Patterns of use of ambulatory mental health services in a universal care setting.

OBJECTIVE: As health care expenditures grow, it is important to understand whether mental health services are being used appropriately. This study examined participants' reasons for seeking the services of a psychiatrist or psychologist to determine the extent to which factors other than an existing clinical disorder, such as culture, stress, or lack of social support, played a role. METHODS: A total of 1,257 randomly selected students who were enrolled at the University of Geneva in 1997 and who had unrestricted access to psychiatric services were asked how many times in the past 12 months they had consulted a psychiatrist or a psychologist. The respondents' mental health, perceived stress, self-esteem, sense of mastery, and social support were measured with validated instruments. RESULTS: A total of 131 respondents (10 percent) reported an encounter with a mental health provider in the past year. In adjusted analyses, female sex, Swiss citizenship, a higher level of stress, and a lower level of mental health were significantly associated with a greater number of visits to a mental health specialist, and self-esteem, sense of mastery, and social support were not. CONCLUSIONS: The respondents' use of mental health services was determined by a lower level of mental health, indicating appropriate use of services based on clinical need. However, service use was also determined by consumer-related variables such as perceived stress and sociocultural characteristics.