Use Of General Health Services Research Articles

Country of birth and non-small cell lung cancer incidence, treatment, and outcomes in New South Wales, Australia: a population-based linkage study.

ObjectiveTo compare treatment within 12 months of diagnosis, and survival by country of birth for people diagnosed with invasive non-small cell lung cancer (NSCLC) in New South Wales (NSW), Australia. Design, patients, and settingA population-based cohort study of NSW residents diagnosed with NSCLC in 2003–2016 using de-identified linked data from the NSW Cancer Registry, NSW Admitted Patient Data collection, Emergency Departments, Medicare Benefits and Pharmaceutical Benefits Scheme, and National Death Index.Main outcome measuresOdds of receiving any treatment, surgery, systemic therapy, or radiotherapy respectively, in the 12 months following diagnosis were calculated using multivariable logistic regression. The hazard of death (all-cause) at one- and five-years following diagnosis was calculated using multivariable proportional hazards regression.Results27,114 People were recorded with NSCLC in the 14-year study period. Higher percentages of older males from European countries applied in the earlier years, with a shift to younger people from South East Asia, New Zealand, and the Middle East. Adjusted analyses indicated that, compared with the Australian born, people from European countries were more likely to receive treatment, and, specifically surgery. Also, people from Asian countries were more likely to receive systemic therapy but less likely to receive radiotherapy. Survival at one- and five-years following diagnosis was higher for people born in countries other than Australia, New Zealand the United Kingdom and Germany.ConclusionsVariations exist in treatment and survival by country of birth in NSW. This may be affected by differences in factors not recorded in the NSW Registry, including use of general health services, family histories, underlying health conditions, other intrinsic factors, and cultural, social, and behavioural influences.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12890-022-02163-z.

Influences of Family Relational Factors and Immigration Generation Status on Mental Health Service Utilization Among Asian Americans

Drawing on data from the National Latino and Asian American Study, this article examines the influence of family relational factors, independently and jointly with immigration generation status, on past-year mental health service utilization among Asian Americans ( N = 1,599). Findings revealed the important role of family relation in influencing the likelihood and type of Asian Americans’ mental health service use. Lower level of family cohesion and higher level of family conflict were associated with increased likelihood of service use. Results from multiple logistic regressions further indicated that generation status interacts with family relation in affecting service use. Specifically, effect of family cohesion on general health service use was modified by generation status among third- or later-generation Asian Americans. Practice implications and future research directions are discussed to better understand and address the mental health needs of this population.

Epidemiology and comorbidity of obsessive–compulsive disorder in late adolescence: a cross-sectional study in senior high schools in Greece

Objective: The aim of this study was to examine the epidemiology, comorbidity and use of health services of obsessive–compulsive disorder (OCD) and subclinical obsessive–compulsive symptoms in late adolescence.Methods: A total of 2427 adolescents attending senior high schools in Greece were selected for a detailed psychiatric interview using the revised clinical interview schedule (CIS-R). Use of alcohol, nicotine and cannabis, and several socio-demographic and socio-economic variables were also assessed.Results: The prevalence of OCD was 1.39% (95% confidence interval [CI]: 1.05–1.84) while that of subclinical obsessive–compulsive symptoms was 2.77% (2.22–3.45). There was a female preponderance for subclinical symptoms. Financial difficulties of the family was the only socio-demographic variable that was significantly associated with OCD but not with subclinical symptoms. The pattern of comorbidity was similar for both conditions but milder in the subclinical form. About one in three reported use of general health services and one in ten use of psychiatric services.Conclusions: OCD and subclinical obsessive–compulsive symptoms were relatively common. Comorbidity with other psychiatric disorders and use of substances was considerable even in subclinical status, but use of specialised health services was small. Clinical and research implications are discussed.

