Discrepancies between survey and administrative data on the use of mental health services in the general population: Findings from a study conducted in Québec

Département de psychiatrie de l'université de Montréal, C,P, 6138 Succ, Centre-Ville, Montréal, H3C 3J7, Canada.
BMC Public Health (Impact Factor: 2.26). 10/2011; 11(1):837. DOI: 10.1186/1471-2458-11-837
Source: PubMed


Population surveys and health services registers are the main source of data for the management of public health. Yet, the validity of survey data on the use of mental health services has been questioned repeatedly due to the sensitive nature of mental illness and to the risk of recall bias. The main objectives of this study were to compare data on the use of mental health services from a large scale population survey and a national health services register and to identify the factors associated with the discrepancies observed between these two sources of data.
This study was based on the individual linkage of data from the cycle 1.2 of the Canadian Community Health Survey (CCHS-1.2) and from the health services register of the Régie de l'assurance maladie du Québec (RAMQ). The RAMQ is the governmental agency managing the Quebec national health insurance program. The analyses mostly focused on the 637 Quebecer respondents who were recorded as users of mental health services in the RAMQ and who were self-reported users or non users of these services in the CCHS-1.2.
Roughly 75%, of those recorded as users of mental health services users in the RAMQ's register did not report using mental health services in the CCHS-1.2. The odds of disagreement between survey and administrative data were higher in seniors, individuals with a lower level of education, legal or de facto spouses and mothers of young children. They were lower in individuals with a psychiatric disorder and in frequent and more recent users of mental health services according to the RAMQ's register.
These findings support the hypotheses that social desirability and recall bias are likely to affect the self-reported use of mental health services in a population survey. They stress the need to refine the investigation of mental health services in population surveys and to combine survey and administrative data, whenever possible, to obtain an optimal estimation of the population need for mental health care.

