Repeated use of psychiatric emergency out-patient services among new patients: a 3-year follow-up study

The aim of this study was to examine repeated use of psychiatric emergency out-patient services during the second and third years after the first contact. A 1-year treated incidence cohort of 537 new patients was studied in the Department of Psychiatry in Oulu, Finland. Repeat users were defined as patients belonging to the upper 10th percentile of the emergency out-patient contacts. The median of emergency out-patient contacts among repeaters was 4. The repeaters constituted 8% of the cohort and they used 65% of the cohort's emergency contacts. They were more likely to be male and living alone, and they tended to have more serious diagnoses than non-repeaters. Having hospital admissions, planned out-patient contacts and repeated emergency out-patient contacts also during the first year of follow-up was associated with an increased probability of repeatedly using emergency services during the second and third years. Living alone and having hospital admissions during the follow-up period were associated with being a continuous repeat visitor during the whole follow-up period. It is concluded that the extended repeated use of emergency services is associated with inadequate social support and serious psychiatric problems.     

Life circumstances and the use of mental health services

Summary The study is concerned with the connection between life circumstances, as examined from the viewpoint of the social support theory, and the use of mental health services. The material comprises 200 successive psychiatric patients from a mental health centre and a central mental hospital in Finland. The follow-up period was five years. — The results of the analysis of the use of mental health services according to marital status, employment status and changes in social relationships were in keeping with social support theory. In the out-patient material economic security and employment at the out-set of the study were the most important variables in predicting whether or not the patient used mental health services for more than one year. The strongest correlation in the in-patient material was between age and rehospitalization.     

Predictors of subjective age in people aged 40–79 years: a five-year follow-up study. The impact of mastery,mental and physical health

Objectives: Assessing subjective age perception (SAP) and changes in SAP as well as exploring which variables of socio-demographic, health and personal mastery independently predicted SAP.Methods: The panel data are from two waves of the Norwegian Study on the Life Course, Ageing and Generations (NorLAG). Our sample consists of 2471 people aged 40–79 years at baseline who were surveyed in 2002/2003 (T1) and 2007/2008 (T2). Univariate and multiple regressions were performed; multivariate analyses assessing the relative importance of the independent variables (at T1) for the SAP at T2.Results: Older chronological age, good physical health, good mental health, a high level of personal mastery and having lower education significantly predicted a youthful SAP. For the whole sample, older age and a high level of personal mastery were the most important predictors. For those aged 40–49 being a man, having lower education, good physical health and high personal mastery predicted a younger SAP, whereas in the group aged 50–59 years being married/cohabiting and having a high level of education were predictors of an older SAP. For those aged 60–69, high personal mastery was the only independent predictor of a younger SAP. For those aged 70–79 years, only health – good mental and physical health – independently predicted a younger SAP.Conclusions: Most respondents feel younger than their chronological age, the more the older they are. Self-rated physical and mental health and personal mastery are associated with SAP and vary in different age groups.     

Mental health problems among single and partnered mothers

Background Research has shown elevated levels of common mental disorders among single mothers compared with partnered mothers. The objectives of this analysis were to examine the prevalence of mental health problems among single and partnered mothers and the extent to which this relationship is mediated by socio-demographic, financial and social support variables. Methods Using cross-sectional data from a large, nationally representative longitudinal Australian household survey—the Household Income and Labour Dynamics in Australia (HILDA) Survey—the prevalence of moderate to severe mental disability (as measured by the SF-36) was assessed among 354 single mothers and 1,689 partnered mothers. A series of univariate and simultaneous logistic regression analyses assessed the association between parenting status, the other explanatory variables and mental disability. Mediational analyses were conducted using the ‘explained fraction’ approach. Results The prevalence of moderate to severe mental disability was significantly more pronounced among single mothers (28.7%) compared with partnered mothers (15.7%). Including all explanatory factors—socio-demographic, household income, financial hardship and social support—accounted for 94% of the association between single mother status and poor mental health. Financial hardship and social support were the strongest predictors, accounting for most of the predictive power of the other variables. Conclusions Single mothers are more likely to experience poor mental health than partnered mothers, and the primary factors associated with this are the presence of financial hardship in particular, as well as perceived lack of social support. Future research should examine the extent to which changes in financial hardship among different family types relate to changes in mental health over time, as well as continue to examine variables that may moderate the relationship between social disadvantage and poor mental health.     