EPA-1708 – Common mental disorders and use of mental health services in the general population in Greece

General population surveys of the prevalence and associations of common mental disorders are necessary for the organization of effective mental health services. To present data on the pattern and correlates of 12-month use of services by persons with common mental disorders from the recently completed general population survey of psychiatric morbidity in Greece. The sample ( n =4894; multistage random sample drawn from population of both mainland and insular Greece) can be regarded as representative of the Greek population aged 18–70. Participants were interviewed at their households by trained lay interviewers. Common mental disorders were assessed according to the ICD-10 criteria with the revised Clinical Interview Schedule (CIS-R), a fully structured diagnostic interview. 73,9% of participants with at least one common mental disorder (CMD) do not receive any treatment for their psychological health, 52% have never spoken to the family physician and 73.3% has not spoken to a mental health professional in the past year. The disorder associated with the most frequent use of general health services for any reason (>4 visits to any physician in the past year) was depression (43.7%). Regarding use of family physician services for a mental health issue, patients with panic disorder (54.4%) and generalized anxiety disorder (52.8%) were more likely to consult compared to other CMDs. The overall percentage of patients with CMDs that choose to talk to a priest or other spiritual for their mental health problem was comparable to that who talked to a mental health professional. Overall, 46.5% of all participants who meet the criteria for a common mental disorder had not spoken to a doctor or mental health professional, with men showing significantly higher rates of no use compared to women (54.6% men vs. 41.5% women). The findings of the present study can help in the better organization of services with the aim to improve prevention and treatment of common mental disorders in Greece especially in a time of economic hardship.

2245 – Common mental disorders and use of mental health services in the general population in greece

General population surveys of the prevalence of common mental disorders are necessary for the organization of effective mental health services. Epidemiological studies are useful for the more objective assessment of the mental health needs of the population. To present data on the pattern and correlates of 12-month use of services by persons with common mental disorders from the recently completed general population survey of psychiatric morbidity in Greece. The sample (n=4894; multistage stratified random sample) was representative for the Greek population aged 18-70. Common mental disorders were assessed according to the ICD-10 criteria with the revised Clinical Interview Schedule (CISR), conducted by trained lay interviewers. 73,9% of participants with at least one common mental disorder (CMD) do not receive any treatment for their psychological health, 52% have never spoken to the family physician and 73.3% has not spoken to a mental health professional in the past year. The disorder associated with the most frequent use of general health services for any reason (>4 visits to any physician in the past year) was depression (43.7%). Overall, 46.5% of all participants who meet the criteria for a CMD had not spoken to a doctor or mental health professional, with men showing significantly higher rates of no use compared to women (54.6% vs 41.5%). These findings can help in the better organization of services with the aim to improve prevention and treatment of common mental disorders in Greece, especially in a time of economic hardship.

Who gets mental health treatment from the GP? Results from the Israel National Epidemiological Mental Health Survey

In view of the pending mental health (MH) reform, an increase in demand of MH services is expected. Primary care physicians will presumably be involved in meeting this expected increased demand. To identify the preferable route of service use of populations with MH problems based on data from the Israel National Health Survey (INHS). The sample was drawn from the INHS which assessed mental disorders as well as the existence of chronic physical diseases in the population and the use of services for MH problems (specialty and primary care). The examined variables were (i) the existence of any mood or anxiety disorder and its severity, (ii) suffering from a chronic physical disease, (iii) use of MH services and (iv) use of general health services for MH problems. Fifty-one per cent of all those treated for MH problems were treated in the MH specialty sector and 49% in the general sector. Among those who met the diagnostic Composite International Diagnostic Interview criteria of any mood or anxiety disorder, the percentages were 62% and 38%, respectively. Irrespective of diagnosis, the proportion of those using the services of the GP is significantly greater among people above the age 50 years than among younger people. People with emotional problems above the age of 50 years are more likely to prefer help for their problems from their GP regardless of the presence of any mental disorder or of a chronic medical disease.

