Lifetime Service Use Research Articles

Patterns and predictors of mental health service utilization in people with Parkinson's disease.

Comorbid psychiatric complications are a common occurrence in Parkinson's disease (PD). However, the majority of people with PD experiencing mental health problems do not receive any professional treatment. A total of 327 Australian adults with PD completed a cross-sectional survey examining patterns of mental health service utilization and predictors of willingness to seek future mental health treatment. Only 8% of participants were currently engaged in mental health treatment despite elevated levels of depressive and anxiety symptoms. The lifetime service use rate was also low at 24%. Logistic regression analysis showed that, second to prior treatment experience (odds ratio [OR] = 3.28, 95% confidence interval [CI] = 1.46-7.35), having had a discussion about psychological symptoms with a primary PD neurologist was the next most important predictor and tripled the likelihood of an individual being willing to seek future treatment, (OR = 3.01, 95% CI = 1.72-5.27). This study highlights the integral role of the PD neurologist in facilitating awareness and treatment of mental health problems for individuals with PD.

The importance of family factors and generation status: Mental health service use among Latino and Asian Americans.

The present study utilized data from the National Latino and Asian American Study to examine ethnic and generational differences in family cultural conflict and family cohesion and how the effects of such family conflict and cohesion on lifetime service use vary by generation status for Latino Americans (n = 2,554) and Asian Americans (n = 2,095). Findings revealed that first-generation Asian Americans reported greater family cultural conflict than their Latino counterparts, but third-generation Latino Americans had higher family conflict than their Asian American counterparts. First-generation Latino and Asian Americans had the highest levels of family cohesion. Results from logistic regression analyses indicated that Latino Americans who reported higher family cultural conflict and lower family cohesion were more likely to use mental health services. For Asian Americans, family cultural conflict, but not family cohesion, was associated with service use. Relative to third-generation Asian Americans, second-generation Asian Americans with higher family cultural conflict were more likely to use mental health services. Given that cohesive familial bonds appear to discourage service use on the part of Latino Americans irrespective of generation status, further research is needed to ascertain the extent to which this tendency stems from greater reliance on family support as opposed to the stigma associated with mental health treatment. Mental health providers and treatment programs need to address the role of family cultural conflict in the lives of Asian Americans, particularly second generation, and Latino Americans across generations, because conflictual family ties may motivate help-seeking behaviors and reveal substantial underlying distress.

Comparing Mental Health of Francophones in Canada, France, and Belgium: 12-Month and Lifetime Rates of Mental Health Service Use (Part 2)

To compare 12-month and lifetime service use for common mental disorders in 4 francophone subsamples using data from national mental health surveys in Canada, Quebec, France, and Belgium. This is the second article in a 2-part series comparing mental disorders and service use prevalence of French-speaking populations. Comparable World Mental Health-Composite International Diagnostic Interviews (WMH-CIDI) were administered to representative samples of adults (aged 18 years and older) in Canada during 2002 and in France and Belgium from 2001 to 2003. Two groups of francophone adults in Canada, in Quebec (n = 7571) and outside Quebec (n = 500), and respondents in Belgium (n = 389) and France (n = 1436) completed the French version of the population survey. Prevalence rates of common mental health service use were examined for major depressive episodes and specific anxiety disorders (that is, agoraphobia, social phobia, and panic disorder). Overall, most francophones with mental disorders do not seek treatment. Canadians consulted more mental health professionals than their European counterparts, with the exception of psychiatrists. Patterns of service use are similar among francophone populations. Variations that exist may be accounted for by differences in health care resources, health care systems, and health insurance coverage.

