Use Of Mental Health Care Services Research Articles

How Income Inequality and Immigrant Background Affect children’s Use of Mental Healthcare Services in Oslo, Norway

During the last decade, Norway has experienced a major increase in permanent poverty among children. Although income inequality among Norwegian families is ranked as the lowest in Europe, the capital city of Oslo is characterized by significant differences in income across and within city districts. This paper analyses the degree to which utilization of specialized mental health services among children and adolescents is influenced by low-income and geographical-income inequality. In particular, do these factors affect immigrant children differently than they do native children? The data include the total population of children and adolescents with a native or non-Western background residing in Oslo (N = 121,449), in addition to register data covering all contacts with specialized mental healthcare institutions during the years 2008–2011 (N = 446,440). Multivariate logistic regression and Poisson regression were applied to analyse variations in rates of mental health care utilization. Non-Western children had significantly lower rates of utilization than their native peers, with the exception of a small minority of children residing in city districts with high levels of income inequality. For native children, there appears to be an inverse relationship between living in an area of income inequality and mental healthcare utilization: living in city districts with high income inequality to some extent lowers the probability of having contact with mental healthcare services. The results are discussed, involving factors such as underutilization, ethnic density effects, and selection processes that influence who becomes poor.

Stigma and Attitude Toward Service Use Among Korean American Parents of Adolescent Children: Does Depression Literacy Act as a Mediator and/or Moderator?

The current study used secondary data analysis to examine mediating and moderating effects of depression literacy on the relationship between depression stigma and attitude toward use of mental health care services in Korean American parents. Of 141 survey respondents, 36 (25.2%) were fathers and 105 (74.8%) were mothers. In mediation analysis, the indirect effects of personal stigma (B = -0.14, p < 0.05) and total stigma (B = -0.09, p < 0.05) were statistically significant. The moderating eff ect of depression literacy on the relationship between personal stigma and attitudes was also significant (B = -0.06, p < 0.05). The current study found that only the relationship between personal stigma and attitude toward mental health care service use was mediated by depression literacy. [Journal of Psychosocial Nursing and Mental Health Services, 56(11), 46-55.].

Veteran-centered barriers to VA mental healthcare services use

BackgroundSome veterans face multiple barriers to VA mental healthcare service use. However, there is limited understanding of how veterans’ experiences and meaning systems shape their perceptions of barriers to VA mental health service use. In 2015, a participatory, mixed-methods project was initiated to elicit veteran-centered barriers to using mental healthcare services among a diverse sample of US rural and urban veterans. We sought to identify veteran-centric barriers to mental healthcare to increase initial engagement and continuation with VA mental healthcare services.MethodsCultural Domain Analysis, incorporated in a mixed methods approach, generated a cognitive map of veterans’ barriers to care. The method involved: 1) free lists of barriers categorized through participant pile sorting; 2) multi-dimensional scaling and cluster analysis for item clusters in spatial dimensions; and 3) participant review, explanation, and interpretation for dimensions of the cultural domain. Item relations were synthesized within and across domain dimensions to contextualize mental health help-seeking behavior.ResultsParticipants determined five dimensions of barriers to VA mental healthcare services: concern about what others think; financial, personal, and physical obstacles; confidence in the VA healthcare system; navigating VA benefits and healthcare services; and privacy, security, and abuse of services.ConclusionsThese findings demonstrate the value of participatory methods in eliciting meaningful cultural insight into barriers of mental health utilization informed by military veteran culture. They also reinforce the importance of collaborations between the VA and Department of Defense to address the role of military institutional norms and stigmatizing attitudes in veterans’ mental health-seeking behaviors.

Refugees’ admission to mental health institutions in Norway: Is there an ethnic density effect?