Impact of the Fast Track Prevention Program on Health Services Use by Conduct-Problem Youth

We tested the impact of the Fast Track conduct disorder prevention program on the use of pediatric, general health, and mental health services in adolescence. Participants were 891 public kindergarten boys and girls screened from a population of 9594 children and found to be at risk for conduct disorder. They were assigned randomly (by school) to intervention or control conditions and were followed for 12 years. Intervention lasted 10 years and included parent training, child social-cognitive skills training, reading tutoring, peer-relations enhancement, and classroom curricula and management. Service use was assessed through annual interviews of parents and youth. Youth assigned to preventive intervention had significantly reduced use of professional general health, pediatric, and emergency department services relative to control youth on the basis of parent-report data. For control-group youth, the odds of greater use of general health services for any reason and general health services use for mental health purposes were roughly 30% higher and 56% higher, respectively. On the basis of self-report data, the intervention reduced the likelihood of outpatient mental health services among older adolescents for whom odds of services use were more than 90% higher among control-group youth. No differences were found between intervention and control youth on the use of inpatient mental health services. Statistical models controlled for key study characteristics, and potential moderation of the intervention effect was assessed. Random assignment to the Fast Track prevention program is associated with reduced use of general health and outpatient mental health services in adolescents. Future studies should examine the mechanism of this impact and service use patterns as subjects reach young adulthood.

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

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

Public health significance of neuroticism.

The personality trait of neuroticism refers to relatively stable tendencies to respond with negative emotions to threat, frustration, or loss. Individuals in the population vary markedly on this trait, ranging from frequent and intense emotional reactions to minor challenges to little emotional reaction even in the face of significant difficulties. Although not widely appreciated, there is growing evidence that neuroticism is a psychological trait of profound public health significance. Neuroticism is a robust correlate and predictor of many different mental and physical disorders, comorbidity among them, and the frequency of mental and general health service use. Indeed, neuroticism apparently is a predictor of the quality and longevity of our lives. Achieving a full understanding of the nature and origins of neuroticism, and the mechanisms through which neuroticism is linked to mental and physical disorders, should be a top priority for research. Knowing why neuroticism predicts such a wide variety of seemingly diverse outcomes should lead to improved understanding of commonalities among those outcomes and improved strategies for preventing them.

Posttraumatic stress disorder and the use of general health services in postwar Kosovo

Studies conducted in high-income countries have demonstrated that posttraumatic stress symptoms are positively correlated with increased use of general health services; however, comparative data are lacking in postwar settings. This survey was conducted in Kosovo after the end of the conflict; 996 people, age 16 or older, were interviewed. Older age, lower education level, worse physical health, and current diagnosis of posttraumatic stress disorder (PTSD) were associated with higher use of any health services. After adjusting for gender, age, place of residence, type of education, poverty, refugee status, and subjective physical health, PTSD remained associated with an increased use of most health care services. Our results underline the importance of taking into account PTSD when restoring health services in postwar countries.

Patrones de uso de servicios entre adultos con problemas de salud mental, en Chile

To describe the patterns in the use of general health services and specialized health services among adults with mental health problems in Chile, as well as those persons' level of satisfaction with the services. The overall objective was to optimize the use of the limited resources available for mental health care in the countries of the Americas, especially Chile. The diagnoses and the patterns of use of mental health services were obtained from the Chilean Study of Psychiatric Prevalence (Estudio Chileno de Prevalencia Psiquiátrica). That representative research on the adult population of Chile was based on a stratified random sample of 2,987 people 15 years old and older, done over the period of 1992 to 1999. The psychiatric diagnoses were obtained using the Composite International Diagnostic Interview (CIDI). The interviewees were also asked about their use of general health care services and of mental health services in the preceding six months, as well as any barriers to accessing the services. More than 44% of the interviewees had had contact with some type of health service during the six months prior to the study, but only 5.6% received specialized care. Those who presented with a diagnosis of obsessive-compulsive disorder or of panic disorder consulted more frequently, but not in specialized centers. Consumption of substances such as alcohol and drugs as well as antisocial personality disorder were associated with a low level of consultation. When asked about sources of assistance for mental health problems, the majority of the interviewees mentioned only the formal health care system. More than 75% of the interviewees said that they were satisfied or very satisfied with the care that they had received. Our results confirm the existence of a wide gap between the need for care and the treatment that is actually received. The informal and folkloric alternative resources (priests, family members, healers, herbalists, etc.) were used less frequently than is generally believed to be true. The indirect barriers of access to services--linked to a lack of knowledge and to stigma--were more frequent than were the direct barriers. A sizable number of people who did not have a positive diagnosis on the CIDI utilized mental health services.

