标题：Trends in Contacts With Mental Health Professionals and Cost Barriers to Mental Health Care Among Adults With Significant Psychological Distress in the United States: 1997–2002
摘要：Objectives. I assessed recent trends in prevalence of any contact with mental health professionals and nonuse of mental health care or prescription medications owing to cost among adults with significant psychological distress. Methods. In samples drawn from the National Health Interview Survey of 1997–2002, multiple logistic regression analysis was used to examine the association of survey year with mental health professional contacts and nonuse of mental health care or prescription medications owing to cost. Results. The prevalence of any contact with mental health professionals increased from 29.1% in 1997 to 35.5% in 2002 ( P <.05). The prevalence of nonuse of services because of cost also increased—from 15.6% to 20.0% for mental health care ( P <.05) and from 27.7% to 34.1% for medication use ( P <.001). Age, racial/ethnic, income, and insurance status disparities in receiving care persisted over the study period. Conclusions. The number of individuals in need of mental health care who contacted mental health professionals grew in recent years, as did the number of individuals who encountered cost barriers to such care. Barring dramatic improvements in health insurance coverage, more individuals will likely face such barriers in coming years. The burden of unmet need for mental health care in the community figured prominently in 2 recent, highly publicized government reports: the President’s New Freedom Commission on Mental Health report 1 and the surgeon general’s report on mental health. 2 While drawing attention to existing deficiencies, disparities, and barriers, both reports put forward a hopeful vision for the future of mental health care in the United States and proposed ways to realize that vision. Consistent with this view, some studies suggested improvements in the community care of serious mental conditions in recent years. 3 – 5 The introduction of new medications with fewer side effects, the development and dissemination of evidence-based guidelines for treatment of common mental disorders, and changes in public attitudes toward mental illness 6 may have contributed to these trends. However, anecdotal reports and observations by administrators involved in the day-to-day workings of the mental health care system present a less optimistic picture. 7 , 8 A recent commentator described how cuts in the public hospital beds across the country, disenrollment of many providers from Medicaid, and rising costs of medications have led to a crisis in access to mental health care for individuals who need such care. 7 These problems are likely compounded by the general problems affecting the US health care system, such as the growing overall cost of medical care, the enduring problem of the uninsured and the underinsured, and the endemic social disparities in access and distribution of resources. 9 Because of the paucity of systematic recent data, the overall impact of these conflicting influences on access to needed mental health services in the community is difficult to surmise. My study addresses this deficiency in data by examining recent trends in prevalence of any contact with mental health professionals and in financial barriers to care among individuals in need of such services in the community. Three specific study questions were posed regarding samples of individuals with psychological problems drawn from the general population: (1) Did the proportion of individuals who had any contact with a mental health professional in the past year change between 1997 and 2002? (2) Did the proportion of individuals who reported forgoing mental health care because of cost change in these years? (3) Did the proportion of individuals who reported forgoing use of prescription medications because of cost change in these years?
