Patterns of mental health service utilization

How many and which individuals, with which psychiatric disorders, receive (and do not receive) mental health services from which professionals in what settings? This question falls within the purview of mental health services research, which is a multidisciplinary field that brings together the methodologies of epidemiology, econometrics, and clinical research. First, in this article, we present an explication of what is known about those individuals in need of psychotherapy and how they access services. Next, we describe the numbers, professional affiliations, and service sites of professionals who are engaged in the practice of psychotherapy. We summarize our current knowledge about the actual utilization of psychotherapy services relative to the needs of patients and the professional background of therapists. Finally, we identify aspects of psychotherapy service utilization that are, as yet, unaddressed.     

Patterns of psychopathology among urban poor children: Comorbidity and aggression effects.

A sample of 3,647 children from Grades 1–6 of inner-city and other urban poor communities and diverse ethnic groups were evaluated for co-occurrence of clinical-level scores on syndrome scales of the Teacher Report Form of the Child Behavior Checklist. Besides examining the relative rate of co-occurring syndromes, the contribution of residence location, ethnicity, age, and gender to such patterns were examined. Latent class analyses were applied to determine the makeup of basic patterns of co-occurring syndromes. Results suggest that comorbidity and the type of comorbidity pattern are related to residence. Gender and ethnicity are also related to pattern. Aggression seems to be a central aspect of the type of co-occurring patterns found among urban poor children. Its presence relates to poorer functioning, particularly in conjunction with internalizing syndromes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health practices and mortality in a rural Japanese population

Association of personal health practices with mortality from all causes was studied. In 1988, 4,318 residents aged 40 years and over in a rural town of Miyagi Prefecture, north-eastern part of Japan, completed a self-administered questionnaire including items on smoking, alcohol consumption, physical activity, sleeping patterns, and weight status. During the four year follow-up, 207 subjects had died. Relative risks (95 percent confidence intervals) of death from all causes adjusted for age, sex, and other confounding variables were 0.62 (0.39-0.98) for never smoking, 0.51 (0.34-0.78) for no or moderate alcohol consumption, 0.66 (0.42-1.04) for exercising physical activity, 0.78 (0.56-1.10) for 7-8 hours of sleep, and 0.75 (0.52-1.07) for not being underweight. Compared with performing only 0-1 of the five low-risk practices concerning the items mentioned above, relative risks (95 percent confidence intervals) of all-cause mortality for performing 3, or all 5 practices were, 0.49 (0.30-0.80) and 0.14 (0.03-0.61), respectively (trend p = 0.0001). The results remained unchanged even after excluding early death occurring within the first year of the follow-up, or excluding the subjects with past history of diseases. Further research is required to explore the combined effects of the practices on mortality for longer observational period.     

Marital distress and mental health care service utilization.

Objective: This study was designed to evaluate the association between marital distress and mental health service utilization in a population-based sample of men and women (N = 1,601). Method: The association between marital distress and mental health care service utilization was evaluated for overall mental health service utilization and for specific sectors of treatment providers, including psychiatrist, other mental health provider, other medical provider, and religious services provider. Interviews were used to assess past-year service utilization and presence of anxiety, mood, and substance use disorders. Results: Approximately 12% of married individuals sought help for problems with their emotions, nerves, or substance use during the 12 months preceding the interview. Marital distress was significantly associated with (a) overall mental health service utilization and service utilization provided by each of the sectors of providers when controlling for demographic variables and (b) overall mental health service utilization and receiving treatment from a psychiatrist when additionally controlling for past-year anxiety, mood, or substance use disorders. There was little evidence that the associations between marital distress and service utilization were moderated by gender or presence of psychiatric disorders. Conclusion: The finding that marital distress is associated with greater mental health care service utilization suggests that clinicians should assess both individual and relationship factors among individuals presenting for treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

School-based service utilization among urban children with early onset educational and mental health problems: The squeaky wheel phenomenon.

