Service utilisation by rural residents with mental health problems.
ABSTRACT To examine the level and type of service utilisation by rural residents for mental health problems, and to explore the influence of level of need, sociodemographic factors and town size on such service use.
This was a cross-sectional, community-based study. Subjects were recruited from three locales in rural north-west Victoria: a large regional centre, towns of 5,000-20,000 population and towns of <5,000 population. Three hundred and ninety-one individuals (54% females) participated. A logistic regression analysis was used to investigate which factors (i.e. need, sociodemographic and town size) predicted lifetime help-seeking for emotional or mental problems from formal health providers in the study sample.
Factors that predicted having ever sought help from a formal health provider for emotional or mental health problems were: a lifetime and/or current psychiatric disorder, being female, being separated, divorced or widowed, and living in medium sized towns (population 5,000-20,000).
While traditionally known predictors of help-seeking, i.e need and gender, were associated with help seeking in this study, help seeking for mental health problems was also more common amongst individuals living in medium sized rural towns than those living in a large regional city. Possible explanations include availability, accessibility and organisation of services, and individual and/or community attitudes towards help seeking.
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ABSTRACT: The authors compared the effects of age, sex, socioeconomic status, and mental and physical health status on the use of outpatient mental health services in one well-established health maintenance organization (HMO) and in fee-for-service plans. In the Seattle site of the Rand Health Insurance Study (HIS), families were randomly assigned to HMO or fee-for-service coverage. Adults incur much greater expense for outpatient mental health services than children in both an HMO and a fee-for-service plan with identical coverage (i.e., free care). However, the difference in use between adults and children is significantly greater for the fee-for-service plan than the HMO (P less than 0.01). Similarly, education has significantly greater effects on use for the fee-for-service than the HMO plan. Increased income has a significant negative effect on use in both the HMO and fee-for-service plans. Mental and physical health status have similar large effects on use in both fee-for-service and HMO plans.Medical Care 11/1986; 24(10):949-60. · 3.23 Impact Factor
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ABSTRACT: This study sought to identify sociodemographic and psychological measures associated with utilisation of mental health services in Australia, using information collected through the 1997 National Survey of Mental Health and Wellbeing. Twenty-one potential predictor variables were selected from the National Survey. Predisposing and enabling factors included age, sex, marital status, labour force status, geographical location and level of education. Predictor variables measuring need for services included the General Health Questionnaire score, a neuroticism scale, diagnoses of affective, anxiety and substance-abuse disorders from the Composite International Diagnostic Interview, and self-identified depression, anxiety and substance abuse. Simple and multiple logistic regressions were undertaken to identify predictor variables associated with use of mental health services from general practitioners, psychiatrists, psychologists and other health professionals. General practitioners were the most commonly reported providers of mental health services with 76% of those receiving any mental health care reporting using this type of service. Using multiple logistic regression, the predictor variables most associated with use of mental health services were measures of the need for such services, such as psychological distress and mental disorder. After controlling for need variables, the sociodemographic variables associated with using services provided by any health professional were being female, level of education and being separated. Living in a remote area was associated with lower use of specialist services, but not with general practitioner services. Older age was associated with less use of psychologists and other health professionals. Income and having a usual language other than English did not affect service use. The factors most strongly related to Australians' use of mental health services are their having a diagnosed affective, anxiety or substance-abuse disorder and their self-identifying as having depression or anxiety. Although there are regional inequalities in levels of utilisation of mental health services, these are seen more with specialist services than with those provided by general practitioners.Australian and New Zealand Journal of Psychiatry 01/2001; 34(6):997-1008. · 3.29 Impact Factor
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ABSTRACT: The absence of an agreed definition of "rural" limits the utility of existing research into a possible relationship between rurality of residence and mental health. The present study investigates the bipolar dimension accessibility/remoteness as a possible correlate of mental health. A continuous area of non-metropolitan Australia was selected to provide a range of scores on the Accessibility/Remoteness Index of Australia (ARIA). A questionnaire measuring demographics, the five-factor model of personality and three aspects of mental health (distress, disability and wellbeing) was mailed to 20 000 adults selected randomly from electoral rolls. Responses were received from 7615 individuals (response rate = 40.5%; 57.1% female). ARIA was not associated with either distress or disability measures, but a small negative association was found between accessibility and two measures of wellbeing. Individuals residing in locales with better access to services and opportunities for interaction reported higher levels of satisfaction with life (SWL) and positive affect (PA). Adjusting statistically for a range of demographic and personality correlates did not alter the effect of ARIA on SWL. The effect on PA remained significant after adjusting for demographics, but not once personality correlates entered the model. By sampling across a single proposed parameter of rurality, a novel profile of correlations was identified. In accord with existing data, accessibility was not associated with distress or disability. In contrast, accessibility was positively associated with the wellbeing aspect of mental health. Further attention to the measurement of rural place and the exploration of accessibility as a parameter with mental health relevance, is warranted.Australian and New Zealand Journal of Psychiatry 09/2004; 38(8):629-34. · 3.29 Impact Factor