Some recent European research claims that immigrants settle in urban areas with low scores on level-of-living conditions and a high prevalence of health-risk factors, and that these settlement patterns adversely affect their health. Other studies question the association between immigrant segregation and area deprivation on one hand, and negative health outcomes on the other hand, and identify possible beneficial effects of segregation, specifically the ethnic density effect. This paper aims to explore the possible ethnic density effect among refugees, a sub-population that often appears relatively vulnerable compared with immigrants in general. The data comprise 30 871 individuals, aged 20–69, with an (post-1989) officially registered refugee status from six major countries, including Vietnam, Somalia, Iran, Iraq, Sri Lanka and Bosnia. Two outcomes are analysed, covering the 2008–2011 period – the probability of being admitted at least once to a mental health institution and the number of bed days during that period. The results show that all immigrant clusters have relatively high concentrations of negative level-of-living conditions. Despite this finding, refugees living in clusters tend to have less use of mental healthcare services. The results suggest that for most refugee groups, living in clusters has positive health outcomes. Many countries use settlement policies to direct the inflow of refugees away from immigrant-dense areas. Norway's settlement policy is no exception, aiming at a geographic dispersal of refugees to avoid the emergence of socially segregated urban ethnic communities. This paper discusses the relevance of such a policy for refugees' overall integration and level-of-living conditions.

Depression and discrimination in the lives of women, transgender and gender liminal people in Ontario, Canada.

This article uses an intersectionality lens to explore how experiences of race, gender, sexuality, class and their intersections are associated with depression and unmet need for mental healthcare in a population of 704 women and transgender/gender liminal people from Ontario, Canada. A survey collecting demographic information, information about mental health and use of mental healthcare services, and data for the Everyday Discrimination Scale and the PHQ-9 Questionnaire for Depression was completed by 704 people via Internet or pen-and-paper between June 2011 and June 2012. Bivariate and regression analyses were conducted to assess group differences in depression and discrimination experiences, and predictors of depression and unmet need for mental healthcare services. Analyses revealed that race, gender, class and sexuality all corresponded to significant differences in exposure to discrimination, experiences of depression and unmet needs for mental healthcare. Use of interaction terms to model intersecting identities and exclusion contributed to explained variance in both outcome variables. Everyday discrimination was the strongest predictor of both depression and unmet need for mental healthcare. The results suggest lower income and intersections of race with other marginalised identities are associated with more depression and unmet need for mental healthcare; however, discrimination is the factor that contributes the most to those vulnerabilities. Future research can build on intersectionality theory by foregrounding the role of structural inequities and discrimination in promoting poor mental health and barriers to healthcare.

Effects of assisted outpatient treatment and health care services on psychotic symptoms

RationaleAn ongoing debate concerns acceptability, benefits, and shortcomings of coercive treatment such as assisted outpatient treatment (AOT). The hypothesis that involuntary commitment to outpatient treatment may lead to a better clinical outcome for a subgroup of persons with severe mental illness (SMI) is controversial. Nonetheless, positive effects of AOT may be mediated by an increased availability of healthcare resources or increased service use. ObjectiveThe purpose of the present study is to evaluate the course of delusions, hallucinations, and negative symptoms among patients with SMI receiving AOT compared to patients receiving non-compulsory treatment (NCT). Moreover, we assessed if the effects of AOT on psychotic symptoms were mediated by increased healthcare service use. MethodsThis study used a quasi-experimental design to examine the effect of AOT and the use of healthcare services on psychotic symptoms. In total, 76 (41.3%) participants with SMI received AOT, and 108 (58.7%) received NCT. The participants were interviewed at baseline every 3 months up to 1 year. Propensity score matching was used to control for group differences. ResultsIn the basic model, AOT was associated with lower severity of psychotic symptoms over all follow-up points. In the model including healthcare service use, the frequency of case manager visits predicted a reduction in severity of all psychotic symptoms. The frequency of visits to the outpatient clinics, frequency of emergency room, and psychiatrist visits were independently associated with lower levels of delusional symptoms. Psychiatrist visits were related to a decrease in negative symptoms. ConclusionResults indicate that the treatment benefits of AOT are enhanced with the increased use of mental healthcare services, suggesting that the positive effect of AOT on psychotic symptoms is related to the availability of mental healthcare service use. Coercive outpatient treatment might be more effective through greater use of intensive services.