Although elementary schools provide an opportunity for early identification and treatment of academic and psychological problems, relatively little is known about the types of symptoms being addressed in schools. Latent profile analysis on data from 678 urban first graders yielded 3 classes of children: nonsymptomatic (NS), internalizers and average performers (IAP), and externalizers and low performers (ELP), with different combinations of symptoms. Survival analyses conducted on the children's use of services (in Grades 1-9) indicated that students in the ELP class received mental health and special education services faster than those in the NS class, whereas IAP children were no more likely than NS children to receive services. Findings suggest that staff may be more sensitive to early educational and externalizing problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hope-focused practices during early psychotherapy sessions: Part I: Implicit approaches.

Hope is recognized as one of four key factors contributing to psychotherapeutic change across a variety theoretical approaches (Hubble, Duncan, & Miller, 1999), especially early in the psychotherapeutic sequence. To date little research has looked at how hope is translated into specific practices by psychotherapists during psychotherapy sessions. This case study employed basic interpretive inquiry (Merriam, 1998) to explore the hope-focused practices of five hope-educated psychotherapists with 11 clients early in the therapy sequence. Two categories characterize the overall findings, that is, implicit and explicit hope-focused practices. This first paper in a two-part research report focuses on implicit hope-focused interventions. Implicit hope-focused interventions were those practices identified by therapists as addressing client hope without employing the word hope explicitly. Implicit hope practices addressed two key aspects of therapy, (a) attending to therapeutic relationship, and (b) fostering client perspective change. The second paper in this series examines findings regarding explicit hope-focused interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of mental and physical health service utilization among Vietnam veterans.

This study investigated predictors of mental and physical health care service utilization among 1,632 male (n = 1,200) and female (n = 432) Vietnam veterans who participated in the National Vietnam Veterans Readjustment Study. Using Anderson's theory as a model (Anderson & Bartkus, 1973), the authors examined both direct and mediated relationships among predisposing factors (i.e., age, marital status, and combat exposure), enabling factors (e.g., household income and insurance), and need factors (e.g., medical and psychological symptomatology) and physical and mental health care utilization outcomes. Need factors were the most consistent and strongest mediators of predisposing variables for both physical and mental health care service utilization, although there were differences between male and female veterans. For men, combat exposure indirectly predicted mental health care utilization through the need variables (with the effects of posttraumatic stress disorder being greatest). For women, physical health problems mediated the relationship between combat exposure and physical health outpatient care utilization. These findings have implications for screening and outreach efforts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health care systems in transition: People's Republic of China. Part I: An overview of China's health care system

The People's Republic of China for the first 30 years of its existence had a centrally directed health care system which achieved impressive health gains for its population. By emphasizing prevention; organizing innovative, low-cost, locally controlled health services; and promoting accessible primary health care in rural areas, China increased life expectancy for most of its people, dramatically reduced levels of infant mortality, and eradicated or controlled a range of infectious and parasitic diseases. Since 1978, however, China's leadership has come to depend more upon market forces than central direction and planning to achieve economic growth. These new orientation has had major effects upon the organization and financing of health services. After more than a decade of economic and agricultural reform, China still has problems providing good-quality, affordable, and equitable health services for the majority of the rural population and both urban and rural poor. The need to pay for health care considerably exacerbates poverty in China. This paper describes the structure of government and the health care system, the nature of change during 1978-90, the impact of the reforms upon health status and health care delivery, and future challenges.     

Mental health service utilization among African American and Caucasian mothers and fathers.

