Does educational background explain inequalities in care service use for mental health problems in the Dutch general population?
OBJECTIVE
To investigate whether (1) education predicts the use of care services for mental health problems, independently of mental disorder and functional impairment and (2) education modifies the association between mental disorder and service use.


METHODS
Predictors of service use were recorded at baseline, and service use itself at 12-month follow-up, in a representative sample (N=7076) of the Dutch population, using the Composite International Diagnostic Interview.


RESULTS
People with more education were less likely to use primary care but more likely to use mental health care. The effects on both types of care remained significant after adjustment for mental disorder and functional impairment. Lower education tended to strengthen the association between mood or anxiety disorder and primary care use.


CONCLUSIONS
Further research on inequalities in service use will benefit from additional explanatory analyses and from the inclusion of sociopsychological variables, like cost-benefit considerations in decisions to use services.
Have
M ten
Mt
Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands. mhave@trimbos.nl
Oldehinkel
A
A
Vollebergh
W
W
Ormel
J
J
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D004522:Educational Status; D006801:Humans; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011320:Primary Health Care / Q000706:statistics & numerical data*