Measuring use of services for mental health problems in epidemiological surveys

MGEN Foundation for Public Health, Paris, France.
International journal of methods in psychiatric research 08/2011; 20(3):182-91. DOI: 10.1002/mpr.346
Source: PubMed


The use of services for mental problems is generally reported as being relatively low. However, the methods used for data collection in surveys may have influenced the quality of self-reported service use. This study compares the information on recourse to physicians for mental problems reported in different sections of a survey conducted in six European countries. Thus, 5545 respondents were asked questions on contacts with physicians at least twice: (1) after the symptoms checklist in any completed diagnostic section, and (2) in a section devoted to use of care for mental problems. Of these 39.3% reported contacts with physicians about mental problems in the diagnostic sections, whereas 29.5% did so in the use-of-care section. Inconsistencies concerned 20.1% of participants, among whom those reporting consultations in diagnostic sections without reporting them in the use-of-care section represented the majority (74.4%). Multiple logistic regression analysis revealed that age, marital status, educational level and country were associated with under-reporting in the use-of-care section, as well as having mood or sleep problems. In conclusion, services used for mental health reasons when measured through a question referring to use of care due to the presence of a mental problem may underestimate the care people received for their problems.

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    • "Yet, not all depressed individuals receive treatment. Documented rates of mental health service utilization vary from 30% in the European ESEMeD study (Sevilla-Dedieu et al., 2011) to 55% in the US-based NESARC (Hasin et al., 2005). "
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    ABSTRACT: The purpose of the study was to examine the association between family history of major depressive disorder (MDD) and mental health service utilization for MDD. Data come from wave 1 (2001-2002) and wave 2 (2004-2005) of the US National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). The AUDADIS was used to determine the presence of lifetime and incident MDD. Participants with a mother, father, grandparent or sibling with MDD were considered to have a positive family history. Mental health service utilization among participants with lifetime MDD was studied. Data were analyzed using logistic regression models adjusted for socio-demographic characteristics (age, sex, education, marital status, family income) and disease severity. Approximately 7940 NESARC participants had lifetime MDD, 54.7% of them had family history of the disorder. Compared to participants with no family history of MDD, those with such family history were two times more likely to access treatment (OR: 2.37, 95% CI: 2.11-2.68). Parental, and particularly maternal history of MDD, was most strongly associated with MDD treatment. Data were unavailable on the timing of family history of MDD and its possible under-report, and differences between participants with treated vs untreated relatives. Institutionalized individuals were not included. Individuals with parental and maternal history of major depression were two times more likely to receive treatment for MDD than those with no such history. Efforts to increase access to healthcare for those who do not report family history of MDD could prove effective in addressing existing unmet treatment needs.
    Journal of Affective Disorders 07/2013; 151(2). DOI:10.1016/j.jad.2013.06.025 · 3.38 Impact Factor
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    • "However, an important limitation of these databases is that they commonly serve other purposes than economic evaluations and the accessibility of these databases may be limited [6]. Furthermore, data needs to be collected from multiple sources which necessitate the cooperation of different institutions and patients’ informed consent at each of these institutions [7,8]. In addition, registrations may be incomplete. "
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    ABSTRACT: Background: Patient self-report allows collecting comprehensive data for the purpose of performing economic evaluations. The aim of the current study was to assess the feasibility, reliability and a part of the construct validity of a commonly applied questionnaire on healthcare utilization and productivity losses in patients with a psychiatric disorder (TiC-P). Methods: Data were derived alongside two clinical trials performed in the Netherlands in patients with mental health problems. The response rate, average time of filling out the questionnaire and proportions of missing values were used as indicators of feasibility of the questionnaire. Test-retest analyses were performed including Cohen's kappa and intra class correlation coefficients to assess reliability of the data. The construct validity was assessed by comparing patient reported data on contacts with psychotherapists and reported data on long-term absence from work with data derived from registries. Results: The response rate was 72%. The mean time needed for filling out the first TiC-P was 9.4 minutes. The time needed for filling out the questionnaire was 2.3 minutes less for follow up measurements. Proportions of missing values were limited (< 2.4%) except for medication for which in 10% of the cases costs could not be calculated. Cohen's kappa was satisfactory to almost perfect for most items related to healthcare consumption and satisfactory for items on absence from work and presenteeism. Comparable results were shown by the ICCs on variables measuring volumes of medical consumption and productivity losses indicating good reliability of the questionnaire.Absolute agreement between patient-reported data and data derived from medical registrations of the psychotherapists was satisfactory. Accepting a margin of +/- seven days, the agreement on reported and registered data on long-term absence from work was satisfactory. The validity of self-reported data using the TiC-P is promising. Conclusions: The results indicate that the TiC-P is a feasible and reliable instrument for collecting data on medical consumption and productivity losses in patients with mild to moderate mental health problems. Additionally, the construct validity of questions related to contacts with psychotherapist and long-term absence from work was satisfactory.
    BMC Health Services Research 06/2013; 13(1):217. DOI:10.1186/1472-6963-13-217 · 1.71 Impact Factor
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    • "But, if those populations had been included, the results probably would have been in the same direction as we have presented. Underreporting of visits to mental health services due to social desirability or recall bias is another potential source of bias (Drapeau et al. 2011; Sevilla-Dedieu et al. 2011 "
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    ABSTRACT: The aim of this study was to analyze individual and contextual inequalities in psychiatrist and psychologist visits in Catalonia. This is a multilevel cross-sectional study using data from the 2006 Catalan Health Interview Survey (n = 15,554). 5.3 % of men and 9.0 % of women visited a psychologist and/or psychiatrist in the last 12 months. People aged 65 years or over were less likely to have visited these professionals and those with a supplemental private health insurance had a higher proportion of having visited. Moreover, people living in lower density regions were less likely to have visited, independently of their level of need. There is a need to develop policies for reducing inequalities in access by people with public health insurance and living in lower density areas.
    Administration and Policy in Mental Health and Mental Health Services Research 06/2012; 40(5). DOI:10.1007/s10488-012-0426-8 · 3.44 Impact Factor
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