Re-Engagement into Care: The Role of Social Support on Service Use for Recurrent Episodes of Mental Health Distress Among Primary Care Patients

  • Marissa C. Hansen
  • Dahlia Fuentes
  • Maria P. Aranda


Given high rates of relapse of depression, understanding mechanisms that provide long-term benefits and optimal outcomes for depressed individuals is crucial. The current study examines social support as a relevant component in service use to manage mental health needs for individuals with recurrent depression over a 5-year period. Conducting a secondary data analysis from a randomized clinical trial titled Partners in Care, the study examines direct and moderating effects over two time points of reported 12-month social support on service use for mental health needs at 57-months for an adult sample (n = 991). Direct effects were supported for demographic and need variables. Increased social support at 12-months positively moderated the relationship between health impairment and service use at 57-months. Findings inform and extend the understanding of social support as an important mechanism to care to integrate into the treatment experience, encouraging service use to manage recurrent depressive episodes.



The authors would like to thank the Drs. Lawrence Palinkas and Merril Silverstein for the generous input and guidance on the development of this paper.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Kessler RC. The costs of depression. The Psychiatric clinics of North America. 2012 Mar; 35(1): 1-14.Google Scholar
  2. 2.
    Alegría M, Chatterji P, Wells K, et al. Disparity in Depression Treatment among Racial and Ethnic Minority Populations in the United States. Psychiatric Services (Washington, DC). 2008; 59(11): 1264-1272.Google Scholar
  3. 3.
    Kessler RC, Demler O, Frank RG, et al. Prevalence and treatment of mental disorders, 1990 to 2003. New England Journal of Medicine. 2005; 352(24): 2515-2523.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Olfson M, Marcus SC, Druss B, et al. National trends in the outpatient treatment of depression. Journal of the American Medical Association (JAMA). 2002; 287(2): 203-209.CrossRefGoogle Scholar
  5. 5.
    Mackenzie CS, Pagura J, Sareen J. Correlates of Perceived Need for and Use of Mental Health Services by Older Adults in the Collaborative Psychiatric Epidemiology Surveys. The American Journal of Geriatric Psychiatry. 2010; 18(12): 1103-1115.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Maj M, Veltro F, Pirozzi R, et al. Pattern of recurrence of illness after recovery from an episode of major depression: A prospective study. American Journal of Psychiatry. 1992; 149(6): 795-800.CrossRefPubMedGoogle Scholar
  7. 7.
    Moffitt TE, Caspi A, Taylor A, et al. How common are common mental disorders? Evidence that lifetime prevalence rates are doubled by prospective versus retrospective ascertainment. Psychological Medicine. 2010; 40(6): 899-909.CrossRefPubMedGoogle Scholar
  8. 8.
    Hardeveld F, Spijker J, De Graaf R, et al. Recurrence of major depressive disorder and its predictors in the general population: Results from the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Psychological Medicine. 2013; 43(1): 39-48.CrossRefPubMedGoogle Scholar
  9. 9.
    Mueller TI, Keller MB, Leon AC, et al. Recovery after 5 years of unremitting major depressive disorder. Archives of General Psychiatry. 1996; 53(9): 794-9.CrossRefPubMedGoogle Scholar
  10. 10.
    Spijker J, De Graaf R, Bijl RV, et al. Determinants of persistence of major depressive episodes in the general population. Results from the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Journal of Affective Disorders. 2004; 81(3): 231-240.CrossRefPubMedGoogle Scholar
  11. 11.
    Spijker J, De Graaf R, Bijl RV, et al. Duration of major depressive episodes in the general population: results from The Netherlands Mental Health Survey and Incidence Study (NEMESIS). The British Journal of Psychiatry. 2002; 181(3): 208-213.CrossRefPubMedGoogle Scholar
  12. 12.
    Walker ER, Druss BG. Rate and Predictors of Persistent Major Depressive Disorder in a Nationally Representative Sample. Community Mental Health Journal. 2014; 51(6):701-707.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    González HM, Tarraf W, Whitfield KE, et al. The epidemiology of major depression and ethnicity in the United States. Journal of Psychiatric Research. 2010; 44(15): 1043-1051.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Rubio JM, Markowitz JC, Alegría A, et al. Epidemiology of chronic and nonchronic major depressive disorder: results from the national epidemiologic survey on alcohol and related conditions. Depression & Anxiety. 2011; 28(8): 622-631.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Harris KM, Edlund MJ. Use of mental health care and substance abuse treatment among adults with co-occurring disorders. Psychiatric Services. 2005; 56(8): 954-959.CrossRefPubMedGoogle Scholar
