Mental Health Care Use Research Articles

Physical Morbidity and Mental Health Care Among Young People

PurposeThis epidemiological study examined associations between morbidity status and mental health care use among young people. MethodsData come from individuals aged 15–29 years (n = 5,630) in the Canadian Community Health Survey-Mental Health (2012). Physical health problems were measured using a standard checklist. The Composite International Diagnostic Interview assessed 12-month mental health and substance use problems. Individuals were asked which types of mental health care they had received in the past year. Logistic, ordinal, and multinomial regression models were computed and the method of variance estimates recovery was used to compare estimates. ResultsIndividuals with comorbid physical health problems had higher odds of mental health care use for those with mental (odds ratio [OR] = 12.54 [7.07, 22.25]) and substance use problems (OR = 2.97 [1.75, 5.05]). While these estimates were higher than for individuals without physical comorbidity, differences were not statistically significant. For mental health care needs not being met, associations were found for individuals with mental (OR = 2.56 [1.24, 5.26]) or substance use problems only (OR = 2.48 [1.06, 5.82]). ConclusionsOdds of perceiving the need for and using mental health care were high in individuals with a physical comorbidity, but similar to those with mental health or substance use problems only. Young people with a physical comorbidity were less likely to report that their mental health needs are not being met compared to those with mental health or substance use problems only. Research is needed to understand barriers and facilitators faced by young people with mental health or substance use problems as they navigate the health system.

Willingness to Use Mental Health Services for Depression Among African Immigrants and White Canadian-Born People in the Province of Quebec, Canada.

Studies suggest that non-Caucasian immigrants to Canada are less likely than Canadian-born people to use mental health services. To meet the mental health needs of ethnocultural minorities, insights into their help-seeking attitudes are of great concern. This study examined the willingness of African immigrants and White Canadian-born to seek care for depression from conventional mental health services. African immigrants (N = 262) and White Canadian-born people (N = 250) living in Montreal, Canada, indicated their willingness to use mental health services under different conditions varying as a function of four factors: the severity of symptoms, the waiting time for first consultation, the type of care offered in the mental health service, and whether informal sources of help were available. Seven qualitatively different positions were identified: Never Consult (18% of the African immigrants and 1% of the White Canadian-born people); Hesitant (18% of the African immigrants and 7% of the White Canadian-born people); Depends on Waiting Time (16% of the African immigrants); Depends on Waiting Time and Symptoms (22% of the African immigrants); Depends on Symptoms (36% of the White Canadian-born people and 6% of the African immigrants); Willing to consult (33% of the White Canadian-born people and 2% of the African immigrants); Certain to Consult (9% of the White Canadian-born people and 4% of the African immigrants), while 14% of participants in each group did not express any position. African immigrants were more likely to underuse mental health services, compared with White Canadian-born people. The above diversity of positions strongly suggests that the design and implementation of interventions to reduce disparities in African immigrants' use of mental health care must not be "one size fits all" but must be tailored to address these immigrants' differing attitudes and needs.

Assessment of shared decision-making in community mental health care: Validation of the CollaboRATE

Background/ObjectiveCollaboRATE is a 3-item self-report measure of the patient experience of shared decision-making (SDM) process. The objective of this study is to assess the psychometric properties of CollaboRATE in community mental health care. MethodA cross-sectional study was conducted at a Community Mental Health Center of the Canary Islands Health Service. Two hundred and fifty consecutive psychiatric outpatients were invited to participate. Of those, 191 accepted (76.40% of response rate) and completed the CollaboRATE, the Control Preferences Scale (CPS), and a form with sociodemographic and clinical variables. ResultsExploratory factor analysis ratified the unidimensionality of the measure. High internal consistency was found (α Cronbach = .95, Guttman's λ = .93, and ω = .95). Strong positive correlations (p < .0001) were found between the CollaboRATE and the CPS. Only 39.80% of respondents gave the best possible score on CollaboRATE. ConclusionsThis study provides evidence for the reliability and validity of the Spanish version of the CollaboRATE as a measure of SDM. The measure is quick to complete and feasible for use in outpatient mental health care. At present, a significative number of psychiatric outpatients are not involved in SDM. The use of this measure in psychiatric routine care can be a key tool in assessing and implementing SDM.

