Job stress, mental health status, and mental health care utilization.

摘要

Evidence from mental health services research suggests that poor mental health status is predictive of future utilization and costs. The job stress literature confirms that job characteristics are potentially modifiable risk factors of poor mental health status. The purpose of this study was to measure the direct and indirect associations between job characteristics and mental health care utilization in a working population.;Working conditions data from the national Quality of Employment Survey were merged with demographic, health status and health care utilization data from employed individuals (N = 1870) in the Rand Health Insurance Experiment. Regression analyses tested the strength of relationship between working conditions, specifically job demands and control, and workers' mental health status. Regression analyses also were conducted to explore the extent that working conditions explained the variation in mental health care utilization over three years, while controlling for demographic factors, health insurance coverage, and mental and physical health status.;The ratio of job demands to control consistently had a strong association with workers' mental health status, even after controlling for demographic factors. The more that demands exceeded the levels of control in an occupation, the greater the likelihood that workers had poorer mental health status.;There was evidence that job demands and control affected mental health status in different ways. Low levels of control on the job were associated with symptoms of depression, whereas high levels of demands on the job were related to symptoms of anxiety.;Workers in occupations with high psychological demands and low levels of control were no more likely to have used mental health care services than other workers. Instead, workers with greater control on their job, no matter the level of demands, were more likely to have used mental health care services.;Additional predictors of higher utilization of outpatient mental health care services included younger age, white race, lower out-of-pocket insurance costs, higher income and poorer mental health status. Higher education level was the major determinant of the quantity of mental health services utilized. The policy and research implications of these findings are discussed.