Predictors of Likelihood and Intensity of Past-Year Mental Health Service Use in an Active Canadian Military Sample

A Prospective Examination of Service Use by Abused and Neglected Children Followed Up Into Adulthood

Initiation and Use of Public Mental Health Services by Persons With Severe Mental Illness and Limited English Proficiency

Little is known about whether or how offenders use mental health services after sentence completion. This study aimed to determine the likelihood of such service use by adult (18-44 years) first-time offenders up to 5 years after sentence completion and possible predictor variables. Pre-sentence and post-sentence mental health service use was obtained from whole-population linked administrative data on 23,661 adult offenders. Cox proportional hazard models were used to determine which socio-demographic, offending and pre-sentence health service variables were associated with such post-sentence service use. The estimated 5-year probability of any post-sentence mental health service use was 12% for offenders who had not previously used such services, but still only 42% for those who had. For the latter, best predictors of post-sentence use were past psychiatric diagnosis and history of self-harm; history of self-harm also predicted post-sentence use among new mental health services users and so also did past physical illness. Indigenous offenders had a greater likelihood of service use for any mental disorder or for substance use disorders than non-Indigenous offenders, irrespective of pre-sentence use. Among those with pre-sentence service contact, imprisoned offenders were less likely to use mental health services after sentence than those under community penalties; in its absence, socio-economic disadvantage and geographic accessibility were associated with greater likelihood of post-sentence use. Our findings highlight the discontinuity of mental healthcare for most sentenced offenders, but especially prisoners, and suggest a need for better management strategies for these vulnerable groups with mental disorders.

Do Canada and the United States Differ in Prevalence of Depression and Utilization of Services?

The Role of Social Network and Support in Mental Health Service Use: Findings From the Baltimore ECA Study

This study examined associations between sociodemographic, military, and psychiatric need variables and past-year mental health service use among active Canadian military members. The likelihood and intensity of services were examined across two provider types--mental health providers and medical providers. Data were drawn from the first epidemiological survey of mental health in the Canadian Forces, conducted by Statistics Canada in 2002. Survey instruments included the Composite International Diagnostic Interview, which was used to assess mental health and service use. Of the 8,441 military members who participated in the survey, 14.5% (N=1,220) met criteria for having a mental disorder in the past year. However, of the 8,441 only 9.1% (N=767) contacted a mental health provider in the past year for mental health problems; even fewer (N=539, 6.4%) contacted a medical provider. Across the two provider types, the majority of those seeing a provider reported five or fewer mental health visits in the past year. In univariate and multivariate analyses across the two provider types, psychiatric need variables were consistently associated with both greater service use likelihood and intensity. In multivariate analyses, lower military rank was consistently associated with both greater service use likelihood and intensity. Of the entire military sample, only a small percentage used mental health services. The observed associations between military and psychiatric need variables and mental health service use in this study should be used by military health care providers and administrators to increase mental health service use among those most at risk of not using services.

This study examined variation in mental health service use among U.S. Latinos by place of origin and service provider type. Data were obtained from the National Latino and Asian American Study. The sample for this study consisted of 2,533 Latino adults, including Cubans, Puerto Ricans, Mexicans, and other Latinos. Use of services from specialty mental health providers, general medical providers, and other providers was examined. Guided by Andersen's behavioral model of health service use, logistic regression models were conducted. Although over one-fifth of the sample (21.3%) had a psychiatric disorder, only 9.6% reported that they received any mental health services in the past 12 months. Overall, Puerto Ricans were more likely than the other Latino subgroups to use any mental health services. Respondents with a psychiatric disorder were more likely to use mental health services from all provider types, but the effect of having a psychiatric disorder on use of general medical care providers was greater among Mexicans than among Puerto Ricans. Findings suggest the existence of variations among Latino subgroups in mental health service use by provider type and place of origin. Mental health professionals should provide tailored outreach and services to this vulnerable population, which underutilizes mental health services. Further research should examine variation in mental health service use by immigrant legal status.

The Mental Health Parity and Addiction Equity Act (MHPAEA) was intended to eliminate differences in insurance coverage for mental health and substance use disorder services and medical-surgical care. No studies have examined mental health service use after federal parity implementation among individuals with diagnoses of eating disorders, for whom financial access to care has often been limited. This study examined whether MHPAEA implementation was associated with changes in use of mental health services and spending in this population. Using Truven Health MarketScan data from 2007 to 2012, this study examined trends in mental health spending and intensity of use of specific mental health services (inpatient days, total outpatient visits, psychotherapy visits, and medication management visits) among individuals ages 13-64 with a diagnosis of an eating disorder (N=27,594). MHPAEA implementation was associated with a small increase in total mental health spending ($1,271.92; p<.001) and no change in out-of-pocket spending ($112.99; p=.234) in the first year after enforcement of the parity law. The law's implementation was associated with an increased number of outpatient mental health visits among users, corresponding to an additional 5.8 visits on average during the first year (p<.001). This overall increase was driven by an increase in psychotherapy use of 2.9 additional visits annually among users (p<.001). MHPAEA implementation was associated with increased intensity of outpatient mental health service use among individuals with diagnoses of eating disorders but no increase in out-of-pocket expenditures, suggesting improvements in financial protection.