Evidence Base for Measurement-Based Care in Child and Adolescent Psychiatry.

Measurement-based care (MBC) is the routine collection of data using standardized, validated measures and use of these data to guide treatment. MBC has been implemented throughout medicine to improve patient outcomes, but its use in mental health care remains low. This article summarizes the evidence of MBC's efficacy in adults then reviews the sparser data in youth mental health care. The literature indicates that MBC must be administered immediately before or during every encounter, results must be available to and reviewed by providers immediately, results must be shared with the patient, and results must be used to guide treatment.

Telemental Health and US Rural-Urban Differences in Specialty Mental Health Use, 2010-2017.

Objectives. To examine whether growing use of telemental health (TMH) has reduced the rural-urban gap in specialty mental health care use in the United States.Methods. Using 2010-2017 Medicare data, we analyzed trends in the rural-urban difference in rates of specialty visits (in-person and TMH).Results. Among rural beneficiaries diagnosed with schizophrenia or bipolar disorder, TMH use grew by 425% over the 8 years and, in higher-use rural areas, accounted for one quarter of all specialty mental health visits in 2017. Among patients with schizophrenia or bipolar disorder, TMH visits differentially grew in rural areas by 0.14 visits from 2010 to 2017. This growth partially offset the 0.42-visit differential decline in in-person visits in rural areas. In net, the gap between rural and urban patients in specialty visits was larger by 2017.Conclusions. TMH has improved access to specialty care in rural areas, particularly for individuals diagnosed with schizophrenia or bipolar disorder. While growth in TMH use has been insufficient to eliminate the overall rural-urban difference in specialty care use, this difference may have been larger if not for TMH.Public Health Implications. Targeted policy to extend TMH to underserved areas may help offset declines in in-person specialty care.

Psychotherapy Utilization, Preferences, and Retention among Women Veterans with Post-traumatic Stress Disorder.

Psychotherapy is the gold standard treatment for post-traumatic stress disorder (PTSD), yet psychotherapy use and retention among veterans is low. Little is known about the barriers to care and factors associated with women veterans' PTSD psychotherapy use and retention. Using a nationally representative sample of 986 women Veterans Health Administration primary care users with PTSD and a perceived need for mental health care, we examined 1) the proportion of women who used psychotherapy, 2) retention in psychotherapy among women who used any psychotherapy, and 3) individual factors related to psychotherapy use and retention. Women completed a survey on their mental health care experiences. Outpatient mental health care use in the year before the survey was obtained from Veterans Health Administration administrative data. Most women (79.1%) used psychotherapy, and 41.7% of those women had a minimal therapeutic dose of psychotherapy (≥8 visits). Mental health diagnostic comorbidity and being African American/Black or identifying as neither African American/Black nor White were significantly associated with higher psychotherapy use. Mental health diagnostic comorbidity, exposure to military sexual trauma, and receiving treatment aligned with gender-related and group-related preferences were associated with higher psychotherapy retention. Being a parent was associated with lower retention. Although a significant proportion of women veterans with PTSD are using psychotherapy, retention is enhanced when women are able to obtain treatment aligned with their preferences. Thus, efforts to promote patient-centered, shared decisions regarding mental health treatment options could increase the efficacy and efficiency of treatment for PTSD among women.

"Asylum is the Most Powerful Medicine": Navigating Therapeutic Interventions in Limbo.

Drawing on ethnographic research among asylum seekers in the Midwestern United States, this article investigates how a profound sense of limbo informed the use, meaning, and experiences of psychotherapeutic interventions, namely psychiatric medication and psychotherapy. In doing so, the article brings into dialogue a consideration of temporal and spatial uncertainty as a key feature of refugee distress, on the one hand, and attention to the subjective experiences of mental health care, on the other. Asylum seekers used therapeutic interventions and found them meaningful in the multiple ways these modalities help claimants endure the asylum process. Yet, ultimately, because they identified the unjust, protracted asylum system as the primary locus of their distress, asylum seekers perceived therapeutic interventions to be limited in their ability to assuage their suffering. In this context, legal status was often understood as the most effective form of healing. Thus, a sense of limbo was often both the impetus for using mental health care and the reason for its perceived limitations. My analyses have implications beyond the context of political asylum, underscoring how attention to temporality is important to better understanding the use and experience of mental health care more broadly.