Service use among Mexico City adolescents with suicidality

Background We report the lifetime and 12-month prevalence and associations of mental health treatment among Mexican adolescents with suicide-related outcomes (SROs; including ideation, plans, gestures and attempts). Methods A representative multistage probability household survey of 3005 adolescents aged 12 to 17 years residing in the Mexico City Metropolitan Area was carried out in 2005. Discrete-time survival analyses were used to assess the relationships between SROs and receiving treatment for emotional, alcohol, or drug problems. Results The prevalence of lifetime service use among respondents with SROs was 35% for those with ideation only, 44% for those with ideation and plan, 49% for those with gesture and 50% for those with attempt; the prevalence of 12-month service use was 10%, 24%, 6% and 21%, respectively. Timing between onset of SRO and receiving treatment for emotional, alcohol, or drug problems showed that about 50% of adolescents will have contact with a service provider before developing any SRO. Healthcare professionals were the most likely to be consulted, followed by school-based programs. Limitations This survey was limited to adolescents living in one of the largest metropolitan areas in the world and the analyses used data on retrospectively reported ages of onset that are subject to recall errors. Conclusions Most suicidal adolescents do not receive treatment, and many adolescents develop their suicidality in spite of prior contacts with service providers. Interventions to increase treatment, prevention, and monitoring are sorely needed for this vulnerable population.

Ethnic disparities in clinical severity and services for alcohol problems: results from the National Alcohol Survey.

This study reports lifetime estimates of the extent of unmet need for alcohol services across the 3 largest ethnic groups in America, and examines factors that may contribute to ethnic differences in service use. Prior studies report mixed findings as to the existence of ethnic disparities in alcohol services, with some suggesting that minorities are over-represented in treatment settings. Drawing on the most recent National Alcohol Surveys, we compare rates and factors associated with the lifetime service use for alcohol problems among Whites, Blacks, and Hispanics who meet lifetime criteria for alcohol abuse or dependence. While bivariate analyses revealed few ethnic differences in service use, there were significant differences by ethnicity in multivariate models that included alcohol problem severity and its interactions with ethnicity. At higher levels of problem severity, both Hispanics and Blacks were less likely to have utilized services than comparable Whites. Hispanics, on the whole, reported higher-severity alcohol problems than Whites. Yet, they were less likely to have received specialty treatment and multiple types of alcohol services, and were more likely to cite economic and logistical barriers as reasons for not obtaining care. Future efforts to study ethnic disparities in alcohol services should utilize analytic approaches that address potential confounding between ethnicity and other factors in service use, such as alcohol problem severity. Our findings suggest that Hispanics and Blacks with higher-severity alcohol problems may utilize services at lower rates than comparable Whites, and that, particularly for Hispanics, this may in part be attributable to financial and logistical barriers to care.

Experiences of and Attitudes Toward Mental Health Services Among Older Youths in Foster Care

Experiences of and Attitudes Toward Mental Health Services Among Older Youths in Foster Care

Where have they been? Service use of regular substance users with and without abuse and dependence

To present lifetime rates of service use for psychological and substance use related problems among regular substance users and to examine factors associated with service use. Data come from a prospective-longitudinal, epidemiological study of a community sample of adolescents and young adults (n = 2548, age 14-24 years at baseline) in Munich, Germany. The Munich-Composite International Diagnostic Interview (M-CIDI) was used at baseline and at two follow-ups to assess substance use and service use. Cumulated lifetime incidence of any substance abuse or dependence was 43.7%. Of those with abuse and dependence 23% had ever used any services for psychological or substance use related problems. Illicit substance users especially those with dependence had the highest rates of lifetime service use (52.1%). Psychotherapists and counseling services were contacted most frequently among regular substance users over their lifetimes. Utlilisation rates of substance abuse services were low (2%). Comorbid anxiety disorders and distressing life events were associated with increased lifetime service use. Only a minority of adolescents and young adults with substance use disorders have ever sought professional help. Specialized substance abuse services play only a minor role. The core role of psychotherapists and non-substance abuse specialized services needs critical research attention. Linkages between psychotherapists and the substance use service system should be strengthened to detect and intervene at early developmental stages of abuse and dependence.