Does caregiver participation in decision making within child welfare agencies influence children's primary and mental health care service use?

Many children in contact with child welfare agencies do not receive needed health services. These agencies have used participatory decision making (PDM) practices as a way to increase families' use of recommended services. However, we lack evidence of whether caregiver participation in PDM increases children's use of health services. This study uses a national sample of children involved with child welfare to compare their health service use between those children serve through a PDM practice and those who did not experience it. Cross-sectional analyses using the 2009-2010 National Survey of Child and Adolescent Well-Being. Propensity score analysis accounted for observed selection bias. PDM practice was measured as whether the caregiver was included in decision-making during service planning meetings. Health service use was measured as child's receipt of any primary or mental health care services in the past year. Primary health care need was measured using standardized measures and caseworker report. The sample was comprised of children ages 2-17 with primary or mental health needs in contact with a child welfare agency. In the unmatched sample of 1,358 children, 14% were served through a PDM service practice, and 12% had a primary health care and 37% a mental health need. Families served through PDM were also reported by caseworkers as more cooperative during the child welfare investigation, and with fewer reports of domestic violence and agency re-referrals (P < 0.05). Analyses using matched samples showed that for primary health care, 59% of PDM children received services compared with 40% for non-PDM children (P = 0.004). Group differences were not significant for mental health services. Lower-risk families were more likely to be served through PDM which was positively associated with child use of primary health services. Inclusion of caregivers in decision making may not be sufficient to overcome barriers to children's mental health service use.

The influence of social support on healthcare service use following transport-related musculoskeletal injury.

BackgroundSocial support has been identified as a significant factor in the recovery of individuals with musculoskeletal injury (MSI). However, relatively limited research has examined the mechanisms through which social support influences healthcare service use. This research examines the direct effects, mediating effects and effect modification of social support on healthcare service use among people with MSI sustained in a transport accident.MethodsThe study design was secondary data analysis of cross-sectional surveys of compensated transport accident victims in Victoria in 2010 and 2011, linked to compensation claims and payment records. Analyses included (i) zero-inflated negative binomial and logistic regressions to model healthcare service use (direct effect), (ii) the Karlson, Holme and Breen (KHB) method to assess social support as a mediator of predisposing factors, need factors and healthcare service use (mediation effect), and (iii) interactions to assess social support as a modifier between predisposing factors, need factors and healthcare service use (effect modification).ResultsResults of the direct analyses showed that support from family was associated with lower uptake of allied healthcare services (odds ratio (OR) 2.17; 95 % confidence intervals (CI) 1.21–3.91). Support from friends was associated with lower uptake (OR 1.87; 95 % CI 1.09–3.21) and lower rate (i.e. number of services per person) of allied healthcare services (incidence rate ratio (IRR) 0.65; 95 % CI 0.52–0.83). Support from friends (OR 0.60; 95 % CI 0.38–0.95) was also associated with lower uptake of mental healthcare services. No statistically significant mediation effects were identified for family or friends’ support on the uptake of allied and mental healthcare services. Family support was found to modify the association between socio-economic indexes for areas and mental healthcare service use. In the group that reported having no social support, mental healthcare service uptake in the socioeconomically advantaged group was lower than in the disadvantaged group (OR 0.36; 95 % CI 0.16–0.83).ConclusionsThe findings suggest that social support has a direct and modifying effect on healthcare service use but does not mediate the association between predisposing factors, need factors and healthcare service use. The study findings have implications for the role of social support in the prevention, treatment and intervention of individuals with MSI.

Impact of involuntary out-patient commitment on reducing hospital services: 2-year follow-up.