The relationship of occupational injury and use of mental health care

Introduction: Symptoms of depression and anxiety are a common consequence of occupational injury regardless of its cause and type. Nevertheless, mental health care is rarely covered by workers’ compensation systems. The aim of this study was to assess the use of mental health care post-injury. Methods: We used a subsample of patient-care workers from the Boston Hospital Workers Health Study (BHWHS). We matched one injured worker with three uninjured workers during the period of 2012–2014 based on age and job title (nurse or patient-care associate) and looked at their mental health care use pre- and post-injury using medical claims data from the employer sponsored health plan. We used logistic regression analysis to assess the likelihood of mental health care use three and six months post-injury controlling for any pre-injury visits. Analyses were repeated separately by job title. Results: There were 556 injured workers between 2012 and 2014 that were matched with three uninjured workers at the time of injury (n = 1,649). Injured workers had a higher likelihood of seeking mental health care services than their uninjured counterparts during the six months after injury (OR = 1.646, 95% CI: 1.23–2.20), but not three months post-injury (OR = 0.825, 95% CI: 0.57–1.19). Patient-care associates had a higher likelihood to seek mental health care post-injury, than nurses (OR: 2.133 vs OR: 1.556) during the six months period. Conclusions: Injured workers have a higher likelihood to experience symptoms of depression and anxiety based on their use of mental health care post-injury and use is more predominant among patient-care associates; however, our sample has a small number of patient-care associates. Practical Applications: Treating depression and anxiety as part of the workers’ compensation system has the potential of preventing further physical ailment and improving the return to work process regardless of nature of injury.

Socioeconomic position and mental health care use before and after first redeemed antidepressant and time until subsequent contact to psychologist or psychiatrists: a nationwide Danish follow-up study

PurposeThe purpose was to investigate inequalities in access to care among people with possible depression.MethodIn this nationwide register-based cohort study of 30,593 persons, we observed the association between socioeconomic position (SEP, education/income) and mental health care use (MHCU) four months before the date of first redeemed antidepressant (Index Date/ID) and 12 months afterwards—and time to contact to psychologist/psychiatrist (PP). Logistic, Poisson, and Cox regression models were used, adjusted for sex, age, cohabitation, and psychiatric comorbidity.ResultsBefore ID, high SEP was associated with less GP contact (general practitioner), higher odds ratios for GP-Mental Health Counseling (GP-MHC), psychologist contact, and admissions to hospital. This disparity decreased the following 12 months for GP-MHC but increased for contact to psychologist; same pattern was seen for rate of visits. However, the low-income group had more contact to private psychiatrist.For the 25,217 individuals with no MHCU before ID, higher educational level was associated with almost twice the rate of contact to PP the following 12 months; for the high-income group, the rate was 40% higher. 10% had contact to PP within 40 days after ID in the group with higher education; whereas, 10% of those with a short education would reach PP by day 120. High-income group had faster access as well.ConclusionBeing in high SEP was positively associated with MHCU, before and after ID, and more rapid PP contact, most explicit when measured by education. Co-payment for psychologist may divert care towards private psychiatrist for low-income groups.

Post-incident reviews\u2014a gift to the Ward or just another procedure? Care providers\u2019 experiences and considerations regarding post-incident reviews after restraint in mental health services. A qualitative study