Common mental disorders and use of general health services: a review of the literature on population‐based studies

To review population-based studies on the association between common mental disorders and the use of general (non-mental) health care services. Literature search in Medline and PsychLit databases. Only studies with a prospective design and correction for somatic morbidity were included for review. On the most general level of outcomes considered and in the majority of studies, mental disorders were associated with higher service use. This general tendency is not consistently reflected in the use of specific health care services, but is materialized in different patterns of out-patient and in-patient service utilization, which vary from study to study. Findings for the elderly were less clear-cut than for other age groups. Mental disorders are related to higher general health care service use on a global, aggregated level. These associations are not specific for certain types of services.

Frequent attenders to an emergency department: A study of primary health care use, medical profile, and psychosocial characteristics

Study objective: We describe, in comparison with a control group, frequent attenders to an emergency department in terms of their general health service use and their clinical, psychological, and social profiles. Methods: One hundred frequent attenders (those who had made ≥4 visits in the previous year) and 100 nonfrequent attenders matched for sex, age, and triage category were interviewed in the ED. Data were gathered on health service use, mental health (by using the General Health Questionnaire–12 item), and perceived social support (by using the Multidimensional Scale of Perceived Social Support). Patients' general practitioners were contacted to validate attendance data. Medical charts were searched for evidence of psychological problems and alcohol or drug abuse. Results: In the overall sample of 200 patients, 32% were female, and the mean age was 55 years (SD 20). Frequent attenders had made more visits to their general practitioner in the past year compared with control patients (median 12 versus 3 visits); a higher proportion of frequent attenders had used public health nursing services, community welfare services, social work services, addiction counseling, and psychiatric services in the past year. Frequent attenders had made more other hospital visits and had spent more nights in the hospital than control patients. General Health Questionnaire–12 item scores were higher for frequent attenders than control patients, indicating poorer mental health. Frequent attenders had lower levels of perceived social support. Conclusion: Frequent attenders to the ED are also heavy users of general practice services, other primary care services, and other hospital services. General Medical Services–eligible patients (84% of frequent attenders) frequently attend the ED, even though they have free access to primary care. Frequent attenders are a psychosocially vulnerable group, and service providers and policy makers need to take account of this vulnerable patient profile as they endeavor to meet their service needs. [Ann Emerg Med. 2003;41:309-318.]

Self-reliance, mental health need, and the use of mental healthcare among island Puerto Ricans.

This paper examines the relationship between self-reliance (preference to solve emotional problems on one's own) and 5 mental healthcare utilization outcomes for Puerto Ricans living in low-income areas. A random probability community sample of noninstitutionalized Puerto Ricans, ages 18-69, living in low-income areas of the island were selected and interviewed in 1992-93 and 1993-94. A series of logistic regression models tested the association between self-reliance and 5 mental health utilization measures, after adjusting for covariates measuring predisposing, enabling, need and barrier factors: any use of mental health services, any use of general health services for mental healthcare, any use of specialty care, use of psychotropic medications, and retention in mental healthcare. Self-reliance was found to be negatively associated with all 5 dependent service utilization measures. Those with a positive self-reliant attitude were 40% less likely to use care on any of the 5 outcome measures. An interaction was also observed between definite need for mental healthcare and having a self-reliant attitude when predicting mental health service use. Definite needers with a self-reliant attitude were 54%-58% less likely to use mental health services compared with definite needers who did not have a self-reliant attitude. Further, decreases in self-reliant attitude over the two data collection periods were associated with increases in mental health service use. Our findings suggest that self-reliance is a significant and robust predictor of mental healthcare utilization among Puerto Ricans living in low-income areas of the island.