Aims and method To evaluate whether involuntary out-patient commitment (OPC) in patients with severe mental disorder reduces their use of hospital services. This is a retrospective case-control study comparing a group of patients on OPC (n = 75) and a control group (n = 75) which was composed of patients whose sociodemographic variables and clinical characteristics were similar to those of the OPC group. Each control case is paired with an OPC case, so the control case must have an involuntary admission in the month that the index OPC case admission occurred. Emergency room visits, admissions and average length of hospital stay over a 2-year follow-up after the initiation of OPC were compared.Results No statistically significant evidence was found in the use of mental healthcare services between the two groups. Different reasons for admission found between the groups limit similarity when comparing the two.Clinical implications The findings cast doubt over the effectiveness of this legal measure to reduce emergency visits, the number of admissions and the length of stay in the hospital.

Patterns and Predictors of Primary Mental Health Service Use Following Bushfire and Flood Disasters

To examine patterns and predictors of primary mental health care service use following 2 major Australian natural disaster events. Utilizing data from a national minimum dataset, descriptive and regression analyses were conducted to identify levels and predictors of the use of the Access to Allied Psychological Services (ATAPS) program over a 2-year period following 2 major Australian bushfire and flood/cyclone disasters. The bushfire disaster resulted in significantly greater and more enduring ATAPS service volume, while service delivery for both disasters peaked in the third quarter. Consumers affected by bushfires (IRR 1.51, 95% CI 1.20-1.89), diagnosed with depression (IRR 2.57, 95% CI 1.60-4.14), anxiety (IRR 2.06, 95% CI 1.21-3.49), or both disorders (IRR 2.15, 95% CI 1.35-3.42) utilized treatment at higher rates. The substantial demand for primary mental health care services following major natural disasters can vary in magnitude and trajectory with disaster type. Disaster-specific ATAPS services provide a promising model to cater for this demand in primary care settings. Disaster type and need-based variables as drivers of ATAPS use intensity indicate an equitable level of service use in line with the program intention. Established service usage patterns can assist with estimating capacity requirements in similar disaster circumstances.

Patterns and predictors of primary mental health service use following bushfire and flood disasters

BackgroundMental health care services play an important role following disasters (Reifels et al., 2013). The aim of this study is to examine patterns and predictors of primary mental health care service use, following two major Australian natural disaster events.MethodUtilizing referral and session data from a national minimum dataset, descriptive and regression analyses were conducted to identify levels and predictors of the use of the Access to Allied Psychological Services (ATAPS) program over a 2-year period following two major Australian bushfire and flood/cyclone disasters. Predictor variables examined in negative binomial regression analysis included consumer (age, gender, household structure, previous mental health care history, and diagnosis) and event characteristics (disaster type).ResultsThe bushfire disaster resulted in significantly greater service volume, with more than twice the number of referrals and nearly three times the number of sessions. Service delivery for both disasters peaked in the third quarter. Consumers affected by bushfires, diagnosed with depression, anxiety, or both of these disorders utilized sessions at significantly higher rates.ConclusionsThe substantial demand for primary mental health services following disaster can vary with disaster type. Disaster type and need-based variables as key drivers of service use intensity indicate an equitable level of service use. Established usage patterns assist with estimating future service capacity requirements. Flexible referral pathways can enhance access to disaster mental health care. Future research should examine the impact of program- and agency-level factors on mental health service use and factors underpinning treatment non-adherence following disaster.

Cost-benefit analysis of a preventive intervention for divorced families: reduction in mental health and justice system service use costs 15 years later.

This cost-benefit analysis compared the costs of implementing the New Beginnings Program (NBP), a preventive intervention for divorced families to monetary benefits saved in mental healthcare service use and criminal justice system costs. NBP was delivered when the offspring were 9-12 years old. Benefits were assessed 15 years later when the offspring were young adults (ages 24-27). This study estimated the costs of delivering two versions of NBP, a single-component parenting-after-divorce program (Mother Program, MP) and a two-component parenting-after-divorce and child-coping program (Mother-Plus-Child Program, MPCP), to costs of a literature control (LC). Long-term monetary benefits were determined from actual expenditures from past-year mental healthcare service use for mothers and their young adult (YA) offspring and criminal justice system involvement for YAs. Data were gathered from 202 YAs and 194 mothers (75.4 % of families randomly assigned to condition). The benefits, as assessed in the 15th year after program completion, were $1630/family (discounted benefits $1077/family). These 1-year benefits, based on conservative assumptions, more than paid for the cost of MP and covered the majority of the cost of MPCP. Because the effects of MP versus MPCP on mental health and substance use problems have not been significantly different at short-term or long-term follow-up assessments, program managers would likely choose the lower-cost option. Given that this evaluation only calculated economic benefit at year 15 and not the previous 14 (nor future years), these findings suggest that, from a societal perspective, NBP more than pays for itself in future benefits.