Public guidelines in many western countries recommend post-incident reviews (PIRs) with patients after restraint use in mental health care. PIRs are one of several elements of seclusion and restraint reduction in internationally used programmes. PIRs may improve restraint prevention, patients’ recovery processes and care providers’ ethical mindfulness. The knowledge base on PIRs is, however, vague. This qualitative study explores professional care providers’ experiences and considerations regarding PIRs that included patients after restraint use in a Norwegian context.MethodsWithin a phenomenological hermeneutical framework, 19 multidisciplinary care providers were interviewed about their experiences and views regarding PIRs that included patients after restraint events. The interviews were performed over the period 2015–2016. Data analysis followed a data-driven stepwise approach in line with thematic content analysis. A group of two patient consultants in mental health services, and one patient’s next of kin, contributed with input regarding the interview guide and analysis process.ResultsCare providers experienced PIRs as having the potential to improve the quality of care through a) knowledge of other perspectives and solutions; b) increased ethical and professional awareness; and c) emotional and relational processing. However, the care providers considered that PIRs’ potential could be further exploited as they struggled to get hold on the patients’ voices in the encounter. The care providers considered that issue to be attributable to the patients’ conditions, the care providers’ safety and skills and the characteristics of institutional and cultural conditions.ConclusionHuman care philosophies and a framework of care ethics seem to be preconditions for promoting patients’ active participation in PIRs after restraints. Patients’ voices strengthen PIRs’ potential to improve care and may also contribute to restraint prevention. To minimise the power imbalance in PIRs, patients’ vulnerability, dependency and perceived dignity must be recognised. Patients’ individual needs and preferences should be assessed and mapped when planning PIRs, particularly regarding location, time and preferred participants. Care providers must receive training to strengthen their confidence in conducting PIRs in the best possible way. Patients’ experiences with PIRs should be explored, especially if participation by trusted family members, peers or advocates may support the patients in PIRs.

158 - Specialist medical and mental healthcare use of psychiatric patients: a nationwide study of claims data in the Netherlands

158 - Specialist medical and mental healthcare use of psychiatric patients: a nationwide study of claims data in the Netherlands

The Impact of Sickle Cell Anemia and Mental Health Diagnoses on Healthcare Use and Preventive Care among Children Enrolled in Medicaid, 2005-2012

To examine mental health diagnoses, healthcare use, and receipt of age-appropriate preventive care, including antibiotic prophylaxis, hydroxyurea therapy, and transcranial Doppler screenings, among children with sickle cell anemia (SCA). Children aged 1-17years with SCA from 6 states having 3 or more Medicaid claims with a SCA diagnosis within a year (2005-2012) were included. Children with mental health diagnoses were identified with 1 or more mental health encounters. Poisson and logistic regression models with general estimating equations assessed the relationship between mental health diagnoses, healthcare use, and receipt of age-appropriate preventive care. In total, 7963 children with SCA were identified (22 424 person-years); 1593 person-years (7.1%) included 1 or more mental health diagnoses. Children with a mental health diagnosis were more likely to have inpatient admissions (incidence rate ratio [IRR] 1.46, 95% CI 1.36-1.56) and outpatient (IRR 1.27, 95% CI 1.21-1.34), emergency department (IRR 1.39, 95% CI 1.30-1.48), and well-child visits (IRR 1.19, 95% CI 1.11-1.29). Those with a mental health diagnosis were more likely to receive hydroxyurea therapy (odds ration [OR] 1.17, 95% CI 1.03-1.33) and less likely to receive transcranial Doppler screenings (OR 0.79, 95% CI 0.68-0.93). Children with SCA do not receive adequate age-appropriate preventive care. Further research is necessary to identify key points of coordination between mental health and SCA services throughout the life course. This approach may help to increase receipt of age-appropriate preventive care and decrease reliance on acute care.

Distress and mental health care and medication use among survivors of multiple primary cancer diagnoses: Findings from the 2016 National Health Interview Survey

ObjectiveOver 1 million survivors of multiple primary cancer (MPC) diagnoses reside in the USA. Information regarding their physical and mental health status is limited. This study examined distress and mental health care use among MPC survivors relative to survivors of a single primary cancer (SPC) diagnosis. MethodsUsing the 2016 National Health Information Survey, MPC survivors (n = 265), SPC survivors (n = 2103), and no cancer controls (NCC; n = 28,320) were identified. The MPC group was compared to the SPC and NCC groups with regard to multiple distress indices and use of mental health care and anxiety and depression medication. ResultsRelative to the SPC group, the MPC group reported more Total Distress (M = 9.59 vs. 8.84; p < .001), and were more likely to report daily or weekly anxiety feelings (OR = 2.07; p < .001), meet criteria for serious psychological distress (OR = 1.49; p = .02) and have talked to a mental health professional (OR = 1.75; p = .01). Comparison of MPC and NweCC groups yielded similar results. The MPC group did not differ from the SPC or NCC groups in severity of anxiety or depression feelings, distress interference, or anxiety and depression medication use. ConclusionsMPC survivors reported greater distress relative to SPC survivors. The clinical significance of this greater distress is unclear, however. While MPC survivors were more likely to have talked to a mental health professional, uptake of mental health care appeared to be suboptimal. MPC and SPC survivors might be considered distinct subgroups and increased attention devoted to potentially unique mental and physical health needs of MPC survivors.