Use of medical services after participation in a community-based epidemiological health survey

Abstract.Background: Personally relevant health information is an important factor that can change individuals perceptions of their health needs. Health information can be delivered through various mechanisms, including health promotion campaigns and the general media. Another means by which individuals may receive personal health information is by participating in an epidemiological health survey. This study investigated effects of such participation on numbers of health services used by a representative sample of 7485 Australians.Methods: Participants in the PATH Through Life Project lived in Canberra and environs, Australia, and were drawn from three age groups: 20–24 years, 40–44 years and 60–64 years. Information obtained included socio-demographic variables, mental and physical health as measured by the 12-item Short Form Health Survey Questionnaire, and national insurance data on numbers of general practitioner (GP) services used before and after survey participation.Results: Both men and women in the youngest age group, men aged 40–44 years and women aged 60–64 years obtained more GP services for 3 months after interview. After this 3-month period, levels of service use by these participants returned to pre-interview levels. Increased service use related primarily to participants reporting poorer mental or physical health and to their being given information on potential health risks as part of the survey process.Conclusions: These findings suggest that participating in such surveys may increase self-awareness of current physical and mental health status, potential health risks and health care needs.     

Factors associated with use of psychotherapy

CONTEXT: Psychotherapies are recommended in manuals of good practice. There is however little epidemiological data assessing access to this type of treatment, and in particular the combined role of the offer and socio-demographic characteristics. The present research aims to contribute data on the profiles of a sample of individuals who underwent psychotherapy in France, and on the respective impact of various factors such as mental health status, socio-demographic characteristics, life events and the care offer, focusing on a specific population for whom the mode of financial cover for this type of care is governed by a complementary health insurance (MGEN). METHODS: Between June 1999 and March 2000 a survey using a self-administered questionnaire was conducted on a sample of MGEN-insured individuals. Ten thousand individuals aged between 20 and 60 were selected randomly, received a questionnaire, and up to three recalls in case of non-response. The overall response rate was 66.5%. The questionnaire comprised 261 questions enabling data collection concerning the main socio-demographic, professional and mental health variables. RESULTS: In this population aged from 20 to 60, lifetime prevalence of recourse to psychotherapy was 11.8%. The main factor associated with use of psychotherapy is the severity of the clinical condition (assessed in terms of comorbidity). Certain traumatic events experienced in childhood are also related. The effect of socio-demographic variables varies according to severity, although it was noted that being female, having high educational status, and being single were consistently related to wider use of psychotherapy. The analysis also evidenced the importance of the density of the care offer. CONCLUSION: Our results suggest that the use of psychotherapy, within a well-informed population with high quality insurance cover, is related primarily to clinical condition rather than to socio-demographic status, especially in people with high levels of comorbidity, although the effect of educational status remains. However, this study only looked at mere use of psychotherapy, without determining the suitability of the treatment provided. It is indeed possible, and even probable, that variables such as educational status, income, or care offer may have a link with resorting to the right type of care, in terms of both relevance and adequate duration.     

The influence of internal migration on mental health status in South Africa

Mental health status is fundamental to overall health and well-being but most studies on the relationship between migration and mental health status deal with international migration and neglects internal migration. Therefore, this study compares the mental health status of internal migrants with that of non-migrants; and also appraises the socio-demographic factors associated with mental health status in South Africa. Data were from the National Income Dynamics Study (NIDS), waves 3 (2012), and 4 (2014) of South Africa. Univariate analysis was used to describe the study population, bivariate analysis was use to explain the mental health status of the population, and binary logistic regression was used analyze the socio-demographic factors associated with mental health status. The study found significant differences in the mental health status of migrants and non-migrants across the waves of NIDS used for this study. While, the migrants had better mental health status in 2012, the non-migrants had better mental health status in 2014. In addition, factors significantly associated with mental health status in 2012, were marital status, income, and province of residence. On the other hand, only race, and province of residence were significantly associated with mental health status in 2014.     