Young people's expectations, preferences, and experiences of therapy: Effects on clinical outcome, service use, and help‐seeking intentions

BackgroundYoung people represent a vulnerable age group for mental health concerns and tend not to seek help. Exploring factors that influence young people's engagement in therapy and clinical outcomes is crucial. This study examined the relationships between young people's expectations, preferences, and actual experience of therapy on their clinical outcome, mental health care service use, and help‐seeking intentions. Gender and age effects were also explored.MethodsA quantitative prospective research method was utilised. Participants included a total of 228 young people aged 12 to 25 years who completed an initial survey on contact with a youth mental health service and 102 who completed an online follow‐up survey 2 months later.ResultsResults showed that young people's actual experiences of therapy and their preference to be personally committed to therapy were positively associated with the outcome variables. No significant associations were evident for initial expectations. No age or gender effects was found.ConclusionsThese initial findings suggest that initial expectations may not be well formed for youth and appear not to be relevant to young people's engagement or outcomes, and are less important than motivation and actual experiences. Youth‐focused mental health services need to ensure a positive early experience to promote early intervention and relapse prevention.

Fewer re-admissions and bed days following an intensive transitional post-discharge aftercare programme for a mixed diagnostic group of patients

Background: The organization of aftercare is important for a successful outcome; still the optimal organization has not been fully explored. An intensive transitional post-discharge aftercare (TA) programme, for a mixed group of non-psychotic patients, was recently developed. Patients with non-psychotic diagnoses are often discharged with low well-being while still symptomatic, placing high demands on aftercare. Aims: To evaluate retrospectively the short and long-term mental healthcare service use during and after the TA programme compared with the service use of a retrospective comparison group (RC), receiving less intensive outpatient aftercare. Methods: Number of re-admissions, bed days and emergency visits after 10 weeks, 6 months and 1 year was retrospectively collected from electronic patient registers. Descriptive statistics, independent samples T-tests and repeated-measures analysis of variance was used to compare the groups. Results: The majority of patients in both groups suffered from affective disorders, followed by personality disorders and a small number of other psychiatric diagnoses. Service use in the TA group was lower than in the RC group with fewer bed days after 10 weeks (P = 0.01) and after 6 months (P = 0.003), and fewer re-admissions after 6–12 months (P = 0.04). Emergency contacts did not differ significantly between the two groups at any point. Conclusions: The present study indicates beneficial effects of intensive TA, for a mixed group of non-psychotic patients. The lower service use in the TA programme group is in line with day treatment programme research for patients with affective disorders.

Borderline Personality Disorder and Mental Healthcare Service Use Among Adolescents

Borderline personality disorder (BPD) is believed to be frequent among adolescents. While several prospective studies have assessed the use of mental health services among adults who suffer from BPD, few studies have provided adolescent data. This paper presents findings from the first assessment point of the European Research Network on Borderline Personality Disorder (EURNET BPD) study. In this study, we describe lifetime treatment utilization for 85 adolescents with BPD (Mean age: 16.3 years old). In line with adult findings, adolescents with BPD reported greater mental healthcare service use (outpatient: 98%; inpatient: 79%) compared to controls. Phenothiazine, a sedative neuroleptic, was the most frequently prescribed treatment. 47% of patients had received psychotherapy; in one our of three cases this was psychodynamic therapy. Patients who had received psychotherapy did not differ on any psychopathological variables from those who did not receive psychotherapy; however, psychotherapy was more frequent among females.

