Determinants of mental health service use in the national mental health survey of the elderly in Singapore

Ma Nyunt,Peak Chiam,Tze Ng,Ee Kua

doi:10.1186/1745-0179-5-2

Abstract

BackgroundDespite high prevalence of mental health problems, only a minority of elderly people seek treatment. Although need-for-care factors are primary determinants of mental health service use, personal predisposing or enabling factors including health beliefs are important but are not well studied.MethodIn the National Mental Health Survey of Elderly in Singapore, 2003, 1092 older adults aged 60 and above were interviewed for diagnosis of mental disorders (using Geriatric Mental State) and treatment, and their health beliefs about the curability of mental illness, embarrassment and stigma, easiness discussing mental problems, effectiveness and safety of treatment and trust in professionals.ResultsThe prevalence of mental disorders was 13%, but only a third of mentally ill respondents had sought treatment. Increased likelihood of seeking treatment was significantly associated with the presence of a mental disorder (OR = 5.27), disability from mental illness (OR = 79.9), and poor or fair self-rated mental health (OR = 2.63), female gender (OR = 2.25), and formal education (OR = 2.40). The likelihood of treatment seeking was lower in those reporting financial limitations for medical care (OR = 0.38), but also higher household income (OR = 0.31). Negative beliefs showed no meaningful associations, but the positive belief that 'to a great extent mental illness can be cured' was associated with increased mental health service use (OR = 6.89). The availability of family caregiver showed a negative association (OR = 0.20).ConclusionThe determinants of mental health service use in the elderly included primary need factors, and female gender and socioeconomic factors. There was little evidence of influences by negative health beliefs, but a positive health belief that 'mental illness can be cured' is a strongly positive determinant The influence of family members and care-givers on senior's use of mental health service should be further explored.

Highlights

Despite high prevalence of mental health problems, only a minority of elderly people seek treatment
A body of evidence [6,7,8] has implicated symptom profile, severity and duration, associated disability and other characteristics of the mental disorder itself in explaining mental health service use. Such need-for-care factors do not fully determine actual health seeking behavior; there are critical personal, social and cultural factors that are not well studied. Such predisposing and enabling factors include age, sex, race, education, income, social network and support, and health beliefs – which are attitudes, values and knowledge that people have about their health and health services and that influence their perceptions of need and use of health services [9]
Using data from a national sample of the Singaporean elderly population in the National Mental Health Survey of Elderly, 2003, we examined mental health service use and the relative extent to which it was determined by need-ofcare, sociodemographic, health beliefs, and family and social support factors

Summary

Introduction

Despite high prevalence of mental health problems, only a minority of elderly people seek treatment. A body of evidence [6,7,8] has implicated symptom profile, severity and duration, associated disability and other characteristics of the mental disorder itself in explaining mental health service use Such need-for-care factors do not fully determine actual health seeking behavior; there are critical personal, social and cultural factors that are not well studied. Such predisposing and enabling factors include age, sex, race, education, income, social network and support, and health beliefs – which are attitudes, values and knowledge that people have about their health and health services and that influence their perceptions of need and use of health services [9]. Few authors have investigated the extent to which personal health beliefs and behavior contribute to the underutilization of mental health services [7]

Results

Discussion

Conclusion