Predictors of incident care service utilisation for mental health problems in the Dutch general population.
BACKGROUND
The determinants of first-time ('incident') use of primary care and mental health care services for mental health problems have not been previously investigated. Such information is needed to identify new client groups and to gain a better understanding of causal factors.


METHODS
Data were derived from the Netherlands Mental Health Survey and Incidence Study, NEMESIS, a prospective general population study of adults. Potential predictors of care use (psychiatric disorders, burden of illness, sociodemographic characteristics) were recorded in the first wave of the study, and the utilisation of care services in the second wave. Psychiatric diagnoses were based on the Composite International Diagnostic Interview (CIDI) 1.1.


RESULTS
Six of the ten indicators linked to the frequent utilisation of care were found not to be associated with incident use: higher age, lower income, living alone, paid employment, mood disorders and anxiety disorders. Four other indicators showed associations with both frequent and incident use: female gender, higher numbers of restricted activity days, poorer social functioning and unmet care needs. Two predictors of incident use only were lower educational attainment and being in treatment for a somatic disorder.


CONCLUSIONS
New clients who come to primary health care or mental health care services with mental health problems are found in all age groups. They are more likely to be women, to have less education, to be in treatment for a somatic disorder and to have functional problems related to their mental health problems.
ten Have
M
M
Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands. mhave@trimbos.nl
Vollebergh
W
W
Bijl
R V
RV
de Graaf
R
R
D000208:Acute Disease; D000328:Adult; D000368:Aged; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011159:Population Surveillance; D011320:Primary Health Care / Q000706:statistics & numerical data; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012917:Social Adjustment; D014600:Utilization Review