Correlates of mental health service use intensity in the National Comorbidity Survey and National Comorbidity Survey Replication

Jon D Elhai, Julian D Ford
Psychiatric Services: a Journal of the American Psychiatric Association 2007, 58 (8): 1108-15

OBJECTIVE: This study explored sociodemographic and mental health correlates of intensity of mental health care use in two large-scale surveys, aiming to discover the set of correlates with the greatest predictive capacity.

METHODS: Data were examined from persons aged 15 to 54 in two nationally representative U.S. household surveys: the National Comorbidity Survey (NCS) (N=5,877), which gathered information from 1990 to 1992, and the NCS Replication (N=4,320), which gathered information from 2001 to 2003. Outcome variables were the number of mental health care visits in the past year to mental health providers, social service providers, and medical providers. This study implemented state-of-the-art statistical methods designed for modeling such outcomes as treatment intensity-that is, visit counts.

RESULTS: Across provider types, significant univariate associations were found for intensity of mental health care use based on access variables (for example, employment and health insurance) and two need variables-psychiatric diagnoses and psychiatric disability. Demographic variables and treatment need variables were not consistent service use correlates. Multivariate regression accounting for excessive zero values demonstrated that after the analyses controlled for sociodemographic and access variables, mental disorders (mood, anxiety, and substance use disorders) and psychiatric disability added incrementally to variance in visit counts for mental health care. However, when mental health service use was dichotomized (any use versus no use) demographic and access variables, as well as psychiatric disorders, emerged as correlates. In both sets of analyses, different patterns of psychiatric disorder and disability were associated with provider service use.

CONCLUSIONS: These findings extend research on correlates of mental health care use, addressing intensity of use, suggesting that sociodemographic factors and presence of a psychiatric disorder and associated disability drive the initial use of services, whereas presence of a psychiatric disorder and associated disability are associated with continued service use.

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