The Relationship between Insurance Coverage and Psychiatric Disorder in Predicting Use of Mental Health Services

ArticleinAmerican Journal of Psychiatry 151(12):1785-90 · January 1995with1 Reads
DOI: 10.1176/ajp.151.12.1785 · Source: PubMed
This study investigated how insurance coverage for mental health services affects outpatient mental health service utilization among those with and among those without a DSM-III psychiatric diagnosis. The authors used a representative community sample to compare the regression effects of insurance coverage on utilization of mental health services among these subjects. Data are from the second wave of the Piedmont, North Carolina, site of the Epidemiologic Catchment Area project. These data contain DSM-III diagnostic measures derived from the National Institute of Mental Health Diagnostic Interview Schedule as well as measures of insurance coverage and utilization. Responses from 2,889 community residents were analyzed using both ordinary least squares and logistic regression. In both models, insurance coverage was strongly associated with care among those with as well as among those without a psychiatric disorder. The association between coverage and the probability of care was strongest among those with a disorder. The findings are not consistent with the claim that failing to provide insurance coverage will reduce discretionary but not necessary mental health care utilization. They provide evidence that failing to provide insurance coverage will reduce utilization as much or more among those with a psychiatric disorder as among those without. This result has important implications for health care reform.
    • "Secondly, enabling factors either facilitate or impede access to MHS (Andersen 1995), which includes both resources available to the individual and its sociocultural characteristics. Health insurance and financial status are good examples of the resources influencing financial decision to access the MHS (Alegria et al. 2012; Landerman et al. 1994) and have been examined by a few studies (Jang et al. 2009; Kim et al. 2010). Sociocultural characteristics can be particularly relevant for immigrant populations. "
    [Show abstract] [Hide abstract] ABSTRACT: Literature concur that there is a disparity between epidemiological prevalence and mental health services (MHS) utilization rates for Latino and Asian Americans. This study adapted the behavioral model of health service use to examine factors associated with MHS use among Latino and Asian Americans. The model consists of predisposing, enabling, and need factors. This study used the National Latino and Asian American Study data, including six ethnic groups. The outcome measure for this study was the use of MHS in the past 12 months. Age, sex, and education predicted higher odds of MHS use among Latinos, none of which were significant among Asians. Needs factors were strongly associated with higher odds of MHS use among Latinos and Asians.
    Full-text · Article · Mar 2014
    • "This may adversely impact the financial wellbeing and access to health care of these depressed workers, given that most would not qualify for Social Security benefits until 62 and Medicare until the age of 65. In particular, health insurance would be critical to most people's ability to afford medical services, including mental health services related to depression (Landerman et al. 1994 ; McAlpine and Mechanic 2000). Otherwise , given that catastrophic medical events are quite common at this older age (French and Jones 2004 ), a substantial amount of the individual's retirement savings may be required to pay for the health care expenditures incurred while uninsured. "
    [Show abstract] [Hide abstract] ABSTRACT: To determine whether late middle-aged U.S. workers with depression are at an increased risk for retirement. Six biennial waves (1992-2002) of the Health and Retirement Study, a nationally representative panel survey of noninstitutionalized 51-61-year-olds and their spouses started in 1992. Workers aged 53-58 years in 1994 were followed every 2 years thereafter, through 2002. Depression was coded as lagged time-dependent variables measuring active depression and severity of depression. The main outcome variable was a transition to retirement which was measured using two distinct definitions to capture different stages in the retirement process: (1) Retirement was defined as a transition out of the labor force in the sample of all labor force participants (N=2,853); (2) In addition a transition out of full time work was used as the retirement definition in the subset of labor force participants who were full time workers (N=2,288). In the sample of all labor force participants, the presence of active depression significantly increased the hazard of retirement in both late middle-aged men (adjusted OR: 1.37 [95 percent CI 1.05, 1.80]) and women (adjusted OR: 1.40 [95 percent CI 1.10, 1.78]). For women, subthreshold depression was also a significant predictor of retirement. In the sample of full time workers, the relationship between depression and retirement was considerably weaker for women yet remained strong for men. Depression and depressive symptoms were significantly associated with retirement in late middle-aged U.S. workers. Policymakers must consider the potentially adverse impact of these labor market outcomes when estimating the cost of untreated depression and evaluating the value of interventions to improve the diagnosis and treatment of depression.
    Article · May 2008
    • "Previous studies examining health and mental health services utilization in the general population have identified a set of factors with demonstrated effects on services access, barriers, and utilization. Among these, demographic features such as gender, race/ethnicity , socioeconomic status, education, and insurance coverage have been identified as significant predictors of services use (Blanch & Levin, 1998; Case et al., 2004; Howard et al., 1996; Landerman, Burns, Schwartz, Wagner, & George, 1994). With regard to mental health services specifically, although the Epidemiological Catchment Area (ECA) (Robins & Reiger, 1991) study and the subsequent National Co-morbidity Survey (NCS) (Kessler et al., 1994 ) addressed an array of diverse issues in mental health including the occurrence of same-sex sexual behavior among respondents , none of these national surveys examined the effects of self-reported sexual identity on mental health services utilization (Dean et al., 2000). "
    [Show abstract] [Hide abstract] ABSTRACT: Studies examining mental health services have identified a series of indicators with demonstrated effects on services access, barriers, and utilization, including gender, race/ethnicity, and socioeconomic status, as well as indicators such as type of insurance, client attitudes toward mental health, and diagnosis. This study identifies predictors of mental health services utilization in a diverse community sample of lesbians and heterosexual women (N=120). Outcomes for study participants are compared to those found in the services utilization literature, and similarities and differences among lesbians and heterosexual women are examined. Suggestions are offered for identifying new factors in mental health service utilization among groups with diverse sexual orientations.
    Full-text · Article · Feb 2006
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