Concern over rising health care costs has put pressure on providers to reduce costs, purportedly by reducing inpatient care and increasing outpatient care. Inpatient and outpatient claims were analyzed for adult users of mental health services (180,000/year on average) from a national study group of 3.9 million privately insured individuals per year from 1993 to 1995. Costs and treatment days per patient were compared across diagnostic groups and stratified by whether patients were hospitalized. Inpatient mental health costs fell $2,507 (30.4%) over the period, driven primarily by decreases in hospital days per patient per year (19.9%), with smaller changes in the proportion of enrollees who received inpatient care (increase of 0.8%) and a decrease in per diem costs (9.1%). Outpatient mental health costs also declined over the period, falling 13.6% for patients also using inpatient services and 14.6% for patients receiving only outpatient care. Patients whose primary diagnosis was mild to moderate depression saw the largest decreases in inpatient cost per patient (42.8%); those diagnosed with schizophrenia experienced the smallest decrease (23.5%). For patients using outpatient services only, those diagnosed with substance abuse experienced the largest decrease in costs (23.5%); those diagnosed with schizophrenia experienced the smallest decrease (8.6%). Substantial cost reductions for mental health services are primarily a result of reductions in inpatient and outpatient treatment days. Declines in inpatient service use were not accompanied by increases in outpatient service use, even for severely ill patients requiring hospitalization. Managed care has not caused a shift in the pattern of care but an overall reduction of care.

This study assessed patterns of mental health service use among adolescents who had attempted suicide and examined factors associated with their service use at individual, family, and community levels. Bivariate and multiple logistic regression analyses were conducted with data from 877 adolescents aged 12-17 who had attempted suicide in the past 12 months and who participated in the 2000 National Household Survey on Drug Abuse. Of the 877 adolescents, less than half (45%) reported that they had used mental health services in the past 12 months. Adolescents from racial-ethnic minority groups were less likely than whites to receive inpatient or outpatient mental health treatment, even when the analyses controlled for other demographic, individual, and family and community characteristics. Poor self-perceived health and living in a single-parent family were associated with use of inpatient services. Female gender, higher family income, participation in extracurricular activities, and the presence of symptoms of anxiety or disruptive disorders were associated with use of outpatient services. Use of school-based mental health services was associated only with participation in extracurricular activities. The mental health service needs of suicidal adolescents, especially those from ethnic minority groups and lower-income families, too frequently remain unmet. Larger racial-ethnic disparities were found in use of inpatient and outpatient mental health services than in use of school-based services. Mental health services offered within school settings can reach suicidal adolescents who need services but may experience barriers to standard types of care.

Royal Canadian Mounted Police (RCMP) officers experience an elevated risk for mental health disorders due to inherent work-related exposures to potentially psychologically traumatic events and occupational stressors. RCMP officers also report high levels of stigma and low levels of intentions to seek mental health services. In contrast, very little is known about the levels of mental health knowledge and stigma of RCMP cadets starting the Cadet Training Program (CTP). The current study was designed to: (1) obtain baseline levels of mental health knowledge, stigma against peers in the workplace, and service use intentions in RCMP cadets; (2) determine the relationship among mental health knowledge, stigma against peers in the workplace, and service use intentions among RCMP cadets; (3) examine differences across sociodemographic characteristics; and (4) compare cadets to a sample of previously surveyed serving RCMP. Participants were RCMP cadets (n = 772) starting the 26-week CTP. Cadets completed questionnaires assessing mental health knowledge, stigma against coworkers with mental health challenges, and mental health service use intentions. RCMP cadets reported statistically significantly lower levels of mental health knowledge (d = 0.233) and stigma (d = 0.127), and higher service use intentions (d = 0.148) than serving RCMP (all ps < 0.001). Female cadets reported statistically significantly higher scores on mental health knowledge and service use and lower scores on stigma compared to male cadets. Mental health knowledge and service use intentions were statistically significantly positively associated. For the total sample, stigma was inversely statistically significantly associated with mental health knowledge and service use intentions. The current results indicate that higher levels of mental health knowledge were associated with lower stigma and higher intention to use professional mental health services. Differences between cadets and serving RCMP highlight the need for regular ongoing training starting from the CTP, designed to reduce stigma and increase mental health knowledge. Differences between male and female cadets suggest differential barriers to help-seeking behaviors. The current results provide a baseline to monitor cadet mental health knowledge and service use intentions and stigma as they progress throughout their careers.

