PATHWAYS TO SPECIALITY MENTAL HEALTH CARE

精神卫生服务系统面临的一个关键挑战是

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.