Sự khác biệt giới tính trong việc sử dụng dịch vụ sức khỏe tâm thần ngoại trú chung và chuyên ngành cho bệnh trầm cảm

BMC Psychiatry - Tập 14 - Trang 1-11 - 2014
Sarah Gagné1,2, Helen-Maria Vasiliadis1,2, Michel Préville1,2
1Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbooke, Canada
2Charles Lemoyne Research Centre, Longueuil, Canada

Tóm tắt

Nghiên cứu này xác định các yếu tố quyết định đặc thù theo giới tính trong việc sử dụng dịch vụ sức khỏe tâm thần ngoại trú cho bệnh trầm cảm nhằm làm nổi bật sự khác biệt giới tính trong những rào cản tiếp cận chăm sóc và giải thích cách thức nam và nữ bị trầm cảm cần chăm sóc có thể khác nhau trong hành vi tìm kiếm giúp đỡ. Dữ liệu trong nghiên cứu này được thu thập từ Khảo sát Sức khỏe Cộng đồng Canada về Sức khỏe Tâm thần và Phúc lợi, chu kỳ 1.2 (CCHS 1.2) được thực hiện bởi Cơ quan Thống kê Canada vào năm 2002 (N = 36.984). Mẫu nghiên cứu được giới hạn ở những người tham gia đáp ứng tiêu chí cho trầm cảm nặng có khả năng trong 12 tháng trước cuộc phỏng vấn (n = 1.743). Phân tích hồi quy logistic đa biến đặc thù theo giới tính đã được thực hiện. Kết quả cho thấy 54,3% người tham gia đáp ứng tiêu chí cho trầm cảm nặng đã tìm kiếm sự giúp đỡ về lý do sức khỏe tâm thần trong năm trước cuộc phỏng vấn. Khi xem xét về loại hình dịch vụ sức khỏe tâm thần ngoại trú, nam giới có khả năng cao hơn trong việc tham khảo bác sĩ đa khoa và chuyên gia sức khỏe tâm thần trong năm qua so với nữ giới. Tuy nhiên, nữ giới có khả năng cao hơn trong việc tham khảo bác sĩ đa khoa mà không sử dụng dịch vụ nào so với nam giới. Những sự khác biệt theo giới tính trong các yếu tố quyết định liên quan đến việc sử dụng dịch vụ ngoại trú ở nam giới bao gồm thu nhập hộ gia đình điều chỉnh thấp hơn, và ở nữ giới bao gồm độ tuổi trẻ hơn, sự hiện diện của hỗ trợ xã hội, các rào cản do bản thân báo cáo, sự hiện diện của ý nghĩ hoặc nỗ lực tự tử do bản thân báo cáo và sức khỏe tâm thần tự đánh giá kém. Cần tiếp tục nỗ lực để thúc đẩy việc tiếp cận dịch vụ chăm sóc sức khỏe tâm thần cho nam và nữ bị ảnh hưởng bởi trầm cảm, nhằm vào những nhóm dễ bị tổn thương cụ thể và tăng tỷ lệ sử dụng dịch vụ.

Từ khóa

#sức khỏe tâm thần #trầm cảm #giới tính #dịch vụ ngoại trú #chăm sóc sức khỏe tâm thần

