General Practice and Mental Health Care: Determinants of Outpatient Service Use

Abstract

Objective: To examine the determinants that lead Canadian adults to consult family physicians, psychiatrists, psychologists, psychotherapists, and other health professionals for mental health reasons and to compare the determinants of service use across provider types. Method: Data from the Canadian Community Health Survey: Mental Health and Well-Being were used for people aged 18 years and older (n = 35 236). A multivariate logistic regression was used to model outpatient consultations with different providers as a function of predictive determinants. Result: Three types of variables were examined: need, enabling, and predisposing factors. Among need, the most common predictors of service use for mental health reasons were self-rated mental health, the presence of chronic conditions, depression and panic attacks, unmet mental health needs, psychological well-being, and the ability to handle daily demands. Among enabling factors, emotional and informational support and income were important predictors. Among predisposing factors, men were less likely to consult with a family physician and other resources but not with psychiatrists; and people with less education were less likely to consult psychologists and other health providers. Conclusion: Need factors were the most important predictors of both psychiatrist and combined family physician and psychiatrist consultation in the previous year. However, sex barriers remain and promotion campaigns in seeking mental health care should be aimed toward men. Further, education and income barriers exist in the use of specialty providers of psychotherapy and policies should thus focus on rendering these services more accessible to disadvantaged people.

Factors associated with delayed diagnosis of mood and/or anxiety disorders

“…This finding is supported by previous studies showing that those without comorbid physical chronic conditions have fewer health care encounters and are therefore less likely to be diagnosed and treated for their mental health issues than those with them. 39,40 Regarding affected Canadians' health status, we found those with long delay were more likely to report the most (≥ 3) activity limitations and "poor" or "fair" mental health. Results from our supplemental analysis provided further confirmation of this, demonstrating that for every year increase in time to diagnosis there was a 5.0% and 4.0% increase in odds of having three or more activity limitations (relative to those with no activity limitations) and "poor" or "fair" mental health (relative to those with "very good" or "excellent" mental health), respectively, upon controlling for all other individual characteristics (data not shown; available upon request).…”

Use of medication and psychological counselling among Canadians with mood and/or anxiety disorders

“…34 A study examining determinants that lead Canadian adults to consult family physicians, psychiatrists, psychologists, psychotherapists and other health professionals for mental health reasons found that those with lower levels of education and income adequacy were less likely to use mental health services, specifically specialty providers of psychotherapy. 35 Furthermore, a Canadian study that examined barriers to mental health care using data from the Canadian Community Health Survey concluded that "despite universal health insurance, there are significant inequi ties in access to mental health care for low-income Canadians." 36 been shown to exist 35,37 and results from our study might well reflect real regional differences.…”

Facteurs associés au diagnostic tardif d'un trouble de l’humeur et/ou d’anxiété

“…Cette observation est étayée par des études antérieures mon trant que les personnes sans comorbidité physique avaient moins souvent recours aux services de soins de santé et, par conséquent, étaient moins nombreuses à recevoir un diagnostic de trouble de santé mentale et un traitement adapté que les personnes souffrant déjà d'une affection physique chronique 39,40 .…”