  16. 16.
    Young AS, Klap R, Shoai R, et al. Persistent depression and anxiety in the united states: Prevalence and quality of care. Psychiatric Services. 2008; 59(12): 1391-1398.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Alegría M, Pescosolido B., Canino G. A socio-cultural framework for mental health and substance abuse service disparities. In B. J. Sadock, V. A. Sadock & P. Ruiz (Eds.), Comprehensive Textbook of Psychiatry. Baltimore: Wolters Kluwer Health, Lippincott Williams & Wilkins. 2008; pp. 4370-4379.Google Scholar
  18. 18.
    Miranda J, Cooper LA. Disparities in Care for Depression Among Primary Care Patients. Journal of General Internal Medicine. 2004; 19(2): 120-126.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Nutting PA, Rost K, Dickinson M, et al. Barriers to Initiating Depression Treatment in Primary Care Practice. Journal of General Internal Medicine. 2002; 17(2): 103-111.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Lippens T, Mackenzie CS. Treatment satisfaction, perceived treatment effectiveness, and dropout among older users of mental health services. Journal of Clinical Psychology. 2011; 67(12): 1197-1209.CrossRefPubMedGoogle Scholar
  21. 21.
    Wang PS, Demler O, Olfson M, et al. Changing profiles of service sectors used for mental health care in the United States. American Journal of Psychiatry. 2006; 163(7): 1187-1198.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Andersen RM. Revisiting the Behavioral Model and Access to Medical Care: Does it matter? Journal of Health & Social Behavior. 1995; 36(1): 1-10.CrossRefGoogle Scholar
  23. 23.
    Andersen R, Newman JF. Societal and individual determinants of medical care utilization in the United States. Milbank Quarterly. 2005; 83(4): 1-24.CrossRefGoogle Scholar
  24. 24.
    Alegría M, Lin JY, Green JG, et al. Role of Rreferrals in Mental Health Service Disparities for Racial and Ethnic Minority Youth. Journal of the American Academy of Child & Adolescent Psychiatry. 2012; 51(7): 703-711.CrossRefGoogle Scholar
  25. 25.
    Pescosolido BA, Wright ER, Alegría M, et al. Social networks and patterns of use among the poor with mental health problems in Puerto Rico. Medical Care. 1998; 36(7): 1057-1072.CrossRefPubMedGoogle Scholar
  26. 26.
    Mulvaney-Day NE, Alegría M, Sribney W. Social cohesion, social support, and health among Latinos in the United States. Social Science & Medicine. 2007; 64(2): 477-495.CrossRefGoogle Scholar
  27. 27.
    Maulik PK, Eaton WW, Bradshaw CP. The effect of social networks and social support on mental health services use, following a life event, among the Baltimore Epidemiologic Catchment Area cohort. The Journal of Behavioral Health Services & Research. 2011; 38(1): 29-50.CrossRefGoogle Scholar
  28. 28.
    Litwin H. Social networks, ethnicity and public home-care utilisation. Ageing & Society. 2004; 24(06): 921-939.CrossRefGoogle Scholar
  29. 29.
    Vera M, Alegría M, Freeman DH, et al. Help seeking for mental health care among poor Puerto Ricans: Problem recognition, service use, and type of provider. Medical Care. 1998; 36(7): 1047-1056.CrossRefPubMedGoogle Scholar
  30. 30.
    Have TM, Vollebergh W, Bijl R, et al. Combined effect of mental disorder and low social support on care service use for mental health problems in the Dutch general population. Psychological Medicine. 2002; 32(02): 311-323.CrossRefGoogle Scholar
  31. 31.
    Spijker J, de Graaf R, ten Have M, et al. Predictors of suicidality in depressive spectrum disorders in the general population: results of the Netherlands Mental Health Survey and Incidence Study. Social Psychiatry & Psychiatric Epidemiology. 2010; 45(5): 513-521.CrossRefGoogle Scholar
  32. 32.
    Kouzis AC, Eaton WW. Absence of social networks, social support and health services utilization. Psychological Medicine. 1998; 28(06): 1301-1310.CrossRefPubMedGoogle Scholar
  33. 33.
    Choi S, Morrow-Howell N, Proctor E. Configuration of services used by depressed older adults. Aging & Mental Health. 2006; 10(3): 240-249.CrossRefGoogle Scholar
  34. 34.
    Gadalla TM. Comparison of users and non-users of mental health services among depressed women: A national study. Women & Health. 2008; 47(1): 1-19.CrossRefGoogle Scholar