Screening for HIV, HBV and HCV markers among drug users in treatment in rural south-east England.

This study was designed as an opportunistic screening to estimate the prevalence of blood-borne viral infection among drug users in treatment in the rural population and to investigate related risk factors and use of general health services. A total of 102 patients aged 18 years and over (78 male, 24 female) with problematic self-reported drug use, recruited between 1 February 1996 and 31 January 1997, in a mixed urban-rural population in south-east England, were interviewed for information on socio-demographic status, drug use history, HIV-related risk behaviours, hepatitis B vaccination, general practice consultations, and use of A&E departments and medical out-patient clinics. Diagnostic testing was offered to all patients for anti-HIV-1, anti-HBc, HBsAg and anti-HCV. The mean age at onset of illicit drug use for the entire sample was 15.33 (SD 3.36) years; 3.7 per cent (1/27), 20.4 per cent (18/88), and 55.8 per cent (48/86) had antibodies to HIV-1, HBc and HCV, respectively; 1.1 per cent (1/88) tested positive for HBsAg indicative of a carrier state. All 18 patients anti-HBc seropositive were male (p = 0.009). There was no gender difference for anti-HCV serological status. The proportion of town residents and village dwellers seropositive for anti-HBc and anti-HCV did not differ significantly. Patient's age at interview, age at onset of opioid use and duration of opioid use showed a significant association with anti-HBc and anti-HCV serological status. The proportion directly sharing injecting equipment was too small for rigorous statistical analysis; however, indirect sharing involving cooking equipment and frontloading rituals achieved statistical significance. Anti-HBc serological status showed a significant association with vaginal intercourse without a condom (p = 0.03); none of the sexual risk behaviour variables revealed any significant association with HCV infection. Although only one-third of the sample consented to HIV antibody test, consenting and non-consenting groups did not differ significantly except on one variable: having a drug-using sexual partner (chi2 = 5.6167; p = 0.017). Serum aspartate amino transferase and gamma-glutamyl transpeptidase concentrations were raised above the upper limit in 23 (25.7 per cent) of the 89 patients who gave blood specimens; 41.2 per cent (42/102) were referred to treatment by their general practitioners. There was no significant relationship between HBV and HCV serological status and general practice consultations. Only eight (7.8 per cent) had received hepatitis B vaccination, and although 48 (47.1 per cent) had in the preceding 12 months used A&E departments, only seven (6.2 per cent) had been seen in medical out-patient clinics. In this study the prevalence of HIV, HBV and HCV in the rural population is as high as has been reported for inner cities. The poor uptake of hepatitis B vaccination among drug users, their poor response to HIV antibody test and poor health service utilization suggest the need for an urgent appraisal of service provision and a review of prevention and treatment strategies.

Attitudes of Chinese people toward obtaining dental care in the UK.

To explore the attitudes of Chinese people regarding dentists and toward obtaining dental care in the UK. Injudicious use of general health services has been reported among Chinese people in the UK. In relation to oral healthcare, the extent to which cultural beliefs and values affect use remains uncertain. Chinese communities in the north east of England. A quota sample of 156 Chinese people was recruited in 1996. 50 elderly people, 56 adults, 50 teenagers were interviewed by 5 trained and standardised multilingual Chinese interviewers using a validated structured questionnaire. Access varied substantially according to age, with the younger generations more likely to obtain dental care without difficulty. Overall, the sample perceived that dentists possessed adequate technical competence, but their patient management skills lacked sensitivity. Older Chinese people placed less trust in dentists. Many elderly people reported problems in finding a UK dentist and would have preferred one of Chinese origin. Potential problems in follow-up prosthetic dental care were also apparent among this age group. Cost, communication problems, anxiety and cultural beliefs were identified as major barriers to dental care. There is a clear need to raise cultural awareness among dental professionals as well as to help Chinese people's positive attitudes toward dentists and dental care.