注意差距:消除美国多元化景观中的心理健康差距

Margaret Fischer, Jennifer Swint, Wei Zhang, Xi Zhang
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摘要

背景:在美国,心理健康差异一直是一个重大的公共卫生问题,某些人群承受着不成比例的精神疾病负担,在获得护理方面也存在障碍。本系统性综述旨在综合目前不同人口群体中心理健康差异的证据,并找出导致这些不平等现象的关键因素:我们使用 PubMed、PsycINFO 和 Scopus 数据库对 2010 年至 2024 年间发表的同行评审文献进行了全面检索。我们纳入了对美国不同种族/民族、社会经济、性别、性取向和地域群体的心理健康结果、就医途径和治疗效果进行研究的文章。两位独立审稿人筛选文章、提取数据并评估研究质量:在初步确定的 2345 项研究中,有 127 项符合纳入标准。在多个领域都观察到了一致的差异,少数种族/族裔、低收入人群、LGBTQ+人群和农村居民的心理健康失调率较高,获得优质护理的机会较少,治疗效果较差。主要的诱因包括系统性种族主义、社会经济障碍、耻辱感、缺乏文化上胜任的护理以及保险覆盖面不足:本综述强调了美国持续存在的、多方面的心理健康差异。要解决这些不平等问题,就必须采取全面的政策干预措施,增加对社区心理健康服务的资金投入,提高医疗服务中的文化素养,并开展有针对性的研究,为得不到充分服务的人群开发有效的、符合其文化背景的干预措施。
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Mind the Gap: Unraveling Mental Health Disparities in America's Diverse Landscape
Background: Mental health disparities persist as a significant public health concern in the United States, with certain populations experiencing disproportionate burdens of mental illness and barriers to care. This systematic review aims to synthesize current evidence on mental health disparities across various demographic groups and identify key factors contributing to these inequities. Methods: We conducted a comprehensive search of peer-reviewed literature published between 2010 and 2024 using PubMed, PsycINFO, and Scopus databases. Studies examining mental health outcomes, access to care, and treatment efficacy across racial/ethnic, socioeconomic, gender, sexual orientation, and geographic groups in the US were included. Two independent reviewers screened articles, extracted data, and assessed study quality. Results: Of 2,345 initially identified studies, 127 met inclusion criteria. Consistent disparities were observed across multiple domains, with racial/ethnic minorities, low-income individuals, LGBTQ+ populations, and rural residents experiencing higher rates of mental health disorders, lower access to quality care, and poorer treatment outcomes. Key contributing factors included systemic racism, socioeconomic barriers, stigma, lack of culturally competent care, and inadequate insurance coverage. Conclusion: This review highlights persistent and multifaceted mental health disparities in the US. Addressing these inequities requires comprehensive policy interventions, increased funding for community-based mental health services, improved cultural competence in healthcare delivery, and targeted research to develop effective, culturally-tailored interventions for underserved populations.
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