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、更高的不健康行为发生率、身体问题和死亡率(Tanielian&Jaycox，2008)。尽管每个人都有暴露于引发创伤后应激障碍的创伤性事件的风险，但一项新兴的文献表明，在创伤后应激障碍的风险方面存在显著差异，特别是对于少数族裔(例如，波尔等人，2008年)和妇女(例如，奥尔夫等人，2007年；托林和福阿，2006年)。例如，拉丁裔被认为是创伤和创伤后应激障碍的高危人群(Eisenman等人，2008年)。女性创伤后应激障碍的总患病率更高(10.4%比5.0%)，而且更有可能在遭受身体攻击等特定创伤时患上创伤后应激障碍(Kessler等人，1995)。患有创伤后应激障碍的人报告的护理障碍比没有这种疾病的人更多(Amaya-Jackson等人，1999年)，某些亚群可能比其他人经历更多的障碍(Boscarino等人，2005年；Jaycox等人，2004年)。尽管有治疗创伤后应激障碍的有效疗法(Foa等人，2000年；Ursano等人，2004年；退伍军人事务部2004年；尼斯，2005年)，包括药物治疗、心理治疗以及教育和支持服务，但许多人不寻求治疗或大大推迟了寻求治疗的时间。即使那些患有创伤后应激障碍的人确实得到了护理，也可能是不够的(Frueh等人，2006；Wang，Lane等人，2005)。然而，人们对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。这项研究试图1)通过检查创伤和创伤后应激障碍的暴露和发展方面的种族-民族和性别差异来确定哪里的需求最大；2)通过探索创伤后应激障碍患者在获得精神卫生保健方面的种族-民族和性别差异；以及3)描述患有创伤后应激障碍的种族-民族和性别群体中精神卫生服务的利用模式。这项研究是在罗纳德·安德森(Ronald Andersen)(1995)的卫生服务使用行为模型的指导下进行的，并使用了协作精神病学流行病学调查数据。这些数据包含20,013次诊断性访谈，其中1,194名受访者在一生中的某个时候符合创伤后应激障碍的标准。这是第一次有足够的力量来调查文化对精神健康的影响的国家数据(Colpe等人，2004年)，而且还没有在合并的数据中发表关于创伤后应激障碍的研究。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。本研究旨在通过探索创伤暴露和随后的创伤后应激障碍的差异、心理健康护理的障碍以及精神健康服务的利用差异，来缓解创伤后应激障碍(PTSD)的种族-民族和性别差异。这项研究的结果将有助于缓解创伤后应激障碍的差异，方法是确定负担较重的人群，更好地针对和改善预防和干预的结果，使提供者做好准备，更好地照顾经历差异的人口，并为解决健康差异的资金问题提出建议。

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.