Professional health care use and subjective unmet need for social or emotional problems: a cross-sectional survey of the married and divorced population of Flanders

Abstract

BackgroundThe high mental health care consumption rates of divorced singles may constitute a heavy burden on the public health care system. This raises the question of whether their higher health care use stems from a greater need, or whether there are other factors contributing to these high consumption rates. We examine both health care use and subjective unmet need (perceiving a need for care without seeking it) because of social or emotional problems of the divorced singles, the repartnered divorcees, and the married. Moreover, we investigate how health care use and subjective unmet need relate to each other.MethodsWe conduct several gender specific logistic regressions employing data from the Divorce in Flanders Survey (N men = 2884; N women = 3317).ResultsResults show that the divorced singles have more contact with professional health care providers (general practitioners, psychiatrists, and psychologists) because of social or emotional problems, and more often perceive unmet needs. The higher health care use rates and greater subjective unmet needs can largely be attributed to higher levels of depressive symptoms. Surprisingly, we find that non-frequent health care users more often perceive a subjective unmet need than frequent health care users and those who have not contacted any health care provider.ConclusionThe single divorced consult health care providers more often because of social or emotional problems and they also perceive unmet needs more often.

The Role of Perceived Helpfulness in Predicting Subjective Unmet Need and the Frequency of Health Care Use

“…If this hypothesis is correct, it would suggest that people who feel that they have not been helped will more often hesitate to return to their health care provider if they are confronted with problems again. In line with this assumption, a study of Colman and colleagues, employing the same survey data as the current study, has shown that non-frequent health care users more often perceive an unmet need than frequent health care users and non-users (Colman et al, 2012). We thus predict that a lower perception of helpfulness will be associated with less frequent contacts among health care users (hypothesis 2a).…”

“…This resulted in a response rate of 43.3% among the divorced and 39.5% among the married, and a sample of 4538 respondents. Descriptive analyses of this sample and the correlates of professional health care use and subjective unmet need can be found elsewhere (Colman et al, 2012).…”

“…Some respondents (N = 212) have contacted more than one of these health care providers and are included in multiple analyses. As women more often contact a health care provider because of social or emotional problems (Colman et al,2012), they constitute two thirds of each sample are women (see Table 1). …”

“…Somewhat surprisingly, these recent studies show consistently that health care users more often perceive an unmet need than do non-users, even after health status is controlled for (Colman, Symoens, & Bracke, 2012;Kjeken et al, 2006;McColl & Jarzynowska, 2010). The question has now emerged of how these elevated levels of unmet need among health care users can be explained.…”

“…Despite their growing demographic importance, little is known about how this heightened risk of mental health problems is translated into health care use. The limited research on this topic consistently shows that the divorced have a higher use of mental health care than the married, even after taking mental health differences into account (Bracke, Colman, Symoens, & Van Praag, 2010;Colman et al, 2012;Wang, 2004;Wang et al, 2005). Therefore, these frequent health care users form an interesting group to study the relationships between the perceived quality of care, subjective unmet need, and health care use.…”