Mental health services have been routinely underutilized. This study investigated the influence of parents' gender, race, and psychopathology on perceived barriers and attitudes toward mental health utilization for themselves and for their children. A unique contribution of this study is the examination of father, mother, and child factors influencing service utilization from the parents' perspective. A total of 194 African American and Caucasian parents were recruited from the community to participate. Parents completed measures on barriers and attitudes toward treatment for themselves and for their children, history of mental health service utilization for themselves and for their children, and their own current psychological symptoms. Results indicated that 36.3% and 19.4% of parents and children, respectively, had used mental health services during their lifetime. Parents perceived fewer barriers and had more positive attitudes toward seeking services for their children than for themselves. Race and gender differences were found in parents' perceptions of barriers and attitudes toward treatment. Furthermore, barriers, attitudes, and psychopathology predicted parents' plans for future utilization of mental health services. The clinical implications of this study and directions for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development and validation of the Multidimensional Health Profile. Part I: Psychosocial functioning.

This article describes the development and preliminary validation of the Multidimensional Health Profile, Part I: Psychosocial Functioning (MHP-P), a self-report screening instrument for use in mental health and primary care settings. The MHP-P assesses mental health, life stress, coping skills, and social resources. In Study 1, retest reliability, validity, social desirability response bias, and factor structure were examined in a national sample of men and women (N?=?673). In Study 2, the effect of time frame on the retest reliability of the mental health scales was examined in a sample of male and female college students (N?=?147). A national sample of men and women (N?=?2,411) provided data for additional confirmatory factor analyses and norm development in Study 3. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health financing, service utilization, and national policy: A conversation with Stan Jones.

Interviews Stan Jones, Vice President for Government Relations for Blue Cross/Blue Shield, about his perspective on major health care issues. Topics discussed include access to health care, the role of government in health care services, and factors affecting rising health care utilization and increasing costs. The moral and economic issues related to competition as a means of cost containment are considered. Also discussed is the importance of consumer demand in securing new health insurance benefits, such as coverage for mental health services. Marketplace and diagnostic/treatment issues that make insurance coverage for mental health services problematical are explored. (0 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Investigation of the health status of a representative population sample of one region in the CSSR by medical examinations. Part I. Introduction and methods

Ornithine decarboxylase (ODC) can be induced up to 100-fold over basal levels four hours after addition of glutamine to the medium of HeLa cells growing in suspension culture. As demonstrated in several other cell types, ODC is inactivated very rapidly in HeLa cells, and the rate of inactivation is seen to vary with a half life of 9-15 minutes in uninduced cells and rises to ca. 60 minutes at the peak of induction. Quantitatively, the change in rate of inactivation cannot completely account for the observed rise in activity, thus synthesis or activation of ODC must also be involved in the induction process. The inactivation process requires metabolic energy and it can be sustained by glycolytic derived energy. Other factors which are known to inhibit protein breakdown in mammalian cells, such as sodium fluoride, insulin, or tosyl phenylalanyl chloromethyl ketone, had no effect on the rate of inactivation of ODC. Attempts to demonstrate ODC inactivation in a cell free system at neutral pH were unsuccessful.     

Wartime military service and utilization of VA health care services

A case of an atypical thyroglossal duct cyst is described in a 9-year-old boy who presented with a lateral neck mass that was hypofunctioning on thyroid scan and clinically indistinguishable from a thyroid nodule. Preoperative fine needle aspiration biopsy results demonstrating abundant, normal appearing squamous epithelial cells and keratinaceous material was suggestive of the diagnosis. Definitive diagnosis was made only after complete mobilization of the left lobe of the thyroid gland and cyst resection. A standard Sistrunk procedure was performed, and cyst excision was accomplished without resection of the left lobe of the thyroid gland. Microscopic examination disclosed a keratinizing pseudostratified squamous epithelium that has not been previously reported with thyroglossal duct cysts.     

Good and poor practices in psychotherapy: National survey of beliefs of psychologists.

