Predictors of Mental Health Services Use Across the Life Course among Racially–Ethnically Diverse Adults

摘要

Highlights ? This study determined that socioeconomic, social support, psychiatric, and medical predictors uniquely influence use of mental health services across the life course. ? Key factors included marital status, history of suicidal behavior, comorbid psychiatric disorders, chronic medical conditions, and perceived cognitive impairment. ? Exploratory analyses suggested that associations of chronic medical conditions and marital status with services use across the life course are modified by race-ethnicity. ? These findings add to the literature by providing evidence that key factors differentially influence mental health services use in younger, middle, and older age. ? Targeting key factors at different stages of life may encourage use of mental health services across the life course for those in great need of care. Objective Little is known about key factors associated with use of mental health services across the life course. This study determined key socioeconomic, social support, psychiatric, and medical predictors of services use in younger, middle, and older age. Design, Setting, Participants, Measurements The sample included 3,708 adults with DSM-IV–based mood, anxiety, and substance use disorders in the Collaborative Psychiatric Epidemiology Surveys. Key predictors of mental health services use for each age group were systematically determined by multivariable models, and exploratory analyses examining potential effect modification by race–ethnicity and sex were assessed by interaction terms. Statistical analyses included complex design-corrected and weighted logistic regression analyses that provide results generalizable to the United States. Results Psychiatric and medical issues such as prior suicidal behavior, comorbid psychiatric disorders, and perceived cognitive impairment increased odds of mental health services use in younger, middle, and older age. Chronic medical conditions also influenced services use in younger and older age, with their impact on use across age potentially modified by racial–ethnic disparities (p interaction?=?0.01). Moreover, socioeconomic factors like marital status influenced use in middle and older age, where being divorced, separated, widowed, or never married encouraged use. The effect of marital status on use across age was also potentially modified by racial–ethnic disparities (p interaction?=?0.02). Conclusions Key socioeconomic, social support, psychiatric, and medical predictors uniquely influence use of mental health services across the life course. These findings will help inform efforts to encourage greater services use by adults across the life course in need of care.