Depression and mental health visits to physicians--a prospective records-based study.
Previous studies of access to care for depression have been based on cross-sectional surveys of self-reported use of mental health service use. As the recall of use may be differentially biased by mood states, inferences about how well persons with depression are accessing services in comparison to other groups may be misleading. Accordingly, we estimated the magnitude of the depression-use associations in relation to key covariates based on prospective records of mental health visits to physicians. The sample, N = 23,063, of persons 12 years and older, was drawn from the 1996/97 Ontario Health Survey and linked to their administrative mental health care records 24 months forward in time. We found that depression-use associations were in the expected direction but similar in magnitude to associations for gender and education unlike previous self-reported use surveys. Female gender was positively related to the use of a primary care physician but negatively related to seeing a psychiatrist as opposed to a primary care physician. Those who had attained higher levels of education were more likely to be seen by physicians than those with lower education levels. The meaning behind these findings bears further study as it may have implications for primary care reform and the design of future studies of access.
Rhodes
Anne
A
St. Michael's Hospital, Suicide Studies & The Inner City, The Arthur Sommer Rotenberg Chair in Health Research Unit, 30 Bond Street, Toronto, Ont., Canada M5B 1W8. rhodesa@smh.toronto.on.ca
Jaakkimainen
R Liisa
RL
Bondy
Susan
S
Fung
Kinwah
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000453:epidemiology* / Q000628:therapy; D005191:Family Characteristics; D005260:Female; D019538:Health Care Surveys; D006306:Health Surveys; D006801:Humans; D008297:Male; D008499:Medical Records; D008605:Mental Health Services / Q000191:economics / Q000706:statistics & numerical data*; D011939:Mental Recall; D008875:Middle Aged; D009313:National Health Programs / Q000706:statistics & numerical data; D009864:Ontario / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011570:Psychiatry / Q000191:economics / Q000706:statistics & numerical data*