Use of the Ecomap and Cultural Ecogram in Strengthening Healthcare Services for Urban African American Grandparents With Diabetes Type 2: A Case Application

The purpose of this article is to present an application of two tools the ecomap (Hartman, 1995) and cultural ecogram (Yasui, 2015) used sequentially so that it may help in the process of assisting health professionals in determining ways to improve culturally informed, instead of culturally competent healthcare provision. Both tools have been developed in the context of clinical delivery of social services, have some known research that points to the benefits of their use in health and mental healthcare (Lloyd, 2005), but have not yet been applied to promoting the cultural sensitivity with awareness in healthcare management of diabetes type 2 with urban African American grandparents who are caretakers of children.

Racial/ethnic segregation and health disparities: Future directions and opportunities.

Health researchers have investigated the association between racial segregation and racial health disparities with multilevel approaches. This study systematically reviews these multilevel studies and identifies broad trends and potential directions for future research on racial segregation and health disparities in the US. After searching databases including CINAHL and MEDLINE, we identified and systematically reviewed 66 articles published between 2003 and 2019 and found four major gaps in racial/ethnic segregation and health disparities: (a) the concept of segregation was rarely operationalized at the neighborhood level, (b) except for the evenness and exposure dimension, other dimensions of segregation are overlooked, (c) little attention was paid to the segregation between whites and non-black minorities, particularly Hispanics and Asians, and (d) mental health outcomes were largely absent. Future directions and opportunities include: First, other segregation dimensions should be explored. Second, the spatial scales for segregation measures should be clarified. Third, the theoretical frameworks for black and non-black minorities should be tested. Fourth, mental health, substance use, and the use of mental health care should be examined. Fifth, the long-term health effect of segregation has to be investigated, and finally, other competing explanations for why segregation matters at the neighborhood level should be answered.

The role of health insurance in mental health care for young adults

ABSTRACT This study investigates the effect of health insurance on young adults’ utilization of mental health care, by exploiting the dependent coverage expansion that was an early provision of the Affordable Care Act. Using the National Health Interview Survey (NHIS) from 2011 to 2013, we utilize the regression discontinuity design to overcome the problem of endogeneity. There are two key findings. First, health insurance has increased young adults’ mental health care. Second, young adults’ physical health care has not been affected by health insurance. The results suggest that the use of mental health care might be more responsive to changes in health insurance coverage than the use of physical health care is. Furthermore, the effect of health insurance on mental health care utilization is heterogeneous across metal health statuses.

Substance use, affective symptoms, and suicidal ideation among Russian, Somali, and Kurdish migrants in Finland.

Comorbidity of substance use with affective symptoms and suicidality has been well documented in the general population. However, population-based migrant studies about this association are scarce. We examined the association of affective symptoms and suicidal ideation with binge drinking, daily smoking, and lifetime cannabis use among Russian, Somali, and Kurdish migrants in comparison with the Finnish general population. Cross-sectional data from the Finnish Migrant Health and Wellbeing Study (Maamu, n = 1307) and comparison group data of the general Finnish population (n = 860) from the Health 2011 Survey were used. Substance use included self-reported current binge drinking, daily smoking, and lifetime cannabis use. Affective symptoms and suicidal ideation were measured using the Hopkins Symptom Checklist-25 (HSCL-25). We performed multivariate logistic regression analyses, including age, gender, and additional socio-demographic and migration-related factors. Suicidal ideation (OR 2.4 95% CI 1.3–4.3) was associated with binge drinking among Kurds and lifetime cannabis use among Russians (OR 5.6, 95% CI 1.9–17.0) and Kurds (OR 5.5, 95% CI 1.9–15.6). Affective symptoms were associated with daily smoking (OR 1.6, 95% CI 1.02–2.6) and lifetime cannabis use (OR 6.1, 95% CI 2.6–14.5) among Kurdish migrants. Our results draw attention to the co-occurrence of suicidal ideation, affective symptoms, and substance use, especially among Kurdish migrants. These results highlight the variation of comorbidity of substance use and affective symptoms between the different populations. This implies that screening for substance use in mental healthcare cannot be neglected based on presumed habits of substance use.