  35. 35.
    Wells K, Sherbourne C, Schoenbaum M, et al. Five-year impact of quality improvement for depression: results of a group-level randomized controlled trial. Archives of General Psychiatry. 2004; 61(4): 378-386.CrossRefPubMedGoogle Scholar
  36. 36.
    Wells KB. The design of Partners in Care: Evaluating the cost-effectiveness of improving care for depression in primary care. Social Psychiatry and Psychiatric Epidemiology. 1999; 34(1): 20-29.CrossRefPubMedGoogle Scholar
  37. 37.
    Wells KB, Sherbourne C, Schoenbaum M, et al. Impact of disseminating quality improvement programs for depression in managed primary care: a randomized controlled trial. Journal of the American Medical Association. 2000; 283(2): 212-20CrossRefPubMedGoogle Scholar
  38. 38.
    Wells KB, Tang L, Miranda J, et al. The effects of quality improvement for depression in primary care at nine years: Results from a randomized, controlled group-level trial. Health Services Research. 2008; 43(6): 1952-74.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    World Health Organization. Composite International Diagnostic Interview (CIDI) Core Version 2.1 Interviewer’s Manual. Geneva, Switzerland: World Health Organization; 1997. United StatesGoogle Scholar
  40. 40.
    RAND Health. Partners Use Files: User Guide. RAND Health 2008.Google Scholar
  41. 41.
    Ware J, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: Construction of scales and preliminary tests of reliability and validity. Medical Care. 1996; 34(3): 220-33.CrossRefPubMedGoogle Scholar
  42. 42.
    Sherbourne CD, Stewart AL. The MOS social support survey. Social Science & Medicine. 1991; 32(6): 705-14.CrossRefGoogle Scholar
  43. 43.
    Kachigan SK. Statistical analysis: An interdisciplinary introduction to univariate & multivariate methods. New York, NY: Radius Press; 1986.Google Scholar
  44. 44.
    Long JS. Regression models for categorical and limited dependent variables. Advanced quantitative techniques in the social sciences. Thousand Oaks, CA: Sage Publications, 1997.Google Scholar
  45. 45.
    Borooah VK. Logit and Probit: Ordered and multinomial models. Thousand Oaks, CA: Sage Publications, 2002.CrossRefGoogle Scholar
  46. 46.
    Cohen J, Cohen P. Applied Multiple Regression/Correlation Analysis for the Behavioral Sciences. Hillsdale, NJ: Laurence Eribaum, 1983.Google Scholar
  47. 47.
    Aiken LS, West SG, Reno RR. Multiple Regression: Testing and interpreting interactions. Thousand Oaks, CA: Sage Publications, 1991.Google Scholar
  48. 48.
    Holmbeck GN. Toward terminological, conceptual, and statistical clarity in the study of mediators and moderators: examples from the child-clinical and pediatric psychology literatures. Journal of Consulting & Clinical Psychology. 1997; 65(4): 399-410.CrossRefGoogle Scholar
  49. 49.
    Areán PA, Gum A, McCulloch CE, et al. Treatment of depression in low-income older adults. Psychology & Aging. 2005; 20(4): 601-609.CrossRefGoogle Scholar
  50. 50.
    Fiorri KL, Antonucci TC, Cortina KS. Social network typologies and mental health among older adults. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences. 2006; 61(1): 25-32.CrossRefGoogle Scholar
  51. 51.
    Hansen MC, Aranda MP. Sociocultural influences on mental health service use by Latino older adults for emotional distress: Exploring the mediating and moderating role of informal social support. Social Science & Medicine. 2012; 75(12): 2134-2142.CrossRefGoogle Scholar
  52. 52.
    Substance Abuse and Mental Health Services Adminsitration (SAMHSA). Results from the 2012 National Survey on Drug Use and Health: National Findings. Substance Abuse and Mental Health Services Administration Substance Abuse and Mental Health Services Administration (SAMHSA). 2013.Google Scholar
  53. 53.
    Street Jr RL, Makoul G, Arora NK, et al. How does communication heal? Pathways linking clinician–patient communication to health outcomes. Patient Education & Counseling. 2009; 74(3): 295-301.CrossRefGoogle Scholar
  54. 54.
    Epstein RM, Street RL. The Values and Value of Patient-Centered Care. Annals of Family Medicine. 2011; 9(2): 100-103.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© National Council for Behavioral Health 2017

Authors and Affiliations

  • Marissa C. Hansen
    • 1
  • Dahlia Fuentes
    • 2
  • Maria P. Aranda
    • 2
  1. 1.School of Social WorkCalifornia State University, Long BeachLong BeachUSA
  2. 2.Suzanne Dworak-Peck School of Social WorkUniversity of Southern CaliforniaLos AngelesUSA

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