Tài liệu tham khảo

World Health Organization: The World health report 2002 - Reducing risks promoting healthy life. 2002, Geneva: World Health Organization, Available at: http://www.who.int/whr/en Hasin D, Goodwin R, Stinson F, Grant B: Epidemiology of major depressive disorder: results from the national epidemiologic survey on alcoholism and related conditions. Arch Gen Psychiatry. 2005, 62 (10): 1097-1106. 10.1001/archpsyc.62.10.1097. Patten S, Wang J, Williams J, Currie S, Beck C, Maxwell C, El-Guebaly N: Descriptive epidemiology of major depression in Canada. Can J Psychiatry. 2006, 51 (2): 84-90. Katon W: Clinical and health services relationships between major depression, depressive symptoms, and general medical illness. Biol Psychiatry. 2003, 54 (3): 216-226. 10.1016/S0006-3223(03)00273-7. Kessler RC, Frank RG: The impact of psychiatric disorders on work loss days. Psychol Med. 1997, 27 (4): 861-873. 10.1017/S0033291797004807. Kessler R: The costs of depression. Psychiatr Clin North Am. 2012, 35 (1): 1-14. 10.1016/j.psc.2011.11.005. Simon G: Social and economic burden of mood disorders. Biol Psychiatry. 2003, 54 (3): 208-215. 10.1016/S0006-3223(03)00420-7. Simon G, Katon W, Lin E, Ludman E, VonKorff M, Ciechanowski P, Young B: Diabetes complications and depression as predictors of health service costs. Gen Hosp Psychiatry. 2005, 27 (5): 344-351. 10.1016/j.genhosppsych.2005.04.008. Stephens T, Joubert N: The economic burden of mental health problems in Canada. Chronic Dis Can. 2001, 22 (1): 18-23. Satyanarayana S, Enns M, Cox B, Sareen J: Prevalence and correlates of chronic depression in the canadian community health survey: mental health and well-being. Can J Psychiatry. 2009, 54 (6): 389-398. Wulsin L, Vaillant G, Wells V: A systematic review of the mortality of depression. Psychosom Med. 1999, 61 (1): 6-17. 10.1097/00006842-199901000-00003. Aalto-Setälä T, Marttunen M, Tuulio-Henriksson A, Poikolainen K, Lönnqvist J: Psychiatric treatment seeking and psychosocial impairment among young adults with depression. J Affect Disord. 2002, 70 (1): 35-47. 10.1016/S0165-0327(01)00316-0. Alonso J, Angermeyer M, Bernert S, Bruffaerts R, Brugha T, Bryson H, Vollebergh W: Use of mental health services in Europe: results from the european study of the epidemiology of mental disorders (ESEMeD) project. Acta Psychiatr Scand Suppl. 2004, 109 (420): 47-54. Burns B, Ryan Wagner H, Gaynes B, Wells K, Schulberg H: General medical and specialty mental health service use for major depression. Int J Psychiatry Med. 2000, 30 (2): 127-143. 10.2190/TLXJ-YXLX-F4YA-6PHA. Cole M, McCusker J, Sewitch M, Ciampi A, Dyachenko A: Health services use for mental health problems by community-living seniors with depression. Int Psychogeriatr. 2008, 20 (3): 554-570. Hämäläinen J, Isometsä E, Sihvo S, Pirkola S, Kiviruusu O: Use of health services for major depressive and anxiety disorders in Finland. Depress Anxiety. 2008, 25 (1): 27-37. 10.1002/da.20256. Katz S, Kessler R, Frank R, Leaf P, Lin E, Edlund M: The use of outpatient mental health services in the United States and Ontario: the impact of mental morbidity and perceived need for care. Am J Public Health. 1997, 87 (7): 1136-1143. 10.2105/AJPH.87.7.1136. Ojeda V, McGuire T: Gender and racial/ethnic differences in use of outpatient mental health and substance use services by depressed adults. Psychiatry Q. 2006, 77 (3): 211-222. 10.1007/s11126-006-9008-9. Schomerus G, Appel K, Meffert P, Luppa M, Andersen R, Grabe H, Baumeister S: Personality-related factors as predictors of help-seeking for depression: a population-based study applying the behavioral model of health services use. Soc Psychiatry Psychiatr Epidemiol. 2013, 48 (11): 1809-1817. 10.1007/s00127-012-0643-1. Smith K, Matheson F, Moineddin R, Dunn J, Lu H, Cairney J, Glazier R: Gender differences in mental health service utilization among respondents reporting depression in a national health survey. Health. 