Dysproporcja pomiędzy częstością występowania zaburzeń lękowych i depresyjnych w populacji mieszkańców powiatu żywieckiego a korzystaniem z psychiatrycznej opieki zdrowotnej

Introduction: The aim of the article is to estimate the disproportion between the incidence of anxiety disorders and depression in adult population of the Żywiec Poviat and the use of mental health care. Material and methods: An anonymous survey was conducted in a randomly selected group of adults living in the Żywiec Poviat. 1659 completed questionnaires were obtained. The Hospital Anxiety and Depression Scale (HADS) was used as a screening tool. The data were compared with the number of outpatient and hospitalized people in psychiatric health care facilities in the poviat. Results: The study released a significant disproportion between the occurrence of anxiety disordes and treatment for this reason. In outpatient settings 1.23% of people suffering from anxiety used medical care, 0.06% were hospitalized. A similar situation applies to the disproportion between the occurrence of depression and treatment for this reason. Among people whose symptoms implement the criteria of depressive episode, 1.11% used outpatient treatment and 0.14% were hospitalized. Conclusion: Prevelence of anxiety disorders and depression and related to this health needs in examinated population significantly exceeds the real use of psychiatric healthcare. Constant underestimation of health needs in the field of psychiatry can be a result and one of the causes of this phenomenon. For better planning of activities in the field of health policy, it is necessary to perform epidemiological studies that reveal scale of the problem.

Outside the Military "Bubble": Life After Service for UK Ex-armed Forces Personnel.

Military personnel who have seen active service can be affected by their experiences. Much of the literature on the mental and physical health battles faced by men and women who leave the Armed Forces is dominated by research in the United States (US) (1), and is particularly focused on exposure to deployment, combat conditions, and effects on mental health. Research in the United Kingdom (UK) tends to focus on depression or alcohol misuse and the impact these issues have on currently serving personnel. This study aimed to present UK veterans' first-hand experiences related to military service, access to and use of mental healthcare and interventions, and the impact of transition on the military family. Semi-structured interviews explored experiences of 30 participants (27 male, 3 female). Participants ranged in age from 26 to 92 years (M = 53.33), and across multiple war cohorts (from WWII to Iraq and Afghanistan). Data were analyzed using Thematic Analysis and Narrative Analysis. Findings show meaning-making from experiences of transition across veteran cohorts. Main themes were reasons for leaving Armed Forces, life outside the military, and mental health concerns after service. Subordinate themes additionally focused on evaluation of identity and mental health service provision. Future clinical research should include the experiences of UK serving personnel and the effects of pre-and post-military adversity, alongside the impact of deployment experiences. Interventions designed to address transition into life after service are discussed.

Increased mental health care use by mothers of children with multiple sclerosis.

We compared the prevalence of physical and mental conditions and rate of health care utilization in mothers of children with multiple sclerosis (MS) (MS-mothers) with that of mothers of children without MS (non-MS-mothers). Using population-based administrative data from Ontario, Canada, we identified MS-mothers and non-MS-mothers, matched on maternal age at childbirth, region, and the child's age and sex at the time of MS diagnosis. We compared the prevalence of any physical condition or any mood or anxiety disorder between the cohorts, in the child's MS diagnosis year, and 5 years before and after diagnosis. We compared rates of physician visits before diagnosis, during the diagnosis year, and after the child's diagnosis using multivariable regression models with generalized estimating equations adjusting for maternal age, socioeconomic status, region of residence, and index year. We identified 156 MS-mothers and 624 non-MS-mothers. MS-mothers had a higher prevalence of any physical condition and of any mood or anxiety disorder than non-MS-mothers, before, during, and after their child's diagnosis. On multivariable analysis, MS-mothers did not have higher rates of primary care visits (rate ratio [RR] 1.04; 95% confidence interval [CI] 0.90-1.20), but exhibited increased odds of having any psychiatry visits (odds ratio 1.60; 95% CI 1.10-2.31); the rate of visits did not differ when they did occur (RR 0.66; 95% CI 0.33-1.30). Mothers of children with MS use more mental health services before and after their child's MS diagnosis than mothers of children without MS. Pediatric health care providers should consider the mental well-being of mothers and their children with MS.