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Available from: Richard Boyer, Jul 01, 2014
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    • "In terms of outpatient care visits, underestimations were the greatest when reporting on the number of visits; the degree of this underestimation was correlated with age and the frequency of outpatient visits. Another study found the degree of underestimation to be significantly higher for self-reports of medical services utilization by people with mental illnesses [7] and suggests that this underestimation is primarily due to recall bias and social desirability bias. "
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    ABSTRACT: Background: The large-scale representative population surveys conducted by Germany’s Robert Koch Institute (RKI) contain questions pertaining to health and its determinants as well as the prevalence and frequency of outpatient services utilization. The same holds for the Socioeconomic Panel (SOEP, Sozio-ökonomisches Panel) and the Bertelsmann Healthcare Monitor (Gesundheitsmonitor) surveys. The purpose of this study is to examine the comparability of the instruments used in these surveys and their results. Methods: The questions on outpatient care utilization examined in this study were taken from the public use files of the East-West Health Survey (Ost-West Survey; OW1991), the 1998 Federal National Health Survey (Bundesgesundheitssurvey; BGS1998), the 2003 Telephone Health Survey (TEL2003), and the 2009 German Health Update (Gesundheit in Deutschland aktuell GEDA2009). The study also used data from the 26 waves of the SOEP (1984–2009) and the 16 waves of the Bertelsmann Healthcare Monitor (2001–2009) studies. Results: In the OW1991 and the BGS1998, questions on outpatient services utilization differ by the types of physicians inquired about. The four-week prevalence of contact with general practitioneers (GP) was 29% in the OW1991; the twelve-month prevalence in the BGS1998 was 69%. The OW1991 and the BGS1998 also surveyed participants on the number of physician contacts made during those reference periods (average number of contacts: 1.8 over the previous four weeks (OW1991) and 4.9 over the previous 12 months (BGS1998)). The TEL2003 inquires into the three-month prevalence of contact with private practice physicians in general (63%) as well as the number of contacts with primary care physicians over the previous twelve months (88% with at least one contact, average number of contacts: 4.6, range: 1–92). In the GEDA2009 survey, 88% of participants reported having contacted a physician at least once over the previous twelve months and an average of 6.1 contacts with all physicians working under contract with the German statutory health insurance (SHI) funds. The 2009 SOEP survey revealed a 28% three-month prevalence of contact with all types of physicians and an average of 3.6 contacts (among participants who had made at least one contact during this period). According to the Bertelsmann Health Monitor, the twelve-month prevalence of contact with GPs was 82%, with the average number of contacts being 5.0. The Bertelsmann Health Monitor also surveys participants on contacts made with four other types of physicians; the OW1991 and the BGS1998 ask about contacts made with over ten different types of physicians when examining the frequency of services use. Conclusions: Not only do the target groups of the RKI surveys, the SOEP and the Bertelsmann Health Monitor differ; their questions on outpatient care utilization also differ in terms of examined reference period and types of physicians contacted by survey participants, question wording including clarifications (e.g., asking the participant to also consider contacts not made “in person” with physicians when answering a question), and response categories. Therefore, unlike the results of the surveys’ questions on inpatient care, the results of questions on the use of outpatient care services are not easily comparable, even those regarding contact with primary care physicians and GPs. The results of secondary analyses of German SHI claims data could be used to confirm the external validity of the surveys’ results.
    GMS Psycho-Social-Medicine 10/2012; 9:Doc10. DOI:10.3205/psm000088
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    • "Self-report data on the utilization of mental health services are subject to social desirability and recall bias [75] even though investigators reported acceptable concordance between self-report and administrative data [76,77]. In this study, we were unable to assess the reliability of the self-reported data, by a comparison with case notes for example. "
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    ABSTRACT: Background Numerous studies highlight an important gap in the quality of care for depression in primary care. However, basic indicators were often used. Few of these studies examined factors associated with receiving adequate treatment, particularly with a simultaneous consideration of individual and organizational characteristics. The purpose of this study was to estimate the proportion of primary care patients with a major depressive episode (MDE) who receive adequate treatment and to examine the individual and organizational (i.e., clinic-level) characteristics associated with the receipt of at least one minimally adequate treatment for depression. Methods The sample used for this study included 915 adults consulting a general practitioner (GP), regardless of the motive of consultation, meeting DSM-IV criteria for MDE during the 12 months preceding the survey (T1), and nested within 65 primary care clinics. Data reported in this study were obtained from the “Dialogue” project. Adherence rates for 27 quality indicators selected to cover the most important components of depression treatment were estimated. Multilevel analyses were conducted. Results Adherence to guidelines was high (>75%) for one third of the quality indicators that were measured but was low (<60%) for nearly half of the measures. Just over half of the sample (52.2%) received at least one minimally adequate treatment for depression. At the individual level, determinants of receipt of minimally adequate care included age, having a family physician, a supplementary insurance coverage, a comorbid anxiety disorder and the severity of depression. At the clinic level, determinants included the availability of psychotherapy on-site, the use of treatment algorithms, and the mode of remuneration. Conclusions Our findings suggest that interventions are needed to increase the extent to which primary mental health care conforms to evidence-based recommendations. These interventions should target specific populations (i.e. the younger adults and the elderly), enhance accessibility to psychotherapy and to a regular family physician, and support primary care physicians in their clinical practice with patients suffering from depression in different ways such as developing knowledge to treat depression and adapting mode of remuneration.
    BMC Psychiatry 09/2012; 12(1):142. DOI:10.1186/1471-244X-12-142 · 2.21 Impact Factor
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    • "There are many different barriers that hinder the access to mental health services, and even prevent the reporting of the need for access to services [8]. For example, cultural prejudices may promote stigma and shame [9,10]. "
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    ABSTRACT: The prevalence of mental illness and psychological suffering is greater than the availability of primary care services in Europe and, in particular, in Italy. The main barriers that hinder the access to these services are economic, the lack of proximity of services and some prejudices that may promote stigma and shame.A new mental health service, named "Psychologist in the Neighbourhood" was created to intercept unexpressed needs for psychological assistance. The service allows everyone to ask for free psychological consultation, consisting of no more than four meetings with a psychologist, in certain chemists' shops around the city of Milan. This article aims to present the service specific features of this initiative and the results of a pilot study. Information gathered on all users included socio-demographic data, the reasons why they approached this specific service, how they learnt about it, the main presented problem and, for a random sub-group, the level of psychological well-being (as measured by the PGWBI). Socio-demographic data were compared with previously collected information about general users of psychological services. The outcome of the intervention was assessed by the clinicians. During the two-year project a total of 1,775 people accessed the service. Compared to traditional users of psychological services, the participants in this service were characterized by a higher presence of females, unemployed and retired people. The main factors encouraging access were proximity and the fact that the service was free of charge. Many of the users were redirected to more specific services, while for about a third of the sample the consultation cycle was sufficient to resolve the presented problem. The interest and participation of the population was high and this initiative intercepted an unexpressed requirement for psychological support. Free access and home proximity, were the main reasons for accessing this specific service. Subjects were mostly re-directed to appropriate services, while about a third of the sample addressed and resolved their problem with the psychologist in the chemist's shop.These encouraging results suggest the benefits of bringing psychological consultations closer to citizens, particularly to those who cannot afford it, reducing socio-economic inequalities.
    BMC Public Health 07/2012; 12(1):501. DOI:10.1186/1471-2458-12-501 · 2.26 Impact Factor
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