As part of a larger study of behaviors and standards of psychologists and resources for guiding their actions, survey data were collected from 456 (231 male and 225 female) American Psychological Association members selected from Division 29 (Psychotherapy). Participants were asked to rate the degree to which they considered each of 83 behaviors to constitute good or poor practice. About one fourth (22) of the behaviors were considered to be uniformly "poor" by at least 60% of the participants. Only 2 behaviors were judged uniformly "good" by at least 50% of the participants. About one fourth (18) of the behaviors were difficult to judge (i.e., at least 20% of the participants indicated "don't know/not sure"). Participants tended to report that their behavior conformed to their standards of good practice and had a tendency to maintain stricter standards for judging whether a behavior was good or poor practice than for judging whether it was ethical or unethical. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Morbidity pattern, health care utilization and per capita health expenditure in a rural population of Tamil Nadu

This retrospective analysis intends to evaluate by histeroscopy the endometrial findings in a group of 63 patients in post-menopausal treated with tamoxifen for breast cancer. Our patients assumed tamoxifen for a different period between 6 and 120 months. Patients have been divided in two groups: I) patients undergoing hysteroscopy because of some clinical symptoms; II) patients who undergoing hysteroscopy as a routine examination. The most important observation of this work is the correlation between the presence of negative endometrium and low risk hyperplasia (LRH) associated to: symptomatology and duration of therapy. In the group of asymptomatic patients the LRH is found only after 3 years of treatment, while in the group of symptomatic patients, LRH is present within the first two years of treatment; beyond this period high risk hyperplasia (HRH) and endometrial carcinoma have been diagnosed. We also observed a higher incidence of endometrial polyps in this population than among the non treated group and among the symptomatic patients. From these data we conclude that hysteroscopy follow-up has to be performed in the group of patients treated with tamoxifen and that it would be necessary to have a hysteroscopy before the beginning of therapy and that this one has to be repeated once a year through the treatment. Obviously the symptomatic patients have to undergo hysteroscopy as soon as possible as a higher incidence of HRH and endometrial carcinoma has been detected in this group of patients.     

Bioelectronic noses: a status report. Part I

The present state of the art to record or mimic electronically the human senses of olfaction and taste is characterized. In this part I, an introduction to our present understanding in the development of electronic and bioelectronic noses is given. Finally the natural olfactory system is described in detail.     

PARATI--a dynamic model for radiological assessments in urban areas. Part I. Modelling of urban areas, their contamination and radiation fields

The structure and mathematical model of PARATI, a detailed computer programme developed for the assessment of the radiological consequences of an accidental contamination of urban areas, is described with respect to the scenarios used for the estimation of exposure fields in a village or town, the models for the initial and secondary contamination with the radionuclide 137Cs, the concepts for calculating the resulting radiation exposures and the changes with time of the contamination and radiation fields. Kerma rates at various locations in tropical urban areas are given, and the contribution of different contaminated surfaces to these rates after dry or wet deposition are discussed.     

Cost of care for patients with human immunodeficiency virus infection. Patterns of utilization and charges in a public health care system

BACKGROUND: The increasing impact of human immunodeficiency virus (HIV) infection on the health care delivery system requires surveillance of current patterns of HIV-related health care utilization to adequately plan for future needs. Most studies to date have concentrated on inpatient care for patients with the acquired immunodeficiency syndrome (AIDS). Outpatient utilization has been less well studied and there are few data regarding HIV-infected patients without a diagnosis of AIDS. METHODS: Denver Health and Hospitals is a public system delivering comprehensive health care to mostly indigent residents of the city and county of Denver. Patients with HIV infection in this system were identified through multiple surveillance sources, and billing system records for these patients were analyzed. RESULTS: During 1990, 812 patients with HIV infection of 13 years or more were accessed in the Denver Health and Hospitals. During that year, the total HIV-related health care charges were $7,858,690, of which 57% were for inpatient care and 43% for ambulatory care. Patients with AIDS (34% of patients) accounted for 62% of all charges, and patients with HIV infection but without a diagnosis of AIDS (66% of patients) for 38% of charges. Compared with national predictions, patients with AIDS in our system had lower inpatient and higher outpatient utilization. CONCLUSIONS: These results are consistent with a shift from inpatient to outpatient health care services in patients with AIDS. A significant proportion of HIV-related health care costs are incurred by patients who have not yet developed AIDS.