Treatment Patterns and Barriers in Comorbid Mental and Substance Disorders

共病精神和物质障碍的治疗模式和障碍

• 批准号: 8301802
• 负责人: RAMIN MOJTABAI
• 金额: $ 23.86万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-15 至 2014-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8301802
• 关键词: Abstinence; Adult; African American; Alcohol or Other Drugs use; Alcohols; Anxiety Disorders; Caring; Caucasians; Caucasoid Race; Clinical; Communities; Comorbidity; Data; Data Sources; Disease; Drug Addiction; Drug abuse; Drug usage; Epidemiology; Ethnic Origin; Face; Future; Gender; General Population; Health; Health Campaign; Health Services Accessibility; Hispanics; Improve Access; Individual; Learning; Literature; Mental Health; Mental Health Services; Mental disorders; Minority; Mood Disorders; Moods; NIH Program Announcements; Outcome; Participant; Patients; Pattern; Perception; Population; Prevalence; Prevention; Process; Provider; Psyche structure; Public Health; Race; Recording of previous events; Research; Sample Size; Sampling; Services; Social Functioning; Stigmata; Subgroup; Surveys; Time; Treatment outcome; Variant; base; care systems; design; expectation; experience; follow-up; improved; longitudinal design; population survey; public health relevance; racial and ethnic; response; single episode major depressive disorder; social; social stigma; substance abuse treatment

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.

描述（由申请人提供）：很大一部分患有酒精和非法药物滥用和社区依赖的人也患有精神障碍，反之亦然，大部分患有各种精神障碍的人也患有药物障碍。然而，这些人中的大多数不寻求治疗。即使在接受治疗的人中，合并症疾病的治疗结果通常也比非疾病或物质疾病差。但是，我们对这些人使用的服务类型或他们未满足的治疗需求一无所知。我们也不知道他们是否面临与患有精神障碍或物质障碍的人相同的访问服务障碍。如果我们要改善这些人获得适当的心理健康和药物障碍服务，我们必须更多地了解他们的服务使用方式，未满足的需求以及他们在获得服务中面临的障碍。在拟议的项目中，我们计划使用美国普通民众的大型和最新代表性调查的两个数据来源，以获取这些急需的信息。我们将使用对酒精和相关条件的纵向国家流行病学调查（NESARC）WAVES 1和2的数据，以及2004 - 2008年的年度药物使用与健康调查（NSDUH）年度横断面国家调查（NSDUH）。这些数据提供了一个前所未有的机会，可以检查服务使用和障碍在人口亚组（例如少数族裔）中，由于样本量较小，因此无法在先前的研究中进行充分检查。在研究的目标1中，我们研究了使用服务的模式，并比较了这些调查中的参与者与合并症和非疾病的疾病，以确定它们是否使用相同类型，混合或精神健康或药物障碍服务的方式。我们还将这些小组就未满足的护理需求进行比较。在AIM 2中，我们比较了合并症和非合并小组关于不使用所需服务的特定原因的类型和患病率，并比较了不使用心理健康与药物障碍服务的原因。我们利用了NESARC数据的纵向设计，以评估某些原因是否比其他原因更持久，以及某些原因是否与未来时间不使用服务更强烈，而不是其他原因。在AIM 3中，我们还使用纵向NESARC数据来评估某些服务的使用或基线时的某种服务混合物是否与物质使用，禁欲或随访时的社交功能更大相关。我们还将在这些分析中研究种族种族和性别的影响。除了他们的科学优点外，这项研究的结果将有助于设计对合并症患者精神和物质障碍患者需求更快的服务。这些数据还将有助于设计旨在通过减少污名和其他态度和结构性护理障碍来改善服务获得的公共活动。 公共卫生相关性：大多数合并症的精神和物质疾病的人都不寻求治疗，在寻求治疗的患者中，治疗结果通常比非疾病疾病差。为了帮助改善这组个人的服务和护理结果，本研究将使用来自两项大型美国流行病学调查的数据来回答三个问题：（1）合并症的人是否使用与非合并症的人相同的类型，数量和服务，以及他们是否经历了相同程度的无量需求； （2）患有合并症的人是否面临与非疾病障碍的人相同的心理健康和药物障碍服务障碍，哪些障碍更加持久并造成更大的障碍； （3）某种类型的服务是否与合并症患者的临床和社会成果更好有关。