Discrepancies between survey and administrative data on the use of mental health services in the general population: findings from a study conducted in Québec

Aline Drapeau,Fatoumata Binta Diallo,Richard Boyer

doi:10.1186/1471-2458-11-837

Abstract

BackgroundPopulation surveys and health services registers are the main source of data for the management of public health. Yet, the validity of survey data on the use of mental health services has been questioned repeatedly due to the sensitive nature of mental illness and to the risk of recall bias. The main objectives of this study were to compare data on the use of mental health services from a large scale population survey and a national health services register and to identify the factors associated with the discrepancies observed between these two sources of data.MethodsThis study was based on the individual linkage of data from the cycle 1.2 of the Canadian Community Health Survey (CCHS-1.2) and from the health services register of the Régie de l'assurance maladie du Québec (RAMQ). The RAMQ is the governmental agency managing the Quebec national health insurance program. The analyses mostly focused on the 637 Quebecer respondents who were recorded as users of mental health services in the RAMQ and who were self-reported users or non users of these services in the CCHS-1.2.ResultsRoughly 75%, of those recorded as users of mental health services users in the RAMQ's register did not report using mental health services in the CCHS-1.2. The odds of disagreement between survey and administrative data were higher in seniors, individuals with a lower level of education, legal or de facto spouses and mothers of young children. They were lower in individuals with a psychiatric disorder and in frequent and more recent users of mental health services according to the RAMQ's register.ConclusionsThese findings support the hypotheses that social desirability and recall bias are likely to affect the self-reported use of mental health services in a population survey. They stress the need to refine the investigation of mental health services in population surveys and to combine survey and administrative data, whenever possible, to obtain an optimal estimation of the population need for mental health care.

Highlights

Population surveys and health services registers are the main source of data for the management of public health
The analyses mostly focus on the last two categories (i.e. 637 respondents who were recorded as users of mental health services in the Régie de l’assurance maladie du Québec (RAMQ)’s register and who were self-reported users or non users)
The overall agreement between data from the CCHS-1.2 and the RAMQ was low for the use of mental health services and it was lowest in seniors

Summary

Introduction

Population surveys and health services registers are the main source of data for the management of public health. The validity of survey data on the use of mental health services has been questioned repeatedly due to the sensitive nature of mental illness [1,2,3,4]. Negative attitudes towards mental illness and towards people with mental health problems tend to increase with age [10,11,12] and to be more apparent for schizophrenia than for depression [10,11,13], in men than in women [10] and among singles and individuals living with a partner than in divorced, separated or widows [14]. No statistically significant association has been found between employment status and negative attitudes towards mental illness [12,16] despite the pervasive stigmatisation of people with mental health problems in the work environment [19,20]

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Conclusion