Reports an error in "Attitudes about the VA health-care setting, mental illness, and mental health treatment and their relationship with VA mental health service use among female and male OEF/OIF veterans" by Annie B. Fox, Eric C. Meyer and Dawne Vogt (Psychological Services, 2015[Feb], Vol 12[1], 49-58). The institutional affiliation in the byline for Annie B. Fox and Dawne Vogt did not include the National Center for Posttraumatic Stress Disorder. The online version of this article has been corrected. (The following abstract of the original article appeared in record 2014-45062-001.) In the present study, the authors explored gender differences in attitudinal barriers to and facilitators of care for Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans and examined the relationship of those factors with VA mental health service use among female and male veterans with probable mental health conditions. Data were collected as part of a national cross-sectional survey of OEF/OIF veterans; the current sample was limited to participants with a probable diagnosis of posttraumatic stress disorder, depression, or alcohol abuse (N = 278). Although negligible gender differences were observed in attitudes about VA care and perceived fit in the VA setting, men reported slightly more negative beliefs about mental illness and mental health treatment than women. In addition, logistic regressions revealed different associations with VA mental health service use for women and men. For women only, positive perceptions of VA care were associated with increased likelihood of seeking mental health treatment. For men only, perceived similarity to other VA care users and negative beliefs about mental health treatment were associated with increased likelihood of service use, whereas negative beliefs about mental illness were associated with lower likelihood of service use. For both women and men, perceived entitlement to VA care was associated with increased likelihood of service use and negative beliefs about treatment-seeking were associated with a reduced likelihood of seeking mental health care in the past 6 months. Results support the need for tailored outreach to address unique barriers to mental health treatment for female and male OEF/OIF veterans.

In the present study, the authors explored gender differences in attitudinal barriers to and facilitators of care for Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans and examined the relationship of those factors with VA mental health service use among female and male veterans with probable mental health conditions. Data were collected as part of a national cross-sectional survey of OEF/OIF veterans; the current sample was limited to participants with a probable diagnosis of posttraumatic stress disorder, depression, or alcohol abuse (N = 278). Although negligible gender differences were observed in attitudes about VA care and perceived fit in the VA setting, men reported slightly more negative beliefs about mental illness and mental health treatment than women. In addition, logistic regressions revealed different associations with VA mental health service use for women and men. For women only, positive perceptions of VA care were associated with increased likelihood of seeking mental health treatment. For men only, perceived similarity to other VA care users and negative beliefs about mental health treatment were associated with increased likelihood of service use, whereas negative beliefs about mental illness were associated with lower likelihood of service use. For both women and men, perceived entitlement to VA care was associated with increased likelihood of service use and negative beliefs about treatment-seeking were associated with a reduced likelihood of seeking mental health care in the past 6 months. Results support the need for tailored outreach to address unique barriers to mental health treatment for female and male OEF/OIF veterans.

Medicaid Enrollment and Mental Health Service Use Following Release of Jail Detainees With Severe Mental Illness

Asian American (AsAm) youth experience persistent disparities in mental health service use, but quantitative data are lacking in existing investigations of barriers in this population. Here, we sought to characterize key barriers to youth mental health services across multiple domains (i.e., structural, perceptual, cultural, trauma-specific) and explore associations between barriers, youth symptoms, and service use. AsAm caregivers (N = 149, Mage = 39.23, 55% female) completed the study online, reporting on barriers, youth psychopathology, and past-year service use. Caregivers reported significant barriers to seeking youth mental health services in each barrier domain. For youth mental health needs, caregivers reported using medical services most frequently, followed by school-based care and therapy/counseling. Caregivers of youth with clinically significant symptoms (clinical subgroup; n = 51) endorsed barriers more frequently compared to caregivers of youth without (n = 98), and unique key barriers emerged in the clinical subgroup. In the overall sample, mean barrier scores were positively correlated with perceived need for therapy and school-based support services, but not with medical support services. Barrier scores were positively correlated with past-year use of school-based support services, but not with therapy or medical services. Finally, barriers were significantly correlated with youth mental health symptoms, suggesting that caregivers of youth with more severe symptoms perceived more barriers to care. Addressing culturally relevant barriers, in addition to universal barriers, could improve access and engagement with mental health services for AsAm youth. Further research is needed to replicate and generalize these findings to broader samples of AsAm youth and caregivers.