2013, 5 (10): 1561-1571. 10.4236/health.2013.510212. Wang J, Patten S, Williams J, Currie S, Beck C, Maxwell C, El-Guebaly N: Help-seeking behaviours of individuals with mood disorders. Can J Psychiatry. 2005, 50 (10): 652-659. Wang P, Lane M, Olfson M, Pincus H, Wells K, Kessler R: Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005, 62 (6): 629-640. 10.1001/archpsyc.62.6.629. Starkes J, Poulin C, Kisely S: Unmet need for the treatment of depression in Atlantic Canada. Can J Psychiatry. 2005, 50 (10): 580-590. Cameron I, Lawton K, Reid I: Appropriateness of antidepressant prescribing: an observational study in a Scottish primary-care setting. Br J Gen Pract. 2009, 59 (566): 644-649. 10.3399/bjgp09X454061. Cepoiu M, McCusker J, Cole M, Sewitch M, Belzile E, Ciampi A: Recognition of depression by non-psychiatric physicians–a systematic literature review and meta-analysis. J Gen Intern Med. 2008, 23 (1): 25-36. 10.1007/s11606-007-0428-5. Chan K, Bird C, Weiss R, Duan N, Meredith L, Sherbourne C: Does patient-provider gender concordance affect mental health care received by primary care patients with major depression?. Womens Health Issues. 2006, 16 (3): 122-132. 10.1016/j.whi.2006.03.003. Kohn R, Saxena S, Levav I, Saraceno B: The treatment gap in mental health care. Bull World Health Organ. 2004, 82 (11): 858-866. Lecrubier Y: Widespread underrecognition and undertreatment of anxiety and mood disorders: results from 3 European studies. J Clin Psychiatry. 2007, 68 (2): 36-41. McQuaid JR, Stein MB, Laffaye C, McCahill ME: Depression in a primary care clinic: The prevalence and impact of an unrecognized disorder. Affect Disord. 1999, 55: 1-10. 10.1016/S0165-0327(98)00191-8. Piek E, van der Meer K, Hoogendijk WG, Penninx BH, Nolen WA: Most antidepressant Use in primary care is justified; results of the Netherlands study of depression and anxiety. PLoS One. 2011, 6 (3): 1-8. Leaf PJ, Bruce ML: Gender differences in the use of mental health-related services: A re-examination. J Health Soc Behav. 1987, 28: 171-183. 10.2307/2137130. Lin E, Goering P, Offord D, Campbell D, Boyle M: The use of mental health services in Ontario: epidemiologic findings. Can J Psychiatry. 1996, 41 (9): 572-577. Mosier K, Vasiliadis HM, Lepnurm M, Puchala C, Pekrul C, Tempier R: Prevalence of mental disorders and service utilization in seniors: results from the Canadian community health survey cycle 1.2. Int J Geriatr Psychiatry. 2010, 25 (10): 960-967. 10.1002/gps.2434. Rhodes A, Goering P, To T, Williams J: Gender and outpatient mental health service use. Soc Sci Med. 2002, 54 (1): 1-10. 10.1016/S0277-9536(01)00002-8. Rhodes A, Jaakkimainen R, Bondy S, Fung K: Depression and mental health visits to physicians--a prospective records-based study. Soc Sci Med. 2006, 62 (4): 828-834. 10.1016/j.socscimed.2005.06.039. Tiwari S, Wang J: Ethnic differences in mental health service use among White, Chinese, South Asian and South East Asian populations living in Canada. Soc Psychiatry Psychiatr Epidemiol. 2008, 43 (11): 866-871. 10.1007/s00127-008-0373-6. Vasiliadis HM, Lesage A, Adair C, Boyer R: Service use for mental health reasons: cross-provincial differences in rates, determinants, and equity of access. Can J Psychiatry. 2005, 50 (10): 614-619. Angst J, Gamma A, Gastpar M, Lépine J, Mendlewicz J, Tylee A: Gender differences in depression. Epidemiological findings from the European DEPRES I and II studies. Eur Arch Psychiatry Clin Neurosci. 2002, 252 (5): 201-209. 10.1007/s00406-002-0381-6. Galbaud du Fort G, Newman S, Boothroyd L, Bland R: Treatment seeking for depression: role of depressive symptoms and comorbid psychiatric diagnoses. J Affect Disord. 1999, 52 (1–3): 31-40. Cheung A, Dewa C, Cairney J, Veldhuizen S, Schaffer A: Factors associated with use of mental health services for depressed and/or suicidal youth aged 15–24. Community Ment Health J. 2009, 45 (4): 300-306. 