title: Self-reliance, mental health need, and the use of mental healthcare among island Puerto Ricans.
abstract: This paper examines the relationship between self-reliance (preference to solve emotional problems on one's own) and 5 mental healthcare utilization outcomes for Puerto Ricans living in low-income areas. A random probability community sample of noninstitutionalized Puerto Ricans, ages 18-69, living in low-income areas of the island were selected and interviewed in 1992-93 and 1993-94. A series of logistic regression models tested the association between self-reliance and 5 mental health utilization measures, after adjusting for covariates measuring predisposing, enabling, need and barrier factors: any use of mental health services, any use of general health services for mental healthcare, any use of specialty care, use of psychotropic medications, and retention in mental healthcare. Self-reliance was found to be negatively associated with all 5 dependent service utilization measures. Those with a positive self-reliant attitude were 40% less likely to use care on any of the 5 outcome measures. An interaction was also observed between definite need for mental healthcare and having a self-reliant attitude when predicting mental health service use. Definite needers with a self-reliant attitude were 54%-58% less likely to use mental health services compared with definite needers who did not have a self-reliant attitude. Further, decreases in self-reliant attitude over the two data collection periods were associated with increases in mental health service use. Our findings suggest that self-reliance is a significant and robust predictor of mental healthcare utilization among Puerto Ricans living in low-income areas of the island.
authors.affiliation: Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut 06520-8034, USA. alexander.ortega@yale.edu
authors.forename: Alexander N
authors.initials: AN
authors.lastname: Ortega
authors.forename: Margarita
authors.initials: M
authors.lastname: Alegría
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D016015:Logistic Models; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011204:Poverty Areas; D011647:Puerto Rico