Reliability of the Services Assessment for Children and Adolescents

This study examined the test-retest reliability of a new instrument, the Services Assessment for Children and Adolescents (SACA), for children's use of mental health services. A cross-sectional survey was undertaken at two sites. The St. Louis site used a volunteer sample recruited from mental health clinics and local schools. The Ventura County, California, site used a double-blind, community-based sample seeded with cases of service-using children. Participating families completed the SACA and were retested within four to 14 days. The reliability of service use items was calculated with use of the kappa statistic. The SACA- Parent Version had excellent test-retest reliability for both lifetime service use and previous 12-month use. The SACA also had good to excellent reliability when administered to children aged 11 and older for lifetime and 12-month use. Reliability figures for children aged nine and ten years were considerably lower for lifetime and 12-month use. The younger children's responses suggested that they were confused about some questions. This study demonstrates that parents and older children can reliably report use of mental health services by using the SACA. The SACA can be used to collect currently unavailable information about use of mental health services.

Unmet needs for substance abuse and mental health services among Northern Plains American Indian adolescents.

Use of mental health and substance abuse services was examined among 109 American Indian adolescents in a Northern Plains reservation community. Each was interviewed to assess psychiatric diagnosis and service use and to determine whether an adult had recognized a problem in the adolescent-a critical determinant of receipt of services. Of the 23 youths who had a disorder, nine (39 percent) reported lifetime service use. Of the 25 who received services, 17 were treated by a school counselor; only one received services from a mental health specialist. Eight of the 25 youths with a psychiatric or substance use diagnosis who did not receive services reported that an adult had recognized a problem.

Reliability of self-reported service use: Test-retest consistency of children's responses to the Child and Adolescent Services Assessment (CASA)

This paper reports on the reliability of children's responses on the Child and Adolescent Services Assessment (CASA) — a self-report instrument for use with 8− to 18-year-olds that gathers information about services used to address mental health problems. Findings were based on interviews completed by 77 children at a one week test-retest interval. Results showed that reports of lifetime service use were as reliable as were reports of service use in the preceding three months. Children reported restrictive and intrusive services more reliably than services that were provided in their natural environment. Reliability appeared to be associated more strongly with characteristics of the type of service than with characteristics of the child. Children also could report reliably on some details about their encounters with service providers (e.g., length of stay, number of visits, and onset of service use).

Patterns of hospital care for patients with HIV infection and AIDS.

The aims were to describe the use of inpatient resources by patients with HIV infection and patients with AIDS; to examine trends in service use over time; and to provide data for planners concerned with service provision for HIV infection. An inner London health district reporting 9% of AIDS cases nationally. Data on survival times and inpatient and day care use of resources were derived from existing patient records or collected prospectively between 1983 (when the first case of AIDS was diagnosed in the district) and 31 March 1990. A total of 488 HIV positive patients of whom 396 had been diagnosed as having AIDS were studied. Inpatient days consumed per annum; trends in the number of bed days per person year with AIDS; the lifetime inpatient use per AIDS patient; and the influence of survival on service use estimates were determined. Altogether 16.4% of a total 17,785 hospital inpatient days were attributable to HIV positive patients who did not fulfil the criteria for AIDS. For patients with AIDS, there was an initial increase in the intensity of inpatient use in 1987 when a dedicated HIV ward was opened. After 1988, however, inpatient use fell to 30.8 bed days per person year with AIDS. Patients diagnosed after April 1987 had noticeably longer survival times than those diagnosed earlier (a median of 17-18 months compared with a median of 10-11 months). From 214 lifetime service use records, it was estimated that patients with short survival (less than six months) would consume 36 days of inpatient care, while those expected to survive longer would consume approximately twice that number of days, irrespective of how much longer they survived. The data indicate less intensive use of inpatient care by AIDS patients over time, and hence the apparent ability to manage an increasing AIDS patient workload without a comparable increase in occupied bed days. Increases in the size of that workload and changes in the survival profile of patients, together with a relatively constant rate of service demand by longer survivors, however, will continue to place increasing strains on finite inpatient resources. Further research is needed to establish the extent to which the greater use of outpatient and community services can offset this.