10.1007/s10597-009-9205-8. ten Have M, de Graaf R, Vollebergh W, Beekman A: What depressive symptoms are associated with the use of care services? Results from the Netherlands Mental Health Survey and Incidence Study (NEMESIS). J Affect Disord. 2004, 80 (2–3): 239-248. Wang J, Langille D, Patten S: Mental health services received by depressed persons who visited general practitioners and family doctors. Psychiatr Serv. 2003, 54 (6): 878-883. Wu P, Hoven C, Cohen P, Liu X, Moore R, Tiet Q, Bird H: Factors associated with use of mental health services for depression by children and adolescents. Psychiatr Serv. 2001, 52 (2): 189-195. 10.1176/appi.ps.52.2.189. Drapeau A, Boyer R, Lesage A: The influence of social anchorage on the gender difference in the use of mental health services. J Behav Health Serv Res. 2009, 36 (3): 372-384. 10.1007/s11414-009-9168-0. Vasiliadis HM, Tempier R, Lesage A, Kates N: General practice and mental health care: determinants of outpatient service use. Can J Psychiatry. 2009, 54 (7): 468-476. Albizu-Garcia C, Alegría M, Freeman D, Vera M: Gender and health services use for a mental health problem. Soc Sci Med. 2001, 53 (7): 865-878. 10.1016/S0277-9536(00)00380-4. Moller-Leimkuhler A: Barriers to help-seeking by men: a review of socio-cultural literature with a particular reference to depression. J Affect Disord. 2002, 71 (1–3): 1-9. Galdas PM, Cheater F, Marshall P: Men and health help-seeking behaviour: Literature review. J Adv Nurs. 2005, 49: 616-623. 10.1111/j.1365-2648.2004.03331.x. Green CA, Pope CR: Gender, psychosocial factors and the use of medical services: A longitudinal analysis. Soc Sci Med. 1999, 48: 1363-1372. 10.1016/S0277-9536(98)00440-7. The Standing Senate Committee on Social Affairs, Science and Technology: Out of the shadows at last: transforming mental health, mental illness and addiction services in Canada. 2006, Available at: [http://www.parl.gc.ca/39/1/parlbus/commbus/senate/com-e/soci-e/rep-e/rep02may06-e.htm] Wang J, Patten S: Perceived effectiveness of mental health care provided by primary-care physicians and mental health specialists. Psychosomatics. 2007, 48 (2): 123-127. 10.1176/appi.psy.48.2.123. Gravel R, Béland Y: The Canadian community health survey: mental health and well-being. Can J Psychiatry. 2005, 50 (10): 573-579. Kessler RC, Ustun TB: The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr. 2004, 13: 93-121. 10.1002/mpr.168. APA: Diagnostic and Statistical Manual of Mental Disorders, Edition 4 (DSM-IV), Text Revision. 2000, Washington DC: American Psychiatric Association Silverstein B, Edwards T, Gamma A, Ajdacic-Gross V, Rossler W, Angst J: The role played by depression associated with somatic symptomatology in accounting for the gender difference in the prevalence of depression. Soc Psychiatry Psychiatr Epidemiol. 2013, 48 (2): 257-263. 10.1007/s00127-012-0540-7. Gravel R: Canadian community health survey: mental health and well-being, public use microdata file guide (82M0021GPE). 2002, Ottawa: Statistics Canada Kessler R, Brown R, Broman C: Sex differences in psychiatric help-seeking: evidence from four large-scale surveys. J Health Soc Behav. 1981, 22 (1): 49-64. 10.2307/2136367. Addis ME, Mahalik JR: Men, masculinity, and the contexts of help seeking. Am Psychol. 2003, 58: 5-14. Vasiliadis HM, Gagné S, Jozwiak N, Préville M: Gender differences in health service use for mental health reasons in community dwelling older adults with suicidal ideation. Int Psychogeriatr. 2013, 25 (3): 374-381. 10.1017/S1041610212001895. Kessler R, Zhao S, Katz S, Kouzis A, Frank R, Edlund M, Leaf P: Past-year use of outpatient services for psychiatric problems in the National Comorbidity Survey. Am J Psychiatry. 1999, 156 (1): 115-123. Tedstone Doherty D, Kartalova-O’Doherty Y: Gender and self-reported mental health problems: predictors of help seeking from a general practitioner. Br J Health Psychol. 2010, 15: 213-228. 10.1348/135910709X457423. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-244X/14/135/prepub