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Explaining service use for mental health problems in the Dutch general population: the role of resources, emotional disorder and functional impairment

Abstract

Objective

To analyse explanations of service use in terms of resources, emotional (mood or anxiety) disorder and functional impairment.

Method

Data was derived from a prospective cohort study in a sample representative (n = 4848) of the Dutch adult general population.

Results

The occurrence of an emotional (mood or anxiety) disorder led to a greater use of services as a partial consequence of the functional impairments that accompanied the disorder, but this applied only to primary care services and not to specialised mental health services. After adjustment for the influence of all other determinants in the model, people with more education and those with higher neuroticism scores were more likely to use specialised services in particular.

Conclusions

Future research could benefit from applying the models derived here to further clarify the use of the two service modalities, as well as to assess additional psychological resources.

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Author information

Correspondence to Margreet ten Have.

Appendix 1

Appendix 1

Results of structural equation modelling analyses on the conceptual explanatory model of service use for mental health problems. Model fit at each step

  Step Chi-Square df p RMSEA NNFI
Primary care only
Conceptual model 1 43.18 10 0.000 0.027 1.00
Paths deleted
    All paths associated with service use, except emotional disorder 2 130.73 16 0.000 0.039 1.00
Paths added
    Education → service use 3 92.19 15 0.000 0.033 1.00
    Neuroticism → service use 4 75.24 14 0.000 0.031 1.00
    Social role impairment → service use 5 58.97 13 0.000 0.028 1.00
    Emotional role impairment → service use 6 43.31 12 0.000 0.024 1.00
    Error variance between perceived social support and living alone (=basic model) 7 17.58 11 0.092 0.011 1.00
Specialised mental health care
Conceptual model 1 38.23 10 0.000 0.025 1.00
Paths deleted
    All paths associated with service use, except emotional disorder 2 356.06 16 0.000 0.070 1.00
Paths added
    Education → service use 3 69.76 15 0.000 0.029 1.00
    Neuroticism → service use 4 57.52 14 0.000 0.027 1.00
    Social role impairment → service use 5 45.78 13 0.000 0.024 1.00
    Error variance between perceived social support and living alone 6 31.27 12 0.002 0.019 1.00
    Neuroticism → social role impairment 7 23.16 11 0.017 0.016 1.00
    Neuroticism → emotional role impairment 8 10.49 10 0.398 0.003 1.00
Paths deleted
    Living alone → emotional disorder 9 11.65 11 0.390 0.004 1.00
    Social role impairment → service use (=basic model) 10 14.36 12 0.278 0.007 1.00

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Have, M.t., Iedema, J., Ormel, J. et al. Explaining service use for mental health problems in the Dutch general population: the role of resources, emotional disorder and functional impairment. Soc Psychiat Epidemiol 41, 285–293 (2006). https://doi.org/10.1007/s00127-005-0028-9

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Key words

  • cohort studies
  • mental disorders
  • mental health services
  • socioeconomic factors
  • personality