Correlates of Adolescents' Satisfaction with Mental Health Services

While there has been increased attention to consumers' satisfaction with mental health services as an indicator of quality of care, little is known about the construct of consumer satisfaction, especially for youth. The goal of this study was to examine potential correlates of adolescents' satisfaction with mental health services. One hundred eighty adolescents who had received out-patient mental health services completed a multidimensional satisfaction scale and measures of behavior problems, attitudes and expectations about treatment, perceived choice/motivation in seeking treatment, and service use history. Results indicate that the strongest unique correlates of satisfaction are severity of behavior problems, positive expectations about services, and perceived choice in seeking services. Satisfaction with services was also associated with service site, length of time in treatment, and reason for entering treatment. Demographic variables were not related to satisfaction. A discussion of the appropriateness of using satisfaction as an indicator of quality of care is included.     

The use of mental health services among young adults with emotional and behavioural problems: equal use for equal needs?

Objective  Mental health problems are highly prevalent in young adults. Despite possibilities for effective treatment, only about one-third of young adults with mental health problems seek professional help. Little knowledge exists of which groups of young adults are underusing mental health services and for what reasons. The present study examined socio-demographic inequalities in the use of mental health services by young adults, and examined whether such inequalities were attributable to differences in objective need, subjective need, predisposing or enabling factors. Design  Cross-sectional study among the general population aged 19–32 years (2,258 respondents). A postal survey was administered including questions on socio-demographic factors and mental health service use. Data were analyzed with logistic regression analysis. Setting  South–West Netherlands. Participants  All respondents with serious internalizing and externalizing problems (n = 367). Main outcome measure  Twelve-month primary and specialty mental health services use. Results  Only 34.6% of young adults with psychopathology had used any mental health services: 16.2% had used only primary mental health services and 18.4% had used specialty mental health services. No socio-demographic differences were found in the use of only primary mental health services. However, recipients of specialty mental health services were more often female (OR = 2.12, 95% CI = 1.14–3.96), economically inactive (OR = 3.12, 95% CI = 1.59–6.09) or students (OR = 2.38, 95% CI = 1.05–5.42) and they were less often higher educated (OR = 0.49, 95% CI = 0.25–0.97). The higher odds ratio for specialty service use among young adults who were female or economically inactive attenuated when adjusting for need for care. The other socio-demographic disparities in specialty service use did not attenuate when adjusting for need, enabling or predisposing factors. Conclusion  Among young adults, equal use of specialty mental health services for equal needs has not been achieved. The underserved groups of young adults oppose the traditionally underserved groups in the general population, and may inform interventions aimed at improving young people’s help-seeking behaviours.     

Children of Mothers Diagnosed with Serious Mental Illness: Patterns and Predictors of Service Use

Children who have a parent diagnosed with a mental illness are at risk of psychiatric and behavioral problems; yet, these children do not necessarily receive needed services. Research has investigated correlates of child mental health service use, but not for these high-risk children. This study is part of an NIMH-funded, longitudinal investigation and describes child problems, service use, and predictors of service use for 506 children of 252 mothers diagnosed with serious mental illness. Mothers are primarily poor, minority women from urban areas. A multilevel-model approach is used to examine service use for multiple siblings in a family. More than one third of children had received services (from school or mental health agencies) in their lifetimes. Service use was predicted by child demographic characteristics (being male, non–African American, and older), social context variables (more negative life events, less financial satisfaction, and more parenting dissatisfaction), and maternal psychiatric variables (positively by high levels of case management receipt and affective diagnoses, negatively by maternal substance abuse history). In a subsample of target children, mothers' rating of child behavior problems additionally predicted service use. Implications of results for research and intervention are discussed.