbid Mental and Substance Disorders

描述（由申请人提供）：社区中有很大比例的酒精和非法药物滥用和依赖的人也有精神障碍，反之亦然，有各种精神障碍的人也有很大比例的物质障碍。然而，这些人中的大多数并没有寻求治疗。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心理健康和物质障碍服务的机会，我们必须更多地了解他们的服务使用模式，他们未满足的需求以及他们在获得服务时面临的障碍。在拟议的项目中，我们计划使用两个来源的数据，从大型和最近的全国代表性调查的美国一般人口，以获得这急需的信息。我们将使用2004-2008年纵向全国酒精和相关疾病流行病学调查（NESARC）第1和第2波以及年度全国药物使用和健康横断面调查（NSDUH）的数据。这些数据提供了一个前所未有的机会，以审查服务的使用和障碍，以照顾人口亚组（如，少数民族），由于样本量小，在以前的研究中无法充分研究。在本研究的目标1中，我们检查了服务使用的模式，并将这些调查中的参与者与共病和非共病疾病进行比较，以确定他们是否使用相同类型，混合或数量的心理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。在目标2中，我们比较了共病组和非共病组关于不使用所需服务的具体原因的类型和患病率，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随着时间的推移，某些原因是否比其他原因更持久，以及某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，我们还使用纵向NESARC数据来评估基线时使用某些服务或某种服务组合是否与后续的物质使用，禁欲或更好的社会功能的减少有关。我们还将在这些分析中研究种族-民族和性别的影响。除了他们的科学价值，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公共运动，旨在通过减少污名化和其他对护理的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共病的人不寻求治疗，在寻求治疗的人中，治疗的结果往往比非共病疾病更差。为了帮助改善这一人群获得服务和护理的结果，本研究将使用美国两项大型流行病学调查的数据来回答三个问题：（1）患有共病疾病的个人是否与非共病疾病的人使用相同类型、数量和组合的服务，以及他们是否经历了相同程度的未满足需求;（2）患有共病障碍的个人是否与非共病障碍的人一样面临同样的心理健康和物质障碍服务障碍，哪些障碍更持久，造成更大的阻碍;以及（3）某种类型或组合的服务是否与患有共病疾病的个体的更好的临床和社会结果相关。

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.