Podstrony

• Index
• Guarino Mario Bank Boga i bankierzy papieza
• Llosa Mario Vargas Pantaleon i wizytantki (SCAN da
• Eating Disorders Mario Maj, KathrineJuan Jose Lopez Ibor, Norman Sartorius
• Phobias Mario Maj (2)
• Wojna i pokoj t.3 i 4 Tolstoj
• A. Graham Bell Two Stroke Performance Tuning
• Mendoza Eduardo Rok Potopu (SCAN dal 790)
• Beard Henry N.,Kenney Douglas C Nuda Pierscieni
• Cook Glenn Czerwone Zelazne Noce
• Philip K. Dick Transmigracja Timothyego Archera
• zanotowane.pl
• doc.pisz.pl
• pdf.pisz.pl
• ministranci-w.htw.pl

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.Private psychotherapists, clergy and social service agencies were consultedby 16 17% of social phobic individuals.A remarkable finding was,however, that only about 3 5% of individuals with pure social phobiasought outpatient psychiatric help [5,17].The proportion of individuals seeking treatment is also dependent uponthe presence of comorbid mental disorders.This has a considerable impacton help seeking, for example leading to an increase of 10% of the amountspent on utilization of services and an increase of about 25% of the numberof outpatient visits [2].Patel et al.[23] investigated five different sources ofhelp seeking in individuals with social phobia.They found that, for everysource investigated, social phobics with comorbid mental disorders,compared to those without such comorbidity, consulted more inpatientservices (20.6% versus 1.8%), had more outpatient episodes (61.7% versus53.1%), had more home visits by health and social services (19.5% versus2.1%) had more therapy contacts (13.0% versus 6.6%) and finally had morecontacts with general practitioners in the 12 months preceding the interview(37.1% versus 19.0%).Moreover, a statistical interaction between thepresence of a comorbid disorder on the one hand and the source of helpseeking on the other was not found: medical doctors were more likely to beconsulted (13.3%) than other mental health professionals (8.9%), independ-ent of the presence of a comorbid mental disorder.Similar results wereobtained by Schneier et al.[17] and Davidson et al.[22].These findings arevery similar to those of Wittchen et al.[19] (Figure 6.2), who reported thatthe mean proportion of help-seeking individuals was significantly higher inthe comorbid than in the pure condition of social phobia (28.0% versus12.3%).The finding that comorbidity increases the odds of help-seekingbehaviour does not, however, imply better management and outcome of thephobic disorder.Indeed, the presence of a comorbid disorder may obscurethe identification of social phobia as such, and thus blur accuraterecognition and treatment by the health professional.This conclusion,however, should be interpreted with great caution, since studies investi-gating the reasons for help seeking in social phobia with comorbidityremain somewhat indecisive on this topic.While some authors suggest thatcomorbidity leads to higher odds of reporting other complaints than thephobia [18], others conclude that phobic complaints are more likely to bereported when a comorbid disorder is present [4,19].The proportion of individuals seeking help also varied upon generalizedversus non-generalized forms of social phobia.The lowest mean proportionof help-seeking behaviour was found in non-generalized forms of socialphobia (Figure 6.2): about 13% of persons with non-generalized socialSOCIAL AND ECONOMIC BURDEN OF PHOBIAS: A REVIEW ___________________ 307Figure 6.2 Proportion of help seeking in individuals with social phobia.Reproduced from Wittchen et al.[19] by permission of Cambridge University Pressphobia sought help in the six months preceding the interview, compared toslightly more than 40% in the generalized social phobia condition.Moreover,although we may say that generalized social phobia as well as the presenceof a comorbid mental disorder may increase the odds of help seeking, itdoes so only for seeking help of medical doctors and not of non-medicalmental health professionals [19].Barriers to TreatmentThe systemic model of Goldberg and Huxley [24] has been successful inidentifying obstructions to help-seeking and inappropriate service use.Their model conceptualizes help-seeking pathways as a progressionthrough a serious of levels, each separated by permeable filters.Forexample, starting from community-based prevalence rates (level 1),decreasing proportions of individuals make progress to the filter of primarycare (level 2), conspicuous primary care morbidity (level 3), formal mentalhealth services (level 4) and psychiatric inpatient care (level 5).A way ofviewing the problem of a low service use is thus to consider various  hurdles  on the path from level 1 to level 5.Following this systemicmodel, it is conceivable that an optimal use of services is hampered bypatient and doctor filtering barriers.308 __________________________________________________________________________________________ PHOBIASPatient-Filtering Barriers to TreatmentA recent study by Olfson et al.[5] investigated treatment barriers relating tosocial phobia.The authors simply asked individuals why they did not seektreatment for their problems.About one in five reported that   fear of whatothers might think  was a major barrier to treatment, since that is the coreproblem of social phobia.Furthermore, more than one in four individualswith social phobia was not seeking help because they   could handle thesituation on their own .The finding that self-management is preferred overprofessional treatment is in line with findings from other studies [25 27].Another hurdle is that phobic individuals are not likely to interpret theiremotional problems in mental health terms [28].Following the early age ofonset, phobic behaviour can therefore be interpreted as a normalbehavioural standard and not as deviating.Phobic patients often see theirphobic complaints as caused by cautiousness rather than a mental disorder[10].It looks as if the majority of individuals suffering from phobicdisorders may have learned to live with their phobic fears and considertheir lifestyle as normal, since it is the presence of a comorbid disorder (e.g.depression, other anxiety disorders or substance use disorders) that urgesthe individual to seek help.In this light, psychoeducation should beessential in dealing with the phobic patient [3].In this light, we can alsoexplain the finding that the proportion of help-seeking varies considerablydepending upon the type of phobia.That agoraphobics have the highestrate of help-seeking behaviour could be explained by the hypothesis thatthese individuals are more likely to interpret their problems in mentalhealth terms, for example because the age of onset of agoraphobia is muchlater in life than that of simple and social phobia [10].A second barrier to treatment of phobic disorders lies in financialobstructions.As Olfson et al.[5] pointed out, a significant proportion ofsocial phobic individuals reported that a lack of insurance (17%) and aninability to afford treatment (25%) were main reasons for not seekingprofessional help for their phobic complaints.However, the finding thateconomic considerations are barriers to treatment is questionable [ Pobierz całość w formacie PDF ]