Help seeking for mental health care among poor Puerto Ricans: problem recognition, service use, and type of provider.
OBJECTIVE
This study examines the effects of health, predisposing, and enabling factors on recognition of a mental health problem, use of formal mental health care, and contact with a specialized mental health provider.


METHODS
Interviews were conducted with a probability sample of 3,435 adults. The variables examined include measures of mental health; social and demographic factors; and enabling factors relevant to the help-seeking process.


RESULTS
Subjective and objective measures of mental health were associated with the recognition of a mental health problem. The objective assessment of definite need for services was relevant for the use of formal services. However, the subjects' perception of poor mental health was strongly related to receiving care from a mental health specialist. Although interaction with social networks is associated with use of formal services, low economic strain is related to receiving care from the specialty sector.


CONCLUSIONS
The results support the importance of using multiple measures of mental health problems. The finding that individuals' perceived economic strain increases the likelihood of receiving specialized care suggests that studies of economic barriers to the use of mental health services might benefit from the adoption of measures that assess perceived economic circumstances.
Vera
M
M
Center for Evaluation and Sociomedical Research and Department of Administration, School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan 00936-5067, USA.
Alegría
M
M
Freeman
D H
DH
Robles
R
R
Pescosolido
B
B
Peña
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D015984:Causality; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000592:standards; D006801:Humans; D016015:Logistic Models; D008297:Male; D008605:Mental Health Services / Q000145:classification / Q000706:statistics & numerical data*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011203:Poverty / Q000523:psychology*; D011647:Puerto Rico; D012944:Social Support; D011795:Surveys and Questionnaires