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: 8139187
• 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 2013-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8139187
• 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）：社区中很大一部分酗酒和非法药物滥用和依赖的个体也患有精神障碍，反之亦然，很大一部分患有各种精神障碍的个体也患有物质障碍。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，共存疾病的治疗结果也往往比非共存精神或物质疾病更差。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心理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、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，我们计划使用来自最近对美国普通人口进行的大规模全国代表性调查的两个数据源来获取急需的信息。我们将使用 2004-2008 年全国酒精及相关病症纵向流行病学调查 (NESARC) 第 1 波和第 2 波纵向数据，以及年度全国药物使用和健康横断面调查 (NSDUH) 的数据。这些数据提供了前所未有的机会来检查人口亚组（例如少数族裔）的服务使用和护理障碍，而先前的研究由于样本量较小而无法充分检查这些亚组。在该研究的目标 1 中，我们检查服务使用模式，并将这些调查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、组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感知到的未满足的护理需求。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流行率，并比较了不使用心理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与未来不使用服务的相关性更强。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药物使用的更大减少、禁欲或更好的社会功能相关。我们还将在这些分析中研究种族和性别的影响。除了科学价值之外，这项研究的结果还将有助于设计更能满足患有精神和物质障碍的患者需求的服务。这些数据还将有助于设计公共活动，旨在通过减少护理方面的耻辱感以及其他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：大多数患有共存精神和物质障碍的人不会寻求治疗，而在寻求治疗的人中，治疗结果往往比非共存疾病更差。为了帮助改善这群人获得服务的机会和护理结果，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) 患有共存疾病的个人是否使用与他们相同的服务类型、数量和组合。那些患有非共病疾病的人以及他们是否经历了相同程度的未满足的需求； (2) 患有共病障碍的个体在精神健康和物质障碍服务方面是否面临与非共病障碍患者相同的障碍，哪些障碍更持久并造成更大的障碍； (3) 某种类型或组合的服务是否与共病患者更好的临床和社会结果相关。