78. Determinants of Mental Health Care Service Use Among Depressed Adolescents

78. Determinants of Mental Health Care Service Use Among Depressed Adolescents

Implications of the Mental Health Parity and Addiction Equity Act

Implications of the Mental Health Parity and Addiction Equity Act

Direct Health Care Costs of Treating Seasonal Affective Disorder: A Comparison of Light Therapy and Fluoxetine

Objective. To compare the direct mental health care costs between individuals with Seasonal Affective Disorder randomized to either fluoxetine or light therapy. Methods. Data from the CANSAD study was used. CANSAD was an 8-week multicentre double-blind study that randomized participants to receive either light therapy plus placebo capsules or placebo light therapy plus fluoxetine. Participants were aged 18–65 who met criteria for major depressive episodes with a seasonal (winter) pattern. Mental health care service use was collected for each subject for 4 weeks prior to the start of treatment and for 4 weeks prior to the end of treatment. All direct mental health care services costs were analysed, including inpatient and outpatient services, investigations, and medications. Results. The difference in mental health costs was significantly higher after treatment for the light therapy group compared to the medication group—a difference of $111.25 (z = −3.77, P = 0.000). However, when the amortized cost of the light box was taken into the account, the groups were switched with the fluoxetine group incurring greater direct care costs—a difference of $75.41 (z = −2.635, P = 0.008). Conclusion. The results suggest that individuals treated with medication had significantly less mental health care cost after-treatment compared to those treated with light therapy.

Physical, Behavioral, and Mental Health Issues in Asian American Women: Results from the National Latino Asian American Study

Asian American women's health has been understudied while the Asian American population is increasing. The purpose of this study was to examine the physical, behavioral, and mental health of Asian American women. Using a nationally representative sample (n=1097) from the National Latino Asian American Study (NLAAS), the first comprehensive epidemiologic survey in the United States, we examined the annual rates of behavioral, physical, and mental healthcare service use, including general medical, specialty mental health, and any medical services, in three major subgroups of Asian American women. Health problems varied with three major subgroups of Asian American women. In physical health, Chinese American women reported the highest rates of headache, other pain, hypertension, heart diseases, heart attacks, chronic lung diseases, and asthma. Vietnamese American women reported the highest rates of ulcer, stroke, and diabetes. Filipino American women had the highest rates of cancers and epilepsy. In behavioral health, Filipino women ranked highest on all types of drug use and cigarette smoking, compared with their counterparts. In mental health, Filipino American women reported significantly better mental health self-rating compared with their Chinese and Vietnamese American counterparts. Asian American women from each ethnic group sought health services at distinct rates. However, the help-seeking patterns of health services are similar. Asian American women encountered various physical, behavioral, and mental health problems, yet they had low rates of seeking healthcare services. Hence, it is critical to further examine factors associated with the underestimation of physical and mental health problems and underuse of health services by Asian American women.

P02-416 - Borderline personality disorder and mental healthcare service use among adolescents

Borderline personality disorder (BPD) is believed to be frequent among adolescents. While several prospective studies have assessed the use of mental health services among adults who suffer from BPD, few studies have provided adolescent data. This paper presents findings from the first assessment point of the European Research Network on Borderline Personality Disorder (EURNET BPD) study. In this study, we described treatment utilization of 85 adolescents with BPD (M = 16.5 years old). In line with adult findings, patients with BPD reported greater mental healthcare service use (outpatient: 98%; inpatient: 79%) compared to controls. Phenothiazine, a sedative neuroleptic, was the most frequently prescribed treatment. 47% of patients received psychotherapy; one-third of these patients received psychodynamic therapy. For all psychopathological variables, patients who received psychotherapy did not differ from those who did not receive psychotherapy; however, psychotherapy was more frequent among females. These data suggest that psychotherapy may be difficult to access for adolescents suffering from BPD, especially males.