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: Aline Drapeau, Jan 11, 2016
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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.
    Full-text · Article · Oct 2012 · GMS Psycho-Social-Medicine
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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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    Full-text · Article · Sep 2012 · BMC Psychiatry
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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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