title: Combined effect of mental disorder and low social support on care service use for mental health problems in the Dutch general population.
abstract: BACKGROUND
  People with a mental disorder have high rates of service utilization for emotional or addiction problems. Little is known about the role of functional impairments and low social support in such service use. This article investigates: (1) whether the presence of multiple functional impairments mediates the link between mental disorder and service use; and (2) whether social support modifies that association.
  
  
  METHODS
  Data were derived from the Netherlands Mental Health Survey and Incidence Study, NEMESIS, a prospective general population study. Predictors of service use (mental disorder; functional impairments; social support) were recorded in the second wave of the study, and service use in the third wave.
  
  
  RESULTS
  Persons with a DSM-III-R disorder and persons with multiple functional impairments were three to seven times as likely to use primary or mental health care. People with low perceived social support were two to three times as likely to use them, and living alone increased the likelihood by 30% to 80%. The effect of mental disorder on service use was mediated by multiple functional impairments. In people with a mental disorder, low levels of social support intensified mental health service use.
  
  
  CONCLUSIONS
  Service utilization by people with mental problems can be better understood through a model incorporating: (1) independent effects of mental disorder, functional impairments and social support on service use; (2) a mediating effect of multiple functional impairments on the link between mental disorder and service use; and (3) interaction effects of mental disorder and low social support on service use.
authors.affiliation: Netherlands Institute of Mental Health and Addiction, AS, Utrecht.
authors.forename: Have M
authors.initials: HM
authors.lastname: ten
authors.forename: W
authors.initials: W
authors.lastname: Vollebergh
authors.forename: R
authors.initials: R
authors.lastname: Bijl
authors.forename: J
authors.initials: J
authors.lastname: Ormel
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011320:Primary Health Care / Q000706:statistics & numerical data; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012847:Single Person / Q000523:psychology; D012931:Social Environment; D012944:Social Support; D014600:Utilization Review